Dr. Andrea Alfonso is an anesthesiologist in a private hospital in Milan, the second most populous city in Italy. Every day, he goes to work on almost empty streets in a country struggling with at least 69,000 cases of COVID-19 and more than 6,800 deaths.
The working conditions are physically exhausting, said Alfonso. It takes 10 minutes to dress with all protective equipment, gloves, face masks and more once in the hospital. And every six hours – because shifts can last eight or even 12 hours – everything has to be removed and changed, only to start the adjustment process again.
There is no food or drink while wearing the equipment. There is no break, no “downtime” – just an incessant flow of patients with respiratory disease, not to mention those who come for other emergency issues.
Putting on and taking off the equipment and standing all day is not the hardest part of the job, said Alfonso. The hardest part is feeling helpless in the face of an invisible and seemingly endless force.
For those who still call it “just the flu” or complain #Stay at home Politics. A photo of #Bergamos: among the richest cities in Europe, the leading healthcare system. These Italian army trucks carry coffins to other cities. The local crematorium is full, too many dead. pic.twitter.com/hl6uBIzFYP
“As a doctor, it’s frustrating to see people die,” said Alfonso. “There is no way to do more than what we are doing now. This is the problem.”
Doctors around the world face similar problems: lots of patients, long hours and frustration. And there is concern that it could lead to serious mental health problems, even post-traumatic stress disorder or PTSD.
“I think it will have a lot of psychological impact on people, not only the doctors but also the nurses and all those who work [the critical care] “Said Dr. Laura Hawryluck, manager of the critical care intervention team at the Toronto Western Hospital.
When asked if Alfonso expected to see PTSD with doctors in Italy, he replied, “100%. The answer is yes.”
His response was not surprising.
A new study published this week in JAMA Network examined the health effects of the COVID-19 epidemic in China on front-line workers. It found that frontline workers involved in the diagnosis, treatment and care of patients with the disease were at higher risk for symptoms of depression, anxiety, insomnia and distress.
Hawryluck was on the front line during the SARS epidemic in Toronto. She said she saw the toll it took not only on quarantined patients – a subject she wrote about a study – but also on those in the medical field. Some, she said, have chosen to leave the field entirely.
“We have seen that some people are leaving our fields and feel that this is no longer an area of practice in which they want to be,” she said. “Other people may say,” You know what? We were successful, and I think it made me stronger in terms of the way I work and work with my team. “”
Alfonso considered leaving the profession during these difficult times.
“It is quite complex to explain in simple words,” he said. “But aside from this feeling that you can’t do enough for people, there is also an additional fear [for] your friends and relatives. “
Life and Death Decisions
Italian doctors have shared stories of the need to make the agonizing decision between who lives and who dies, due to a shortage of fans needed to keep people breathing.
It is these choices that can deeply affect doctors, said Hawryluck, even if they are trained to make these difficult decisions.
13 / Someone must already be intubated and go to intensive care. For others, it is too late … Each ventilator becomes like gold: those in operating rooms that have suspended their non-emergency activities become places of intensive care that did not exist before.
& mdash;@ silviast9
But those who work in the intensive care units have a very strong connection, she said. It is this bond that can sometimes help them cope with such difficult situations.
“Our ties are so strong because we have lived these moments together, and we will relive them in the future. And we all know it,” she said.
But there are also colleagues in different areas they can rely on, such as counselors, psychologists and psychiatrists.
“I got angry”
While cities, provinces, states and entire countries issue foreclosure orders, which is particularly frustrating, said Alfonso, is the stubbornness or selfishness displayed by people who violate the orders.
“I woke up in the morning, I left my house and I took my car and I went to the hospital. And I started looking around. … And I see people doing jogging or doing stupid things they shouldn’t be doing, “he said. “And I got angry because I am [putting] my life at stake – for these idiots. “
And it is this behavior, he says, that makes fighting the virus so difficult.
“We are facing a very unknown enemy. It is a big problem, but if you add to the behavior of these people, then, forgive me, we are crazy.”
All of this, said Alfonso, can be very demotivating, almost soul-sucking. But he has a job to do, and he will, despite the personal cost.
“I have never been as stressed as I am now,” he said.
Hawryluck said the doctors and others on the ground were going to be pushed to the limit.
“We have a longer journey to go – overcoming this particular pandemic,” said Hawryluck. “I think it will hit the medical community very hard.”