TURIN — How are you? “So-so …” A flat, exhausted voice replies. The young doctor speaking has come from an intensive care unit in Turin, dragging herself slowly and methodically, as if to give shape to her weary frame.
“We’re doing grueling shifts; I’ve lost count of the hours. And more and more people are coming. More and more,” she says. “This contagion must be slowed down at all costs. But it doesn’t depend on us, it depends on all of you. Get this message across: It’s the only thing that matters.” We’re trying.
So here we are at this special Covid-19 hospital, facing the flood of victims of the new virus, hoping there will not be too much water because if the wave of patients mounts too high, there is no system that can withstand it. “We have reorganized the spaces and the people: the departments used for normal surgical operations have been transformed into intensive care, the operating room staff has moved to emergency services.”
The new set-up faces a much more complex tide than it might seem from what you read. The doctor explains: “It is not true that there are only elderly people. There are many young people too. And it’s not true that you can get infected only by being in close contact; sometimes a dinner is enough.”
There are choices a doctor never wants to make.
This is why the waters are rising, and it’s beginning to require choices a doctor never wants to make. “We can only respond with available resources.” The ICU doctors received a document: 15 pages with a title that might send shivers down your spine: Recommendations of clinical ethics for admission to intensive treatments, and for their suspension in exceptional conditions of disparity between needs and available resources. It is the same protocol that regulates disaster medicine, the doctor explains. “You have to be pragmatic. The means are scarce — in some hospitals they’re already running low, in others they will be soon.”
Sometimes pragmatic means ruthless; We’re talking about distributive justice. “If beds and doctors become scarce, the criterion no longer will be taking care of the first patient who arrives or of the one in more critical condition, but favors the greatest life expectancy.” Age, type and severity of illness, pre-existing conditions, compromised organs.
“The availability of resources does not usually go into the evaluation of cases until resources become so scarce that they do not allow us to treat all patients,” explains the doctor. “The shifts are exhausting. Our life has no sense of space or time. We are putting our families out, and we are also putting them in danger: Asking our parents to look after the children while we are at work means asking them to put their health at risk.”
This is also why it is important that this great collective sacrifice is not done in vain or lead us to an inhuman choice, such as letting go of one life to save another one more “probable” to survive. “Again, it doesn’t just depend on us, unfortunately,” the doctor repeats. “We are working hard, but limiting the contagion depends on what happens outside of here. On all of you.”
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