RWC Series: "Facing Challenges from Around the Globe: Covid-19"
By Barbara Parolini , EYECARE CLINIC at Crystal Palace, Brescia (Italy)
Member of AAO (American Academy of Ophthalmology), EVRS (European VitreoRetina Society), ASRS (American Society of Retina Specialists), SOI (Societa’ Oftalmologica Italiana), GIVRE (Gruppo Italiano di Chirurgia VitreoRetinica) among others.
Dear Colleagues,

I am Barbara Parolini, a vitreoretinal surgeon living and working in Brescia, Italy. Since a few weeks, Brescia is one of the Covid-19 hot spots.  
On February 25th, when we had the first cases, I thought it was a flu, so I kept working.

Then, one patient who had been checked on February 22nd, called to say that his brother had died of Covid within 2 days, and that he had been in contact with him. So, in my clinic everybody panicked, and we stopped working for a few days, waiting to find out if that patient turned positive at the test, or whether some of us would get sick. He turned out to be negative.
Still, we were thinking we could work, just less. So, we started to see one patient every 45 minutes, with mask and gloves, asking the relatives to wait outside the clinic, and disinfecting the slit lamp and every instrument after every patient. But all around us, within two weeks, the number of infected people was building, and we were all wondering what the right thing to do was. We stopped operating cataracts, but we were still operating some retina and glaucoma cases. We were worried about the virus but, let me tell you, we were also worried for the economic collapse. We were asking ourselves: how can we completely close the clinic? How can we assist our patients? How can we not work?

However, the patients were also self-limiting, calling to cancel the appointments.

Then, I remember that day, one patient called. I had done a cornea transplant in January. He was healthy at the time. A very nice man and the father of a Zeiss technician who had been with me in the OR many times. He called to say “I cannot come tomorrow for my appointment. I am sick in the hospital nearby. The doctors told me that if I get worse, they will not give me artificial ventilation because there are too many patients here and they don’t have enough machines. I want to thank you, doctor, for what you have done. I want to tell you this because I know I am dying, and I will never see you again.” He died one week later. But that day I fully realized what was happening: not just the virus itself, which maybe an immunocompetent person can deal with, but the logistics of the pandemic! We did not have (and don’t have) enough resources to contain the damage! So, a new term was coming up: the NC or “non candidate”. Meaning non candidate for ICU. And the criteria for NC were, and are, age and previous systemic conditions that lower chances of survival. But the age threshold was down to 65. My patient was 65.

So that day we decided to indefinitely LOCK DOWN the clinic and comply with the “limit the spreading” (“flatten the curve”) theory. I am still going to the clinic, but only on call.

When patients call the clinic, they are transferred to a cellular phone. My secretary responds and she forwards the messages. This way, I select what to take care of by phone or videocall, and what by going in-person. But it seems that emergencies in ophthalmology disappeared! They did not, but certainly people are going to the ER much less.

I am at home spending a lot of time with my family. I am preparing talks and studying. Mainly, I am thinking. I am thinking about my colleagues who work in hospitals and are at high risk. Some of them died already. My husband works in a community hospital. He is the Head of Radiology, so he is in contact with infected people. So far, so good. Every day I kiss him and say: Please come home negative! 

I feel bad staying at home while colleagues are there. I have been thinking about volunteering in a hospital. Many are opposing my decision because I am an ophthalmologist and do not know how to deal with these patients, but even if it were as a nurse, or just writing certificates, my family is opposing because I am at high risk because of my previous pathologies.

So, this is a time for reflection, for thoughts, for thinking at what is really important. People say: now you discover what is really important in life. Actually, everything that was important before, seems still very important to me. It just so happens that suddenly we are forced to HAVE TIME for something else then work. Suddenly we, as a community, are forced to realize that we are equal in front of a common enemy. Suddenly, we are all forced to choose what is most important and what we would like to do if these were our last days. Though truthfully, at the moment, we have many limitations on what things to choose. 

So, as a doctor, I am spending as much time as I can studying and preparing to go back to work more prepared. As a mother, I know my daughters will have learned a great lesson in life. As a wife, I thank my husband and I feel fortunate because home and family, for me, is the best place to be. As a human being, I hope that when this is all over, we all remember that we were all open to a common enemy, equal in front of him. I hope humanity will come out of this with less barriers. As I have written in the past, bacteria and viruses don’t pray. They do not choose based on religion, or color, or money, or nations.

I wish all of you the best. But be prepared NOW.
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