Interview to the Covid Warrior Maria Concetta Monea

M.C. Monea – Head Anesthesia and I.C.U. of A.O. Cannizzaro

I gratefully accept this award in the name of the sacrifice of the Doctors, Nurses and Auxiliaries of all the Intensive Care Units of the Cannizzaro Hospital that I have the honor of directing.

Everyone today is talking about intensive care, semi-intensive care, ventilators, oxygen. I would like to emphasize a message that we have all been forced to read because of or thanks to this pandemic. The central importance of intensive care in our health care system, which represent a “heritage” of inestimable value, with a high human and technological profile.

The importance of healthcare Ethics. Ethics intended as a custom, as a change, as a habit. Habit, we hope, to a new view that always keeps the physical and mental health of human being at the center of all our choices. Even at the cost of putting in the background the controversial budgets, whose exasperation has been the cause of indiscriminate cuts in healthcare in recent decades.  Until Covid-19. It arrived to rub in our faces the need to put the human being first. 

I direct the Unit of Anesthesia, Intensive Care Unit and Trauma Center of Cannizzaro, a level II hospital and regional hub for emergency.
Since March, we have all been living in a suspended time. Before telling what life is like during the present Covid emergency within the intensive care unit, I would like to remind everyone what an anesthesiologist intensivist doctor actually does.
Because putting a patient to sleep and waking them up is just one of the many tasks they are required to do. The anesthesiologist is the specialist who is entrusted with the vigil of the patient during long and complex interventions, with the task of ensuring the delicate and amazing balance between the central nervous system, cardiovascular and respiratory.
This role is performed by making use of ventilator and powerful dangerous drugs. To do this, it is also necessary to know the work of the surgeon, follow all his maneuvers, so as to prevent any problems.

A good anesthesiologist is also a good intensivist.
Anesthesiologist is a somewhat obsolete term today. It recalls the idea of a rapid and decisive approach, without the vision of a therapeutic project, as instead evokes the word intensive care and therefore intensivist. This approach is necessary in 118 or in the emergency department, where anesthesiologists are always present, when the patient is very serious. If today we are able to perform major cardiac surgery, treat polytrauma, or severe sepsis, just to name a few, it is thanks to the development of anesthesia and intensive care.

The Intensive Care Anesthesiologist is perhaps the last doctor who has a “holistic”, non-sectorial vision of our organism and therefore of medicine, with expertise in cardiology, neurology, pulmonology, endocrinology, immunology, etc.. and all the surgical branches found in the hospital where he works. A hospital Hub for Emergency as the Cannizzaro, today more than yesterday, must put at the center of its system a team of anesthesiologists intensivists prepared and technically experienced alongside the doctors of P.S. and emergency medicine, surgeons and nurses experts. The team of intensivist anesthesiologists represents the hard core of the emergency organization.

The “truth virus“.
I would like to take the opportunity of this recognition to tell everyone about the ICU and the coronavirus guilt.
Even before I am an executive, I am an Intensive Care Anesthesiologist. Which is not the same thing as anesthesiologist, who most of the time doesn’t know how your patient ends up. But the Intensivist does, and how! The Intensivist makes a project of diagnosis and therapy, works in a team, uses machines from NASA, sophisticated and that it takes a lifetime of work and daily training to know how to exploit them to their full potential. 

You get up very early in the morning to go to work, when you’re not already up because you haven’t gone to bed at all and the night in the ward has flown by with only one serious patient or running from one bed to another without respite. And no Christmas or August bank holiday changes that.
At the end of a night, getting out in the fresh air makes you breathe deeply. You are cleaned of the heavy air, barely breathed in for what it takes, never more.  Outside, the air is always tingly, even in summer. Because fatigue makes you cold. But the morning light! It repays you for everything, it washes over you and makes you discover the beautiful sky always, even when it rains.
You think back on all you’ve done in a moment, you go back and wonder if you forgot something in the deliveries.On your way home you hear a news broadcast: 100, 200, 400 dead? A war or a plane crash? There are so many, the number seems to make no difference.
You for one, just one, along with your nurses fought a whole night of your life and you don’t know if it will have helped. But yes, of course it did, it always does. Because you gave and giving is like throwing a stone into a lake: it is energy that walks.

Nobody expected the coronavirus. But to tell the truth, in our hearts we all knew that sooner or later something would happen that would put our fragile system in crisis. 
Every time economic resources were cut, there was the usual lone voice that raised a cry of alarm, unheeded, and then everything went back to seemingly working as before. With the sacrifice of many silent Intensive Care Doctors and Nurses, accustomed to remain in the trenches, out of a sense of duty. As if squeezed in a vice without being able to free themselves due to the pressure of work, which if you escape you know that someone can die. And so you continue because you think that sooner or later those in charge will understand.

And here comes the coronavirus.
The “Truth Virus”, I called it this way from the beginning. It breaks into our lives and changes them suddenly.
Yes, but this is not how I expected the change. If there ever will be. At what price! We are afraid too, but no one is backing down, it’s our job and we know that without us, the dead will be counted even more and we remain nailed down without looking at the hours. 

I am the Chief and I must give them serenity and security. The eyes speak.
I look at the eyes of my Intensive Care Anesthesiologists and my Nurses and I read fear in them, but also courage; what courage is without fear!
I know I can count on everyone, even those who would like to run and don’t.
As we are used to clinical diversity, suddenly sick people arrive who all seem to be the same and we, dressed as Martians, go around them, connect them to the respirator and to sophisticated monitors, we cannulate large vessels with long catheters full of taps that we connect to syringe pumps, we try to understand through X-rays, CT scans and laboratory tests the degree of gravity they have. We know that those who die will never see their loved ones again and their loved ones will never see them afterwards either. We are tried but we know how to keep our wits about us, we don’t stop.

And where are the other sick people? 
They arrive, but only the most serious ones. The less serious ones are afraid and stay at home. For us, the work increases a lot because the most serious patients always arrive, especially in my hospital, Cannizzaro in Catania, which is an emergency hospital and they are added to the coronavirus patients. But they must also be treated and so what do you do? And meanwhile swabs to all, if they were carriers too? 
Let’s diversify the pathways otherwise they all get infected. Complicated to be realized in a system that is blissful of choices suitable for a health care budget, from efficient a “productive” system, economically. But intensive care is another story. Coronavirus is another story. It will be necessary to redesign a new health care system with the emergency at the center, all of it, and especially in first place the Intensive Care Unit. Health care ethics will have to be rewritten. Ethics as a habit, as a change of course, as a way of living. A way, we hope, to a new look that always keeps the physical and mental health of man at the center of all our choices.

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