Thursday, June 04, 2020

Retired doctors in Italy are heading back into the fray to treat coronavirus patients

Mar 29. 2020
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By The Washington Post · Chico Harlan, Stefano Pitrelli

ROME - The retired doctor was at his countryside home in northern Italy, working in the vegetable garden, when his phone rang - an incoming call from his former boss. Their conversation was short. Then, Mario Cavazza, 67, went inside to inform his family about how his life was changing.

"I was called back to work," he told them.

All across Italy, in response to a pandemic that is surging too fast for the health system to cope, a legion of retired doctors and nurses is returning to hospitals. It's a jarring, risky life reversal on a broad scale.

The retirees are stepping back into the field to contend with a virus that is particularly deadly for seniors. And even for those returning to familiar clinics and hospitals, the jobs they perform are now unrecognizable - coordinating war-style triage in places deluged with patients, or contending with people isolated from their families and gasping for breath.

In a growing number of places dealing with major outbreaks, from London to New York, retired health workers are responding to similar calls to deal with the influx. Countries with the largest emergencies are looking not just to older doctors, but also volunteers, people who left midcareer, or those willing to relocate from other countries or lesser-hit regions.

Some U.S. medical schools have offered early graduation for students willing to jump into the coronavirus fight. In Italy, too, medical students have been given the option to skip over final exams and rush into the field.

But the situation in Italy stands apart from others in the West, because the outbreak has been going on longer, and because more than 6,300 health-care workers have already contracted the virus, according to the national health service, thinning the ranks of medical personnel. Facilities are short on protective equipment for employees.

And at least 50 doctors have died after contracting the coronavirus. Three of those, according to the federation of Italian doctors, were retired or semiretired.

 

"Toward the end of February, I told him, 'Gino, be careful,' because we are quite old," Gabriele Fasoli said about his brother, Gino Fasoli, a doctor who died this month at 73. Fasoli had been semiretired, and had continued to fill in for general practitioners in the northern province of Brescia even as the pandemic broke out, his brother said.

"He had been in a tough spot," Gabriele Fasoli said. "The health authorities gave him only a bland warning and a kind of light mask, not those that are specific for an ongoing virus."

By March 9, the virus had progressed to the point that Fasoli was too feeble to speak.

He died one day after a test confirmed he was positive for the coronavirus, his brother said.

The wave of returning doctors is mostly in their 60s and 70s. Some volunteered to come back. Others are like Cavazza, who had retired in early January after 35 years spent in emergency rooms, and had been happy to break free from the life of middle-of-the-night calls.

He'd been given a surprise party for his retirement, and he'd been learning to relish what his wife called the "slow life." He was exploring the hidden corners of his city, Bologna. He was making regional dishes for dinner, pastas with a hearty ragu. He was spending time fixing up a second house in the countryside.

"I was happy to conclude my work as a doctor, to do something else entirely. I wanted to take back my time," said Cavazza, who had undergone heart surgery in October.

But several weeks ago, he found himself returning to work - this time, not in the ER, but rather helping to coordinate between hospitals in the area. He also began an existence of isolation. His wife and youngest daughter retreated to the country home. Cavazza stayed in Bologna.

"We won't see dad again until who-knows-when," his youngest daughter, Marta, said. "Otherwise he'd be thinking every evening, 'Oh god, I may have brought [the virus] back with me.' "

Describing their experiences over the past weeks, several retired doctors told stories of tracking the virus from afar - first reading about the initial outbreak in China, then wondering if it might fizzle out like SARs, only to realize in late-February that it was in Italy and about to overpower the health system.

"A pandemic means the whole national health care goes to hell," said Vanni Borghi, 63, who had been semiretired before the coronavirus. "You have this feeling of being powerless."

Most of the recruited doctors have come to hospitals in Italy's stricken north, which has seen the majority of the country's 9,000 coronavirus deaths.

At a hospital in Montebelluna, eight retired nurses and doctors have come aboard, plus another who had departed the medical field midcareer - to become a local mayor.

That mayor, Mauro Migliorini, returned to the hospital last week to retrieve his new medical badge, only to find a facility entirely redrawn for crisis: barriers at the entrance directing patients with a fever and a cough; elevators designed exclusively for covid-19 patients marked "biological risk."

Migliorini, who is 50, said he signed a six-month contract.

"It can be renewed in case of emergency," he said.

The center of the Italian emergency is the city of Bergamo, where the public hospital has five critical patients for every intensive care bed, and where a once-retired doctor spends his days devising ways to reduce the agony of people who struggle to breath.

Before the outbreak, 74-year-old Fredy Suter, a specialist in infectious diseases, had been semiretired, but still had a hand in palliative care. In February, while making the rounds in the region, he had noticed a slew of unusually serious pneumonia cases across the region.

Soon, tests showed at least one of those patients was positive for the coronavirus. Suter thinks he might have contracted the virus itself and fought off a mild case.

As the outbreak came into focus, he visited the hospital from which he had retired in 2011.

"If you need an old doctor," he remembers telling the director of Papa Giovanni XXIII Hospital, "I am available."

Since returning, his job has been to tend to patients suffering from with what Suter calls "desperation" - people who are at once panicked, hungry for air, and sealed off from their loved ones as they fight for their lives.

"It's grievous," Suter said.

At the hospital, the worst-off patients are intubated, lying on their stomachs, sedated. But Suter deals with people who haven't yet reached the most severe point - people capped with transparent, bubblelike oxygen helmets.

"Sometimes they get agitated," Suter said. "They realize the gravity of what is happening."

He said that people with the virus struggle to speak audibly when wearing the helmet, but removing it, even briefly, is dangerous. "It's like opening a zipper for the virus," he said.

Still, he has done it. For patients with the strength to speak, he asks if he can get in touch with their families. What should I tell your son? Your daughter?

"I try to break this persistent solitude," he said.

Suter said the recent weeks have felt like nothing before.

Across Bergamo, signs saluting medical workers say "don't give up" in the local dialect, and inside the hospital, workers are doing what they can to keep up. Suter said he calls families a half-dozen times every day, updating them on the condition of their relative, and letting them know when it might be worsening.

"Whenever a patient passes away, in a short time later, their bed is filled anew," Suter said.

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