An angel at my door, the doctor who treats Covid house by house

January 11, 2021

This article is published in number 48 of Vanity Fair on newsstands until December 1, 2020 To subscribe to Vanity Fair, click here. When they open the door of the house you see only the eyes, the rest of the face is hidden behind the masks, but they are eyes full of gratitude. Patients welcome Professor Luigi Cavanna as a savior. Here everyone knows him by name or by hearsay. First because he was the head of oncohematology of the Piacenza hospital and his patients never lacked extra attention, a visit home when necessary. Then because in March, when Covid arrived, which hit in a violent way in Piacentino, he was the first to understand that to deal with it in the right way it was necessary to anticipate: on the territory. [cn_gallery id=”127555″ pos=”0″ type=”wp|Gallery” layout=”landscape” numero=”true”] «Professor, you treated my cousin up in Pianello. Remember? Now she is well and greets her a lot ». Luciana, 65, Covid took it from her son, who first attacked her, then her father, then her partner. And perhaps also to the two young children, who, however, have no symptoms. They all live in a low house with a beautiful garden on the outskirts of San Nicolò, a small town on the outskirts of Piacenza. They called Cavanna directly to come and visit Luciana who for days has had a fever, a cough and feels exhausted. When the door opens they are all there, silent, waiting in the dim room with the windows closed and the artificial flowers on the wooden table. They wait for the doctor to dissolve their doubts and speak out. “Lady, sit down here in the chair. Uncover your back and take deep breaths. How is the cough, dry? What about the fever? It eats? Do you download regularly? ‘ It seems to have gone back 50 years when family doctors went house to house to visit the sick. Only then there was no Covid and there was no need for two layers of protective suits, sterile shoes to change after each visit, an ffp3 mask with a surgical one on top and two pairs of gloves. There was no need for these thousand precautions that make movement almost difficult, but do not prevent the doctor from reassuring, controlling, supporting his patient while he fights this disease made up of few certainties and many fears. [cn_quote text=”Come oncologo ho sempre saputo che il mio dovere è andare verso i bisogni del malato” cite=””] «As an oncologist I have understood for years that it is the doctor’s duty to go towards the needs of the sick. When it is necessary, the medicine must leave the hospital, ”says Cavanna. And he applied the same principles in curing this sneaky virus. After seeing, in the first moments of the pandemic, that many patients arrived in the emergency room when the disease was already presenting symptoms that were too advanced – after several days of cough, fever and lack of air -, he decided that it was necessary to act first: immediately identify the patients, treat them early at home and monitor the evolution of the virus daily to hospitalize only if necessary. “I didn’t expect a second wave so violent, though. Instead, only hospitals were thought of. But just to ensure that hospitals do not clog and collapse, we should act first, ”he explains as he takes off his second gown before getting back into the car. They started in two, he and his head nurse Gabriele and, eight months later, at Signora Luciana’s home they are still the two of them. “Do you have the oximeter? Please, use it twice a day, on the middle finger, always standing or sitting, never lying down ». Meanwhile Gabriele takes a small portable digital ultrasound from his bag and the professor checks the lungs. «You see?», He says looking at me, «there are some small outcomes of pneumonia, but he is in the process of recovery. Here we certainly cannot make plates or even a CT scan, but this tool is useful and precise. Lady, we are on horseback, we are on horseback, continue with the cortisone and heparin and you will see that it will get better. But who coughs like this? ». For fifteen minutes, Giancarlo, Luciana’s sixty-six-year-old husband, has been coughing angrily on the other side of the room. They came here only for her, but the professor without hesitation makes him sit in the chair instead of his wife and while the son, daughter-in-law and grandchildren huddle in a corner, he proceeds with the second visit. “Who is your doctor?” Now I write the recipe. The antibiotic must be started immediately. And call me every day to tell me how it is proceeding ». When we leave the house, the spouses want to pay the bill, they insist. “Don’t worry, you will offer me a coffee when you are well”. [cn_quote text=”Mi aspettavo che dagli organi preposti fosse sviluppata una strategia efficace di intervento precoce sul territorio” cite=””] Cavanna and his assistant have already earned more than 360 coffees in recent months by going up and down with their white pandino through the dusty streets of the Apennines, up to the border with Liguria, and in the silent villages of the province . In the case an ultrasound machine, the oximeters to leave if necessary to the sick, the swabs for doubtful cases and the drugs (at the moment antibiotics, heparin and cortisone) which are usually prescribed but if necessary also delivered directly.

Then there is the possibility of having an oxygen cylinder arrive home within a couple of hours when needed. Before, hydroxychloroquine was also used, which according to Cavanna, if taken in the initial phase and in moderate doses, was an excellent drug to limit aggravations, but which now, after some very controversial studies, has been eliminated from the protocols.

“Fifteen days after we started our activity throughout the territory of our province and the Region, the Special Continuity Assistance Units were organized (today there are about 70 Usca active in Emilia-Romagna with 450 doctors and health workers employed, ed) “. During the first wave, they visited 330 patients, of which only 5% were hospitalized. “The greatest satisfaction is that there was no death among them. The emotional relationship that is established with people is very intense. A strong solidarity is born immediately ».

[cn_quote text=”Il rapporto emotivo con il paziente è subito molto intenso” cite=””]

“You are angels,” says Giovanna when she opens the door. Her husband Arnoldo has been ill for almost 15 days, they are treating him at home with an oxygen tank, since this morning his saturation is very low, and she is in the throes of anxiety: she fears a sudden deterioration. Arnoldo is in isolation in the tavern of his house in Gossolengo, to keep him company with his three dogs and a large TV hanging on the wall, his appearance and mood are good but the oxygenation of the blood is not. «Gabriele, check the cylinder, it seems to me that it is not working well». A new cylinder, a badly turned wheel and Arnoldo was left without air. In a few minutes the saturation goes back to 95. “They didn’t explain anything to us when they came to change it, they treat us as if we were plagued,” says his wife. In addition to the virus, patients often find themselves having to face the social stigma of a disease that can be unfairly experienced as a fault or having to deal with loneliness. Like Maria Giulia, 76 years old, widow, that Covid faced him with her cat and a great dose of courage. «Professor, after 15 days I am still positive. Why?”. The visit confirms that he is in remission. “Promoted. You will see that the next will be negative », Cavanna jokes.

“We are in constant contact with patients to monitor the development of the disease and also to give emotional support,” he adds.

[cn_quote text=”La paura c’è ma il pensiero di poter aiutare i pazienti ci guida” cite=””]

Perhaps Franco, if there hadn’t been the Special Continuity Care Units, would now be hospitalized. “I don’t know where my husband could have gotten sick,” says his wife as he leads us to their room, which is now only his, photos of their two children on top of the bed. «We have been very careful. Never a dinner, no meeting between friends. Work and then home, shopping twice a month. We also preferred to give up on holidays, yet he got infected. He is asthmatic, he breathes badly, at night he gets a fever and sweats a lot, and during the day he is without strength ». The visit confirms that there is pneumonia, but a touch-up to the therapy and the patient can continue to stay at home assisted by his wife (which fortunately is negative) in his apartment on the second floor of a building in Borgo Trebbia.

“Thank you”, “if you weren’t there”, “she saved our lives”, “now I’m more serene”, word after word, house after house, it becomes clearer what drives these men to do extra shifts, to overcome fatigue and fear. “Fear? There is more than one », Cavanna says,« There is that of contracting the virus and this one is kept at bay by protecting oneself. Then there is that of inadequately treating a patient at home. At first we had a lot less knowledge and more fears, then we gained experience. But what has always helped and guided us have been the requests of patients who told us: “I don’t want to go to the hospital because if I go I die, and I die alone” ».

Photo by Gabriele Micalizzi