Dispatches: Vascular surgery and pandemic redeployment in New Orleans

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Charles Leithead

At one point in the COVID-19 pandemic timeline, New Orleans was in a perilous position. In late March, the Louisiana governor reported that the state bore the highest rate of growth in cases anywhere in the world—and the Big Easy was its epicenter.

At Ochsner Health, the healthcare system in which vascular surgeon Charles Leithead, MD, practices, there was a sense of being at the heart of the fight locally. As he relates, the institution handled somewhere in the region of 60% of the COVID-19 patients in the area, renovating to incorporate three floors of intensive care units (ICUs) in order to accommodate the influx.

Leithead saw the crisis unfold from the frontlines. As vascular case volume decreased, the six-strong vascular surgery group of which he is part was pitched into the fight, he explains—led from the front by vascular titan Samuel R. Money, MD, Ochsner’s newly installed department of surgery chairman. Coupled with W. Charles Sternbergh, MD, chief in the division of vascular surgery, Leithead says the team was primed to tackle the coming challenges head on.

“We were very fortunate to have two leaders in vascular surgery leading our group and hospital through the pandemic,” says Leithead. “We saw this crisis coming and began to prepare early. We began doing only urgent-emergent cases in March. That was a change; however, we remained consistently busy because of the breadth and diversity of the cases we take care of as vascular surgeons.” Like it did across the country, as non-emergent care was curtailed, Leithead saw his vascular practice take a hit: His case volume was cut by about 50% in April.

During the peak of COVID-19 in New Orleans, he recalls, “we began testing all of our patients in the hospital so that all safety measures could be taken to care for the patients that were COVID+, including our vascular surgery patients who needed urgent and emergency vascular surgical intervention that we performed with all necessary PPE [personal protective equipment].”

Luckily, Leithead goes on, there was “no devastation from a faculty or staff standpoint, but I believe that was because of all the safety measures taken. It was a very intense time. The fear was real. In the early stages, if they contracted the virus, most patients did not do well. Early on, that was regardless of age. Certainly, there were some people who were higher risk than others. That’s why Ochsner went all hands on deck and prepared in every area possible.”

But the vascular team was mindful of burnout.

“When certain members of our vascular division were in ICUs helping the COVID patients, other partners were picking up their call,” Leithead explains. “We tried to maintain positivity and appreciation.”

Rotation was key, he says, as was ensuring no one was working too many shifts. “I was not part of the initial, first volunteer group due to my own concerns of spreading the virus—having a young child and a baby at home.

“Dr. Money contacted me in the first couple of weeks and said they really wanted to focus on more volunteers helping in the ICU—and he was helping care for the COVID patients himself. That’s when I agreed to assist. You don’t want any one person to become too burned out or to be put at too much risk and stress. Prior to my ICU shift, there had been improvement in the care of our coronavirus patients, and I was notified that my assistance was no longer needed.”

Leithead picked up on an ingrained resiliency among some of his colleagues who had been through Hurricane Katrina, which hit New Orleans in 2005. “A lot of the hospital employees had experienced Katrina, assisting during that time, and it appeared many were able to rise up naturally. Because we were learning something every hour, every day. New meetings. New decisions.”

That’s around the time social distancing measures kicked in, and when surgery was stripped back to urgent-emergent procedures. By April, Leithead tells of a settling, an assertion of a level of control and understanding of the care and treatment required.

Into May, as numbers decrease and he observes a plateauing, he is getting back to work.

“Now, we are operating on time-sensitive patients, so, for example, large aneurysms again,” Leithead says. “What’s very important is that we are continuing to maintain the safety mentality of  conserving resources to keep the patients and the staff safe. We are ramping up methodically. We are approaching patients who were canceled first, we’re approaching patients on a priority basis for most urgent first—and that’s certainly true of vascular surgery but also all departments.

“We are seeing that some patients are delaying their surgical dates. My experience is that that’s due to the patients’ fear of contracting the virus and coming to the hospital. There has been a patient driven delay in rescheduling cases, which is pretty unique to this time.”

There also are silver linings.

“We are doing many more virtual visits, and that has actually improved efficiency,” Leithead adds. “So we’re ramping up, getting back to doing cases safely, and I’m seeing more patients in clinic now because of the telemedicine component.”

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