COVID-19 Update from Dr. Smith: 4/15/20

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,

On the ides of April, we have plateaued.  Unfortunately, coronavirus has not signed an armistice, and shows no signs of surrender.  Walking among the ICU teams yesterday I was blown away (once again) by everyone’s cheerful resolve as they throw themselves into no-man’s land, day after day.  For reasons I’ve covered many times, reaching our plateau doesn’t take the pressure off.  First-punch adrenaline may wane at a time when effort cannot.  It is prosaic in mountaineering to emphasize the frequency of injuries on descent.  Surgeons will understand this analogy:  a difficult reoperative cardiac reconstruction of some kind is finished.  Plateau!  But in this cold, coagulopathic patient every bleeding mediastinal and chest wall capillary must be controlled before you can safely close.  More than rising to the occasion, you sink to the level of your training, and shift gears to maximize miles/gallon.  You aren’t aware of aching feet or a distending bladder (your assistants are) until everything is dry, hours later.  You close, and collapse in a chair to write your op note.  But the initial chest tube drainage is excessive.  You reopen….

We will be moving off our plateau with some advantages.  Remember that we stopped doing elective surgery, only four weeks ago, in large part because PPE was so scarce that even regular surgical masks were limited, to say nothing of N95s.  That was before other public health measures like social distancing were in effect, and testing was extremely limited, so risk of exposure was probably much higher than it is now.  Today PPE is abundant, PCR testing for virus has minimal limitations, and serologic testing for antibody is poised to take off at high volume.  It is conceivable that our healthcare workforce could be comprehensively tested within a week or two.

I will say again, it is time to look ahead, which leads me to hazard comments on our role in the region.  Starting with 20 years of unequivocal reputational superiority in the tri-state area, it is not an accident that the NYP system has carried an outsized share of the burden.  Reputation alone would have counted for nothing without execution, delivered through the combination of commitment, competence, creativity, and civic duty that has carried our city to the plateau in this unprecedented pandemic.  We all deserve to share deep pride in that fact.  The same qualities will lead our city through to the other side.  That will require unprecedented investment and cooperation within our systems.  This will be challenging and exciting, in ways that require the same energy and tenacity that you’ve expended to reach the plateau.  Yes, we might have to reopen once or twice….

Last week a number of our non-clinical staff volunteered to work as patient transporters in the ED.  Yesterday was the first day for one of our volunteers.  In an email she described being welcomed warmly by “an extraordinary team” and made to feel useful, despite her lack of clinical skills and experience.  The N95 mask was a new experience that left a lasting impression on her nose.  She concluded “When it is time to reopen our world again…we will not be the same and that may not be such a bad thing….”  Simple, prophetic, and we will prove her right.

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

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