A Surgeon’s Voice in the COVID-19 Era

We send our thoughts, prayers, gratitude and respect to the health care workers in the greater New York City area and other U.S. regions who are fighting for patients in the epicenters of COVID-19.

Anthony J. Vine, MD, FACS, Assistant Clinical Professor of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, and an ACS Board of Governor delivers a second report for our newsletter. This message focuses on a poignant meeting he and his colleagues had before entering the COVID-19 battlefield. Read more below.

Prior to my deployment tomorrow—and yes, I use battlefield terminology—we had such a Zoom meeting with our Surgical Commander-in-Chief, Michael Marin, MD, FACS, and with his military aide-Vice Chair of Administration, Paige McMillan, MHA.

As Dr. Marin addressed the platoon, the first segment of his speech alluded to the harrowing nature of the beast we are fighting: this is nothing like anything we ever have encountered. For now, we are no longer surgeons, nurse practitioners, residents—we all are equal healthcare soldiers. There will be chaos. People will die: we will witness this and we may be powerless to prevent this outcome.

However, as Dr. Marin had each of us on the team—visible on the Zoom Gallery mode—introduce ourselves, he also requested that we reveal a personal, perhaps intimate, detail beyond our credentials. Here was a single mother, trying to prepare for Passover with her son and daughter; a plastic surgery resident with young children; myself, a violinist and chamber musicians.

As the conference progressed, Dr. Marin outlined the team approach, designating the Chief/Senior Resident as the group’s Platoon leader—in charge of a duffle bag of PPE, of coordinating the team members (2 MDs/Chief Resident/NP or PA/2 medical assistants)—the go-to central figure. And no different from a platoon or seal team, we must all look out for one another at all times, even while caring for the sick. We must prioritize the team’s safety and welfare—physical and emotional—while still providing the best care possible.

Then silence. Few or no questions asked.

As we all signed off and wished each other good luck, I had simultaneous sensations of terror and sadness, but I realized two other feelings surfacing that Dr. Marin had communicated and exuded: the overriding, more controlling emotions of calmness and inspiration—and it is with these latter two that tomorrow morning I will march to the (to me) unfamiliar front line of Mount Sinai Brooklyn, proud that I am a Mount Sinai NY Surgeon.

The COVID-19 pandemic has given rise to feelings of fear, anger, and helplessness, according the Samuel P. Carmichael II, MD, MS, acute care surgeon, Wake Forest School of Medicine, Winston-Salem, NC. In a brief report from the front lines, Dr. Carmichael suggests that, with up to 1 million projected deaths in the U.S., the virus has changed how surgeons and other health care professionals provide care. Rotating schedules decreased time in the hospital, the provision of only urgent or emergent procedures, and transfer of surgeons to medical critical care units are just some of the adjustments U.S. hospitals have made.

He notes the importance of collaboration, pointing to a recent emergent cesarean section requiring surgical acute care that ended with a healthy birth. “There is light to be seen in the darkness of times and war and plague,” he says, asking that surgeons keep acting on their shared humanity and goodwill.

Watch a video interview that ACS Regent Steven Wexner, MD, PhD (Hon), FACS, FRCS (Eng), FRCS (ED), FRCSI (Hon), Hon FRCS (Glasg), Director, Digestive Disease Center at Cleveland Clinic Florida in Weston conducts with Antonio Spinelli, MD, PhD, FASCRS, Chief of the Division of Colorectal Surgery at Humanitas University Hospital in central Milan, Italy. Professor Spinelli has been continuously caring for COVID-19 patients for the entire month of March.

In addition Dr. Wexner speaks with Julio Mayol, MD, PhD, Chief Medical and Innovation Officer and Professor of Surgery, Hospital Clinico San Carlos, Universidad Complutense de Madrid in Madrid, Spain. Dr. Mayol has been the spokesperson for surgery for the Madrid hospitals to SkyNews and to many other media outlets. He offers his perspective on preparation and execution of COVID-19 strategy.