Italy: in the trench hospital
The doctors in the intensive care department are at the point of exhaustion: “Here there are just desperate cases, we pray that a patient or two will wake up”.
They are there behind that glass. The shapes are human but have now become unnatural, suspended between green and bluish flashes. Living dead cradled by the distressing echo of the electrocardiograms. Breaths suffocated by the flow of the oxygen shot into the pulmonary interstices.
Men who no longer have a face, name or expression. You only see their feet. They protrude from a piece of bedsheet placed between their hips and the tangle of tubes and cables. Toes down. Heels up. The diaphanous skin of the sole pointed at your face. Almost telling you the tale of the wretched, grotesque overturning of what remains of the rest of their lives.
They are being called the pronati (people in the prone position). And that is sufficient. This word, which until three weeks ago would have sounded crazy and exotic even to the veterans of the intensive care unit, encapsulates how their existences have been turned upside down. There is not only the unnatural suspension of assuaged consciences. There is the overturning of procedures, experiences and the certainties of Cremona hospital, its doctors and its nurses. “We are required to keep them like that in order to improve the relationship between perfusion and ventilation and to recover the declivitous parts of the lung. It is the only procedure we have and there is no guarantee of a positive outcome”, explains Dr. Antonio Colluccello, the head of this intensive care unit, with professional clarity.
But to understand how these pronati and Covid-19 have changed the hospital we must listen to Carla Maestrini, the matron in charge of the team of nurses who for three weeks have shared their lives and their sufferings with these thirty unaware pronati. “I have been here since 20 February and still I do not see any light at the end of the tunnel. Friday and Saturday were terrible days. So many deaths, too many”.
Carla speaks, a stretcher-bearer makes us move. From the white bedsheet spread across the stretcher the shape of a corpse emerges. Carla raises her head: “Slowly all these deaths are slowly killing us too. The more days that pass the more I wonder whether I am still able to treat people, whether it still makes sense for me to be here. I ask myself this all day long then at night I go home and die on the sofa. My husband and my daughter talk to me but I do not listen. It is terrible. I sink into a sleep that is not a sleep. Every hour I wake up with nightmares. I think about my colleagues and the doctors who have fallen ill and I’m scared. I see those patients and fear ending up being my face down myself. But the worst thing is seeing none of them wake up. Those that have got a bit better go to other hospitals and then we get more desperate cases. We cannot take this anymore. We need to remove a tube and see a patient who wakes up again. Until we do so we will not regain the feeling that we are doing anything useful”.
According to the health director, Rosario Canino, the subtle red line between normality and the tsunami was 21 February. On that day patient one arrived at Cremona hospital. It was a young woman, she was only 31 and within two days she entered and left accident and emergency. The first test however was negative. When the good one arrives it is too late. “Between that Friday 21 and Sunday 23 we were faced with 40 cases of interstitial pneumonia caused by Covid and had 12 beds in the infections department. On that day we understood we were in the front line, the outpost where the first great wave of Covid is being fought.
In 12 hours we equipped an empty department and twelve hours later everything was occupied. We cleared two surgical wards and changed them into Covid wards and the wave does not subside.