The devastating effects of the novel coronavirus pandemic are multifarious and far-reaching, touching both life and limb themselves as well as less tangible aspects of daily life like economic vitality and job function.
Each applies unequivocally to vascular surgeons, not least of which the ability of specialists to carry out many of the procedures they otherwise would be busy performing.
That was the focus of an International Society of Endovascular Specialists (ISEVS) seminar that took place today (April 2) aimed at tackling some of the more personal issues that flow from the new world COVID-19 has helped create.
Unfortunately, difficult decisions often have to be made, the seminar heard.
“We are thinking about ways in our department and hospital system as to how to cut costs: no travel, we’ve given up call pay for a lot of the things that we do,” said Bernadette Aulivola, MD, director of the division of vascular surgery and endovascular therapy at the Loyola University Health System in Chicago. “We’re starting to look at what staff are critical to the function of our healthcare institution.
“But we’ve also started to have conversations about ways to rebound. So, being proactive: For example, once we get back to full clinical activity and we have that glut of patients—those non-urgent or emergent procedures that we’ve been putting off—can we commit to staffing clinics on the weekends or nights? Can we commit to doing cases in our ambulatory surgery center on weekends, or extending hours into the night?”
The seminar, which drilled into the impact of the virus on career, pregnancy and family, was moderated by ISEVS secretary Palma Shaw, MD, and consisted of vascular surgeons Ellen D. Dillavou, MD, Alan Lumsden, MD, and Charudatta S. Bavare, MD, as well as Aulivola. They were joined by obstetrician-gynecologist Patricia H. Bellows, MD.
Bellows, assistant professor of obstetrics and gynecology at Houston Methodist Hospital in Houston, elaborated on the nexus of COVID-19 and pregnant physicians—or physicians who may have a pregnant wife at home.
“The most important things are good hand-washing, wiping down surfaces,” she said. “If you are a physician working in a hospital where you are exposed to coronavirus patients and you are coming home to a pregnant spouse, it is going to be important for you to de-contaminate as best as possible. If you are concerned you’ve been exposed to a positive patient, it might be worthwhile for you to distance yourself as best you can from that spouse until you can be tested or have time to prevent for symptoms.”
Shifting routines
The panelists elucidated how their daily routines had changed, particularly with regards to the process by which they avoid cross-contamination between work and home.
“My wife is an intensivist at one of the regional hospitals here [in Houston] and so we’re always worried about carrying something home,” said Houston Methodist DeBakey Heart & Vascular Center surgeon Bavare, who has two young children—a 5 month old and a 6 year old. “Clearly we have to make an effort to keep clothes separate … we have a wipe-down routine that we do and our nanny helps with. We wipe down every single surface touched by the baby and touched by us.”
For Aulivola, a new normal has formed at the intersection of her career and home life in the crucible of COVID-19. “I have a full-time nanny who typically cares for the kids,” she explains. “My husband is an anesthesiologist so our work hours are quite long. I have decided to have the nanny take on the homeschooling responsibilities, partially because—even though I am not clinically responsible since we’re on a rotation schedule—as the director of my division my administrative tasks have multiplied, so I have to be at work or at home working day-to-day.”
That new routine, Aulivola conceded, required some thought for another, grave reason: The family nanny’s mother is currently fighting cancer. “One of the things that came up was, ‘Do we have her stop coming because of the potential for us to transmit COVID to our nanny, who brings it home to her family member who is immunocompromised.”
Leadership qualities, too, are of paramount importance amid the crisis, said moderator Shaw, associate professor of surgery at SUNY Upstate University in Syracuse, New York. “We are leaders for the people who work for us, the people around us—our family,” she said. “They’re looking to us to be strong right now because so many people are very frightened. Leadership is showing everything is going to be okay—we’re going to handle it.”
In her home life, Dillavou, whose children are 12 and 13 years old, has noted a paradox. “My kids have been pretty chill [about the COVID-19 emergency],” she explained. “Interestingly, I find that a couple of times a week, it’s the adults in my life—my sisters, my mom, our billing person—who are having overwhelming anxiety about this, and it bubbles to the surface … the kids have rolled with it a lot more easily, I find.”
Medical students-turned-babysitters
Dillavou highlighted the emergence of a grassroots initiative started by Dartmouth College medical students to help healthcare workers handle childcare. It has become a contagion of a different order, she explained. “Across the nation, medical students have volunteered to do childcare for their healthcare colleagues who are on the frontlines,” said the associate professor of vascular surgery at Duke University School of Medicine in Durham, North Carolina. “I know at Duke and many medical schools students have been dismissed of any clinical responsibilities, and especially the third and fourth year students find themselves with a lot of time.”
Back on the theme of departmental finances, Lumsden, chief of Houston Methodist DeBakey Heart & Vascular Center and also ISEVS president, mused on the as yet unknown quantity of the true impact. “I worry the recovery phase of this is going to go on for years,” he said. “It is clearly having a devastating effect on every hospital and every institution, and I think some of them are not going to survive.
“We have not been in a position where we have had to talk about salary reductions, but, for example, I anticipate being able to say to faculty, ‘There will be no travel between now and the end of the year.’ We’re going to have to find the easy ways of saving money before we move on to the much more difficult ways of saving money. However, the faculty, at the end of the day, will be fine. The folks I worry about are the 4,000 furloughed employees we have here at the moment.”
Yet, if there’s a silver lining to the crisis, said Dillavou, it might be the rise of virtual modes of working. “I think we’re all finding ways to do more things virtually. It will be interesting to see moving forward what we keep. We’ve all had all sorts of meetings—both local and far—canceled, and we’re doing everything virtually now. Especially as we are trying to do more environmental conservation and things like that, I’m hopeful we can stay with some of these virtual steps in order to give us all a little more free time, and use this technology we have put forth during this crisis.”
Lumsden captured the magnitude of change in an illuminating statistic from his hospital: “A month ago, our institution was doing 40 virtual visits a day,” he said. “The technology was in place. Now, we’re doing 4,000 a day.”
Back up north, Dillavou said a number of roadblocks stood in the way of virtual visits at her institution. Until about a month ago, that is. “Magically, all the roadblocks have been dissolved now. I think that’s a great thing, both for us and our patients. Hopefully, we’ll be able to keep this—and keep the reimbursements for the virtual visits.”
