The current pandemic of COVID-19 has already brought out the best and the worst in people all over the world. These dark days have also brought out some deep-seeded feelings of fear, anger, selfishness, and, thankfully, selflessness. As a surgeon in a busy tertiary care center, and as a human living in tony Los Angeles, I see the best and the worst in humanity in a matter of minutes each day.
Certainly, in the world of health care and in particular surgery, these scary days (yes, the doctors are scared) seem to be bringing out the best in people. For example, there is the relationship between surgeons and anesthesiologists. Even though we hold each other in the highest esteem, there is a long history of our two specialties poking fun at one another, leading to some ribbing, some hilarious memes (a surgeon falls off his bicycle, and yells “F*#king Anesthesia!”), and occasionally some spats.
Most of this is lighthearted, but not always. We surgeons like to blame anesthesiologists. (Some surgeons are notorious for not even speaking to them by name. Instead, “Hey, anesthesia!”) for just about anything: the patient is too awake, the patient is too sleepy, the surgery is delayed, the bleeding is because the anesthesiologist is running the blood pressure too high. And for heaven’s sake, it’s raining! They are a hearty lot, and most know that grumpy, demanding, ofttimes irrational, surgeons are par for the course. They brush it off and do their jobs. Very well, mind you. We blame them for canceling surgeries if the patient ate breakfast that morning. (Patients need to come to surgery on an empty stomach, to prevent any food sitting in the stomach from going down the windpipe, leading to pneumonia.)
Many of us have argued, “It was just a light bite! They’ll be fine!” We blame them for canceling surgery if the patient did not complete their preoperative clearance with their doctor: “It’s a quick procedure! They’ll be fine!” All as changed now. We surgeons are questioning the necessity of any surgical procedure, which now puts potentially millions (yes, millions) of people’s lives at stake, not just the life on the operating room table. Even the simplest of surgeries, say ear tubes, a five-minute surgery under general anesthesia, can place the entire operating room team (at least four or five people), their families, the recovery room team, their families, the operating room check-in team, their families, and so on and so on, at risk for a potentially life-altering or life-threatening case of COVID-19. We are no longer bantering with anesthesiologists about proceeding with or canceling a surgery; we are bantering with ourselves. Every surgical procedure no longer carries just risks to the patient. The risks to those caring for each patient, extending to a wide web of individuals, is astronomical.
Surgeons, anesthesiologists, and all operating room staff are banded together more than ever before. We thank each other for being there. We look out for each other: If I say “Stop touching your face!” one more time to an unknowing colleague, I’ll punch myself. We make sure that all have whatever personal protective equipment (PPE) is available at all times. Many who work in operating rooms, especially anesthesiologists, are not used to wearing eye protection, gowns, tight-fitting masks, or double gloves. While they wear scrubs, hats, and masks, they do not “scrub in” for surgeries, so higher-level protection is all new to them. We help them protect themselves now more than ever. With our increased personal space in the operating rooms, we have developed a closer connection of mutual respect, caring, and understanding. We thank each other for being there over and over again. We cannot say that enough. We tell each other to go home and stay safe and stay healthy. Many of us know that we will be needed in ways we’ve never been needed before in weeks to come. We need the rest now. We otolaryngologists may be asked to help with intubations and ventilator management. Anesthesiologists will be asked to become intensive care unit doctors and respiratory therapists. Nurses will be needed in the coming weeks more than ever before. We will all be pushed out of our comfort zones. We may be working in tents, already set up at our hospital entrance. Many of us will be home sick. Some of us will be hospitalized, cared for by our colleagues with whom we work caring for others every day. A number of us will die.
Sadly, I’ve seen images of desperation in and out of the hospital, aside from hoarding toilet paper and food. (Enough with the toilet paper already!) Patients have been seen stealing boxes of gloves and masks. Although we’ve seen it before our very eyes, we have not reported them or even called them on it. This terror is bringing out their worst. So be it. We do, however, now have all such supplies locked up. What we do currently have will likely not be replenished when it runs out. These precious, wildly uncomfortable, acne-inducing masks, cumbersome sticky gowns, and bulky eyewear, now under lock and key, are passed out to hospital workers on an individual basis, as if we were Oliver Twist, timidly asking, “Please sir, I want some more.”
We are well aware that each set of PPE equipment we take very likely means one less set available to another caregiver in the coming weeks. We do not use the gear unless we absolutely need to. We make sure everyone in the room has what they need. This is good. As a physician, friends have reached out as never before. I have received generous offers from individuals who are just as terrified themselves of this contagion to donate their stash of precious, now priceless, N95 masks. (Many Californians have a small stock of N95 masks at home, as we’ve lived through evacuations due to wildfires, and risk smoke inhalation injuries.) People are sending each other emails, texts, and even using something as archaic as a telephone, simply to touch base and stay connected. It all matters, and it all helps. In the days after 9/11, people looked at each other a bit differently: There was increased racism and xenophobia. Increased fear of the unknown. There was hoarding and looting. But there was also a lot more concern and connection, checking in on friends from afar, offering to help, making sure even the most distant acquaintance was safe. The extremely thin, albeit powerful, silver lining of today’s debacle is the evidence of humanity and kindness on so many levels — a glimmer of hope, for perhaps millions of people.
Nina Shapiro is a pediatric otolaryngologist and a professor, department of head and neck surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. She is the author of Hype: A Doctor’s Guide to Medical Myths, Exaggerated Claims, and Bad Advice – How to Tell What’s Real and What’s Not and can be reached on her self-titled site, Dr. Nina Shapiro, and can be reached on Twitter @drninashapiro.
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