key: cord-0697331-pk24va5s
authors: Zerbi, Simona; Resmini, Barbara; Merlino, Maurizio; Licciardello, Carmen; Aloardi, Roberta; Palmetti, Daniela; Danelli, Laura
title: Inferno, disruption, concern, sense of community, teamwork, tears: reflections by renal healthcare team members on the front lines of the COVID-19 pandemic
date: 2021-01-04
journal: J Nephrol
DOI: 10.1007/s40620-020-00921-y
sha: 644430fd0b5d429db5c5c886554e9c4a57008aea
doc_id: 697331
cord_uid: pk24va5s

nan

Since December 2019, an outbreak of a new coronavirus disease , caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has grown into a global pandemic [1] . Its appearance in Italy officially dates back to February 21st. The deadly coronavirus swept through Bergamo city and its province [2] , claiming thousands of lives and putting our hospital under strain. Predictions were surpassed by the events and the magnitude of the pandemic hit us like a tidal wave. Elective surgeries were postponed and outpatient consultations were suspended. Most doctors, nurses and nurse's aides had to leave their specializations to take care of Covid-19 patients. Everyone was at risk: the doctor and the nurse, the nurse's aide and the cleaning crew. The fear of infecting our families intensified our suffering and isolation. Panic was growing and, at that moment, just being able to breathe well was felt as a blessing.

With this in mind, we would like to share a collection of thoughts about the experience of our nurses, nurse's aides and psychologists during the first surge of the pandemic, from February to May 2020. Most reflections were collected during the past summer, through moving talks that took place in the same rooms in which we had walked through hell. Everything around us was quiet, but the wheezing, hissing sounds of the ventilators somewhere in the background came back at times while we gradually drifted back to that timeless realm (Fig. 1 ).

I was moved from my Renal Unit to the Covid ward overnight. Everything was unreal. A sea of infected patients arrived in a mere few hours, most of them quickly worsened and died. It was hell. Nobody talked, fear hovered over all of us. Every single day I arrived at work after a lonely car ride, donned my protective equipment and entered a paradoxical world with no idea of what was going to happen. We worked gruelling shifts. Patients were alone and stunned. The beckoning of their frightened eyes was ever-present; looked upon by patients, we watched them searching for a nod of support from us, as if to say 'it will be ok'. Who knows, I hope I was able to give them a bit of serenity, despite going through one of the worst periods in my life: I looked at them and thought of my own daughter who was in isolation with respiratory distress due to Covid-19.

But it wasn't all bad. I will always cherish the memory of the encounter between two spouses. The husband had been hospitalized weeks before due to a severe case of Covid-19. His wife came to the hospital on the day of his birthday carrying a package. We arranged to let her say hello to him from afar. It was unforgettable: he immediately recognized her and waved his arms at her with shining eyes! They were married for 52 years, Covid-19 kept them apart.

( 

Following a few quick messages, Stefania, Maura, Daniela and I met on a Sunday morning to revise paths in the Dialysis Unit. In about three hours we moved wardrobes, carts and materials, creating filter areas and new access routes to reduce the risk of contagion [3] . Then it all blew up. I got scared. I felt confident only inside my protective equipment and strongly wished to put it on, even though it was exhausting to wear for hours. I felt so much regret for patients. Sometimes I think about how they died and how quickly it happened. We tried to hide our anguish but they felt it anyway. While leaving this room, some of them whispered "I know I'm going to die, thank you for everything". We had treated them for years and suddenly our relationship had become more loving. We had no weapons to fight the infection with, and there was so much displeasure for the end they were going to meet. I felt powerless. I tried, in my own small way, to be around them and ask (for that extra thing); when the shortness of breath prevented them from talking, I merely made them feel my closeness. At home I gave in to tears. I realized that the most valuable things I have are my family and the staff who shared this tragedy with me. A huge community spirit grew. Now there is an unbreakable bond between me and some of my colleagues.

(Roberta Aloardi, Nurse)

There is a before and an after. I identify the switch-over with the Sunday we met in the Dialysis Unit to modify the access routes. Then it was all a crescendo: positive swabs, infected patients, isolation. During the lockdown my trip from home to work took me across a post-apocalyptic landscape: a beautiful spring season had arrived that brought with it an unreal silence and not a soul to be seen. I wondered how nature could be so beautiful in such a tragic moment. Getting dressed was a torment, but provided me with great confidence: I have never been afraid of getting sick. Conversely, I was scared of infecting my family, which was doing its utmost to take care of me and draw my attention away from the pandemic. The emotional bond with patients became deeper: I saw them becoming afraid of getting infected, looking at their companions getting worse, greeting them for the last time before they died, and staring at their empty beds. I still remember their eyes wide open. The pandemic exposed people: it forced us to wear masks, but took away our costumes. We finally knew the value or the smallness of the people working alongside us. I have become categorical and no longer tolerate those who pretend not to see or who deny the gravity of the pandemic. Having shared dramatic moments has created a huge connection with some colleagues, and we no longer need to talk to be able to understand one another.

( Sure, it is scary. Sometimes you would like to do more, but you can't. I've heard physicians at the end of the shift before starting self-isolation say that they wouldn't have wanted to go and leave us alone. I've listened to them say 'let's hope we can weather this storm together without losing pieces along the way'. I've heard nurses say 'I haven't done that for 20 years, but I'm here if you need me'. I've seen nurse's aides work gruelling shifts and give up seeing their grandchildren for weeks. That is why I cry. Because if I did not, I could not come back to work the next day, put on my best smile and start over again listening to all of this. And this is my only role, the only thing I am able to do and I want to keep doing it! (Laura Danelli, Psychologist) And now, we are at the tipping point of a second, even bigger wave; cases are surging mainly in other provinces and our hospital is supporting them. Our Renal ward was the first one to be transformed back into a Covid Unit about one month ago, followed by most of the others in the ensuing days. Hospital rooms and operating areas for intubation were set up, C-PAP and monitors were prepared, and body bags were stored. A surreal silence and the terror of facing uncertainty again prevailed throughout the whole time. The greatest pain is speechless. What we saw during the first wave of the pandemic left our feelings broken, we know it will be harder than the first time because now we know what to expect when we go to work. Despite the trauma we went through, we are ready to do our duty again. And we know our team will keep each other going, as we did before.

Covid-19 WHO declares pandemic because of "alarming levels" of spread, severity, and inaction

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Committee on Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations (2012) Institute of Medicine: crisis standards of care: a systems framework for catastrophic disaster response

The author is especially grateful to Barbara Resmini, Maurizio Merlino, Carmen Licciardello, Roberta Aloardi, Daniela Palmetti and Laura Danelli for having shared their experiences. In deep appreciation, the author also would like to thank all the nurses and nurse's aides of the Nephrology and Dialysis Centres of Treviglio Hospital and Romano di Lombardia Hospital for their invaluable effort during the pandemic.Funding No funding was received for this editorial.

Conflict of interest The author declares that there is no conflict of interest.Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors.