New York surgeon writes about rationing coronavirus-free care


By Elizabeth Cohen, John Bonifield and Minali Nigam | CNN

In a haunting letter to friends and colleagues, a Columbia University surgeon describes how the coronavirus forced doctors to ration care for very sick patients who don’t have the virus but still need medical procedures .

“We had to make decisions that I never had to contemplate before,” wrote Dr. Emile Bacha, director of pediatric and congenital heart surgery at Columbia University Irving Medical Center. “We had to ration care and make decisions about people considered urgent or emerging.”

Bacha explains that nurses have been deployed to treat patients with coronavirus and that safety equipment is scarce.

“The lack of personal protective equipment is exasperating. Who would have thought that a simple simple surgical mask, something we use and throw away several times a day in normal times, would become a rationed product in one of the wealthiest cities in the world? ” he wrote.

He said his pediatric heart surgery program was reduced to a single operational team, “barely.”

“The most recent guidelines from the hospital are that only really life-threatening problems are allowed,” he wrote. “And we have to decide what to do with countless other cases, such as shunt-dependent infants, children with ventricular septal abnormalities in heart failure, adolescents with bad valves, etc. – all families in need, looking for our help. ”

Bacha refused to be interviewed for this story.

While New York City was the epicenter of the US coronavirus epidemic, hospitals in areas with relatively small numbers of coronavirus cases have postponed certain procedures to prepare for the epidemic.

Governors in dozens of states have ordered elective or elective procedures to be delayed or postponed, according to the Ambulatory Surgery Center Association. Six other states have different levels of recommendations to delay these procedures.

There is often a blurred line between what is considered elective and what saves lives.

Mary Devorak, a 33-year-old marriage and family therapist, was born with multiple heart defects and underwent five heart surgeries and more than a dozen cardiac catheterizations. She lives in Minnesota, where there is an executive order to postpone indefinitely all “nonessential or elective surgeries and procedures” that use personal protective equipment or ventilators.

In the past few months, she has experienced an irregular heartbeat. She says that the last time she felt this, it meant that her pacemaker battery was starting to wear out.

It wasn’t a life-threatening problem immediately, and in November, so she set up appointments on April 17 and 23 to have her pacemaker tested.

In late March, she received a phone call from her cardiologist’s office canceling the procedures.

“It is scary because it makes me realize how dependent I am on a functioning medical system. I took it for granted, I have always been very attentive, “she said. “It is terrifying to think that if something happened now, it would be completely out of my control. “

Jolene Baxter has the same fear. Her daughter, Marlee, has a congenital heart defect and the right side of her heart is not working.

Marlee had three open heart surgeries before her second birthday. She is now 3 years old and was doing well until a few weeks ago, when her oxygen saturation index – a measure of the amount of oxygen in the blood – started to drop.

“I want to know why they are low because they haven’t been in two years, and now they are,” she said.

In early March, her pediatric cardiologist in Oklahoma planned to have Marlee undergo cardiac catheterization on March 17, but the day before, her office called to cancel it and said they did not know when he would be postponed.

In Oklahoma, there is an executive order to postpone all elective surgeries.


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