COVID-19 Update from Dr. Smith: 3/27/20

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,

The enemy is inside the wire. This became unavoidably obvious yesterday when another colleague was intubated. Just one of an unsettling number of new ventilator cases at CUIMC, but proof for everyone of how real this is getting, regardless of one’s personal proximity to the razor wire and the Claymores. A widespread anxiety surge followed, with night-long text chains between the newly rattled. What is the proper response? First, at the most practical level, accept that there is no place to hide. The virus has no opinion on class, race, socioeconomic status, or professional stature. This latest reality-test reminds me that when I first bowed at the altar of healing, I felt I had cut a deal with the devil that I would freely sacrifice in countless ways for others, but in exchange for protection of my family. That lasted only until the first of several times that the devil reneged on our deal.

Perhaps each of us manages this trick by different means, but we find a way to pull out of an anxiety-driven small view and rise up to the big view. For what it’s worth, I'll offer a personal example: Picture me in the final stages of drying up the minor bleeding that typically follows straightforward replacement of two heart valves. All is very routine until the back of the heart starts to bleed; it’s coming apart. This is a patient I looked in the eye and agreed to care for, to the best of my ability. The preoperative probability of death was ~2%—something like COVID-19—suddenly that has become a very real number, and closer to 50%. I’m not ashamed to confess that my first reaction, 100% of the time, is crippling anxiety and self-doubt. Can I put Humpty together again? But there is no one but me to take care of this. The only response possible is to turn down my thermostat and start trying to do what must be done to save the patient. At least half the time that saves the patient. Back to this reality, we can expect the vast majority of COVID patients to do very well. Even most of those who go on ventilators survive, but not by chance. They survive because we don’t give up. We take care of them, even when we’re distressed. Even so, no one has any illusions about how difficult that can be.

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

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