Omicron: ethical tension among caregivers



On this winter day, dark and shrunken like the hope of finally emerging from successive epidemic waves, I sat down next to him, oxygen glasses put askew on the bridge of his nose, nothing big and a little lost under the yellow and white sheets of Public Assistance. Let’s call him Jean, this exhausted patient who, for twelve days, has been fighting against Covid-19. The first three in a small suburban hospital where her mother will die soon, carried away by the infection, then five days of resuscitation for high flow oxygen therapy. He was transferred to our unit to free an intensive care bed where some sicker people will soon be admitted.

It was a late morning, a day of visiting professorships where you take the time to settle down to understand. Her eyes part as we walk through the door. Doctor please don’t tell me about vaccines. I have not yet uttered a word, and yet already, he like me know that to understand the inexplicable passes by the words which one must put on his decision not to be vaccinated and to have advised against it to his mother aged. Am I going to make it? Why didn’t you get vaccinated? I wanted a French vaccine. But it does not matter his nationality if he protects from the sufferings of the disease. But we have no hindsight on messenger RNA. It is the pharmaceutical industry that is making money off our backs …

Silencing the dilemmas

And in this buzz of words hardly uttered by this breathless man, I hear the words of caregivers on the lack of human resources, overwork, canceled vacations, overtime. I hear the hallway conversation I had this morning echoing about the ethical dilemma that confronts us: where to look deep within ourselves for the ability not to judge, while we continue to work, infected with the Omicron variant without really symptoms, in a hospital overwhelmed by those who voluntarily chose not to be vaccinated? Where can one find in oneself the faculty to disregard the vaccination status when one has to offer a rare resuscitation bed to an unvaccinated patient with a severe form of Covid-19, while another, vaccinated, will not be able to benefit from it for n ‘? any other illness, because arrived ten minutes too late in an emergency room where no intensive care bed is available?

Hippocrates told us, and we swore, the right hand raised in front of this man whose sculptural representation thrones in all the medical schools: “I will respect all people, their autonomy and their will, without any discrimination according to their state or their convictions”. How these words find a particular meaning in the face of this ethical tension that runs through our community of caregivers! A tension fed by the exhaustion of a personal investment whose end we do not see, with this sixth wave so stuck to the fifth that it takes in our minds the form of a sharp tidal wave.

Jean finally stopped speaking, he closed his eyes, calmed his breath. I listened to his silence. And when he asked me if he would come out in time to say goodbye to his mother, I squeezed his hand. I caressed the rough grain very gently, smiling at him, my gaze warm. “Admitted in the intimacy of the people, I will keep silent the secrets which will be entrusted to me … I will do everything to relieve the sufferings”.

By soothing his suffering, I silenced my dilemmas.

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