COVID-19 Update from Dr. Smith: 4/16/20

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,

“Reboot” has replaced “quarantine” and “lockdown” in our daily lexicon, at least if measured by frequency of use rather than immediate relevance.  I get the metaphor, and I wholeheartedly agree with the directional vector it implies, but it’s the wrong word, for several reasons.  For one, we haven’t crashed.  Nor are we electively resetting an annoying processing glitch, like cardioverting atrial fibrillation.  What awaits us is not a clean screensaver asking politely for login.  We’re not returning to basecamp after reaching the summit of Mount Everest.  On the contrary, we have powered through a harrowing pandemic surge at the epicenter of a hotspot to reach the plateau, and now we need to claw our way back to normal—to a new normal.  We are not returning to basecamp, we’re going down the other side into Nepal.  When we get there, much will be familiar but much will not, and there is no way back.

Some examples are already obvious.  Of necessity, we have quickly learned to use telehealth for a remarkable array of patient interactions.  The potential efficiencies have been staring us in the face for a year or two, but habit prevented us from taking advantage.  Traveling to Washington Heights to see our doctors has never been a major attractor.  Minimizing that requirement may extend our reach very positively and competitively.  It’s not perfect; issues surrounding data security and reimbursement require attention.  Telehealth will have less competitive advantage if these doctor-patient encounters feel like ordering take-out, and any California roll will do.  Pixels with audio don’t always match the impact of being in a room with a patient and family.  We will need to figure out when face-to-face is essential for good patient care, as well as for helping patients distinguish us from Brand X.

There are always pros and cons.  The seductive ease of WebEx and Zoom has improved attendance at meetings of all kinds.  Being off-site is no longer an excuse, nor is the time to move from one meeting to the next, since the transition occurs at the speed of light.  On the con side, body language becomes hard to read, since so much of that in live meetings happens stage-left or stage-right when someone feels unobserved.  The distracting and unrelenting exposure to my own image makes me squirm.  That is a completely new element in human interactions that only Narcissus could enjoy.  I’m relieved of that particular burden outside home or office, but ubiquitous PPE has the opposite effect.  Socially important subtleties of facial expression are obscured by masks.  Friendly and happy?  Angry and threatening?  Smoldering with malice?  OR personnel learn to fill in many of those gaps by reading eyes, but not so easily in people we don’t see every day wearing a mask.  We sometimes have trouble recognizing each other without masks. 

At least we have flattened the curve.  More patients are being extubated and discharged.  The steps ahead will take time, and uncertainties abound, but opening up is guaranteed to be more enjoyable than shutting down.

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

Get Dr. Smith's COVID-19 updates in your inbox.