diary of a hospital

A Surgeon’s Hope

“We were looking into the valley of chaos, but we found order.”

The ICU team during the resuscitation of a patient who suffered cardiac arrest on March 30. Photo: Patrick Schnell M.D.

As the COVID-19 crisis continues to unfold, the medical staff at Mount Sinai Brooklyn is providing regular dispatches about their daily experience fighting the virus. Today, we spoke with vascular surgeon Gary Gwertzman, who, like countless other health-care workers in New York, has left his area of specialty to focus entirely on COVID-19 patients. Performing rounds in the hospital’s newly constructed second ICU, built just last week, he’s been using his vascular-surgery skills to inserting intravenous and arterial lines that COVID-19 patients depend on for support. Here, his dispatch.

I first trained as a general surgeon, then in vascular surgery afterward. Mass-casualty events are part of our scope of training and surgery. But while COVID-19 is a mass-casualty event, it’s not a surgical event. The emergency-room doctors and the critical-care doctors are really on the front lines of managing this with support from people like nurse anesthetists and anesthesiologists.

In the beginning, as a surgeon, I felt like my role was ill defined. What is the role of a surgeon in a large group of patients who basically have severe viral pneumonia? And I wasn’t alone. What happened with surgeons in general is that we stopped elective surgery. So you have a very skilled and devoted group of physicians with some free time on their hands.

Everybody knew this was coming, but no one knew who was going to get hit hard. And then it became apparent after a few days, about two weeks ago, that the hot spots in New York City initially were Brooklyn and Queens. Once that became apparent, that chairman of surgery over at the main Mount Sinai started talking to me almost every day — three, four times a day. And what he managed to do is organize these surgeons’ skills and deploy those passionate people throughout the health-care system.

A community hospital like ours generally has one ICU, and it was becoming obvious that the intensivists there alone couldn’t handle the influx of critically ill pneumonia patients. So right away a group of surgeons from the main Mount Sinai came over to that ICU and staffed it. And it’s not just general surgeons; it’s been plastic surgeons and vascular surgeons. I’m proud of them. They’ve walked into a hospital where they’ve never been in their lives, and they have managed to step up to the plate and take over and take very, very good care of the patients. That has allowed our intensivists to just kind of step back and oversee more than actually being in the trenches. And I think our patients have benefited greatly from that.

We started building a second ICU in the hospital last week. We had the beds, we had the space; it was just a matter of updating monitors and getting staffing. Which is a challenge — you can’t magically produce an ICU nurse. But we’ve been able to figure out ways to do that. People have been coming to New York from all over the country to help us, and we’ve managed to organize it over the last few days. They’re managing the floor patients and the ICU patients, they’re managing our ventilators. I’ve met people from Wisconsin, Texas, Tennessee.

There’s been a lot of hit jobs on hospitals. It’s not really fair. Here, at every level, we’re working on PPE, we’re working on all these things. Sure, there’s a lot more intensive care and a lot more codes, but if you walked into our hospital right now, you would see order. Everyone is strained, but we’ve risen to the challenge. We were looking into the valley of chaos, but we found order.

Some people are starting to say Brooklyn may have peaked already. We don’t know. We don’t know where we are. Everything’s a theory.

The first week was very stressful, and I was not sleeping as well. But now I’m much better. I think people look for order. Once you have a sense of purpose and a sense of order, things kind of flow through that. I feel like there’s a process now.

Every day now at 7:30 in the morning, there’s a hospital-leadership conference call. And I listen in on that just to have a sense of where we were and what will happen today. And then up until today, my main contribution has been rounding in the ICU on the second floor. Because my specialty is vascular, I’m starting a lot of lines, intravenous lines, arterial lines, which are necessary to manage these patients. But thanks to the greater health-care network, I’ve been able to bring in staffing from the vascular department to actually take over the lines, and that’s been very helpful. I had to relearn a lot of critical care very quickly.

One of my low points was when a family wanted to come in to view their deceased loved one and I couldn’t let them in. That was brutal. They were understandably upset, and they were unhappy with me, and I was unhappy with me. Emotionally, I was on their side, but I just couldn’t. Another low point is that I have a small vascular team, two surgeons and two technicians and medical and physician’s assistants, one of whom has been with me for 14 years. We’re a close-knit group. And two of them have COVID. When that happens to people that you’re at some level responsible for, you take that personally. It’s irrational, but at the same time I felt really sick about it.

All these health-care professionals who are already here in New York City, plus those people who have come in, are learning how to take care of these patients. And also to some degree, they’re building up immunity to this virus. In a couple of weeks, these people who aren’t from New York will go back to their communities and have an understanding of what it’s going to take to treat these patients when their own communities start getting sick. One of the stories that I think get lost here is that everyone is saying New York is burning down. But New York’s not burning down. And there’s a good chance that when this is all over, New York will help save the country. These guys from Tennessee that I was speaking to yesterday, they will probably have to go back home. And they’re going to bring an operational experience and an organizational experience that can make a huge difference in their communities. I really do think that what’s happening here in New York may make a big difference around the country two weeks from now.

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Diary of a Hospital: A Surgeon’s Hope