- Diogo Belo, the unmasked profile
"All of us when we grow up have our heroes, from the comic books, those with flamboyant tights and costumes, with incredible superpowers that only in dreams we can have and that make us keep our mouths open about how fantastic they are.
I was one of those persons, and Superman, Spider-man and Batman fascinated me, but, one by one, I lost interest in them until only one remained: You.
You are my hero, you who wear your white "cloak" every morning and hide the hours of sleep you miss, the hours of fun and leisure you could have, which you put aside to help an old lady in despair at not knowing what will happen to her husband in the surgery, or a young woman with a giant tumor and who is afraid of being operated on, but that you, with your patience and affection, make her realize that everything will be okay, even if you are afraid that you might make a mistake.
You, besides being my brother, are my hero.
I know it is not easy and that human beings do not make your job easier, but you do not need to carry everything alone, we are here for you. When you feel that the weight is too much, pass it on to us, who will carry it for you, for 1 second, 1 minute, 1 hour or as long as it takes so you can fight for us again!
I know you don't have super-speed, super-strength or x-ray vision (which would be so helpful now), but you have more than that, you have willpower, intelligence and a big heart.
You already know what I am like and that I don't say these things to you over the phone, otherwise I would not finish the first sentence without breaking down in tears, but I still needed to tell you this.
Okay, now that you have had this break, put your gloves back on and go back to the fight, while we are here in your “corner” waiting for you to prepare for another round in this tough fight that life is.
The message was written by João for his brother Diogo, who is a neurosurgeon at Santa Maria Hospital and who will soon complete his sixth internship year. From Diogo, without looking at the doctor, I discover that he was an active student at the Faculty of Medicine, who writes very well and is moved by affection, despite the intrinsic bravery that distinguishes him. It is not in vain that he lives, like so many, practically all day in a hospital like Santa Maria and that gives him life. From Diogo the doctor, I realize that he takes the risk of putting himself on the front line to fulfill his mission which, already in high school, he discovered perhaps by instinct, or by destiny. He says with a smile that maybe it was the same bell that rang in João Lobo Antunes' ear when he knew he had to go running to help a patient.
Curiously, it is precisely in the neurosciences library, and where Lobo Antunes’s father met with all the medical advisors, that we sat at an unusual distance regarding the distance that Faculty room has already gone through.
His name is Diogo Belo, he is 33 years old and was born in Faro. Brother João graduated first in journalism and only realized now that he wanted to follow in the footsteps of his father, a physiotherapist. Humanity and spirit of unity were a family inspiration, a mixture of a proud mother, a kindergarten teacher, and a father who aspired to have a child who would follow in the footsteps of his physiotherapy project; if at first he thought that this person would be his eldest son Diogo, time has shown him that nobody's fate is planned and that each person traces it at his right time.
Although I am afraid, I think I have to go back to Santa Maria Hospital to find someone I want to hear personally, after having received so many references of him being “someone bigger” and that “it will not be good to lose him from the Hospital”.
I find him at the door of the Neurology and Neurosurgery Building. Gentle, he tries to let me pass so I can go ahead, but the truth is that I don't have the courage to carry or hold anything, but I don't say it out of deep embarrassment. He realizes it quickly and does it with a smile, "don't worry, I'll press the buttons, that's fine".
While completing the formalism of keeping the mask and choosing a chair placed diagonally, he explains that the attentive look at others cannot be lost just because there is an obligation of distance and that the same physical distance cannot destroy the attention that a doctor must have for his patient. In the course of our interview, he told me almost at the end that social distance is tempting so that the bonds of the minimum treatment between people are lost and that saying "good morning does not infect anyone".
We started, in fact, at the end. I asked him if he was going to stay on campus. He smiled and explained what the training to be a neurosurgeon entails, but he didn’t answer me. Not for now.
It was at an annual symposium that he heard the testimonial of a then neurosurgery intern. What he heard clearly dictated the goal for his first big race, Santa Maria. A man with strong goals, he always sets goals regardless of the difficulty, but not always everything went well the first time. In the first year he applied to the Faculty, his overall grades only allowed him to enter the Dentistry degree. Already close to his medical school, he looked at it and knew that one day he would start studying at the right address, not by chance, but because he decided to do so.
Always setting more ambitious goals, he understood that traveling the world would constitute fertile material to grow and improve. In the second year of his internship, he spent some time in Berlin to take a training course. There he met a Brazilian neurosurgery director whose area of action was surgery of the skull base. He waited for the lecture break and spoke to the doctor who operates in Ribeirão Preto (State of São Paulo). He realized that the volume of work was such and the means so scarce that he had little help from his interns, ending up operating most of the time alone. It was then that Diogo offered to help someone unknown, on the other side of the world and bearing the cost himself. For three months, he realized that man has the ability to adapt to the greatest hardships, reinventing himself through the scenario that is set for him and finding the necessary solutions for each reality.
As the world is never enough for him, he was recently in Phoenix, USA, in one of the largest vascular neurosurgery centres, with Michael Lawton. There he learned to relativize time even more. He was inspired by a 56-year-old man who reached a pioneering level in the world’s vascular neurosurgery and whose schedules are carefully managed between surgeries, trips to the East, giving lectures, and managing, as CEO, the Barrow (Neurological Institute). For Diogo Belo,resting is a waste of time, postponing crucial moments of integrated thinking, the “bottom-up”, an ever higher thought for improvement as a doctor.
A spartan man regarding actions and thought, he does not defend individual glory, only “get value, and become more value for someone” and this is explained in the way he multiplies himself in actions and hours of work, or interaction with others .
As if it were the common routine of any human being, and for him it is, today he presents himself after a night of work in the emergency room, stopped for an hour to receive me and in another hour he will go to the operating theatre. On average, this group of neurosurgeons can work 100 hours a week.
Talking to this neurosurgeon was extremely opportune, when we were looking for answers to the questions that set the tone for us to write this month.
"Where are the people who are sick and who have disappeared from the streets and hospitals?" "What happened to hospital corridors that remain empty and silent?"
These were the questions we wanted to try to explain, but it became clear that we would learn much more than that.
A while ago you used an expression to describe the first year you did not enter medicine, saying: “one day I will be there”. Are you like this in everything you do?
Diogo Belo: Always. I had a daily reminder where I visualized where I really wanted to go and that was always what I thought about. (he smiles)
Not resting is also part of that perseverance?
Diogo Belo: Our training is a boot camp, often compared by American magazines to a training similar to that of the Navy Seals, that is, we are used to extreme schedules. During the entire internship, we work for 24 hours non-stop and then we will operate. Please bear in mind that there are surgeries that last 7 or 8 hours, but that can reach 12 to 14 hours. It seems absurd, almost inhuman, doesn't it? But the truth is that what seem to be endless hours, nowadays it is almost natural to sleep only half an hour, an hour, take a shower and go to surgery for many other hours. The normal question that comes next is whether it makes a difference for a person to sleep well and be rested, or just to sleep for an hour.
So, a 6 hour sleep is too much.
Diogo Belo: It is. I never slept much. (he smiles) And it's not that I don't like it, but I've always tried to do everything except sleep. Even when feeling tired, if I had no medical activity the next day, I would leave and go training, for example. It's needed. And it is important to maintain some normality in our life.
And does the brain not collapse from tiredness? Does one also learn to control this?
Diogo Belo: Training makes us somehow control our brain. The difference between resting 6 hours, or just one, in linear surgery is not much. This is because a lot is based on bottom-up thinking. If the surgery follows repetitive procedures and does not go outside these linear steps, it is almost automatic. In more complex surgeries, top-down thinking comes into play, that is, the cortex has to think “very well, we are facing a different situation and we will have to act in a thoughtful and appropriate way”. And here our brain has to work differently. Of course, if I'm rested I can figure out 10 different ways to reach the same solution, if I'm deprived of sleep, maybe I have fewer options in front of me. It is as if the thought is “damaged”.
Is this exercise of great mental discipline what makes this Hospital a great Internship School?
Diogo Belo: Professor Lobo Antunes made this American thought, with a very well-defined hierarchy, very clear. Each intern of his your year reports to intern of the year above, and whenever in doubt, one reports above. I am currently in year 6 as a final year student (or Chief Resident) and I am in charge of all the younger interns. I end up giving them a lot of “unwritten” training. Whenever they have a question, they talk to me and, on the other hand, and since I am not a specialist yet, I talk to the older specialists to clarify doubts. This spirit of speaking to the hierarchical superior does not, however, mean that, before we have that hierarchy, that we are not all friends here, which may not be easy because it is so competitive. There is always room for everyone to do and operate here. When the Professor brought this very demanding training method here, he also left us with this pride of having this American training. The endless hours have a purpose, the patient's well-being and our own training, the permanent test to assess that we are at the maximum level. I love this service. The training is immense, but so is the sense of mission.
You wrote some texts where you denote an almost rare sensitivity about the possible condition of patients, at a time when all efforts were focused on patients with covid. The question is whether all the rest have been forgotten?
Diogo Belo: These texts and writings always have an episode behind them. Something that would become unbearable if I didn't do it, due to the need to talk about what is going on in the professional sphere, in this case. And I don’t speak up about these matters on the spur of the moment. It was very difficult, knowing how our emergency rooms are always occupied, to see that everything suddenly ceased to exist. Not even the phone rang. The patients had disappeared.
What happened to these people?
Diogo Belo: (He sighs) That was what was most difficult, it was scary to see the empty corridors. That uncertainty hurt us more than bad news. Then, when we started to see the effects of the disappearance of patients from the corridors and the doctors themselves as many became ill, or were displaced to support other areas, we realized the seriousness of these effects.
After the country “closed” and after everyone heard endless times “don't leave home, avoid hospitals”, a measure clearly necessary to control the pandemic, it should have been accompanied by a footnote saying "If it's bad, don't put it off." Two and a half weeks later and on the same day, I was in an emergency, one night, and then two patients entered, one aged 36 and the other 39 years old. Two women entered with a sudden headache, that is, very severe headaches and vomiting, which had lasted for 5 days. In a young woman it is more than an alarm signal for the possibility of a ruptured aneurysm. In the face of these complaints, a skull CAT scan is performed immediately. But that is not what happened here. As they had headaches and despite vomiting, (one even called the Saúde 24 line), but as she was awake and afraid of going to the emergency room, she stayed at home. Increasingly in pain, she had a sudden change in consciousness and fell into a coma. That's how she got to us. We immediately performed a CAT scan that showed she had a ruptured aneurysm and extensive brainstem injury. Neurologically, she was already brain dead. This story was not enough, 45 minutes later another woman came in with a very similar story, having stayed at home for 15 days afraid of going out and hoping to get better. She also came in dead. (he speaks with regret and often his expression is sad)
If these two women had come earlier, would they have been saved?
Diogo Belo: Most likely. I can't be 100% sure. You know that 50% of patients who have an aneurysm rupture die immediately; of the other half, only 30% leave the hospital without a neurological defect. So in these cases, as there was no immediate death of the patients, we could have avoided a second rupture and death. But in addition to these cases, many others came in: tumour surgeries that were being postponed due to the lack of complete teams, which were placed in more urgent areas. Please bear in mind that when something fails, we all fail, there is no individual fault here. No one is to blame for anyone in particular. At the peak of the pandemic, we had only one operating room per week.
Per week? In a hospital like this? And the sick? What were you doing with your time?
Diogo Belo: (prolonged and heavy silence) As we could not have face-to-face consultations, we called our patients and at the time the teleconsultation was not formally on. But it made no sense not to accompany the patients who had just been operated on and who had been discharged, just a few weeks earlier. It was necessary to re-assess them, as it is very easy that without monitoring something goes less well.
During this period of silence, did your team help the covid team?
Diogo Belo: Yes and no. We made ourselves available, but the administration itself required all services to provide a list of skills in emergency, hospitalization and intensive care, in order to understand which doctors were available to help in the covid areas in the IC units. And we, interns and specialists, prepared for this, created a WhatsApp group where we exchanged recent scientific articles to study the various therapies. We even studied how to dress and protect against this virus, these teachings were very important. You know, it makes us more confused to stand still than to do something. We went to the floor where they received the patients and it was very difficult for us to see that environment, the difficulty in managing the patients, more patients arriving and not enough support… We, older interns, who had already done the intensive care internship, reviewed and studied IC. Thus, the time that we had free was spent not reviewing Neurosurgery, but reading about and studying invasive ventilation and everything that we had already learned in the past.
And how was this activation in the emergency room?
Diogo Belo: Our Director obviously wanted to protect the service professionals in some way, in case they were needed for our highly specialized surgical activity. We were more “on the back line”, operating all urgent or emergent patients who were covid positive or whose results were not yet available and were assumed to be positive. All this poses an added difficulty, which is already high, because imagine what it is to operate in our area, which has admittedly the steepest learning curves, in sub-optimal conditions: with an operating theatre that does not have all the necessary material immediately available, with people who do their best, but who have to reinvent themselves depending on the type of patient and the type of operation, and we speak of the most varied specialties, they have to adapt and help the surgeon. Now add all this to having to perform the surgery wearing a mask, hood, cap, two or three pairs of gloves, under intense heat and everything fogged up.
Touch is practically taken away from you…
Diogo Belo: We basically harmed two of our five senses, touch and vision. And then it makes us evaluate the benefit versus the risk for the patient himself. In other words, we evaluate whether it is worthwhile to operate immediately and with all covid safety procedures, because the person cannot wait any longer, or we postpone the procedure for a few hours and we know the patient tested negative, we do not need as much apparatus of gloves and face shields and then we have the most refined senses.
You are never afraid?
Diogo Belo: No. This answer sounds bad, doesn't it? It is true that this issue affected us a lot, seeing that everything was getting worse in the hospital and we thought we were all going to be infected. Then we thought what percentage of us would end up in intensive care and then I was worried about how I was going to help the sick. But there was a day that, even though I always had this Neurosurgery posture of “going for it”, I was moved…
Diogo Belo: When I read Pope Francis' Urbi et Orbi. And please note that I am a Catholic and a believer, but I do not go to church. But when I read it, I felt that it was shaking the structures of a period that was going to be difficult, that was being difficult. At that moment, I also thought, "Wait, the foundations are here, we can be shaken, but the foundations are here, don't go down". And the next day I returned with the same strength as always, because that is always the way. And the path means that for me there is no doubt about where I have to be. And there cannot and should not be any fear of reaching out to the other, as we did before. Covid-19 does not make me retract my hand, I never did it, it is not now that I will do it. So, in a way, it was good to shake the foundations and understand the situation of being all in the same boat and giving value to what we do. But the value comes from the personal fulfilment of helping people in need and not by externalizing our actions. That is why I think that obstacles only strengthen us, force us to grow.
It won't be the same after all this is over, will it?
Diogo Belo: I think not. And we don't even know how it will be, how it will happen. Just as I don't even know if there is already something changing. But that reminds me of a phrase that Professor Vaz Carneiro said many time in our early years, “in this hospital as in any other, there is not and cannot be anyone above anyone”. We are all human beings. I say "good morning" to all those I pass by. And now this gesture of talking through our elbows makes me confused. Proximity cannot be lost, it must exist. If people are experiencing difficult times and if they are not motivated and do not pay attention to them, they give up, if people are not valued, they leave. In these difficult situations, it is important to commit and be a whole for the sake of the patient. Isolated bubbles are not good for anyone and we have to counter this phase.
In May 2021, Diogo Belo will take the internship final exam. After leaving the specialty, he promised himself to go to Japan for a while. At the last minute of our conversation, he replied that when he returns he will go back to his place, to that place that makes sense to him, at least for now, Santa Maria Hospital.
Over a short period of time, it became clear that Diogo is governed by a huge inner strength, put even more to the test in the face of adversity. But he himself knows that he could only be here now, after all he promised it to himself when in the Dentistry degree.
The phone rings, he has to go to the operating theatre right away, surgeries follow now. Calm, and without anyone being able to guess his sleep deprivation, he accompanies me to the lifts, he will still change clothes and disinfect himself, it seems that everything has time to have time, a sign of already established experience.
If we gave a title to describe it, we might use a phrase that he himself quoted between various thoughts...
“Whenever you think about giving up, carry on. Victory loves the tenacious ones”.
And there is something that tells me that we will still hear a lot about the neurosurgeon from the south who has a stoic spirit and for whom, the denser the mountain, the bigger his desire to reach its summit.