We are glad to present a conversation between Maria Giulia Marini and Giovanni Albano, MD anaesthetist and resuscitator, Director of the Anaesthesia and Intensive Care Unit at Humanitas Gavazzeni (Bergamo, Italy). Dr Albano has written the book I giorni più bui (The darkest days), whose publication is scheduled for January 2021 with the Italian publisher Piemme (Mondadori group); an e-book has been recently published as anticipation.
MGM. Would you like to introduce yourself, Giovanni?
GA. I am a Sicilian who emigrated to Milan with great satisfaction; I was very well received by people in Milan and then in Bergamo. In Humanitas Gavazzeni, there was a great tradition of heart surgery: I set up the anaesthesia and resuscitation group.
MGM. Why did you write the book I giorni più bui, on the days of COVID-19 in the Bergamo epicenter?
GA. I attended a classical high school, and I’ve always liked to write. This time I felt the need; it was a catharsis. I told the story of these days so that what I had gone through and felt would remain in my memory. In this way, I felt more at peace with myself to start over… They say starting over is forgetting. For me it’s not like that, to start over is not to forget. I threw myself into writing at the end of the forty days that started on February 24th, and I finished around April 5th – and in fact, I started writing between April 5th and 8th. It was putting down black on white and leaving memory. I still have difficulty falling asleep, even if I used to touch the bed and collapse.
MGM. We all heard about Bergamo, and every day I prayed that they would close…
GA. Bergamo was like Pompeii under the eruption of Vesuvius: so many possible triggering factors, the number of small and medium enterprises, the Atalanta match…
MGM. In your e-book, there is much attention to the moment when you discovered that the virus had arrived, not only in Rome at Spallanzani but in Codogno, in our land, and like all of us, you calculated the distances, thinking that Codogno was not so far from Milan and Bergamo. We in Lombardy will remember that moment, we will think about where we were, what we were doing, as well as when we were informed about the Twin Towers. But that the virus was at our place, in Europe.
GA. The virus had been with us for a long time, and we only know it now:
unfortunately, the Chinese have not allowed us to be ready from a scientific point of view. The clinical experience in Bergamo and Brescia, where we discovered the vascular attack of the virus and communicated it to the rest of the world, has done much more.
Giovanni stops and then adds after a long silence – We have stopped a whole country, and this has served.
MGM. How come we didn’t see it, unlike Bill Gates who warned us in one of his Ted Talk that the real problem for humanity would not be the Third World War but a pandemic?
GA. We knew it was coming, but we didn’t know when… Man is playing with fire, and the question is ecological: we are going to upset the balance of nature. The air, the pollution, the exploitation without respect for the earth… And then yes, viruses are jumping species because we should leave certain species calmer.
MGM. Let’s talk about the book: it has a chapter structure in which your voice and that of a patient, Giorgio, alternate. How real is Giorgio?
GA. While I was feeling confident in writing about myself, I thought I was sinning of presumption by getting into Giorgio’s head. Giorgio is born from all the patients we have seen, he has complications, and the clinical aspects that we have been able to observe are real testimonies. The patients had confided to us the fear of death because they saw patients dying at their side… In resuscitation, there was not only a great physical pain; the one with the drugs was cured; there was also enormous psychological pain.
MGM. Was it there even before COVID-19?
GA. Yes, there was, but not so great, never seen such a thing; we converted in a few days a hospital that was not for infectious diseases but chronic diseases into a COVID Centre. What struck me the most was the silence in the corridors: you have to know that in a hospital the corridors were always public places of passage, people relatives, doctors, nurses, stretchers, it’s a bustle. Instead, the corridors were empty.
MGM. Giovanni, in your e-book, you dwell a lot on the importance of organization and teamwork, of processes and safety, not only, but also of human relations between health professionals…
GA. In my hospital, and you could see it when you came, there is much empathy between people, and with COVID-19, this emerged extraordinarily. We had the general manager making coffee for doctors and nurses, in short, for all of us who were on the line. The CEO was in the hospital every day even during the darkest days, including Sundays, without missing a day, making us feel his physical presence. The Chairman of the Group exposed himself personally, coming to pay a visit on March 11th. These are things I will never forget. Right away, our management wanted to buy Personal Protective Equipment for us professionals at any price. No one was left behind. And then I found out that even the people I thought weren’t motivated enough did the best they could.
MGM. You describe very well what happens in intensive care: your time is endless, you would like to see the end, as well as your enormous tiredness and the time of patient Giorgio waking up and discovering that a week has passed. What is this dimension of time like for you?
GA. It seems to steal the life of the asleep patient: I keep him asleep, and for me, life has to be lived every moment.
MGM. Maybe there are moments when it’s better to sleep, like in fairy tales not to see… In your e-book, you talk about many gestures, signs, names written on scrubs, or instead of the suits, and a few words, as if they were superstructures.
GA. It was like this: words were one too many, apart from the medical ones which were like a code; to understand each other, the gestures, the looks, the thumbs-up of the patient who told me that he was better, were worth more. It was only afterwards that there was room for words. First, we were frozen; I cried a few times, but then we smiled.
MGM. Perhaps it was the primary primitive emotions that had their dominant role, we smiled and cried together, as in the history of humankind, the spoken language developed later, now that I think about it. And traumas freeze the words.
GA. Yes, the stories came later, like when the patient came to thank us in May and recognized his bed with his ventilator, Vent; it was a technology that allowed him to save himself. It is a machine, the ventilator, with which you have a problematic relationship because you know it is helping, but you also know that you will suffer a little because you have to leave it slowly to learn to breathe on your own again.
MGM. We say to wean from the ventilator, from artificial respiration precisely as to wean a baby from its mother’s breast: it is a detachment.
GA. Yes, so many detachments, between life and death, and so many positive detachments towards healing. In the intensive care unit, there was a brotherhood that moved me, we had 35 intubated patients and to communicate we used our eyes and ears, even tired because with the overalls we could hear less, and our hands to touch: if you knew how much counts, between us and the touch with the patients, the last sense perceived so as not to leave them alone.
MGM. Yes. The last sense to leave us in life is just the touch… I know it’s challenging to summarize, but what if you wanted to leave a central message?
GA. COVID-19 has eliminated the difference between carer and cured. We were in the unknown, apart from some technique coming from China, like pronation or our few discoveries; we were faced with something unknown and so we doctors were humble and powerless. On the other hand, there were patients with us, who sensed our difficulty and also knew that they could be the cause of our contagion. There were no relatives in the middle, they were far away – not that I have anything against them at all, they are fabulous and very useful, but in this case, we were just as doctors and nurses with the patients to support and help us. We received so much from the patients, they encouraged us, they supported us, and we gave what we could provide.
MGM. A mutual aid: would you also advise your other colleagues who have lived your experience to try to put it down on paper, to write, because I have heard so many of them that they are still “speechless”.
GA. It can be as useful as it was for me; it was unthinkable to keep everything inside me… And I did it so that the others would know what happened in Bergamo.
MGM. Your hospital is famous because it has a collaboration with the Carrara Academy, and there are maxi-format reproductions of beautiful paintings attached to the walls.
GA. We were looking at them during COVID, also thinking about all the art therapy activities that we had to suspend, but these paintings maybe helped us. Now they support us even more because we have to go on with the beautiful, taking up art and knowing that good care comes from appropriate technology, good relationships, proper organizational processes and an excellent place to work and try to make people feel good. I have held the Bergamo people in high esteem: people who work and who have not complained about everything that has happened.
MGM. Thank you, Giovanni, for your precious testimony, and I hope that many other medical nurses and people who have been in the front line will find the strength to tell and express what happened. It has been a pleasure and an honour to have your testimony here with us. We are proud that the interview has been translated into English, so that even from abroad, our readers can understand what Bergamo and Lombardy have gone through in the 40 Darkest Days since the bombings of the Second World War that neither you nor I had experienced.