COVID-19 Update from Dr. Smith: 4/10/20

Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.

Dear Colleagues,

Over my career to date, I’ve done roughly 10,000 cardiac operations. A few percent—a few hundred people—have died. The overall mortality rate for COVID-19 is similar. Almost all of my patients meet me beforehand, usually with family. We discuss what lies ahead, including probabilities of success and failure. Discussion continues postop at a level of intensity inversely proportional to how well things are going. Becoming familiar with me may not be a good sign. When a patient of mine dies, there have usually been many discussions with family, face-to-face and unmasked, reviewing prognosis and goals of care. Emotions are shared. Depending on circumstances, my patient might be included. At the end, when it can be anticipated, family often crowds around the bed to say goodbye. I try to make a brief visit to show respect. None of this routine is unique to me.

Contrast that with what happens to COVID-19 patients who don’t survive. A man falls ill. He says goodbye to his wife on his way to an ICU. After three weeks on a ventilator, the man passes away, alone. The man’s children are spread across the country. He waits in a refrigerator truck for the family to make arrangements. The man rests in the company of many others who would tell a similar story if they could. This is tragic, even cruel, but necessary. Scarcity aside, supervising the proper donning and doffing of PPE for visitors would impose an intolerable burden on overloaded staff. With patients doubled-up in normal ICU bays and packed into converted ORs, there is limited space for caregivers, and no room for visitors. Visitors would increase risk of transmission to themselves and others. To me, a great irony of this plague is the contrast between the intensity of living in families under enforced lockdown and the void of dying alone. Necessary as it may be, that void is deeply upsetting.

700 years ago today, on Good Friday in 1300, Dante began his allegorical journey through the underworld, over the portal to which were the words (translated) “Abandon all hope, ye who enter here.” I’m not introducing this famous poem to imply that we’re at that point. We are quite a bit further along on his journey. Anyone so inclined can read the 33 cantos of “Inferno” between now and dawn on Easter Sunday, and save me a spoiler alert. Today I will mention only that the first group of sufferers Dante and Virgil meet are people incapable of conviction, who are only interested in themselves, and who spend eternity chasing a meaningless banner (flag followers) around the anteroom to hell. They aren’t even worthy of Limbo. Those are not the people who have joined us in the fight against this ugly and indifferent virus.

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC

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