COVID-19 Update from Dr. Smith: 4/22/20

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,

It might help to expand briefly on some of the complexities of the restart process.  You’ve heard before that our single greatest obstacle is the CUIMC ICU census, which has been hovering at ~230 patients for the past 6 days.  We can’t convert ORICUs to ORs until we decant the 78 patients occupying them.  We could partially restart today in the eight unconverted rooms on the Heart Hospital third floor, except that most of the OR and PACU nurses, and many of our redeployed faculty, extenders, and residents, are busy taking care of the ORICU patients.  Decanting will be a slow process because the average patient stays on the ventilator for three weeks.  NYP is making aggressive efforts to identify other inpatient facilities capable of managing these patients during the long tail of their chronic illness.  As beds empty, my hope (not a strategy!) is that we will un-redeploy at a steady rate that matches the demands of restart.

Yesterday, earnest readers concerned about my reputation warned me that Stanford President Jordan was a eugenicist.  Indeed, I find that is a Wikipedia truth.  His name was removed from a Palo Alto middle school in 2018 for that reason.  Why stop there?  He was also suspected of covering up the suspicious 1905 death by strychnine poisoning of Jane Stanford, Leland’s wife.  His motive is a subject of unresolved speculation.  Alas, I was seduced by trivial charms…helicopter parents 160 years ahead of their time forced him to attend a girl’s high school!  I don’t mean to imply that was bad—maybe that part of his education explains anything good about him, and confounds us that he could be imperfect.  Whatever, as we say today.  He lost something he cared deeply about, twice, even if it was only some dead fish.  He rebuilt, twice.  That was my point.  I erred in extending compassion to a possessor of bad ideas. 

I will try to redeem myself with another visit to the annals of adversity.  Dietrich Bonhoeffer was a quirky German evangelical Christian.  His education included study under Reinhold Niebuhr at Union Theological Seminary in 1930.  He taught Sunday school at the Abyssinian Baptist Church in Harlem.  Niebuhr urged him to stay in the US.  Bonhoeffer replied “I must live through this difficult period in our national history with the people of Germany….[and] share the trials of this time with my people.”  He returned, and remained outspokenly opposed to Hitler from 1933 until he was hanged in 1945.  His prison camp was liberated 2 weeks later.  He wrote:  “Action springs not from thought, but from a readiness for responsibility.”  Those of us given disproportionate credit for the thought in this crisis would do well to keep that in mind.  I think of the way security, housekeeping, parking, transporters, and so many others have stepped up.  Or the way our Department staff, who are the connective tissue of our organism, have kept working from home, or displaced in compressed and unfamiliar office space, or volunteering as transporters in the ED.  I think of our fearless residents.  Thoughts, like plans, will get you to the faceoff.  After that, the puck goes where you take it.

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

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