COVID-19 Update from Dr. Smith: 4/29/20

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,

In my years playing football I played a variety of positions.  I was frequently the passer, but not a very good one, and did not throw passes in college.  Flashes and streaks of brilliant completions were inevitably followed by an interception, after which I couldn’t force myself to release the ball.  I would run with it, or eat it.  Defenses figured that out fast, which immediately took away my running game.  “Throw the goddamn ball!” the coach would snarl.  “Throw it out of bounds.  Throw it out of the stadium.  Just don’t eat it.”  I never overcame my inability to let it fly after my confidence was shaken.

As we reopen our offices and operating rooms, everyone must step into the pocket and throw again, after this frightening COVID interception.  We must project to every patient our confidence that encounters with us are COVID-safe.  Certain obvious building blocks support that, such as proper surface cleaning, allowances for social distancing, and availability of appropriate PPE.  Responsibility for assuring those elements is broadly shared with others.  Patients can see and smell cleanliness, they can see social distancing, and they can see if PPE is provided for those who don’t have their own.  They will see our staff, MDs, and extenders wearing simple surgical masks and circulating comfortably, greeting patients and guiding them to exam rooms.  If we’ve done those parts right patients will approach the first human in their encounter from a base-camp of confidence.  This is the point at which each one of us can help lead the rest of the climb.  They’ll flee base camp if greeted by someone in an isolation gown, gloved, wearing gaiters and a bouffant, with an N95 under a surgical mask under a face shield.  They’ll flee base camp if someone shows fear of patients, fear of colleagues passing by, or fear of the environment—if one of us quickly backs away when someone enters their six-foot zone, or if everything stops while the pen that was borrowed to sign a form is aggressively scrubbed with Clorox wipes.

No one is exempt from this behavior.  In fact, higher rank only makes the right behavior more effective, and the wrong behavior more corrosive.  Imagine a Dr. X, who staunchly argues that our official policies underestimate the risk of COVID infection, especially in old white males, one of which he happens to be.  Dr. X warily approaches to within hailing distance of the comfortable waiting room described above, dressed like someone about to do a tracheostomy in a COVID patient.  “Mr. Jones?” he shouts.  As Mr. Jones approaches, Dr. X tosses him some additional PPE to don, and scurries back to the exam room, maintaining a large lead.  What message does that send?  We must both project confidence, and be aware of how easily we can erode confidence.  We must set aside our own superstitions to help our patients set aside theirs. 

Am I asking everyone to accept unnecessary risk?  In a word, no.  I’m not suggesting that anyone ignore guidelines for prevention of transmission.  Keep in mind that we faced the greatest risk of transmission at the very beginning of our surge.  More evidence emerges every day demonstrating that there were many thousands of infected patients walking around our region by early March, when few of us took the threat seriously.  We were still crowding together.  Handwashing habits were not well developed.  There was no testing whatsoever, and simple histories to detect COVID infection were done inconsistently or not at all.  Just as the surge got serious, PPE became critically scarce.  Included in the new-normal we’re marching toward is a vastly lower risk of coronavirus infection, even when transmission is still possible, because none of those descriptions still apply.  The reduction in nosocomial infection might even exceed any reductions in non-nosocomial infection.  Can I prove that statement?  Not yet.  Am I confident enough to throw the goddamn ball?  You bet I am.

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

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