Letter from the Trenches

By Amedeo Capetti, MD, infectious diseases expert and consultant to the WHO

Originally published in the Italian newspaper Il Foglio, March 18, 2020

To the Editor:

I am a physician of the First Department of Infectious Diseases of the Luigi Sacco Hospital in Milan, until recently an expert on anti-retroviral therapy, with 650 HIV-seropositive patients, but now thrown into the Covid Section like everybody else from my department.

Today I have a quiet moment and I am writing to share the thoughts that filled my mind this morning as I drove here to the hospital.

My first thought was at odds with the forced optimism that I see circulating these days, with the ovations for and the newfound idolization of the healthcare profession. In my opinion these are understandable attempts to exorcise a very human fear, but they are weak in content. In fact, what does it mean to say, “We are going to make it?” Does this mean that we must just look forward to the end of the epidemic, skipping over the drama of the current situation? And, moreover, who is going to make it? You and I who are writing to each other? The Italian people as an abstract entity? All of this is unconvincing and, frankly, it leaves me puzzled.

My second thought: I have noticed the nearly complete disappearance of complaints, and I find this to be a very important symptom. Rather than complain, my patients send me messages every day to ask me how I am doing, wanting to participate in the incredible and exceptional experience I am living. This is the very reason I have decided to write to you.

In fact, what I am living—but I believe this to be an experience shared by many others—is a phenomenon that we physicians often see in those who have survived a brush with death: the experience of opening your eyes and realizing that nothing can any longer be taken for granted. It is the recognition that everything is a gift: waking up in the morning, greeting your loved ones, and even all the little moments of daily life, that for some are merely time to be filled, but for others, like me, have unexpectedly become even more compelling than before.

The grace of this new self-awareness radically transforms what we do, generating amazement, friendship. We look at each other and say: today we cannot hug each other, but a smile says much more than what a hug used to say. This awareness allows us to participate in the drama of our patients. It is no coincidence that my colleagues ask me to pray not only for their loved ones, but also for their patients, something that has never happened before. And this, too, is contagious. Yesterday a woman from Crema phoned me to get news about her grandmother who is hospitalized and in serious conditions at the Sacco. She told me of her other grandmother, who died of Covid, and of her mother, who is in intensive care in Crema, and then she said, “You see, Doctor, at the beginning I was praying, but now I’ve stopped.” I answered, “I understand, ma’am. Do not worry. I will be the one praying for her.” When she heard this, she was moved and said, “No, Doctor, if you are going to pray, I’ll do it as well. Let’s pray together for my mother.”

All of this is wealth, grace, and if more people became aware of it, this could, in my opinion, be of great social value: recognizing that we are frail and that everything has been given to us (starting with our breath, which, in these days, cannot be taken as a given any longer) would put to rest many useless disagreements and discussions.

My final thought goes to the aftermath. It is common following a time of great enthusiasm for everything to eventually simmer down and for old bad habits to re-surface, as Dante Alighieri lamented of the century that preceded him. What can save us from this foreseeable setback? As far as I can see, gratitude must become the reflective judgment on what is going on, a judgment that finds its expression in the searching questions that we have all been asking and that unite us: in the end, what is the origin of all this? Why did our eyes suddenly open up and start to see the real essence of things? Where can this experience lead us? Where can we discover a human gaze upon each other like the one we are experiencing today in many circumstances? Who can help us?

For me, the experience of amazement entering life, an experience in which nothing is ever to be taken for granted and everything is a gift, began many years ago, and every time it happens again it is like a new beginning that renews my certainty about its origin. For others it will be a new journey. I cannot and do not want to offer pre-defined answers, because everyone will be able to understand it only by experiencing it, just as I have. But I can raise the question, for nothing should fall victim to the “already known” and the aesthetic or intellectual reduction of it.

Now, I have arrived at the hospital.

Translation courtesy of Renzo Canetta and Letizia Mariani.