COVID-19 Update from Dr. Smith: 5/03/20

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,

A colleague finishing her 12-hour shift in the ORICUs sent me a text at 07:00 celebrating the overnight transfer of the last patient in the 4th floor ORICUs.  The 3rd floor ORICUs are emptying steadily.  All 32 ORs will be empty soon.  My text correspondent included a photo of “my” vacant OR 22.  Someday her photo may have archaeological value for memorializing the taped-out perimeters on the floor delineating space for four Covid patients.  I pause to reflect on how few of the patients who passed through OR 22 survived this stage of my room’s lifecycle, then I raise my eyes to the path forward.

In the late 1980s a resident of mine told me about his life in Beirut during the civil war.  He was a medical student promoted overnight to trauma surgeon.  He cared for an endless stream of victims in the basement of their bombed-out hospital, in the former radiology rooms where the location and lead walls provided relative protection.  Lacking simple amenities like IV stands they nailed bags of IV fluid to the walls; at least when they had fluids, and nails.  Now and then groups of fighters from either side would barge in, find their enemies on stretchers, order the doctors to step away from the bedside, and finish them off.  This resident spurned my repeated pleas to train in heart surgery and became a highly regarded pioneer in laparoscopic surgery.  In the present, I hope the basement in his Beirut hospital is overwhelmed with X-rays of broken wrists and CT scans of sore backs.  I wonder when they stop worrying about another surge.

With increased OR capacity approaching, irreversibly we hope, everyone wants to know when we will resume “elective” surgery.  The Governor is assertively in charge of the answer.  That became clear in a March 23rd Directive to “suspend all non-essential elective surgeries and non-urgent procedures statewide.” The April 29th Directive is a familiar mix of mandatory language (must have, shall mean, must comply, must ensure) mixed with nods to reality (adequate, appropriate, should establish, minimize).  It includes marginally related sacraments like “downtime and emotional support.”  One obvious critical issue is the definition of “elective.”  Interpreted most literally, the latest Directive permits anything in Tier 3a and 3b (“most” cancers, intractable pain, cardiac w/ symptoms, several other examples) and would prohibit everything in Tiers 1a through 2b (“non urgent spine & ortho, hip and knee replacement,” along with endoscopies, cosmetic surgery, other).  To bring this home, if we combine our backlog with those patients likely to present, we have plenty of 3a and 3b cases to keep us busy during the ramp-up period.  By the time we’re ready to staff all 32 ORs at Milstein, there will likely be new Directives.  Is this level of regulation too much, or not enough?  Debate over that question is intensely political yet transcends party politics.  Where an institution stands on a particular issue turns on myriad small details, related in most cases to whose ox is being gored.

Forgive me for digressing, but the latest Directive also uses the made-up word “surgeries.”  Fingernails on a blackboard.  Pupils, please:  “Surgery” is the art and science of Surgery.  The things we do treating patients are “operations” or “procedures.”  Have you ever heard a Chemist say he was going to the lab to do “chemistries?”  Or a Physicist say he was off to do “physicses?  Even though I know “surgeries” is already as ubiquitous as PCBs in the Hudson, I feel better every time I get this off my chest.

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

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