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COVID-19: the aftermath – Piacenza, Italy

Post-traumatic stress disorder looks set to become a legacy of the COVID-19 pandemic. As doctors, nurses and allied professionals we have witnessed disturbing scenes, taken difficult decisions, put ourselves at risk, and coped with significant upheaval in our personal and professional lives. These challenges are taking a toll on our mental health.

Piepoli (A&E admission triage) - Piacenza, Italy.jpgHealth systems are focused on providing sufficient ICU beds, ventilators, and PPE. Psychological support is often left behind. No one prepared us for so many deaths and so many suffering people. Patients are alone and isolated on the ward. It is intensely frustrating being unable to provide effective treatments or guarantee a speedy return home. It feels like failure and is amplified by the sadness in their eyes.

We try to lighten the mood by being optimistic, drawing smiles on our masks, and offering video calls with relatives. While it is heartening to connect loved ones, these are also some of the hardest moments. We hold the smartphone for patients: some of them have never used one or are too weak to hold it. Sons and daughters, grandsons and granddaughters say, “I love you” and “I miss you”, and we see tears welling up in the patient’s eyes. Others try to be strong and pretend to feel good, only to break down and cry when the call is about to end.

One of the worst things about this disease is the unpredictability. Was it beneficial for patients to call their relatives? We hope so. When can we stop the ventilation and say, “you will be home soon”? Another unknown. We look at the oximeter for guidance, holding our breath: the number is just over 90% and insufficient to remove the mask. The only thing we can do is take the patient’s hand and provide reassurance. But we cannot promise anything.

Piepoli post ward round-Piacenza-Italy.jpgThe stress never leaves us. At the end of a shift, it seems strange to touch things without gloves, and the pervading thought is, “how can I avoid contaminating myself and my loved ones?”. Our current reality seems unimaginable. Self-isolate to avoid infecting others, keep work clothes in a separate area at home, shower as quickly and thoroughly as possible after a shift, and the recurring thought, “wash your hands”.

A heart failure emergency is coming

We worry about patients with acute coronary syndromes and heart failure. Many are not coming to hospital: what is happening to them? How many sudden cardiac deaths will occur out of hospital with little or no possibility of resuscitation? How many patients with angina or shortness of breath stay home due to fears of infection in the hospital? How many severely damaged hearts will we discover at the end of this crisis?

We did not see the COVID-19 emergency coming and were ill-prepared. But a heart failure emergency is in sight and action is needed to prevent it. We must inform our patients that cardiologists are ready to treat them. They will be safe: hospitals and cardiac units have dedicated “clean” areas, personnel and equipment ready for anyone with an urgent heart condition.

It feels as though a hurricane has hit our hospital and our lives. Out of the devastation, an increased feeling of humanity has emerged. We recognise and appreciate the character and soul of our fellow doctors, nurses, and students, but also managers, cleaners, cooks, and care workers. People have sacrificed themselves without limits, and wisely helped and comforted colleagues and patients, silently, without asking for anything in return. That is what gives us the strength to face the continual stress. We are developing a stronger future for our hospitals: when we resume clinical routines, we will have a clearer vision of the priorities for ourselves and our patients.