When the pen is mightier than the scalpel

When an Italian surgeon is called in for an emergency, which thoughts are occupying his mind? The article reproduces a physician’s reaction to a criminal case for medical malpractice unfolding in an Italian court.

Homicide in Sant'Andrea? Dr. Bianco’s commentary

When an Italian surgeon is called in for an emergency, which thoughts are occupying his mind? Is he thinking about his daughters, who will resent him for this new absence? Perhaps an elderly patient who may never wake up again? The following article tracks an physician’s reaction to a medical case unfolding in an italian court.

Made in cooperation with our partners from esanum.it and esanum.fr

Dr. Angelo Bianco is a 54-year-old Italian surgeon. He has been working for twenty years at the Sant'Andrea public hospital in La Spezia, a port city located 160 kilometres north-east of Florence. Dr. Bianco published a text on Facebook following  the arrest of an emergency department chief at a Lombardy regional hospital. The physician had been accused with intentional homicide for administering lethal doses of succinylcholine (also known as Suxamethonium chloride) and propofol to two COVID-19 patients in March 2020 without any protocols. These substances are normally used to facilitate intubation and induce anaesthesia.

The judicial investigation also covered three other cases. According to the investigators, the physician attempted to conceal the administration of these substances. Excerpts from the indictment were published in a local newspaper. At the time of the facts, the hospital where the accused physician was based, was treating 570 COVID-19 patients. At the time of events, the Italian health care system was on the verge of collapse. In Italy, the death toll was as high as 1,000 per day, more than half of them in Lombardy.  

The judicial investigation is ongoing, yet the media discourse on the case became a sensitive matter for many medical practitioners. Concerned by the coverage style of this case, Dr. Bianco took to Facebook to share a few thoughts on the matter. Dr. Bianco has allowed us to reproduce his reflection on the case, his concern over journalistic practicies in this case, and the qustions that arise in the minds of professionals who more often than not, put their entire careers at stake at every moment and with every decision. His comments caused subsequent ripples amongst some medical circles in Italy. For Dr. Bianco, "this affair aroused the indignation and anger of our profession and my words gave it a voice". Here are his thoughts.

Accusing a physician of killing a patient

This is quite a journalistic eye-catching headline, the type that is sought after by the vultures that haunt certain media outlets. The morbid impact is immediate. These stories spread like wildfire on social networks... By comparison, even the coronavirus is seen as a small player. These stories are perfect to titillate public hatred against what some perceive as a professional caste.

The details don't matter. It does not matter what information is added to the case at a later stage of investigation. The how or why does not matter, neither how the facts are told.  Beyond the headlines, such additional information will be relegated to the back of the newspaper, or somewhere at the bottom of the page under the obituaries.

Only the eye-catching headline will remain etched in the physician's soul, together with his defenceless condemnation, his “trial by media”. And beyond the individual case, there´s an uncomfortable feeling that hits many in the stomach: it is the physician, me, you, all of us medical professionals, that have killed a patient.

"If she dies, they will say that I killed her”

At 4 o'clock, the phone rings. Is it already the alarm clock? It's the hospital calling, I have to operate in an emergency procedure. An acute abdomen problem is unfolding. The lady is very old. I struggle to get dressed. My daughters are asleep, the dog raises one eyelid but goes back to sleep too.

I leave the house quietly, trying to fully wake up and gather my thoughts, even hoping that I have put my underwear on and remembered to take the car keys with me. In the rain, I rush to the hospital, vigilant at every crossroads.  

Everyone is ready in the operating room. The grandmother has been lying there, and so fragile for so long, years perhaps. We are all around her, all there to comfort her, united by the same thought: she is everyone's grandmother, everyone must give the best of themselves. 

She is such an old lady. Ninety-two years old. The risk that she won't survive is real. If she dies, will they say I killed her? I return from my internal chatter to myself, and to her. We are ready, I watch the anaesthetist glued to the monitor, I am calm. And I make the incision.

Like pen, like scalpel

All of us physicians have learned the craft of using science and consciousness. This is how we work. We have studied, it is our profession, we know the sacrifices, it is our passion, and we are for some "ostentatiously" paid (tonight I will earn more than 20€ per hour). But, at least, let's say this loud and clear, we are not serial killers. We are men and women, we are fathers and mothers, we are physicians.

It is a sign of civilization, in a country that is civilized and where right and duty go hand in hand, to demand prudence in journalistic investigations, rigour in the choice of sources, and respect for forms and facts when a physician or any other professional is accused of the most infamous of charges, intentional homicide. For the pen can do as much harm as a scalpel when used without science and conscience.

The operation is over. It is seven o'clock in the morning. The grandmother is alive. Today I won't be that monster that will be rushed to a front page headline, not this time, not yet, I can be relieved. But it's too late to take my daughters to school, and tonight they'll be angry with me. Elisa will tell me once again "You're still out, daddy, I'm fed up." And I'll make up another story, where the physician is the hero. They like hero stories. I'm going to have breakfast, and I think I deserve it. It's 8 o'clock, and my working day starts soon. It's a new day. But yet, I'm not a hero, I'm just doing my duty.