Lying down with her hands on her stomach, Lena * struggles to keep her eyes open. It is almost midnight, Monday, November 29. The 15-year-old girl must answer questions from the pediatric emergency room intern at Necker hospital, in the 15th arrondissement of Paris. She swallowed 24 anti-anxiety pills two hours earlier. “What prompted you to take them?” inquires the young doctor. “I do not know”, Lena whispers. “You’re sad ?” She looks away. “Not particularly. I feel more anger and frustration.”
Like Lena, five other minors passed through the glass doors of the emergency room for psychiatric problems that night. At the care station, the doctors who distribute the patients welcome these new arrivals as best they can. In addition to these six teenagers, caregivers take care of more ordinary pathologies. In the midst of a bronchiolitis epidemic, many infants in respiratory distress require hospitalization for one to three days. Not to mention the children contaminated by respiratory viruses, many in the fall.
In this context, welcoming adolescents with psychiatric disorders, who need hospitalization that can last for several weeks, complicates the task of the service. “We already have fewer beds because there is a lack of nurses and the beds that are supposed to be available are no longer available, because we have to take care of these adolescents”, worries Professor Hélène Chappuy, the head of the service who was not present that night. To receive this flow of young people in distress, some caregivers have received specific training.
The Necker Hospital team has been taking care of these teenagers who have dark thoughts for more than a year. Some arrive after “IMV”, voluntary drug poisoning. “Before the health crisis, we received them once or twice a week at most. Now, we have several cases every day”, says Julia Worcel. Present in the service for two and a half years, the doctor on call is the oldest in the service.
Hélène Chappuy is worried about “to receive more severe psychiatric pictures which affect younger and more numerous adolescents”. Public Health France published alarming figures on November 22 confirming this observation: at the end of September 2021, nearly 150 young people under the age of 15 admitted to the emergency room for suicidal acts, against a hundred during the same period in 2019.
Meanwhile, at the emergency room, the tone rises. About twenty parents wait in the hall. Some fell asleep with their child on their stomachs. “Do you know how long there is?” a mother asks. “I arrived at 6 p.m.! another roared. If my daughter is not one of the urgent cases, you have to tell us! We must free ourselves! “ It’s past 2 a.m. “This is the time when it starts to get complicated”, explains Achraf, a 41-year-old caregiver, ten of whom are in the service. At his side, Marion, 28, childcare assistant. “We can’t answer you, they explain in a soft voice to the parents. It changes all the time based on arrivals. “ And emergencies to be treated as a priority.
With each new arrival, a nurse first examines the patients, before they pass in front of the doctor, who classifies them in order of priority according to a color code. The “green” patients are, if the parents agree, redirected to a city pediatrician present on the premises from 7 pm to midnight. The others, the more serious cases, are taken care of by a doctor or an intern from the department. Theoretically, “yellow” patients should be taken care of within an hour. Those filed in the orange folder in less than 20 minutes. That evening, none of the “orange” patients will have been taken care of so quickly. “Babies under three months old have priority, they are systematically classified in orange, because a simple fever can be symptomatic of bacterial meningitis, of a urinary tract infection, explains Julia Worcel. And then, they are so fragile that they have to be removed from the germ nest “, the waiting room.
Two security guards are continuously present in the emergency room. They were installed at the start of the 2020 school year. Sometimes, their mere presence is enough to lower the tension. Not always. “We are threatened almost daily, deplores Ashraf. Last week, I was filmed by a daddy because I reminded you that you only need one parent in the waiting room “ because of the health context.
Verbal attacks, sometimes physical, long waits… Caregivers are on the front line. The nurses are exhausted. The turnover is important. In this service, they stay on average two and a half years. Despite the recruitment of ten doctors, the medical workforce is still not complete. “It was less complicated in 2018 and in 2019”, assures Sylvie Hagnéré, health executive at Necker hospital.
“We have put a lot of demand on nursing assistants and nurses in recent months, especially with increased overtime, which has made it possible to quickly compensate for absences. But it is increasingly difficult to replace them.”
Sylvie Hagnéré, healthcare manager at Necker hospitalto franceinfo
At the nursing station, the young intern returns from her consultation with Lena. She goes to another intern, a “Ancient”, present for only two years in the service.
“The teenager who took the drugs… She didn’t really attempt suicide… she remarks, in a slight doubt.
– How many pills has she taken already? his colleague worries.
– Twenty four, but hey, she says she doesn’t have dark thoughts and that it’s okay.
– Yeah… that’s almost what’s most shocking, if you want my opinion. “
The two interns paused. “It’s still a shame that there is no child psychiatrist.” Julia Worcel, one of the doctors “senior” who oversees the decisions of the interns, chooses to keep Lena under observation at least overnight. Taking too many anti-anxiety drugs can seriously slow their heart rate and damage their kidneys and liver. Impossible to let her go again. The intern ordered an EKG and blood tests.
At the same time, a new 15-year-old girl fills out her admission form at the reception. She made a “TS”, a suicide attempt. “We said we were limited to five shrink patients”, recalls an intern. “But we can’t let them go home”Julia Worcel retorts. She unsheathes her phone. Her mission: to find an available bed for the newcomer.
“We have to take her to safety. I don’t know how, but it’s going to have to be done.”
Julia Worcel, pediatrician at Necker hospitalto franceinfo
For lack of beds in child psychiatry, general pediatric emergencies welcome these adolescents as best they can. “But this is not intended for, emphasizes Hélène Chappuy. This leads to accidents or defenestrations in hospital services, because there are not enough nurses and we do not have the means to secure the environment. “ Understand: remove dangerous objects to avoid hangings or place patients in rooms with windows fitted with security bars.
“We are trying to recreate the white rooms” psychiatric services, “but it’s impossible”, explains a nurse from the department. These rooms must be able to be locked from the outside and are fitted out to the strict minimum to prevent patients from putting themselves in danger. “We do our best to visit them regularly, we remove the cellphones and we ask the parents to leave to avoid it disturbing them.” Finally, four teenagers remain hospitalized in the emergency room that evening. Julia Worcel managed to transfer two to other departments.
“Sorry, I can see you’re overwhelmed, but you know how long it’s been?” In the waiting room, facing Marion and Achraf, each new entry is an “orange” emergency. A baby barely 15 days old. Another less than 3 months old. They both have fever. The wait will stretch even further for Yoan *, 4 and a half years old, also feverish. He has vomited several times and is embarrassed to breathe. “In fact, he arrived almost at the same time as us”, Marion breathes, looking at Yoan’s father. It is 4 am and the man has been dozing at the entrance to the waiting room for seven hours. He returns to his place. On the computer, its file is circled in yellow.
When Yoan and his father leave Necker, it is almost 6 a.m. Yoan has pneumonia, which will need to be treated with antibiotic treatment at home. He who was grumpy and tired, smiled at the idea of finding “Doudou, his stuffed leopard waiting for him in his bed”his father jokes.
At the treatment station, where crisps and sweets hang out, the residents and the doctor take stock of the night. Interns are ending their 24-hour shift. That of the doctors lasted 14 hours. In all, 100 patients were admitted, and although none of them had time to eat, the night fell. “well spent”. “We know it can be worse, confides Julia Worcel, but nothing that happened this evening is normal: a patient waited for 9 hours in the emergency room and the doctor on duty, who was to leave her post at 12:30 am, left two hours later. Two hours offered, like that, gift, because she couldn’t see herself leaving me alone with so many patients. “
Among the interns present, one is no longer sure of wanting to continue her career as an emergency physician. “Emergencies are a falling dream”, she breathes, tired. A few hours earlier, in the cubicle where Lena was taken care of, when the teenager’s mother left the room, the young doctor asked her what she wanted to do later. “Medicine.” After more than 15 hours on call, the practitioner gave an encouraging smile: “It’s exhausting, but it’s worth it.”
* The first names have been modified to respect the anonymity of the patients.