• Mary MacCarthy

Surgeon predicts post-pandemic future of working from home

Updated: May 6, 2020

Dr. Jane T. is a General Surgeon at a major hospital in Sacramento, California. She gives us the inside view on how doctors are dealing with working from home - a practice she predicts will continue even in the post-pandemic era.

Dr. Jane also tells us how her own hospital has prepared for Covid-19. California has been spared the high death toll seen in New York, thanks to an early state-wide “safer-at-home” directive. But California is woefully behind in testing for the virus; according to the state public health department, as of this week just one-half of one-percent of Californians have been tested. Experts warn that infections - and the death toll - could continue to rise until mid-May.

* Because many U.S. healthcare workers have experienced backlash from their employers after speaking to the media, Dr. Jane prefers to remain anonymous.

HOW ARE YOU GETTING BY? On a personal level, the biggest thing for me was going back to work. Until last week, I was on maternity leave - I have a 4-month-old daughter. I’ve spent hours figuring out how I can breastfeed in the hospital and not bring Covid-19 home with me. It’s not easy - there are a bunch of plastic parts involved in pumping and then storing the milk - how do I get it home safely?

I want to protect my baby, but I’m also the primary breadwinner, so I need to work. And I consider myself really lucky to have a job, at this time - a lot of people don’t.

During my first week back, my hospital had made the switch over to tele-medicine - so that meant I could do a lot of my work from home, holding appointments over the phone.

I was very skeptical that this could work. But - much to my surprise - it’s going great. It turns out that - as a surgeon - after you’ve seen enough people who have the same ailment, there’s a lot that can be sorted out just by talking.

Most of what I do is hernias and gall bladders. And what I’m doing over the phone, it’s no different from what I would do if I saw them in person - minus the exam. I can determine a lot just by what the patient says, and by looking at the lab work already done by their primary care physicians.

After a week, I’m realizing that tele-medicine can be fantastic. I suspect that after the Covid-19 lock-downs, we will increasingly move towards having doctors and surgeons work from home.

We have postponed all elective surgeries. But I do have to go to the hospital for anything urgent. I’m at the hospital now, and I’m on call tonight.

Myself and the other general surgeons, we’re doing a lot of what we call “off-loading” for other departments. When the emergency room gets too busy, or orthopedics gets too busy - they can send us their surgeries

I work for a big hospital which is part of a bigger hospital system. Overall, they've done a lot to prepare for Covid-19.

They put up tents outside, so that pediatric patients and their families can get immunizations done without coming inside the hospital.

Initially, they weren't providing us with N95 masks - but fortunately they have started listening to the recommendations from SAGES - the Society of American Gastrointestinal and Endoscopic Surgeons - and are now giving us N95s to wear for laparoscopic surgeries.

It's during those surgeries that we risk exposing ourselves to high doses of the virus, in an aerosolized form.

[Here I had to jump in and ask Dr. Jane to explain this - because I’ve heard a lot about the “aerosolization” of the virus in hospitals, but I don’t fully understand it.]

Let me explain.

Laparoscopic surgery is when we do surgery making much smaller cuts into the body, compared to traditional surgery.

For what I’m doing - for example a gall bladder surgery - you make just a small cut. Then, you inflate the abdomen, blowing it up like a balloon, with CO2 gas.

All the ports that you’ve put into the patient, they inevitably release a bit of that CO2 into the air. That gas contains whatever is in the cells and bodily fluids of the patient.

We are operating on patients who haven’t been tested for Covid-19, so that leaked CO2 might contain the “aerosolized” version of the virus - which we are then all breathing in, in the operating room.

During the SARS outbreak, there were cases of surgeons being infected this way.

When my hospital initially refused to give us N95 masks, some of my fellow surgeons reacted by saying they wouldn't do laparoscopic surgery at all. For example, for appendicitis - they would do an open appendectomy. For patients, that’s no longer the standard of care! Yet for surgeons - they saw that as the only way to protect themselves from Covid-19.

[We’ve been hearing a lot about an “all hands on deck” approach to Covid-19 in many hospitals, where doctors and nurses from all specialties are called in to treat virus patients. I asked Dr. Jane what the protocols are - so far - in her hospital.]

My hospital has asked for all doctors to list their preferences, in terms of where we would like to be placed if we get a surge of Covid patients.

As a general surgeon, I got a lot of training in trauma - so I am a good fit for the trauma bay, and also for the emergency room. So those are what I volunteered for, as my top choices.

As a breastfeeding mom, I’ll continue to do what I can to avoid the ICU. And hopefully I won’t have to be in a Covid-19 unit. But if I get called, I’ll do it. I’m not going to let my co-workers be understaffed or overworked, just to avoid a potential risk to myself - just because I’m uncomfortable.

Our Covid-19 unit is not yet overwhelmed. Waiting for a surge has been kind of unnerving. It’s like the calm before the storm. And now, things are actually slowing down in California.

Finally - one thing that's frustrating to doctors is the public's lack of understanding of how "flattening the curve" works - when I chat with other surgeons on Facebook groups, we are so annoyed by the meme going around that basically says, "The better we social distance now, the sooner this will all be over." And that's not the case! With social distancing we are flattening the curve - which is exactly what we want - but that also stretches out the curve, which means we have to be committed to social distancing for quite a long period of time. It's easy to understand when you look at the graph - we lower the peak of infections, but that also will extend the duration of the pandemic. By how much longer, we don't know.

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