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Nurse in virus isolation ward describes patients’ touching farewell to dying man

Last month, when Israel had just over a dozen COVID-19 patients, staff at Jerusalem’s Shaare Zedek Medical Center received notice that a new isolation ward to treat prospective coronavirus patients would be swiftly built on its premises.

Rachel Gemara, 32, a Canada-born oncology nurse at the hospital, was among the 20-odd staff members who volunteered to work there.

At the time, there was a single isolated medical unit in the country equipped to treat patients with the highly infectious virus — at Sheba Medical Center near Tel Aviv. The pandemic has since ballooned in Israel, infecting over 1,600 as of Tuesday and causing three deaths, as strict lockdown measures were introduced to prevent its spread. As the number of infections climbed, and having bought some time with the government’s strict quarantine policies, hospitals around the country have hastened preparations for the unfolding crisis.

It was at the popup Shaare Zedek isolation ward, which several weeks ago didn’t exist, that Israel saw its first death on Friday — 88-year-old Aryeh Even, a Holocaust survivor from Jerusalem, as Gemara watched from the nurses’ monitoring station.

Gemara, who spoke to The Times of Israel earlier this week, said she is confident the Israeli healthcare system can handle the strain posed by the virus and avoid the nightmarish situation unfolding in Italy and other countries. But fears of the worst-case scenario — having to choose which patients receive ventilators — linger in the background.

Medical staff at the ward are taking it “day by day,” said Gemara, who moved to Israel from Toronto when she was 19.

“There’s no way, just like in a war-like situation, to know how things are going to progress.”

A ward built almost overnight

With frenzied construction, Jerusalem hospital’s isolated ward was built “sort of overnight,” Gemara said. “It’s completely locked down. The staff, we’re close by, but we’re not exactly in it.”

According to Gemara, medical staff are mostly situated in what they call the chamal [a Hebrew acronym for headquarters, which literally means “war room”] installed with monitors and a video intercom system. The patients have a sensor affixed on their chest that continuously monitors their blood pressure, temperature, pulse, and projects the results on the screens.

“That’s where we are most of the time. We’re constantly in communication with the patients inside the ward and only when it’s absolutely necessary do we get in full protective gear to go inside.”

To transfer food, supplies and medications, medical staff put on gloves and masks and open a pair of glass doors, placing the items on a shelf inside. After leaving and sealing the doors behind them, the patients reach in and grab the supplies.

“There’s 20 beds and so far it’s been fully occupied. And there are beds in the ICU in case that we need to use them. And also there is room to expand and they’ve already prepared the infrastructure for a second unit. That hasn’t opened yet, but it’s only a matter of time,” she said, adding that the reason for this was that the Health Ministry was placing patients with mild symptoms in hotels that had been converted into makeshift hospitals.

All those hospitalized “are there for a reason,” with preexisting conditions including asthma. Many are young, she said, and communicate with their families via smartphones and computers. For the older patients without the technology, “it’s harder that they’re alone.”

In the absence of visitors, the patients themselves, she said, have “kind of created their own family here.”

“It definitely took some getting used to, because oncology — every department really — is very hands-on, I’m constantly with the patients, seeing the patients… [In the isolated ward] I have patients that I’ve not seen face to face yet because I haven’t needed to, I’ve only seen them through the video, so it’s certainly weird, but now we’re kind of used to it… but in the beginning it was for sure an adjustment.”

As for her own safety, she said she wasn’t concerned about contracting the infectious virus. “We’re as close as possible to the virus, we know these patients have it, so that’s a reason a lot of people didn’t want to work there. But I honestly feel very, very safe. I’m in full protective gear, I know which of my patients are positive.”

‘Like in a war,’ battlefield changes every day

While expressing confidence in Israel’s healthcare capabilities, Gemara said the medical crisis unfolding in Italy, where hospitals have been overwhelmed by the pandemic and over 6,000 have died, is “certainly in the back of my mind.”

“We don’t want to get to a situation where, God forbid, we’re going to have to choose who gets a ventilator and who doesn’t — that’s for sure the biggest fear, because it’s absolutely a horrendous situation,” she said. ” I think that Israel is definitely well prepared. I really hope that it’s not going to be what’s happening in Italy.”

For now, she said, they’re taking it one day at a time.

“We know that it’s going to end, but we don’t know when it’s going to end, we don’t know how long it’s going to take. A lot of it really depends on the public and their behavior,” she said. “Right now, like in a war, we’re just taking it day by day… And things are changing from day to day.”

Aryeh Even’s goodbye

Gemara was on call on Friday when Even passed away in the isolated ward, with no relatives permitted by his side.

“During the day, he was fine, he was talking, the patients were talking to him,” she said.

At night, the patients sat down to eat a Shabbat meal together, she said, near Even’s room.

“Me and the other nurse and the doctor, we could see that his heart rate was going up very quickly. There was some sort of arrhythmia. And we knew something’s happening, we need to go in.”

The other nurse and the doctor rushed in, she said.

“And meanwhile, the monitor was beeping a lot and the patients that were inside, they obviously heard it. They became concerned and they went into his room and saw that he was not exactly all there, [though] he was still breathing. They tried to wake him up.”

“I could see from where I was sitting, watching the screen, that his breathing was becoming less and less. Because I’m an oncology nurse, this is something I see all the time, I’m very familiar with it — I see that these are his last breaths. And somehow, they kind of recognized it as well, the patients that went into the room.”

Moments before the doctor and nurse broke into the room, “They put their hands on him, they said [the] shema [prayer], they said goodbye to him,” she said. “They said, ‘Aryeh, we’re with you, we love you,’ they really comforted him.”

Header: Rachel Gemara, a nurse at Shaare Zedek’s isolated ward for coronavirus patients (Courtesy)

Source: TOI – an article by MARISSA NEWMAN