February 23, 2022

What are Specific steps to address governance issues within the Cremona hospital? minimum four steps with paragraphs expla

Human Resource Management

What are Specific steps to address governance issues within the Cremona hospital

minimum four steps with paragraphs explaining steps

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Transcript

Inside Italy’s COVID War

View film https://www.pbs.org/wgbh/frontline/film/inside-italys-covid-war/

FRANCESCA MANGIATORDI:

It’s 8 o’clock on March 17. I just finished my 12-hour shift, and what affected me most tonight? A lady asked me, crying, what was going to happen to her? Why was she there on a stretcher in the hallway with 15 others and only one toilet? There is no dignity anymore; we've lost the sense of humanity.

I don’t know what the aim is of working in this way. And in the end, the role of the doctor loses its meaning.

FRANCESCA MANGIATORDI:

I can barely cry. I don’t know how the patients can have such capacity to stay there, waiting for hours and hours, in some cases days, without knowing what their fate will be. And you really can’t give them an answer.

FRANCESCA MANGIATORDI:

Hi, Francesca Mangiatordi, Emergency Room. What's your situation for beds? Nothing, OK, bye.

Hello, ER. Can you tell me if you have any beds, please? Nothing? Thanks. F—— hell!

Hello, ER. Can you tell me the situation for beds, please? Nothing? Thanks. There are no beds.

MARCH 2020, NORTHERN ITALY

THE HEIGHT OF THE CORONAVIRUS PANDEMIC

MALE NURSE:

No, no, no, no, no no no. You have to keep it on, really.

FRANCESCA MANGIATORDI:

Check if there's space in Waiting Room 3.

EVERY WARD AT CREMONA HOSPITAL IS FULL OF COVID PATIENTS

FRANCESCA MANGIATORDI:

They’ll be a bed available in gynecology. But not for an hour. There's been a death and they're waiting for the cleaning. Yes, yes. COVID.

All the CT scans are practically the same now. They are all ugly. He's 35 years old. He's young! We’ll definitely have to admit him, since it's possible.

Unfortunately, I’m going to have to choose whether to admit him or an 85-year-old.

FEMALE VOICE:

What will you choose?

FRANCESCA MANGIATORDI:

The 35-year-old. We’ve had to make choices like this for a month now.

CRISTEL,30 years old:

I told my husband I’m going to the hospital. He was scared to let me come. We have three small girls and there’s a higher risk of infection. I ended up coming. The doctor said—I’m not sure if I have the virus, but she said it sounds like the initial stages of pneumonia. Let’s hope it all goes well.

I hear that those unlucky not to make it are the elderly. I’m 30. I’m young. I hope—I’m hopeful. But I'm very scared.

Tell me, I’ve got three girls, tell me the truth?

FEMALE NURSE:

Three girls? I don’t know, do they live with you?

CRISTEL:

No, I mean, is it serious?

FEMALE NURSE:

I can’t say, but I mean—

OK, I’ll get you a bottle of water so you can drink.

GIRL'S VOICE ON PHONE:

Mama!

CRISTEL:

Chiara, can you pass me to Daddy?

FEMALE NURSE:

Take this.

CRISTEL:

Thank you. Listen, where are you? Go downstairs a second. They said it’s not pretty, so—I don’t know yet, Sebastian. The radiologist needs to check the X-rays, but at first glance, it’s not pretty. I don’t know, Sebastian. [Coughs] Don’t say anything in front of the girls. OK, bye, bye.

FRANCESCA MANGIATORDI:

Yes, it’s fairly widespread. It starts here and practically her whole lung has pneumonia. No longer functioning. There’s no doubt that the test will come back positive.

She's 30 years old. Healthy. It’s no longer true that it’s affecting just the elderly.

Hi, excuse me from the ER. Do you have a female bed? There’s a young woman to transfer.

CRISTEL:

It feels like a nightmare.

FEMALE VOICE:

How old are your girls?

CRISTEL:

The eldest is 11, the middle one 7 and the little one is 3. The little one can’t live without me.

Sebastian? I can’t handle this. I’m scared. [Cries]

FRANCESCA MANGIATORDI:

Take some deep breaths. Gently.

I know my colleagues, they’re struggling, fighting every moment, having to choose the life of a younger person over an older one. Their faces are almost expressionless now. They’re like walking ghosts, because they don’t want to have to make the decision whether to intubate someone or not.

I believe it's an unfair battle. We have few weapons; the virus has them all. But with the few we have, we are trying to resist and fight back. It may be an unfair battle, but we are fighting it anyway. We won’t give up.

MALE NEWSREADER:

[Speaking English] Let’s bring you some breaking news from Italy. Coronavirus deaths have risen by 683 in 24 hours, lifting the total death toll to 7,503.

FEMALE NEWSREADER:

[Speaking English] We’re now into Day 9 of the lockdown. The authorities believe that the next week or so is very crucial. The peak infection rate still has not yet been reached here.

MALE NEWSREADER:

[Speaking English] Today Italy has passed a deadly milestone: more people dead from the virus than in China.

FRANCESCA MANGIATORDI:

[Speaking Italian] I'm just going to wash my hands. OK, I’m ready. Have you studied everything, kids?

FRANCESCA'S KIDS:

Yes.

FRANCESCA MANGIATORDI:

All of it?

FRANCESCA'S KIDS:

Yeah.

MARIA TERESA MANGIATORDI:

Guess what the homework was about? Viruses.

FRANCESCA MANGIATORDI:

Viruses. You're talking about coronavirus. Let's say the only positive thing is that there's no more pollution. Only that, the rest is tragedy. Right, let's get organized to eat, I'm hungry.

When I get home from work, my family is there. My husband, Michele, and my kids, Damiano, who’s 13, and Maria Teresa who's 11.

So now we are six people down in the ER.

MICHELE MANGIATORDI:

It's war.

FRANCESCA MANGIATORDI:

Yes, it's a war. We're dropping like flies.

I read today that we’ve reached—actually we’ve overtaken—

MICHELE MANGIATORDI:

China?

FRANCESCA MANGIATORDI:

Yes, China.

MICHELE MANGIATORDI:

Yeah, I read that.

FRANCESCA MANGIATORDI:

With Michele, my husband, I talk about everything that happens at the hospital. He's always been very supportive, even though he's more scared than me.

He suffers from a respiratory problem, so if I bring COVID home, he’d be the first to catch it. This scares us both. The thought of living alone at this time would have been really hard, even harder. I don't think I would've been able to confront everything I did in the hospital.

We haven't hugged each other in a month, and I feel the burden because the desire to hug and kiss them is very strong. But I need to protect them. There'll be other times when I'll be able to cuddle them.

Stay home!

MATTIA, 18 years old

FRANCESCA MANGIATORDI:

This morning we admitted an 18-year-old patient named Mattia, one of the youngest patients we've seen so far. He's been intubated and he’s now in the ICU.

The lower parts are totally inflamed.

MALE MEDICAL COLLEAGUE:

Poor kid. While they were putting him to sleep, he said, "I’m scared I’m going to die." I said, "No, we’re doing this to help you."

FRANCESCA MANGIATORDI:

There was no one with him, right? The parents?

MALE MEDICAL COLLEAGUE:

I asked him if he wanted to speak to his mom and he said he didn’t feel up to it.

FRANCESCA MANGIATORDI:

And then did you get in touch with her?

MALE MEDICAL COLLEAGUE:

I think Intensive Care did.

FRANCESCA MANGIATORDI:

Damn it!

It's terrible. For a mother, a situation like this is devastating. She couldn't see him, be close to him, hold his hand in the moment when he was intubated. I would’ve thrown myself on him like a blanket to protect him, really. Because young people are the basis for everything. The elderly have played their part. It’s almost normal that there’s death after a certain age. But waiting for death at 18—it’s horrible.

I hope with all my heart that he will get better. But from what I've seen in the scan—I don’t know.

I'm not expecting big improvements. Damn it. All right. There you go, the mask broke.

FRANCESCA'S MOTHER [on phone]:

Hello?

FRANCESCA MANGIATORDI:

Mom?

FRANCESCA'S MOTHER [on phone]:

Beautiful, what are you doing?

FRANCESCA MANGIATORDI:

I'm just leaving the hospital. How are things? Is everything OK?

FRANCESCA'S MOTHER [on phone]:

Not bad. Your dad is not getting up.

FRANCESCA MANGIATORDI:

Ah, it's OK. Let him rest, leave him. Are you eating?

FRANCESCA'S MOTHER [on phone]:

Yes, your dad had milk and cookies.

FRANCESCA MANGIATORDI:

OK, good.

My father has dementia. My mother cares for him. They're both 80 years old. They never used to go out except to church. They haven't really understood how serious the situation is.

FRANCESCA'S MOTHER [on phone]:

[Laughs] Oh, well! Yes, come for the Easter holidays.

FRANCESCA MANGIATORDI:

What are you saying, Mom. We won't be allowed to travel by Easter.

FRANCESCA'S MOTHER [on phone]:

I wish! But I don't think so. This morning the pope said, "Pray, pray for me."

FRANCESCA MANGIATORDI:

Ah, not for everyone? Yes, you pray and I'll keep busy.

FRANCESCA'S MOTHER [on phone]:

[Laughs] All right.

FRANCESCA MANGIATORDI:

Kisses, Mom, speak to you tomorrow.

The pope will resolve everything, we'll be fine. [Laughs]

FEMALE NEWSREADER:

[Speaking English] There are now more than 525,000 cases globally. The pandemic has killed more than 23,000.

FEMALE NEWSREADER:

[Speaking English] I can’t quite believe we're seeing these numbers. Nine hundred nineteen people have lost their life in the last 24 hours in Italy. That is by far the biggest loss of life in a 24-hour period, not just in Italy, but globally.

FEMALE NEWSREADER:

[Speaking English] It’s impossible to imagine what that feels like for the people working on the front line, the doctors and nurses. We know now that 14% of the positive cases are front-line health care workers as they are well into their third week in lockdown with no end date in sight.

FRANCESCA MANGIATORDI:

[Speaking Italian] Can you hear me? Stick your tongue out. It’s totally dry. Let’s send him to have a head CT scan.

A patient has arrived from another ward with a little bleeding on the brain. Tell them he can be

transferred from orthopedics.

FEMALE MEDICAL COLLEAGUE:

So he’s not a COVID patient?

FRANCESCA MANGIATORDI:

No.

FEMALE MEDICAL COLLEAGUE:

Is he at risk of getting infected?

FRANCESCA MANGIATORDI:

Very high.

Five weeks have passed, and, bit by bit, our colleagues are getting sick.

Put your mask on! Otherwise the virus will fly around.

That’s another fallen soldier.

FEMALE MEDICAL COLLEAGUE:

Oh, yes?

FRANCESCA MANGIATORDI:

Yes. A colleague who worked until yesterday. He was fine.

This is the list of the new doctors who are helping us out. So initially we had 9, 10, 11—11, and we’re left with 2, 3, 4, 5—and 5. So we’re left with less than half.

When we started to admit COVID patients in the first week, I understood that, as medical personnel, we were very fragile.

MALE NURSE:

I’m going out for a breath of fresh air. I’ve got abdominal pain.

FRANCESCA MANGIATORDI:

It’s all the tension.

We were always questioning each other. Any or all of us could be next.

Your temperature? You’ve taken it? All good?

LAURA BOCCHI:

Yeah, but yesterday my nose started running.

LAURA BOCCHI:

I also started getting chills. Then the paranoia started.

There's a fear of becoming infected and in turn infecting the ones who are closest to me. It feels like the virus is circulating and the circle is getting smaller. Now I’m worn out, I’m tired and I’m more scared. So, yeah.

FRANCESCA MANGIATORDI:

We’ll make it, Bocchi.

Let’s give each other strength. I’m almost a stranger to myself. My head and body go in different directions.

LAURA BOCCHI:

You know what my heart rate was last night? 110.

FRANCESCA MANGIATORDI:

Very good. I haven’t measured mine, might have to now. I’m smoking like hell.

LAURA BOCCHI:

Maybe I should start smoking, too.

FRANCESCA MANGIATORDI:

OK, speak later.

THE NEXT DAY, LAURA IS TESTED FOR COVID-19

LAURA BOCCHI:

Today we got back the results from the swab. The swab is positive.

It’s weird being here, at home alone. It’s strange to be here, isolated from my husband and son. So, now I have crossed to the other side. And that’s that.

It’s complicated for me to accept.

LAURA BOCCHI:

But this is how it is.

And so, little by little, not without fear, we’ll attempt to come out of it. And we’ll try to do the things I always say to my patients, but that now I have to do myself instead.

I’m a patient and unfortunately I possess medical knowledge, which doesn’t calm me down and instead sometimes makes my fear worse.

FEMALE NEWSREADER:

[Speaking English] Sixty-one doctors have now died from COVID-19 along with 11,500 citizens in just 5 1/2 weeks. The head of Italy’s emergency response says the virus may now be at its peak, but there’s no respite yet for the country’s health care.

FEMALE NEWSREADER:

[Speaking English] —and the head of the U.N. says the pandemic is the worst global crisis since World War II.

ANTÓNIO GUTERRES, Secretary-General of the United Nations:

We are slowly moving in the right direction, but we need to speed up and we need to do much more if we want to defeat the virus and if we want to support the people in it. This is not a financial crisis. This is a human crisis.

ALDO [on phone]:

[Speaking Italian] Francesca?

FRANCESCA MANGIATORDI:

I can't believe it, Aldo! Damn it! I saw you were a bit odd when we did the afternoon shift, remember?

ALDO [on phone]:

I was tired.

FRANCESCA MANGIATORDI:

I was saying, "Strange, Aldo’s like that." It seemed to me way too odd. And when on Friday they said, "He’s got a fever," I went, "F—, another fallen at war, damn it."

ALDO [on phone]:

No, I was tired. For a few days, I had a bit of nausea. Not much appetite.

FRANCESCA MANGIATORDI:

Yes, Aldo, we’ve seen the picture, you’re not in the clear. You know it well, let's see what it looks like. In the meantime, let’s find out if you’ve got pneumonia or not.

ALDO [on phone]:

Yeah, but I'll s— my pants, you know? Picturing my lungs full of—

FRANCESCA MANGIATORDI:

No! Full of what? You breathe well, your saturation is good. We shall see tomorrow, OK?

Another fallen.

MICHELE MANGIATORDI:

It’s like Laura said, "The circle gets smaller."

In the morning when she leaves I text her, "Keep me updated!" And she just—Got it?

FRANCESCA MANGIATORDI:

It’s true.

MICHELE MANGIATORDI:

It’s not easy. Absolutely not. Then, a bit, but just a tiny bit, I’m a little more fearful than her. Just a tiny bit. Could you not be a house painter?

FRANCESCA MANGIATORDI:

[Laughs] Then we wouldn’t have met! Sacrifice and blood. [Laughs] So—

Bye.

DAMIANO MANGIATORDI:

I don’t worry about Mom because I know she’ll make it.

DAMIANO, 13 years old

DAMIANO MANGIATORDI:

Well, you know when in movies, or in games—ah, "Endgame," OK? There’s the final part where all the Marvel heroes are—I imagine Mom like Captain America. She gives the order to attack. I imagine her in the role of Captain America.

MARIA TERESA MANGIATORDI:

When I was younger, I didn’t really understand what her job was. I just knew she was a doctor.

MARIA TERESA, 11 years old

MARIA TERESA MANGIATORDI:

But now she’s in contact with a lot of people who have coronavirus, I’m scared that she might bring it home. Not much for myself and my brother, but for my dad, who could get it.

DAMIANO MANGIATORDI:

I’m proud of her because I know how difficult it is to be a doctor. I know how tough it’s been for her now. She doesn’t do it for herself, but she does it for us. And for others, too.

MARIA TERESA MANGIATORDI:

I’m scared. I’m also scared for my parents because I’m scared that if they get a severe case of coronavirus and that me and Damiano, my brother and I have to be at home alone and—I don’t know how to cook and him neither, I mean, not very well. And we don’t know how to divide the chores between us. [Cries] Without them, we don’t know how to do anything.

INTENSIVE CARE UNIT

MATTIA

CRISTINA PILATI:

Here we don’t really see them get better, unfortunately. Either they die, or the ones who improve are transferred.

SASHA JOELLE ACHILLI, Correspondent:

How many deaths have there been?

CRISTINA PILATI, ICU Nurse:

Here? I’ve lost count.

This is a really, really horrible thing. All this in the body of a child. Because at 18 years old you’re still a child.

FRANCESCA MANGIATORDI:

So, I've been upstairs to visit Mattia, the 18-year-old boy who was intubated. I read an article in the newspaper, written by his mom, who, in the evening while she’s waiting for the phone calls, hopes not to receive any that might give her even worse news. And above all she asks the nurses to caress him—as if she were doing it herself.

LAURA BOCCHI:

Today I’m starting to get used to the idea that I need to stay locked in here and that I have become a patient.

I’m starting to adapt to the space that my son so generously gave me—namely, his room.

RULES

1. Knock & don’t open

2. Enter only with gloves and mask

3. Wash Laura’s things separately

4. Wash hands every time you cough and you touch the mask

5. No kisses for now

I love you all.

LAURA'S SON:

Mom? Mom?

LAURA BOCCHI:

Tell me?

LAURA'S SON:

Am I disturbing you?

LAURA BOCCHI:

No, love, tell me.

LAURA'S SON:

I wanted to ask if you wanted tonight to have passatelli in broth.

LAURA BOCCHI:

You’ve made passatelli?

LAURA'S SON:

We’d like to make them, they only take 10 minutes.

LAURA BOCCHI:

Yes, yes, that’s fine. But can you tell Dad that I’d like a tea please?

LAURA'S SON:

I can make it for you if you want.

LAURA BOCCHI:

Will you make it? Thank you.

LAURA'S SON:

OK.

LAURA BOCCHI:

What prevails today most of all is a huge fatigue, physical, that has me wondering how was I able to keep on working?

LAURA'S HUSBAND:

If you bring me my cup, we can sit for a bit with Mom.

Are you done?

LAURA BOCCHI:

Yes.

LAURA'S SON:

Can I take this off?

LAURA'S HUSBAND:

No, if we’re inside no, if we’re outside, yes.

LAURA'S SON:

How am I supposed to eat then, like this?

LAURA BOCCHI:

Hi!

LAURA'S SON:

Hi.

LAURA BOCCHI:

How are you?

LAURA'S SON:

Good.

LAURA'S HUSBAND:

Did you put lipstick on?

LAURA BOCCHI:

Oh, yes, I put some on as it’s been a while that I’ve looked very dark and cadaverlike. It’s been two days since I started again.

Maybe this is also a time to rest, to let the images of this past month go a bit—that has been strenuous, from every perspective, both physical and psychological.

LAURA'S HUSBAND:

You know, it’s 10 past five.

LAURA'S SON:

Can we go play for a bit?

LAURA'S HUSBAND:

We’ll stay on the terrace for a bit since it's a nice day.

LAURA'S SON:

True.

LAURA BOCCHI:

That’s right. Even I’m keeping the window open. It’s really nice today.

LAURA'S HUSBAND:

Listen, thanks for the company.

LAURA'S SON:

Bye, Mom!

FRANCESCA MANGIATORDI:

Hey, Laura!

LAURA BOCCHI [on phone]:

Hey! Do you think if I come out of the room with mask and gloves—? What the f— can happen? Nothing.

FRANCESCA MANGIATORDI:

That you infect your family? I mean—

LAURA BOCCHI [on phone]:

With the mask?

FRANCESCA MANGIATORDI:

Yeah, Laura. Don’t risk it, c’mon.

LAURA BOCCHI [on phone]:

You know what? I really miss the presence of physical contact. It’s driving me mad, this thing.

I know you say, "What the f— do I cry for, you’re home not doing a f—— thing."

FRANCESCA MANGIATORDI:

No, of course not. I can only imagine it’s a damn situation. Because being home and being basically a prisoner—

LAURA BOCCHI [on phone]:

In the end, I try to keep busy, you know. But I also feel a bit useless here.

FRANCESCA MANGIATORDI:

I know, I know. But staying at home isn’t useless right now. Listen, I'll call you tonight, when I'm done.

LAURA BOCCHI [on phone]:

Don’t you worry, I’m not going to jump out the window.

FRANCESCA MANGIATORDI:

No, it’s too low, it would also be a shame for the pavement, so leave it. [Laughter] C’mon, I'll call you tonight, OK. Bye love, bye.

MATTIA

10th day in ICU

FRANCESCA MANGIATORDI:

We now have Mattia’s CT scan. Let’s look at the images. These look a little better. It’s less, let’s see, ventilation of the two inferior lobes has definitely improved. With regression of the pulmonary consolidation and infiltrates, it's improved.

FEMALE NURSE:

Mattia, do you feel pain? No. Squeeze my hand, Mattia. Well done, really good. OK, good job.

SASHA JOELLE ACHILLI:

It’s tough having Mattia in here, isn’t it?

FEMALE NURSE:

Yes. It’s tough, very tough. I’m not a mom but most of my colleagues are parents and for this reason they identify with Mattia’s mom. It’s as if he were our son in the end. So knowing that it’s going a little bit better—obviously we don’t want to jinx it, but for us it's a very positive thing. Well, it really helps us.

FEMALE NURSE:

Do a video call?

MALE NURSE:

Yes, yes, I’ll do a video call. Video call his mom.

Do you remember the number? Are you ready? Shall I start it? Don't get too emotional, though.