COVID-19 Update from Dr. Smith: 4/14/20

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,

Today’s census shows once again that more patients are departing than arriving.  Within the NYP system CUIMC and Weill Cornell are bearing the brunt of the ICU/ventilator population, and that population appears to be leveling off, thankfully.  A relative bright spot is that our children’s hospital (MSCHONY) has been relatively spared, although it is sharing some of the adult COVID load in its ICUs.  These trends support our pivot towards restoration of normal.

Inevitably, included among the ongoing challenges of caring for severe COVID-19 illness are details I hadn’t thought to worry about.  Autopsies are one.  When cause of death is unknown autopsy is commonplace, sometimes mandatory, and can have forensic value.  In most settings, autopsies have become uncommon.  Imaging, lab testing, and findings in surgery combine to minimize uncertainty regarding causes of death, and the underlying pathophysiology of various causes is usually well understood.  Offering autopsy to a patient’s family includes acknowledging that the findings may not solve any mysteries, and may not benefit others.  Autopsy can relieve survivors of worry that loose ends were left untied.  Those are not strongly persuasive arguments, but in most circumstances strong persuasion is not justified, especially in the face of religious or cultural discomforts.  Coronavirus upsets that equilibrium and changes the narrative.  We have very little idea why COVID-19 is so lethal and resistant to treatment in certain patients.  Autopsy in COVID mortalities has a relatively high probability of contributing to the advancement of medical science.  On that point we all readily agree, so why is this a worry?  Because phone consent is not considered acceptable—a significant hurdle when visitors are not allowed.  We are pursuing solutions to that unintended consequence of an administrative policy that was less often objectionable pre-pandemic.

Many of you (faculty, NPs and PAs) have been redeployed to the ORICUs and other pop-up ICUs.  I know you are experiencing the challenges of a transition from acute to chronic care.  Your early response to the surge was an allegro of rewarding action—rush the patient to the ICU, carry out life-saving intubation, start lines and drips, stabilize vital signs—all reasonably familiar activities to most of you.  Now your units are full of chronic respiratory failure patients who require oral hygiene, endotracheal tube management, suctioning, turning, skin care, and other important maneuvers for which ICU nurses are specially trained, and our redeployed OR and PACU nurses are not.  This is another important detail I hadn’t thought to worry about in the surge.  The Chairman of Anesthesiology and I are working with NYP to remedy that situation.  We realize your patience, forbearance, and energy are not limitless.

In the past week one of our most valuable and experienced PAs lost both parents to COVID-19 at another hospital in the region.  Seeing this coming, he only wanted them to be together, which couldn’t be done.  In our hospital this week a Surgery business office administrator lost his uncle to COVID-19.  One of our Division Chiefs took her cellphone into the room to give the family a chance to exchange last words.  Nobility in small things will get us through this, together.

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

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