Dr. Brandon Smaglo is an Associate Professor in the Department of Gastrointestinal Medical Oncology at the MD Anderson Cancer Center in Houston.
Submitted July 19, 2020
Since the start of June, things in Houston have gotten quite bad. For a while, I actually thought we might be spared a surge. While cases were surging in other parts of the country, in April and May, we seemed to be holding things at bay and the numbers of our cases were plateauing. Then things were allowed to reopen, too quickly and with much vocal pushback from the medical community. Now, about 8 weeks later, we are rapidly trying to re-control things, are re-shuttering much that had been opened up. It is frustrating because there is no reason we should be in this situation, and yet, here we are.
Fortunately, we had time to prepare, which was put to good use. The hospitals are well stocked with PPE and equipment. Moreover, they are positioned with beds in reserve and also the ability to pivot, to allow certain units to become quickly COVID only, or even ICU. Thus, when it was reported recently that the number of ICU beds in Houston were at capacity, the hospitals were able to increase the N of ICU beds. This does mean, however, that a lot of us are being repurposed, to manage patients in these overfilled hospitals.
The other downside to this to this bed transition is that many people are not able to have the non-COVID treatments that they need. Many surgeries and other interventions that could be postponed already had been earlier, and many are being pushed further back.
One important point that would be our saving grace: even when the city opened up, the hospitals and clinics did not, but kept all of our restrictions in place. I give a lot of kudos to leadership on this. Really saved our hospitals.
There is still pushback in the community towards wearing masks and staying home. Obviously, this is frustrating. Hopefully we will be in another plateau again soon but still, the sentiment here for many of us in the medical community is that we should never have been in this situation in the first place. It is very frustrating.
Submitted April 26, 2020
I have been very fortunate. The hospital systems and medical community in Houston are very strong, and the leadership, both medical and civil, jumped on things early, really shutting them down. As such, we haven’t had a surge like other areas. It has been very tense, nonetheless. First, we keep waiting to see if the other shoe is going to drop and we get hit like other areas have. Second, though, we still have to care for our patients in spite of the COVID risk. I am an oncologist and I do not have the luxury of telling my cancer patients to wait this out, so we have had to figure out ways to get these folks in for treatment safely, and in many cases, keep them on a therapy that causes immune suppression as a side effect, possibly increasing their risk with any exposures. I would describe it like being in the eye of a hurricane. Like, right now, everything is quiet but it is an eerie quiet because we can see a rough time just in the distance and are wondering if the storm will dissipate before that intense area moves over us.
Not being able to touch my patients. Handshakes and hugs, even visual cues like facial expressions are central to my patient care. I feel a big void in the part of my work that is connecting to them.
I live in Texas now, but I grew up in New York, and I went to medical school and did my residency training in Brooklyn. I still have a lot of friends in medicine in Brooklyn. With many of these friends, I have lost touch; with the exception of being connected on social media, we probably have not communicated in years. Suddenly, however, many of them started reaching out, mainly with questions about how bad it was, here in Texas. This happened all at once and from a number of friends up in the City, and I quickly came to realize these messages were a reach for help. I heard, firsthand, how bad it was.
In early January, when things were starting to get out overseas, just on a hunch, I brought two masks home with me from work. One for me and one for my partner, “just in case”. At the time, boxes of these masks were set outside of patient rooms, along with boxes of gloves. They were plentiful. My partner said he thought I was nuts to do so and I felt a little silly myself. About a month later, our gloves and masks were being locked up in the hospitals and distributed because they were being taken en masse. It is hard to believe their supply could be so vital, given how cavalier we used to be about them.
Looking to the Future
I think in the short term, we are going to have to get used to the idea of coming out more slowly. We went into lockdown like a lightswitch but coming back out will be a gradual process, including certainly some periods of going back in as well. This will impact how we shop and dine and go out. I suspect people in large part will be aware of it and appreciate it, keeping their distance in stores and bars and so on for awhile. I suspect for many people, the directives will be slow to fall away and the anxiety will persist, so people won’t go out as much, will continue to mask and sanitize when they do go out, and so on.
In medicine, we’ve rapidly pivoted to do a lot more remotely. This is, I think, a double edged sword. My patients have cancer and time is truly precious. So, visits with me previously, which all had to be in person, had to be doled out carefully. It might be nice if I could have a quick 15-minute visit with a patient to check on them, for example, but if that meant 3-4 hours between driving in, waiting in triage, driving home, etc., then we might forgo it. If we can keep video visits a standard thing, then I can engage more regularly in this way. After all, 15 minutes can really be 15 minutes if the patient can stay home and open up an app or a browser. The flip side is that there is a strong value to in-person clinical assessments. Seeing a patient in person, especially for heftier visits (disease progression, pain assessments, goals of care discussions) really requires face-to-face. I imagine some patients will not agree and will want to do more and more remotely, and I envision having to put some limits on that. I think the pandemic has forced us to make an important and positive move forward in terms of our technological interactions with our patients. We just need to be careful that we don’t end up leaning on it too much.
I have so many friends and colleagues all over the place who are in the front lines of this, in the hospitals and clinics. Every one of them just rolled up their sleeves and got to work. No one complained. No one said, “not my job.” Everyone knew there were increased risks to themselves like never before, and just took it in stride.
The Importance of Unity
The Vassar way is to work together — to take stock of everyone’s talents and skills, and to come together as a group with those to get the job done. There is no worry about ego, or jostling for credit. Nor is there any worry about anyone’s background. There is unity.
Right now, that is how the medical community is getting things done. There is no room for hierarchy. The doctors and nurses and support staff and kitchen crews and maintenance staff are all at the same risk. All have come together to get the job done.
It doesn’t matter what you study at Vassar. Everyone learns the same way, to do their work the same way: as a team, appreciating each other and acknowledging each other. Everyone crosses the finish line the same way, at the same time.