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In our continuing series, we include reflections from Anthony J. Vine, MD, FACS, Assistant Clinical Professor of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, and Member, Board of Governors, American College of Surgeons. Dr. Vine writes about his experience on the job in New York City.

Dr. Vine comments on his first shift back in ICU at Mt. Sinai:

“Back to my ‘home’ at Mount Sinai Hospital, New York, NY, I now am assigned to the medical intensive care unit (MICU) for three days of 12-hour shifts, thankfully partnered with my former ‘platoon leader,’ Christopher LaChapelle, MD, although it is just the two of us assisting the MICU staff. The death rate in New York State still hovers around 600–700 a day—a plateau? But my current thoughts extend beyond the sickness, suffering, and death we all have witnessed, revolving more around the heroics of the other frontline workers and ancillary staff who really did not sign up for putting themselves in harm’s way, but who bravely have stepped up to the occasion: the nurses, the respiratory therapists and radiology technicians, the volunteer emergency medical services workers, the seemingly indefatigable housekeeping staff, the grocers and delivery boys providing food to those who are quarantined and to the captive hospital staff—and the endless list of others taking unexpected and extreme risk.”

He comments on the difference between those with an oath and those who work by choice:

“…physicians—not unlike the military, the police officers, and the firefighters who must face life-threatening dangers—have made a choice and a commitment to battle potentially lethal enemies such as the human immunodeficiency virus, Ebola, Hepatitis C, and now COVID-19. Upon graduation from our respective medical schools, we swore an oath—either of Hippocrates or Maimonides—that ‘into whatsoever houses I enter, I will enter to help the sick….’

…Be it an anesthesiologist/intensivist intubating or a surgeon operating on the chest or abdomen of a COVID-19-positive patient, we accept these quotidian life-threatening risks as part of our job—but this is not so for all the other aforementioned laborers. The housekeeping staff, for example, changing contaminated sheets or tidying the cubicle of a COVID-positive patient, to me exhibits bravery beyond the usual call of duty.

…hospital chaplains directly administering comfort to the sick or dying patients remind me of the clergy who joined the soldiers on the D-Day beaches and comforted the wounded or gave last rites to those who would not survive; they leaned over their ‘congregants’ with bullets whizzing by their heads.

…As surgeons, Fellows of the American College of Surgeons, we must acknowledge with pride and with humility the courageous character of our myriad volunteer troops fighting by our side, who—in spite of their ‘enlisted/non-officer’ pay grade, and likely lesser quality of health care, disability, and life insurance—are putting their lives on the line with us every day. And it is the corollary and underlying tenor of any oath that we had taken long ago, to protect them as well, and to preserve their safety and health as we would our own.”

Notes of his last rotation in the ICU for now…

“…Whether it be normalcy or normality—the latter being the more accepted literary noun—we all want ‘it’ back as soon as possible. What is normality in the daily life of a surgeon?

…My last two days in the MICU just have not given me even a glimpse of that notion of normalcy. As morning rounds were progressing, there were two more deaths…then I found out that the deceased 32-year-old was the sister of one of our gastrointestinal care nurses I knew so well. The patient’s sister and mother were permitted, by the hospital’s policy, to enter the ICU and to be with their loved one. They were gowned and gloved, but no one could hug, and no one could cry on a shoulder; they could release only the loudest of heart-piercing wails that the negative pressure room had no ability to vent to the outside realm…all I could do was to stand in prayer with them….

…I passed by the surgical non-COVID-19 ICU to visit the postoperation (postop) patient [Dr. Vine had operated on this patient for infarcted bowel] one more time before leaving the hospital: she was still on levophed and vasopressin, with an unchanged lactate of 5.

…I spoke to the patient’s husband several times—I had operated on their son’s hernias and his mother’s colon cancer in the past—yet, because of COVID-19, he was not permitted to come visit her in the hospital. And I could not, as is my usual routine, wander down to the family waiting area to chat and sit with him postop.”

Upon returning home, Dr. Vine ponders the future:

“Another day filled with extraordinary suffering and the omens of further mortality…. When will normalcy return? And when it does, what will it be like? I cannot imagine how much post-traumatic stress disorder we will encounter after this viral war, after this crisis has subsided….

I received a most special gift in the mail from a close friend—really almost a brother to me: a gorgeous violin bow that he had fashioned himself from an exquisite block of sacred Pernambuco wood. Of course, after unpacking and immediately throwing away the UPS box, and then wiping with Lysol the PVC tube in which it had been so carefully wrapped, I had to let it sit for three days. The anticipation of looking at it and drawing it across my violin strings was almost unbearable, but I had to abide by my COVID-mania. When will I play chamber music again, and will we have to sit six feet apart to play a Beethoven quartet? I don’t know what the new ‘normal’ will be and when it will occur, but I certainly look forward to penning more optimistic and, shall we say, ‘normal,’ chronicles in the near future, heaven permitting.”