The epidemic of fear

A contribution by Alessandro Jachetti, Emergency Room doctor

If I had to describe the last few weeks in Milan in a single word, it would be “fear”. We are used to seeing it in the emergency room, we often smell it since triage. We see it in the eyes of almost all our patients, some more and some less, often associated with other emotions such as embarrassment, unawareness, trust or others.

But I can consciously say, after a few years of work in an emergency room, that fear is the common thread that unites all our patients. Of course, a justified fear by ignorance of a medical condition, so that even a fever becomes frightening, or exacerbated by anxious family members or by media bombings that push us to hyper-medicalise our existence and seek medical help for any symptom.

Many times we healthcare workers forget that patients do not have our knowledge, so what for us is an improper access to emergency services for a “banal flu” does not always appear as such to patients, who are scared and fearful and approach us hoping that we, modern sorcerers, will drive them away from death.

Regardless of the social or economic context, the fear of the unknown, and in this case of death from illness, equalises us all and the only place to quickly heal fears is precisely the emergency room. Even the aggressiveness often shown by patients is the result of stress and worry: understanding it does not mean justifying it but would perhaps allow us to better learn how we feel on the other side.

But if we are so used to fear, why does it characterise the last few weeks? Because it is a different fear, more contagious of the coronavirus itself, affecting patients but also healthcare workers.

This time we are infected. You can see the fear when the triage operators discover the positivity of a patient seen the day before, and they begin to mull over if all the PPE were used correctly. When the doctors pull up the mask even in the relaxation room when they talk to each other over a coffee or wait anxiously for swab’s results. When the reanimators get upset because there are no more places for patients. When the interns no longer go out to drink a beer after work but run home to read articles from the New England Journal of Medicine on epidemic updates. When the health worker barely approaches patients and distributes the meal quickly to stay as distant as possible to them. Fear has infected us too.

And then you see it, more significant than ever, in patients coming to the emergency room asking for a COVID-19 swab as if their life depended on this result. You see that social conventions are skipping, patients begin to beg indifferently to your explanations, they no longer want your opinion or a visit, they want a swab. The swab, the true hero of this emergency, positive or negative, black or white, dead or alive.

Also because of questionable choices by authorities and because of an excessive media burden, people trust in this sort of plastic and cotton Pontius Pilate as if their future depended on it: a pocket oracle that will decide your fate. The explanations on his low sensitivity, on the need to maintain hygienic practices and the precautions to avoid contagions, to nothing the reassurances on the nuanced symptoms or on the low mortality.

Anxiety has such infected patients that suddenly the other symptoms – the back pain for a month, the dry cough after eating, the dizziness appearing getting out of bed, have disappeared. If we have to thank this epidemic for something, is that it is bringing emergency services back to their primary role, and putting patients’ priorities back in order – at least for some time because we all know that these hundreds of improper access will return.

Fear is so widespread that it has broken all our relationships: no one goes to eat with friends, to find parents or to take public transport. The few going out wince at every cough or sneeze, not to mention the hundreds of terrified people who have unreasonably attacked supermarkets.

We forgot that we are (or should be) a modern and civilised country, we have so little confidence in the system that we lock ourselves in our houses, with our supplies and we trust social networks more than healthcare.

Yet, despite this expected and inevitable fear, there is one thing that emerges: courage. Courage is the child of fear because without it we would not see it and therefore, in these times of terror, we see the courage of all the healthcare workers on the front line, regularly at work, no one excluded. The courage of the laboratories and biologists who work 24 hours a day. The courage of the directors who prepare guidelines and indications even when there are uncertainty and confusion from the Healthcare Departments. The courage of a public National Health Service which faces the most significant biological emergency ever experienced by our country, demonstrating that our values and our skills are not only high-level but are indeed at the service of the whole population.

This gradually emerging courage will be our real guide and will allow people to regain confidence in a system that is too often mistreated and criticised, but which is the salvation of our country.


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