by Gabriele Bronzetti *
It is necessary to safeguard the health and dignity of those who care for us. A well-known cardiologist offers a comparison with the pilot of an airplane
You are about to board the plane. At a certain point you are overtaken by a guy running towards the cabin out of breath, dishevelled, sweaty, in a rumpled and greasy tracksuit. Ask who he is and they answer: the pilot. Climb up. You are flying sardines in a bus without wheels. The speaker hammers you with charity raffles, discounted perfumes and new reachable destinations. You can’t take it anymore, the poor pressurization suffocates you, the children cry incessantly due to the absurd tension in their eardrums. And here you see him again, the pilot, offering coffee for three euros and a half mineral for five. A sandwich costs a gastroscopy. There is turbulence, there is dancing, the pilot disappears. Finally he lands. The plane has been stopped for a while but you can’t get off. From the window you always see him, the pilot, who single-handedly extracts the luggage from the hold and throws it to the ground. After a while you disembark, you miraculously find your suitcase and when you queue for the taxi, he, the pilot, passes by again, hunched towards the buses. Would you still get on that plane? Consider the loneliness of that pilot, because he could be your doctor.
The Covid-19 pandemic could be for healthcare what September 11th was for civil aviation. From that moment on we looked at planes with distrust and fear. The stewardesses have aged suddenly. Planes have become country couriers, same price and same inconvenience. an era cloaked in faith in progress, mechanical precision and glittering beauty, even winged luxury is over. Do you know when the plane pierces the clouds and you are dazzled by blue? For a moment you don’t understand if you are alive or dead, in paradise. Anesthesia before surgery. If it happens in a modern aircraft, with elegant stewardesses and stewards, with well-dressed and well-rested pilots, it gives rise to hope of waking up alive. Now, who would trust a tired, depressed and lonely pilot? The plane is a hospital. It is not normal for an object weighing hundreds of tons to fly, just as it is not natural for people to make love only a few days after a heart attack. Yet we fly, without knowing anything about lift, about reactors, about the time we will have up there. Someone studied for us. We have to trust and we can only control the crew, from the captain to the stewardesses. Among many rights, patients have the duty to watch over the health of their doctors. We must not allow hospitals to become low-cost companies. It is clear that if investments are lowered too much, safety standards will not be respected. The staff will be fewer and fewer and more tired.
Let’s take a good look at these doctors: how do they walk, how do they dress, how do they speak? Investing them in a missionary habit is not an alibi to keep quiet about their martyrdom. We have hit rock bottom. Even in unsuspecting circles, the suspension of a few anti-vax doctors (promptly reinstated) was lamented more than the deaths of the health workers who fell in the first pandemic wave, hundreds of them. Passion should also be recognized for the sacrifice it etymologically entails, not just for its gratuitousness. The patient has the right to a doctor who is ready, not tired, not burned out and happy with his work. All specialties must be respected: an emergency doctor is not a dermatologist, who nevertheless must have rested eyesight to discover a microscopic melanoma. There are different services and different ages: experience and teaching are taken from older doctors, curious and caring energy is taken from young people. Masochists should be distinguished from normal people who are not necessarily immoral. Wretched is the land that needs heroes, said Bertolt Brecht. It is a paradox that doctors are mistreated by their employers, beaten by patients and relentlessly persecuted by the law: precisely today, when we owe medical science a life expectancy of 90 years (the forest that grows silently), we only talk about the 90 day expectation for an echo (the falling tree).
Only the return to a relationship of trust can save us: not the contract or you heal me or I report you, but I will cure you, if you trust. I promise not to heal you, but to cure you. And the more you trust, the more you can heal. Instead, today it is forbidden to die. Miraculous expectations make death no longer feel like a possibility, but a complication for which someone has to pay. Human error is statistically inevitable, but an organized structure must allow adequately trained and selected people to reduce it to a minimum, which in any case will never be zero. There is a big difference between public and private, between real risk and perceived risk. People die on a plane much more rarely than in a car, yet while many are afraid of the plane, no one is afraid of the ring road. When the irreparable happens – except in exceptional cases of serious negligence – medical negligence should be decriminalized. The blame must be shared with and among those who did not teach enough, those who did not control, those who demanded too much and therefore, collectively. The honest doctor who causes the death of a patient dies with the patient. It shouldn’t be a pilot’s widow and orphans who pay compensation to victims of a plane crash.
We cannot afford low-cost hospitals with underpaid staff. If everything has a price, for what misguided mission should the doctor give away his time and his health? Even guards can die, as demonstrated by the cardiovascular events and breast tumors that strike overworked doctors. Why is it that if I save a newborn baby no one rewards me and if I apply the same science to a ninety-year-old who then dies of pneumonia I receive ignominy and complaints? While the relatives of the unfortunate person risk real estate compensation, coaxed by zealous lawyers? Let us not fall into the mistake of considering human shifts, non-humiliating bureaucracy, fair remuneration and the decriminalization of doctors as a trade union issue, as some would like us to believe. , on the contrary, a profound ethical dilemma. The doctor has the duty to study and do his utmost, to go to the hospital with the elegance and freshness that we would like in the commander who overtakes us at the gate, with a trail of smiling and perfumed hostesses. The sick person, the passenger that we will all be sooner or later, deserves a society that does not waste or evade even a single euro so that this can happen to us. We are all on the same plane.
* Head of Pediatric Cardiology, Sant’Orsola Hospital, Bologna
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December 2, 2023 (changed December 2, 2023 | 07:56)
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