Elena Vavassori is an Anaesthetist-Rianimator at Fondazione Poliambulanza Istituto Ospedaliero in Brescia. She has been involved with narrative medicine for some years and has recently taken an interest in traditional Chinese medicine, in a combination of knowledge and interests always in search of contact with the human being.
What has been your experience in this year of Covid-19?
During the first pandemic wave, the hospital was overwhelmed, and all possible actions were taken to accommodate Covid-19 patients: we normally have sixteen ICU beds, but last spring we had more than eighty, including the regular multipurpose ICU beds and those made out of the old ICU space. The hospital also stopped all surgeries and converted the operating room space into intensive care beds.
That period was exhausting because we were completely overwhelmed by the experience, with twelve-hour shifts, accumulating great physical, mental and emotional fatigue: people were dying around us. We are not used to this kind of experience, even though we are anaesthetist-resuscitators and work in situations of urgency or emergency: the presence of such massive death disconcerted everyone.
There were also no relatives. Normally, at the Poliambulanza, relatives can stay in intensive care from morning to nighttime, next to their loved ones, but the Covid-19 has abolished this. The possibility, therefore, of knowing how your loved ones were doing was dependent to a telephone call in the morning: you had to tell them how the night had gone, that the patient was ill. Your voice was the image of what was happening, and on the other end of the phone there was a silence of listening and waiting for good news, which most of the time did not come. Once I had to announce the death of a patient to his family. After a few minutes, his son phoned me back, thanking me for everything we were doing. This left me very perplexed because the announcement of a death was matched by a thank you: why? I don’t know why… maybe because the perception of the seriousness of everything and that the doctors were doing everything they could was very strong at that time.
We discharged the last patient from intensive care in July and then gradually resumed normal activity. For the second pandemic wave, the situation is a bit different because there are two ICUs for Covid-19 patients, but the multi-purpose ICU remains free for non-Covid-19 patients, since the operating theatres remain active. I think this is correct: for me, it is an ethical issue. The operating theatres are dedicated to cancer patients, emergencies and other situations that cannot be ignored. My colleagues and I are therefore committed to these fronts.
What were the sensations and responses of the mind and body to this abnormal situation?
From the physical point of view, extreme tiredness. You came home, ate, had a few words with the people at home, and then sometimes collapsed on the sofa, and sometimes had trouble sleeping.
However, we also found the strength to do a narrative medicine work: through the method of semi-structured narrative, we collected evidence of the experience of being a doctor before and after Covid-19. It turned out to be a good work, although the stories we collected were just a few. The suffering of the colleagues emerged, together with the difficulty and the attempt to overcome this difficulty, linked to the fact that the knowledge of medical science – which was therefore everyone’s knowledge – was not enough. It is true that in the ICU people are always in a delicate situation, but the number of daily deaths in the time of Covid-19 was really heavy to bear.
How do you stand and act when faced with something unknown? And what was the group’s role in coping with the emergency?
From a therapeutic point of view, ventilatory therapy and the use of antibiotics, cortisone and heparin are crucial. Then you need to pay attention to complications and respiratory weaning in order to allow the resumption of spontaneous ventilation in patients who had previously been subjected to mechanical ventilation. Compared to the first wave, although we were disconcerted, we felt more prepared for the events. There has always been a good coping strategy and management of the unexpected factor: the shortcomings or difficulties of one person (whether emotional, personal or scientific) were embraced (never judged) by another. A collective chain of knowledge was thus created, which made it possible to overcome the most difficult and complicated situations, whether they concerned the patient, the doctor or the family members. I often think of the image of Olympic circles: all united, circles that contain and do not let go. No one felt alone because there was a human chain of help. We were always working to find a balance and being able to find it was the strength of the group.
We must always think of the other side of the scale, to the “non-Covid-19” patients who are an equal suffering because they are alone in facing an intervention, even an important one. It is therefore important to take care of those who do not have Covid-19, who are still sick: that is also Health!
How do you think people’s perception of anaesthetists has changed?
Once, when I was leaving the hospital, there was a banner saying “thank you for your hard work: you are heroes”, and I got moved, partly because I didn’t expect it, and partly because I didn’t feel like a hero. There was this metaphor of the hero fighting the enemy, but we are not heroes, our job is to do the best thing for the patient in an emergency, which is to work in the best way possible before Covid-19, in this difficult time, and we will continue to do so.
At the Poliambulanza, we have always been well regarded as anesthetists because we put ourselves at the service of the hospital community and of the patients, and that is the spirit of Poliambulanza: a service to others. From the outside I often hear people say “how are you doing”, “how do you feel”, “you’re doing so many good things”, “congratulations”, “thank goodness you’re here”, and I believe that those things ae said because people understand in their hearts that we are there and that we are important, as doctors, as resuscitators, as anesthetists.
What have you given and what have you lost in this year?
I think I’ve given and always given all; I haven’t felt different inside. I have felt fatigued certainly, I gave a lot of my life, my hours, my tiredness, my sleep.
However, I have taken more, there is no doubt about that. We all realized that we are not omnipotent: the illness and death from Covid-19 taught us to be more humble and even more attentive to people, to their fears. Narrative medicine has helped me a lot in this because it is a huge source of energy that opens the mind and the heart; and that energy gave me the strength to do the project. And I am grateful to have found colleagues willing to participate. In short, I gave a lot, but I took more.
As for the lost, I don’t think I have lost anything, I don’t feel cheated of anything, perhaps because I have always loved my work, it has always been enriching, even in the bad times. Even physical tiredness eventually recovers… One thing I have learnt since I was at school is to look for resources, for energy that will get me through difficult personal and work moments. So, I can say that I haven’t really lost anything.
Would you like to tell us something about your narrative medicine project? Something that struck you.
The narrative medicine project started with the question: “how do doctors live this pandemic within themselves”, we wanted to investigate whether we felt different before and after Covid-19. The incipit was “I became a doctor because…” and a continuity emerged in the narrations: “I became a doctor because I wanted to cure people”. A colleague referred to Fabrizio De André’s song Un Medico [“when I was a child I wanted to heal the cherry trees. I thought they were wounded when they were red with fruit. I thought health had left them when the snow flowers they had lost”, ed.] telling how this song had accompanied her in her choice to become a doctor.
Regarding the experience of the Covid-19 pandemic, one colleague wrote: ‘I saw all the certainties disappearing around me’; another: ‘I experienced the bewilderment of the feeling of the absolute futility of my work’. This was how the situation was perceived. Also of interest were the numerous metaphors of belonging, to quote a few: “we all rowed in the same direction”, “no one was left behind”, “no tear was not wiped away». This is heartwarming and allows you to hope for the future.
The Plague by Albert Camus was the red threadwithin this work of narrative medicine. One sentence, the final one, reads: “Rieux decided to write the story that ends here […] to say simply that what one learns in the midst of scourges is that there are more things in men to admire than to despise”. In my opinion, this is an extraordinary sentence in this day and age, heroes or no heroes.