COVID-19 has transformed every inch of this hospital and life itself. Grueling decisions must be made, some of which occur more quietly than others. After many friends and colleagues reached out to Emile Bacha, MD, pediatric cardiac surgeon and Chief of the Division of Cardiac, Thoracic and Vascular Surgery, he sent this letter on 3/24/20.
Dear friends and colleagues:
Several of you have asked how it is going and so I will respond here. As most of you know NYC is now the epicenter of the COVID epidemic and my hospital (NewYork-Presbyterian/Columbia and Cornell) has hundreds of patients infected with COVID. As you can imagine, and our Italian, Spanish and Chinese colleagues and others have experienced before us, this has led to a complete change in the life of every single health care worker, both professionally and personally. While cardiac surgeons have not (yet) been deployed in the ICUs, we have had to help in many other ways, including placing COVID patients on ECMO and doing emergency cases under difficult conditions. Our nurses have been redeployed. For example, even nurses who were in charge of databases only are doing basic screening and such. ORs have been transformed into ICUs, with one ventilator serving for two patients. The lack of Personal Protective Equipment is galling. Who would have thought that a simple plain surgical mask, something we use and discard multiple times a day during normal times, would become a rationed product in one of the richest cities in the world?
Specifically to pediatric cardiac surgery, we have had to make decisions that I personally have never had to contemplate before. We have had to ration care and make decisions about who is considered an urgent or emergent case. These boundaries are fluid in our specialty! In-house PGE dependent neonates, Status 1A transplants and hemodynamically unstable patients are easy decisions, they get done. But we only have one OR team, barely. And we have had to decide what to do about endless other cases, such as shunt-dependent infants, Children with ventricular septal defects in heart failure, teenagers with bad valves, and so on- all families in need, looking for our help. The most recent guidelines from the hospital is that only truly life-threatening problems are allowed. The problem is that we don’t really know when we can get these patients back on the schedule and so the anxiety of the parents is extreme. We have initiated transfers to other centers, but they have their own issues as well.
In any case, I sincerely hope that we in NY will be the only ones to be faced with these decisions, at least in the US. I know other places have gone through this before. Maybe this will help others prepare. I can tell you that this kind of work, mixing triaging and ethics and medicine as well as dealing with colleagues getting sick (one cardiac surgeon and several cardiologists at this point) is very different from what we are used to as cardiac surgeons. It’s exhausting in a very negative/mental kind of way, a very different type of exhaustion than the one we all know too well from operating long hours or managing sick patients, which is a much more positive kind of work.
Anyhow, I don’t mean to depress anybody but that’s the new reality now for us.
Best wishes to all and may everybody stay safe,
Emile
Emile Bacha, MD, FACS
Chief, Division of Cardiac, Thoracic and Vascular Surgery
Director, Pediatric and Congenital Cardiac Surgery