The Man, the Doctor and SARS-COV-2

Giuseppe Palamara

I write this little memoir to tell my personal and direct experience with Covid-19: experience as a man, but in particular as a doctor.

Who I was, where I come from, who I am

As a boy I always dreamed of being able to practice as a doctor, despite knowing that it would not be easy given the economic conditions of my family of origin; despite this and with many sacrifices, I studied with commitment and passion until I obtained a degree in medicine and surgery. Again for economic reasons I was forced to give up my specialization and to move to Bergamo for work, where I was motivated to share my knowledge and experience in the professional field with other colleagues, animated by the desire to be useful and to be able to help people with problems of health. I have been a Doctor for more than 40 years; I remember the beginnings and the difficulties encountered and overcome, starting from the bottom and finding myself where from time to time I was needed. I did everything: the emergency medical service as coordinator, not having a driving license for home visits, the assistant in urology at a clinic, the emergency room doctor. On Sunday I was an Avis doctor who left at five in the morning to go to the mountain villages to do the blood tests, I replaced the family doctors, I was the private insurance doctor. All this to carry on the family, which in the meantime was growing numerous, with four children today all with a stable and successful social position. I let my children follow the path of life they had chosen without influencing them, leaving them the freedom to choose their own path without ever interfering. In the meantime, we went on with not few difficulties, but always with the confidence of those who are extremely convinced that the difficulties would settle over time, dedicating a lot of time to my business but little space for the family. On Sundays I visited my hospitalized patients to bring a word of comfort and support and they helped me to go on with their thanks and their gestures. I have always had an extremely human relationship with my patients, based on mutual respect and in fact almost everyone calls me “Doc”. Since the beginning of my business, I have been interested in Aesthetic Medicine and Trichology as having a very creative personality, all things new stimulate my interest. My motto is: creatives are born, entrepreneurs are made!

The Values of a Life

I have always been a non-practicing Catholic believer because I am convinced that good deeds are done on the street helping the weak and in the work of a Doctor, when for example you go to the hospital to give a word of comfort or a caress to those who suffer. During my illness I found faith again and prayer helped me a lot to overcome the moments of discouragement and the fear of not making it: these moments were many. Today I am a practicing Catholic believer.

The Illness

I started getting sick on March 3, 2020 with the classic symptoms of this virus. The relationship with health institutions was disappointing right from the start, almost satirical if this situation hadn’t been a tragedy, in the face of so many people who suffered and died, especially in the Bergamo area where I work. From the second day of illness I started calling 112, where they only suggested that I call the toll-free number of the Lombardy Region. I was answered by an administrative employee who, despite having introduced myself as a Doctor, made me a diagnosis of flu by telephone; then I called 1500 of the Ministry of Health and after a wait of 15 minutes in this case (many users were waiting for several hours) an administrative employee answered me who after 15 minutes of telephone interview, transferred the call to a doctor who gave me another diagnosis of flu, although I was convinced that it was not the classic flu of the winter period and despite insisting that I had the flu shot. At this point I just had to call ATS of BERGAMO who, after several attempts, replies through another administrative employee who – although having introduced myself as a Doctor and continuing to insist that I want to speak to a Doctor – says that he would have me contacted by a Doctor who was dealing with this emergency. The call came in the evening of the next day. For nine days I stayed at my home also because the idea of going to the hospital terrified me, despite my son – also a doctor who works in the hospital – insisted on hospitalization. At home I had started the therapy which in those days was also followed in the hospital. I, who do not take drugs, but take care of complementary therapies, having also studied this aspect of medicine, I began to notice that after nine days the situation had worsened and I began to need oxygen. Everything I had done was not enough and so I convinced myself to be hospitalized at 6pm on March 13, 2020, during the darkest period, of maximum epidemic.

The Hospitalization

I arrived in the emergency room on the evening of March 13, 2020 at 6.00 pm in the height of the epidemic. I am accompanied by car to avoid the long waits of the ambulances, in those days the waits were hours; the waiting room of the emergency room is a very large room, it was empty and, once the admission procedures have been completed, they put two bracelets on my wrist, one with my personal data and one with an entry number for that day: I have this number in mind and I think I will never forget it: 8_9. Once the paperwork is complete, a second nurse tells me to sit down and a sliding door opens. At that moment I was aware of not having more than a 50% chance of going back, even if I didn’t let my emotions show. My partner had brought me a backpack with the essentials, but my fear was such that I didn’t think of taking it with me. I, who control everything, felt disarmed, I was aware of not being able to do anything, I had to entrust myself to others. Crossing the door I saw the sick man, the war films, the stretchers were not counted, as a Doctor I understood that the conditions of some patients were serious, the nurses did not know who to help, the sick arrived with 70% oxygen saturation and even if I was sick I remained alert and tried to keep the situation under control, but the fear increased over time and became terror. A nurse takes the first parameters from me and tells me verbatim: “you move away from here because you don’t seem to be in bad shape” and in fact I walked away into the corridor on the opposite side; soon after I moved to another corridor and after about ten minutes I went into a study to do a chest x-ray. After the x-ray, I ask the technician what was there and she replies with some perplexity: “there are flecks of pneumonia on both lungs”. I remained mute and the fear became more and more terror, but I tried to maintain an attitude that did not let my emotions leak out. Once I got out of the surgery where I had done the x-ray, I sat on a chair and after several minutes a nurse pointed to a stretcher: I ran up as if I had won a gold medal at the Olympics and I went to the podium for the ceremony, so as not to miss the award ceremony. And, in the meantime, I looked around and saw nothing but stretchers with suffering patients on both sides of the corridors and nurses and doctors running from one patient to another. I reflected: it is the end, it seemed unrealistic to me, but I had never imagined having to live in such a dramatic situation. My luck was that that stretcher was right at the entrance to the doctors’ offices and I was distracted by hearing the doctors speak, when they said my name I tried to steal what they were saying, meanwhile the comings and goings of doctors, nurses, health personnel continued, patients complaining, going to the bathroom; they gave me a bottle of water; then a nurse gave me a sample for blood tests and after a while a doctor who knew me having replaced me in the past tells me almost sorry and scared “Giuseppe, the exams are not going well unfortunately, I have to hold you back”. Total darkness even though I was aware as a Doctor that my conditions were such that they could not discharge me.

The Night

Throughout the night it was a dozing off, a half-sleep with the overalls on, it was a continuous passing of nurses, doctors, stretchers who kept coming and in the meantime I heard the doctors discussing and almost for me it was a way to distract myself. At three in the morning the oxygen cylinders arrive and a loud noise, a thud as they unloaded it. In the atrium where we were there was no longer room even for oxygen cylinders. Meanwhile, I saw two other patients arriving who were placed a little distant from where I was; I continued to observe everything in silence, while with my thoughts I reflected on how it would end. At about four in the morning I opened my eyes and realized that there were 4/5 patients left in the corridor where I was. So I reflect: “good! This means that this morning it’s my turn to go to the ward, perhaps in a more comfortable bed “. But after 10, the corridor was already filled with stretchers with the sick. And then, another crisis arrived, made up of a silent fear … And instead the hours passed inexorably without news, the fever continued to rise, the comings and goings of doctors and nurses continued and so for the whole afternoon and finally around 18.00 I was able to get up to move a little and to see how my breathing was going with the movement; I hear my surname called I run out of the blue. I say “it’s me” and they tell me we’re going to the ward. It was like experiencing an unexpected victory.

The Department

They take me on a stretcher along a corridor that seemed very long to me. We finally get out of the ward; a nurse rings the bell to be able to enter the “pneumo covid” ward, as they called it. They take me to a room where there is another patient with CPAP. The environmental situation seemed to me to have already improved and in the meantime the evening is coming. I ate dinner but I didn’t taste the flavors (ageusia), so I pretended to eat something while the fever was always high. They checked all the parameters and they attached the drip infusion. Meanwhile, the night arrives and the desire to rest a little more relaxed. Around four in the morning a nurse comes in to check us, I hear her immediately; she approaches the patient’s bed in the room with me and she begins to say sentences and calls her colleague. I immediately understand that unfortunately the patient had not made it and for me it is another trauma. They put ECG – as per law – for 40 minutes while I looked at the monitor which was always flat in front of me. After 40 minutes, they take a sack to put the patient in and after another 10 minutes a man comes. He was the assistant who would take care of the deceased patient; he comes into the room with the coffin, he also apologizes to me. The patient was only 64 years old.

The Resignation

It’s Sunday, usual routine: doctors, nurses, exams… I spend the day with a fever and more and more down in the dumps. I’m alone in the room. The thought is vague, the fever rises, resignation takes over with the thoughts: “maybe my time has come. My sister left us when she was younger than me, I am already 69 and a half years old. Here we are”. On Monday still checks and specific therapy, in the late afternoon a new patient arrives: his name is Stefano, he is 58 years old, I speak to him immediately, but I understand that he is a bit reserved and he too scared. I take initiative and continue to talk and so ends the day with ups and downs in my condition. The next day is the same, but at lunch I taste the flavors of the food. The day goes by, but at 22.00 I have a worsening of clinical conditions and from laboratory tests, also the arterial pressure has risen to 190. Today I try to retrace those moments, but the memories are confused, suspended in a dimension where time and space are indefinite, in an uncertain and evanescent limbo. I am a bradycardic hypothesis and the doctors present – including my son Fabrizio who at that time was assigned to the Covid wards, and others I knew personally as they collaborate with me – decide to put the CPAP; it’s a drama, so I spend all night with the deafening noise of oxygen pressure and with that helmet that does not allow you to rest your head and to drink you even have to call the nurse who removes a cap at the level of the mouth and with a straw allows you to drink. They give me an intramuscular injection to lower the blood pressure. So I try to rest for a while even if it is impossible with the deafening noise of the oxygen pressure and the position I am forced to hold. The next day my conditions seem to improve, they take off my so-called helmet but I always keep the “Orevoir” mask; after a few days I will switch to the “Venturi” mask. They do a chest x-ray for me and I ask how it goes. They replied that “there is always the presence of interstitial pneumonia” and then they make me other samples and blood gas analyses and so the whole day goes by. I tried to talk to my roommate when we weren’t asleep, they didn’t even allow me to get up to go to the bathroom; around Wednesday conditions seem to improve, saturation is always better with medical oxygen. On Friday around twelve they tell me that I have to move to the Medicine ward because they needed a bed in the semi-intensive ward where I was staying. They transport me on a stretcher to the new ward and in my room I find a very old man with a CPAP helmet. The clinical picture of him is very problematic. The whole series of exams starts again so that my arms were all bruised, while my condition continued to vary: in the morning I was better and worse in the afternoon or vice versa. I go on like this for days as conditions improve and wonder if it is possible to reduce the oxygen pressure. We arrive on Sunday and always at noon they tell me that I am being transferred to a clinic in Bergamo because a bed is needed. They take me in a wheelchair along the usual corridor and then out into the parking lot where there is an ambulance waiting for me and three other patients, all with our bags and the usual company of oxygen bottles. In the meantime I had been weaned from the “Venturi” mask replaced by the so-called “goggles”; that day it was very cold, it was March 22 and I was afraid that I might get sick being in precarious conditions. Arriving at the clinic, we go up one at a time in the elevator to the fifth floor and they assign me a room where a sick person who had been there for thirty days was staying. As always, I try to check everything and study the room; I thought I was lucky because once again the room was near the trolleys where there are nurses who prepare the therapies and this represented a diversion for me. Some colleagues know me, they check my parameters several times a day. My roommate was not very talkative even though I tried to talk. In the morning at 5.00 the assistant arrived for cleaning and immediately afterwards the nurses for routine checks; I continue to improve and the following Monday I ask – seeing the good saturation – if I can remove the “goggles” for oxygen because I breathe well and in fact they take away my oxygen. I try to move around the room as you could not go out in the corridors. I try to do some respiratory physiotherapy exercises and finally on Wednesday in the morning they tell me that I am dischargable! I alert all family and friends, I spend the whole day anxious to be able to go out, but unfortunately it is a false alarm and I spend the night anxious hoping that they will release me the next morning. In fact, in the morning they tell me that they are also discharging me because in the meantime four other very elderly sick people have arrived. Finally at 2.00 pm I am discharged: I am very weak and tired, they take me to the ground floor and I wait for my partner to come and get me. So I get home and find my sofa and a delicious lunch. I am pampered like a “King”, everything is served, I feel more serene, I try to move a little, but I also feel the need to rest during the day. I find everything in the house ready and sanitized as if an important person were to arrive. This disease causes enormous fatigue as a symptom. After a few days, I begin to feel better also because the environment of my home helps and the diet is different (even if you didn’t eat badly in the hospital), I move more freely around the house, I sleep alone for more than a month. After fourteen days, I run a first swab and unfortunately it is positive; I repeat the swab after a week and this time it is negative. We hope well! After four days, I repeat it again and again it is negative. Altogether I did six tests. I continue to do exercises and respiratory physiotherapy at least twice a day, and this helps me further.

The Tests

After three swabs during hospitalization and three swabs after discharge from the hospital, I’m “negative”! Basically I was cured according to the interpretation that derives from the result of the swab even though I would like to be able to see that the right enshrined in Article 32 of the Constitution was respected! I would like for me and for all Italian citizens to be able to perform the serological test and I can’t explain why they cannot be performed privately, if validated. These tests would also be useful for screening and general epidemiological evaluation. This situation was subsequently unlocked for private laboratories, also because the ATSs are unable to perform the huge number of tests necessary for all citizens. Today, therefore on May 4, 2020, I feel a little safer and more calm even if I am very tired, I can go out with all the necessary precautions: double mask, double gloves, cleaning the gloves every time I touch something, even if I don’t I do it often, and I just go out on the terrace in limited time. It is July: the Papa Giovanni XXIII Hospital in Bergamo, where I had been hospitalized, calls me to perform clinical checks at the Bergamo Fair where the Covid clinic has been set up. I am subjected to various types of tests: electrocardiogram, blood sampling, pneumological examination, chest X-ray, physical and infectious disease examination. During the psychological visit, from the questions that the expert asks me, the awareness that I will need a long time to metabolize what I have gone through, the long journey covered and the test I faced. That in the same way, I have won a difficult battle, I am able to overcome this period and start again. It is important to have the will to move forward, the important thing is to be there and to be aware of wanting to go on with the work I believe in and love, also in order not to throw away all the sacrifices made in all these years. Everyone tells me to take it with more serenity, but I can’t. I’m fine, even if a little tired and with a little joint pain … but I keep going. I hope to continue my work to help all those in need. This gives me enormous satisfaction.

The Processing of Fear

I have begun to elaborate the thought of death. It often comes to my mind and I am saddened by the thought of all the pain and anger of family members who have never seen their loved ones again. A special memory goes to my fellow Doctors who are no longer here and whom I have known in the course of my professional life. A particular memory goes to Giambattista Perego, a colleague with whom I had been together in mid-February in Florence on the occasion of a conference.

July 8: The Gift

Today 8 July, as I am about to finish this little story with the description of my experience which I hope will be of help to all those who will read me, after more than three months, I am fine, I have no health problems, although maybe I am working too much…. In the meantime, I went to Sotto il Monte to “our” Good Pope, in Caravaggio and I plan to go to S. Giovanni Rotondo and Lourdes, to thank the Lord who has granted me the grace of Living, I consider it a GIFT of God.

Thanks

I would like to thank one by one all the health workers (doctors, nurses, assistants, …) who have given all their medical and psychological support, who have shown that they are not HEROES, but simply MEN and WOMEN who BELIEVE IN THEIR WORK THAT IS A MISSION. A special thanks to my children Gabriele and Fabrizio, to my sister Giuseppina, to the daughters-in-law Milena and Guja, to my nephews who were in constant contact with a WhatsApp chat, and to Serena who helped me to heal. A thought to Our Lord who made me rediscover the faith I had lost.

To the future…

Today I am about to publish these few thoughts that have pervaded my mind during those dramatic moments of the first phase of the pandemic: I feel perfectly healed, I am fine and even though I have resumed my work and a normal life, often my mind returns to those difficult times and to all those who have not made it.