Dr. Gonzalo Luis Alonso Salinas
Cardiology Department – Heart Failure Unit
University Hospital Ramón y Cajal
I am a 32-year-old cardiologist with a focus on heart failure, but one day Pepe Zamorano said to me, “from tomorrow you will also need to take care of COVID patients”. So today, during the current crisis, I am primarily a COVID doctor. No doubt, my life changed immediately. You need to combine your willingness to help others and be in “Ground Zero” with the rest of the Cardiology Department with the natural fear of being infected.
My day is split into two parts. I arrive at the hospital at 08:00 and spend the first hour organising my heart failure unit. We are cancelling most scheduled hospital visits and managing patients by phone. But some patients have advanced heart failure and require intravenous drugs such as diuretics. For them we arrange a hospital appointment but trying to avoid the emergency room and the risk of contagion. The hospital is big and there are some safe parts but now those are getting smaller and smaller, and we share them with cancer patients.
The second part of the day is visiting patients who are in hospital because of COVID-19. In our hospital the units have disappeared. Cardiology is not cardiology anymore. We have become a really big unit dedicated to COVID patients; we call it the MacroCOVID. In normal times the hospital has approximately 900 beds, but with more than 1,000 COVID-19 patients admitted, an extra 200 or so beds were ordered. Rooms that usually have two patients, now have three. We have put beds in surgery rooms, in places that had been used for administering intravenous drugs or chemotherapy. It’s a different hospital now.
In the morning all the heads of service have a meeting and allocate staff according to the hospital’s needs. Today our hospital is a COVID hospital. During my COVID shift, I can be assigned to any part of the hospital. For example, last week I was seeing COVID patients in what used to be the gynaecology ward. I hadn’t even been there before. I see any patient with the infection, not just those with heart disease. In some ways it’s like a normal visit but these patients have pneumonia, so we must be very careful not to get infected. We change the treatment, give antivirals, and all the things that the internal medicine doctors and infectious diseases specialists do because there are not enough of them.
A few days ago, Pepe made a wise move. Since we now have more experience in treating COVID-19 patients, he decided that all cardiologists will again work as a team and treat COVID patients in groups of three doctors. We always have an assigned supervisor for asking specific questions to infectiology, pneumology, etc., but we are back together, all of us in cardiology, and a team spirit is crucial for this war.
The most important challenge for me professionally is that this is not cardiology. COVID-19 is not a heart disease and it is not what I trained for. On top of that, we are not used to treating this number of patients. Sometimes there are more patients than the hospital can manage.
Psychologically, this is tough. I don’t want to be COVID positive. I want to remain healthy. It’s like an obsession. Inside we fear the patients and getting infected, but we cannot show it because they are also afraid. Outwardly we must be confident. This goes with the job.
As for cardiology patients without COVID, we have noticed something – we don’t like it – that the number of admissions we normally have for heart failure and myocardial infarction has drastically diminished. We are treating 20 or 30% of the patients we treated before. We don’t know if the patients are suffering at home and don’t come to the emergency department because they are afraid of being infected.
Personally, the most difficult part of this situation is that I cannot see my wife and baby, who will be six weeks old today. We see each other through video calls. When this started, we rented another apartment to keep them safe and because my wife’s parents are living there and are at high risk from the infection.
I could have refused to work in the COVID area, but I needed to volunteer. We became doctors to act in these situations, not to sit comfortably behind a desk. My wife is also a cardiologist in the same department and a specialist in cardiac imaging. She completely understands my choice to treat COVID patients and is frustrated that she cannot join us.
There are around 400 doctors in the hospital and every speciality is focused on COVID patients. We work together as one large team – cardiologists, surgeons, oncologists, and so on. I hope we will continue working like this long after the pandemic has passed. We are learning a valuable lesson: we are so much stronger together.