“DOCTOR, TELL THE TRUTH. HOW ARE YOU REALLY?”
With this question Edgardo began my first appointment of Week Zero of COVID-19. It is Monday, February 24, early in the morning. I asked him not to come in person but to Skype. He is a young man, elegant and slim, from a well-off family, and works in the arts with passionate dedication. In general, though he is involved in the process, he maintains a certain aristocratic detachment, to the point that I sometimes ask myself how committed he really is to the therapy. Perhaps it comes from an earlier analysis, ruled by an excess of coldness and distance—what I would call rigidity. But now it is my problem. He is present, very much so. And this time I can really feel it. Really, as he said with his first question. What if, in the fear, the long-distance session, the general situation, Edgardo has finally found his way to be close to me, and to feel close?
This pandemic has changed our parameters and our habits.
In our work every gesture has its own precise content and symbolism. How we open a door, how we greet people when they enter and exit, where we put our hands during the conversations, how we cough and sneeze, the distance between us (who ever measured it before?).
We grow used to confronting our thoughts in a session, some of them unpleasant, some pleasant. In general we attribute them to our patients, who “put them in.” Now, though, they seem to be our own thoughts, ours . . . And the fear? And age? “Senior citizens over 65 should stay at home!” But how dare they—who is the senior citizen here? Can we work? Can we not work? Where is the line between responsibility and recklessness, between ethics and sacrifice?
It is extremely difficult to sum up the number of changes that have taken place, between the emergency, individual precautions, sanitary advice, and government decrees. In only two weeks the general picture has changed at a speed greater than our own abilities to adapt—and maybe those of the virus itself.
Where individual flexibility has won out over habit, fear, rigidity, the therapeutic relationship itself has benefited.
From the very beginning, I shared every decision with my patients. Almost all of them have appreciated that choice, opting to continue with long-distance sessions. A few others have preferred to suspend the therapy and try to get along by themselves, postponing our joint work to the end of the crisis.
When the tests are ready, the doctor calls me in. “It could be bacterial, but you have a serious oxygen deficiency: class 4. I need to admit you to the hospital.”
The swab test will take a day.
I lose consciousness. I am tired, it is 1 a.m. I am not lucid. I am afraid. Where will they put me?
I ask if I can go home for the night and return to the hospital the next day. I sign the form. I leave.
Pure insanity. Can I say that? Total idiocy? Maybe my brain was infected, too.
I do not hesitate—I take the bed by the window. A good choice, as I will discover later.
Not long after come the first exams and the first visits. Two doctors: one on staff, the other his intern. In addition to taking my vitals and a general exam, they perform the first ultrasound of my lungs. Terms and abbreviations pass between them, incomprehensible to me, but I am able to decipher these words: “Your lungs are totally full of fluid. We need to help you dry them out. We’ve gotten good results from wearing a helmet with an oxygen supply for several hours a day. We’ll start that shortly, and then we’ll start the therapies. We only need your verbal consent; we can’t keep any pieces of paper.”
For the second time I identify myself as a doctor, and they seem happy.
They administer some retroviral drugs (AIDS drugs, now that’s a thought), and antimalarials. At the same time, because I am a doctor in another specialty, I do not quite realize what my conditions really are. I am reassured by being in the hospital, and now they will take care of the therapies, the dosage, the care. I entrust myself to them. Totally.
* * * * *
It will only be many days later that I discover that among the phone calls the doctors make to my home, the first goes like this: “Signora [Madame], do you know that your husband is in critical condition? We have him in the ward, but right next to intensive care, and we’re ready to move him tonight at the first sign of a problem. We need to anticipate what may happen, not be taken by surprise. We need to preempt the infection, not chase after it.”
Fortunately, I had no idea. Even today I am sorry to have created such worry. I am a little woozy, but something grabs my attention immediately. In all the comings and goings of people in the room, I notice that they always move in pairs. At first I do not understand why, but later, day after day, I realize that it is a choice, with the precise aim of providing mutual support in the face of a terrible, risky task—continual contact with death and fear. I never succeed in asking whether it was devised as a special protocol. In any event, it is an excellent choice that also benefits us as patients.
Another thing strikes me. Whoever comes into the room is dressed in an antiviral suit. A tight hood, goggles, and a plastic visor that comes down to the neck, an FFP3 mask closed around nose and mouth, three pairs of gloves, a disposable gown over the uniform, and booties over their shoes.
It is impossible to tell who they are, what their role is, what their identity might be. At the same time, the patients are also wearing masks: encounters between masked men and women. This is disturbing for someone like me who bases most of his relationships on recognition, exchanging glances, and knowing one another. I like to understand something about people by observing what kind of aspect they have, their facial expressions. Now I am disoriented. Some try to write a name or a position on their coats, but it is not consistent. I try to adjust, fix my attention on their eyes. Some strike me: an intense blue, a marvelous Asian outline, but it is not enough. I shift to details: many of the women doctors wear glasses; I look for the brand name on the armature. One young male doctor hides a ponytail under his cap, and I tell him it will be easy to recognize him because of it. “Careful not to get confused, two of us have them,” he replies.
Bit by bit I begin to orient myself among my conversation partners.
Maybe that is why I have felt the need to define myself. “My name is Roberto. I’m a doctor.” Saying it helps.
At the same time, I see a harmony among them, a solidarity, an extraordinarily strong bond. A doctor raises the blind, a nurse makes the beds, another throws out the trash; they help each other as they help us.
But these are thoughts that accumulate inside me over time, as the days go by.
TREATMENT: ANOTHER BEGINNING
The helmet arrives. I will become familiar with its name: CPAP. It is a transparent plastic affair, a kind of ball you put your head into, somewhere between a hair dryer and a diving bell. As with every beautiful thing, it has its defects. Like spending hours and hours inside it (up to 20 each day, at the beginning), that it is hard to bear with a high fever (hot air circulates around you), and it is extremely noisy (like a plane with bad soundproofing), an issue brilliantly resolved with earplugs or earbuds for music. Like an astronaut inside their space suit with all the attendant consequences for satisfying their bodily needs. With Alberto, my roommate and companion in the adventure, we say at the beginning of every cycle that we are taking off on a plane flight. We circle the whole world, length and breadth.
But alongside the virtual travel, I need to say something about the mental voyages the condition of disease—this disease—activates. The first day, the doctor I speak to on the phone warns me that the collateral effects of the therapies might include delirium, hallucination, and states of confusion. Fever and fear factor, too. I am sure of it.
The central phase of the disease lasts five days, an intense and passionate hand-to- hand combat with Mister Corona. The nights are the worst, between nightmares and thoughts that spin like drills. Once I saw my daughter sitting on a seat at the foot of my bed. She looked at me lovingly. I was critical of her non-presence, but I was glad to see her there. I cherish the memory. Another time I imagined myself on a mountain, in the middle of an extreme climb. I know that in some cases death comes to us because we are so exhausted; we let ourselves go, into the arms of fatigue, wind, cold. I think that at the worst I might have had that opportunity. I try not to let any news reach me, but on the little television in our room we see images of the deaths and tragedy unfolding in Bergamo, my native city. I wonder whether the Bergamaschi might have some genetic fragility that makes them defenseless against the virus. Another time I get upset at the thought of all the things I would still like to do, all the people I would enjoy meeting, all the opportunities to benefit from. And I give in to regret, fearing that I could never have them again.
Friday night, my second under the CPAP, someone comes in and tells me, writing on a piece of paper that they hold out in front of the helmet, that they want to administer an experimental drug intravenously, a drug used to suppress the inflammation of rheumatoid arthritis. “Do you give your verbal consent?” I would have given my consent to pranotherapy at that point. And then the thoughts: if they are in this much of a hurry, it means that . . .
Every so often, vital signs, the reasons for living. My family, my granddaughters, my patients, my work, the things I like, my friends. Two extremely powerful thoughts: if I survive, I will write something about this adventure and think seriously about my professional future, about the Italian Psychoanalytic Society. Between moments and thoughts, good and bad, the company I kept by necessity, solitude and isolation played their part—inside the helmet and out, recombining past choices and priorities.
* * * * *
This epochal tragedy has a collective dimension because of its numbers and the degree of involvement, but it is made of so many tiny individualities that cannot be forgotten. So many voiceless solitudes.
Whoever is on the front lines suffers both a personal risk and a risk to loved ones: the healthcare worker who lives away from home out of fear; the person who feels cared for and the one who feels abandoned; the person who manages to pass triage over the telephone; the person who hears agonized voices and bears the burden; the person who is too confused to know how to respond; the person who goes unheard; the person who cannot get through on the phone; the person who dies alone; the person who chooses to die at home to avoid dying alone; the person who is a helpless witness to death; the person who has no idea where the body of a loved one will be cremated, hoping that it won’t be a military convoy or a deconsecrated church, waiting, without knowing where that body will end up, or when the ashes will return; the fatalist who does not care; the person experiencing it all directly; the person who experiences at a distance.
Protagonists, witnesses, spectators: whether they like it or not.
For me, no visits. Permission only to receive a change of underwear once a day. Fortunately, I came with a phone, tablet, Mac, and, above all, good music. An excellent soothing remedy.
Along with mindfulness. Breathing, so fundamental to the practice, becomes the purpose of every well-taken breath. Trying to feel present in every moment, a condition of serenity. Acceptance helps. “Let the needles enter into you,” I repeat to myself every time. They stanch two or three. Good for them, and good for me.
I discover early on that far from the hospital, but close to my heart, a multitude of people, truly numberless, live through the same worries, fears, hopes, joys, and relief as my family and me. I imagine them as a crowded Greek chorus that sustains me and pushes me from behind as the street opens out in front of me. I know, and here I run the risk of sounding New Age, that each one of them is part of my healing. I hear from people I had never known, and hear again from people I had lost touch with.
And then my healers. They treat me with competence and attention, affection even. I develop an uncontrollable feeling of love for every health care worker who comes near me: nurses, doctors, aides, orderlies, anyone wearing a white coat.
And, presumptuously, I have the impression that the affection is mutual. I find myself in a harmonious ward; my son feels it when, with admirable dedication, he hands over my changes of underwear. Apparently, it is without conflicts, or the conflicts are well disguised. I am among people who respect and help one another with a shared objective: curing us.
My fever begins to go down, finally to disappear, and each taking of my temperature is awaited with great anxiety. What can I say about that doctor who, after the hundredth measurement of the day, takes the thermometer in hand, looks at it, and gives me a high five. What, I am not infected?
“We’re learning how to cure all of you, together,” another doctor tells us. Someone can get nervous hearing that kind of statement. To me, it seems to reveal a humility, an acceptance of one’s own limits, of listening to every clue. In psychoanalysis, we call this “co-construction.” I believe in it, and I use it in my practice.
“Maybe there’s something wrong with me, but when things go well for one of you, I get all excited, the way I do when an athlete wins a medal!”
Another doctor, in the face of the latest positive data, draws a heart in the air with her finger, the way soccer players do for the fans and their girlfriends after they score a goal. A standing ovation.
Thinking back, there was an evening when we were not so affectionate. A nurse refused to turn out the light until midnight. I was inside my helmet and could not get up to do it myself. I tell him to go to Hell.
The first Sunday arrives on the ward and I am beginning to feel better. I ask myself who will visit us today.
It comes a pair of doctors, male and female. They are in a good mood, full of trust and enthusiasm. They tell me that I am progressing really well, that there is still a road ahead, but I will make it. They take away the experimental drugs, the antibiotics, they reduce my daily hours on the CPAP. I am ecstatic, I phone home, I get emotional.
Then I reconsider. Have they come right from that board game Operation? It is difficult to relax, to chase away the bad thoughts, if only out of superstition.
But I am feeling positive, and not only for coronavirus. I write a second email to my patients. I explain that I am in the hospital for something more serious than bacterial pneumonia, that I am receiving excellent care, and everything seems to be going well. Perhaps I should have waited, though the reactions that come in are moving and unforgettable.
By now we are all used to the concept of medicine that aims for the minimum time in the hospital, that sends new mothers home the day after childbirth, surgery almost exclusively for outpatients, the shortest possible stays. But now you are discharged only if you are really well, beyond relapse. They do not want to incur risks. I agree with them.
And so, this article that revolves to such a great extent around the room, my consultation room, now has to reckon with a cubicle, with a bed rather than the couch, a little table rather than a desk, another patient, Alberto, my mirror and my partner in conversation, especially in the evenings. Pleasant company.
When do you know you are getting better? And from what?
There are objective data, clinical parameters, ultrasounds, numerical data. There are subjective sensations. Useful ones.
My son arrives. He has to wait for me on the ground floor. Now for the second walk.
I take my briefcase and tote bag, moving along the corridor in the opposite direction.
My things are heavy. I wonder if it is too much of an effort. We have entered into a new phase: temporary, the state of fear for what happens afterwards.
I get into the car on the rear seat, among the gloves and masks. I do not even know what I feel. But there is a photo of me in the car, looking like a winner.
Joy. Certainly. I’d rather have done without it.
On March 23, I was discharged. Cured. Like 7,432 other Italians and 6,075 residents of Lombardy since the start of this epidemic. I am safe. I have saved myself, unlike the 3,776 people who have died in our region.
All of them numbers that will only be increasing in the coming days.