SGIM Forum


Nessun Dorma!

Nobody shall sleep!...
Nobody shall sleep!
Even you, oh Princess,
in your cold room,
watch the stars,
that tremble with love and with hope.
But my secret is hidden within me,
my name no one shall know...
On your mouth, I will tell it when the light shines.
And my kiss will dissolve the silence that makes you mine!...
(No one will know his name and we must, alas, die.)
Vanish, o night!
Set, stars! Set, stars!
At dawn, I will win! I will win! I will win!

— Nessun Dorma! from Turandot by Giacomo Puccini

I am at a loss for the words that can adequately describe these last several weeks. I know all of you have been deep in the throes of this pandemic. I know you lost patients. You may have lost colleagues or loved ones. This is unprecedented. This is historic. I think it’s fair to say that most of us have never had nor imagined an experience like this. But general internists are made for this. We have the capability to clinically function on many facets of the care team to support the front line. Our skills in research, education, and leadership also make us critical to our organizations in coordinating the overall short- and long-term response at the health system, community and national level.

Before the crisis hit New York City, I had been following and continued to follow the situation as it unfold- ed in Italy. Among the news coverage reporting numbers of cases, mortality and Italy’s health care system’s response were stories and videos of opera singers singing from their balconies while quarantined. For some reason, the song that was most commonly sung in these videos was the aria Nessun Dorma! from Giacomo Puccini’s Turandot. I wondered why? Was this purposeful or just a random performance of a popular song in Italian culture?

The story of Turandot is an apt metaphor for what we’ve been going through—it is one of confidence, determination, and resolve in the setting of overwhelming odds. In Puccini’s opera, Turandot is a beautiful and cruel princess who challenges her many suitors to answer three questions. If they are wrong, the punishment is death. No one has ever succeeded.

Calaf is a brave prince from an unknown land who falls in love with the princess and declares his suit. She presents her riddles and, in triumph, the unknown prince answers them correctly (see table). Turandot despairs and the prince takes pity—offering the princess a riddle of his own—“If before morning you can discover the name I bear, I shall forfeit my life.” But Calaf’s riddle risks more than his own life since the princess then decrees that none shall sleep, under penalty of death, until the name of the unknown prince is discovered. Calaf admonishes the princess for her cruelty and Turandot’s strength and desire for revenge leave her, and she weeps for the first time. Calaf then reveals his true identity thereby putting his life in Turandot’s hands. With the arrival of dawn and the assembly of the court, Turandot addresses the emperor and the people and states: “I have discovered the stranger’s name—it is Love!”

Nessun Dorma! Nobody shall sleep! I know many who have not slept much during this difficult time, meeting and working round the clock—all the healthcare workers and their trainees on the front lines treating victims of the pandemic while caring for other patients stemming the exponential and relentless rise. To meet the needs of the front line care effort, leaders and managers organized teams of providers not accustomed to inpatient, ICU, and ED care with many primary care physicians performing duties not done since training. The situations were not ideal; make shift hospitals, ICUs, lack of testing capabilities, shortages of swabs, masks, and ventilators. The effort to “flatten the curve” required ingenuity and determination. Researchers racing to study the characteristics of the virus and its epidemiology with the intent to reduce its spread, and develop therapeutics, and ultimately a vaccine. All this in several weeks!! Nobody shall sleep!

These are times where our resolve is tested in order to improve the care for all. And these are the times we show everyone what we are made of. The SGIM listserve, GIM Connect, has been lively with ideas and suggestions for diagnosing, managing, and post discharge caring of patients infected and recovering from the COVID virus. It is this collective energy that makes our society and our alliances a gift.

Leadership roles taken on during difficult times are particularly challenging yet especially critical.

It is during this crisis that our new president, Dr. Jean Kutner from the University of Colorado, makes her debut, not in Birmingham as anticipated. This issue of Forum features her inaugural President’s column.

I look forward to her leadership during this difficult time.

#Letter to the Editor

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