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’d call rigidity. But now it’s 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.
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.
In the office: sanitizers appeared, along with the shared handwashing procedures, the dealing with distance that is no longer “social distance” but distance measured in meters and centimeters. And we have had to renounce basic aspects of our way of being together with others, like the handshake at the beginning and end of a session, and every spontaneous gesture that might have been habitual with us or with our patients. Like that young adolescent who at the end of every session found some surprising way to greet me and thank me, maybe with a pat on the back, maybe with a high five, sometimes hugging me ecstatically. All put on hold. The office is closed. I would have to do all my appointments online. Legally obliged.
On Monday, March 2, I feel vaguely unwell: shivers, some fatigue, pained muscles, loss of appetite. I think it must be the effect of a weekend in London, the stress of the trip. Tuesday evening, I discover that I have a low fever without any other symptoms. I feel strong, but also prudent. I call the state hotline, they answer after a few rings. They reassure me. On Wednesday I call my primary care physician. “Take a Tylenol.” The fever goes down. The fever goes up. On Friday, I finally stop. Bedridden, tired, senses dulled, inert. Despite that, fearless. On the kitchen table I find a note my son has left for me. Stay strong dad!
Saturday, my wife, Cristina, flies back early to Milan. The first step in the sequence of my cure, and my salvation.
Sunday, a long consultation. I start antibiotic therapy.
Monday, March 9, chest X-rays and blood work. Diagnosis: bacterial pneumonia. I feel as happy as a kid. I think about the paradox of the moment we are living though. Happy to have pneumonia, because it’s bacteria, treatable.
Something in the world is already starting to break down.
New therapies and antibiotics. I’ll make it. Maybe.
I need to tell my patients, at least the ones who have decided to do distance therapy. So I send out the first message after the “institutional” ones about the state of my health. I have no doubts about doing this; I’ve chosen transparency, at least as much as possible. I know there will be repercussions. We will face them. I have no regrets. I write that I have been diagnosed with a bacterial infection of the lungs and that I can’t work for at least a week. I receive warm, affectionate replies. Tuesday, the fever and fatigue continue. That evening, the turning point—my primary care physician calls 911 to take me to the emergency room at Fatebenefratelli for an exam, and, we hope, a swab test.
I clearly remember the sense of irritation at the decision, buried in a fatalism that seemed to regard the bed as my only certain refuge. I remember a friendly, energetic paramedic taking me by hand in the ambulance. He is the first health worker I’ve seen dressed as if he’s in a film about biological warfare. We talk about volunteering and red crosses as we cross an already deserted Milan. From the little windows I play at trying to guess our route from the shapes of the tallest buildings. I don’t quite know what’s happening inside and outside of me. I let myself be carried along on the wave of events, more inescapable than ever.
Wednesday morning, March 11, my at-home guardian angel (I’ll have many more in service from here on out) phones 911. By this time, it’s a second home.
After an hour, they’re already seeing me. Again the doctor suggests bacterial pneumonia. They give me tests for various kinds of infections: blood, urinary tract, Legionnaires disease. They attach me to an oxygen tank. I’ll be admitted to intensive care for observation as we wait for the swab results. I feel better.
While I wait to be admitted, half worried and half desperate, all alone in limbo, searching for human contact, I think of a colleague who works in the cardio-pulmonary section and wonder whether he’s in service. I imagine contacting him. Then I fall asleep.
When I wake up, they take me to my room. A double for single use. No other choice.
Here I have my first harsh encounter with isolation and safety precautions. A nurse, more terrified than me, tells me to wear my mask all the time and warns “You won’t be here long. You’ll be transferred, even if you’re negative [for COVID-19]. And don’t take anything with you. If you’re positive, everything you have will be thrown away and incinerated.” I think about my briefcase, my jacket, my clothing. I can’t believe it.
For the first and last time I hear a terrible word applied to whoever comes into my room: “I’m dirty,” says another nurse. She means that she’s no longer sterile. It makes me feel sick. I’m dirty, too.
Thursday morning another doctor shows up.
Sacco was built as a sanatorium for tuberculosis patients in 1927, when it was called Vialba. It was also where I went my first year of medical school to perform my first autopsies. Famous later for its treatments for AIDS. Here, I saw my godfather, Gigi, for the last time, dying of stomach cancer. My thoughts rush along rapidly, ugly, ruthless, I can’t stop them. I know my mind; it’s hard to control it right now. They take us to Medicine 2, which has just been converted to receive COVID-19 patients. When the door to the ward opens, I see a cluster of nurses and doctors ranged at the end of the corridor. They move around us, suited up and wary. They seem to give each other courage. “Which bed do you want?” It’s a large room that normally holds three beds. Now it is set up for two.
I don’t hesitate—I take the bed by the window. A good choice, as I’ll discover later.
The helmet arrives. I’ll become familiar with its name: CPAP. It’s 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’s hard to bear with a high fever (hot air circulates around you), and it’s 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’m 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’d have given my consent to pranotherapy at that point. And then the thoughts: if they’re 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’ll 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 can’t 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 doesn’t care; the person experiencing it all directly; the person who experiences at a distance.
Protagonists, witnesses, spectators: whether they like it or not.
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’m 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 weren’t so affectionate. A nurse refused to turn out the light until midnight. I was inside my helmet and couldn’t get up to do it myself. I tell him to go to Hell.
I’m flattered—I think that if they are asking me for help, it means I can give it now rather than receive it. Furthermore, this is my hobby horse: empathy. I take off. “It’s great that you’re so involved, but, look, you need to put yourselves in other people’s shoes without becoming those other people . . .” They interrupt me right away. “Yeah, yeah, we know that. But we need to find a way to sleep.” I change my register right away. I can still do that. “OK, give me your email and I’ll send you the recommendations. You can take good quality melatonin, or a mild tranquilizer, a few drops. For the thoughts and images, think about those big red emergency buttons that cut off the current. Imagine an even bigger one that turns off your thoughts when they start twisting around. And in time there may be other solutions, if necessary.” Two days later they stand in the doorway. “We took the melatonin. We’re sleeping. And the big red button works wonders.” When all this is over, I’d like to help someone pro bono.
Thursday, March 19. Father’s Day. I’m still in the hospital, but everything is going well. The parameters are OK: no helmet, still on oxygen, and it all seems to be a normal progression. The morning doctors are optimistic. I’m happy.
Dear all, with great, immense joy I can tell you I have recovered!
This is the message that, from the moment I became ill, I’ve wanted and imagined being able to send you as soon as possible.
And I can’t deny that it has been one of my strongest motivations for successful healing.
As you can imagine I am extremely happy and I am delighted to share the news with you.
The office will obviously remain closed until the government issues a new decree, but I am available for sessions by Skype, FaceTime, Zoom, or any other means you want to use. Even if it’s just to say hello after this abrupt break.
I ask, then, that you let me know individually what your plans are and the possibility of rescheduling the timing of our meetings, so that we can respond to your and my new needs and availabilities.
For now I greet you all collectively, awaiting the opportunity to do so one on one.
The morning passes between preparations and waiting, greetings and farewells.
During my final sampling of arterial blood, I ask Federica, the young specialist: “Dottoressa, without any pretense at science, can you give me the percentage of responsibility for my cure between your competence, the therapy, and . . . dumb luck?” 30-30-30 she says without thinking. I think she underestimated the third component.
We say goodbye. I want to hug, I tell her, but I know we can’t.
“But we can clasp two hands. That, we can,” she says. We do it with the appropriate pleasure and intensity.
“I don’t know how to thank you.”
“It’s we who should thank you.”
If we didn’t have masks on, we’d probably discover that we’re both teary-eyed.
I say a warm goodbye to Alberto. I’m sorry he’s staying there, and so is he. He’s worried about who will come next.
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’s too much of an effort. We’ve 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 don’t even know what I feel. But there’s 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’ve 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.
ABOUT THE AUTHOR AND TRANSLATOR
Pietro Roberto Goisis is a Milan-based psychiatrist, psychotherapist, psychoanalyst SPI and IPA. He is a survivor of the coronavirus.
Ingrid Rowland is a professor at the University of Notre Dame with a joint appointment in the Department of History and School of Architecture who serves as a faculty fellow at the Nanovic Institute for European Studies. She is a regular contributor to the New York Review of Books and lives in Rome.
ABOUT THE PHOTOGRAPHER