“My dad is dying.” This simple WhatsApp message from my niece in Mallorca told me what I had known for three days. My brother Gabriele subsequently died of complications arising from a Covid-19 infection, aged 69.
I had been in regular contact with him for the weeks preceding his death. He was a respected English language teacher in Bergamo, Lombardy, epicentre of the Covid-19 epidemic in Italy. Our calls had gone from disbelief at the hysteria surrounding the virus, a disbelief I shared, despite having the medical knowledge as a GP to have known better, to concern, as he developed symptoms suggestive of an infection.
As the illness progressed, so did the frequency of calls. He was not eating or drinking much, losing weight, constantly feverish and sleeping for most of the day. His wife was alone nursing him, as Italy was in lockdown and her two daughters living locally were not allowed to visit.
I would be asked to encourage him to eat, drink, take his medication. He was apathetic and said things like: “I feel like an alien has taken over my body.” We became alarmed when he developed confusion for a few hours, but relieved when he finally started eating the following day, on day six of a severe illness. We felt he had turned the corner.
That same night he became increasingly breathless. His confusion returned. All the reasons we had given for calling an ambulance manifested rapidly and overwhelmingly. My last conversation with him was to plead with him to get into the ambulance, in order to spare his wife the trauma of nursing him to his death at home.
He was lucky. Despite health services crumbling under the onslaught of the epidemic, the ambulance responded rapidly. There was even more luck when a bed was found in a local hospital. I suppose he could be considered lucky for having been intubated and ventilated despite his age. Because within 24 hours of his hospitalisation, he was in the intensive care unit (ICU) on life support. His chances had gone from 14 per cent while he was at home, to no better than 50 per cent now that he was in ICU.
They deteriorated further when he developed sepsis over the next two days, with multiple blood clots and kidney failure. He was hitting the worst-case scenario milestones with alarming regularity. There could only have been one outcome.
There was no possibility of being with my family in Italy at their time of loss, there were no planes. His wife, in quarantine, had to grieve in solitude. There was no consolation for her or his daughters.
“Once more unto the breach” – this quote kept springing to mind as I confronted the second pandemic of my lifetime. My time as a rural doctor in Kwazulu Natal, epicentre of the global HIV pandemic, had exposed me to the destructive force of a global viral pandemic, but this was a different beast.
I doubt that Covid-19 will claim the 32 million lives that HIV has, but the rapidity and ferocity of the epidemic has startled with its aggression. With HIV, the slow progression of the disease always made you feel as if you could offer some form of care or kindness, some modicum of control, but this virus is merciless, random and medically disempowering.
The 105 Italian doctors dead due to the virus attest to the exposed position we occupy as healthcare providers. But this is not the time for hesitation, it is time to “Hold hard the breath and bend up every spirit to his full height”. This is the time to unite as we have, hold fast as we have and “set the teeth”, because it will require sacrifices of us all to contain this global threat.
Dr Giovanni Baldassini is a GP at the Cork Road Clinic in Mallow, Co Cork
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