I am a simple country surgeon. I take care of children in Louisiana from birth until the hospital tells me they’re too old for our colorful walls and stickers. You will see these children when you stroll along New Orleans’s French Quarter, playing makeshift drums with their bands in Jackson Square or reaching out for beads along the St. Charles Mardi Gras parade route. You may forget about them after each hurricane fades from the news, but they are here, living, thriving and yearning for a normal that seems to fade deeper into their short memories. These children still come in waves through our doors at Children’s Hospital New Orleans after being shot; getting in a car accident; or experiencing a sickle cell crisis, cancer, premature birth, appendicitis or asthma exacerbations … and the pandemic has not spared them.
This has been a hard year and a half for everyone, and it seems like with every wave it gets worse. Five days ago, after a particularly hard weekend on call, I pleaded with friends to reconsider their stances against masking, vaccinations and distancing. I have read the anti-masking and anti-vaccination posts and memes, and I desperately want to convince those with hesitation that COVID is real — and that this Delta wave is different, especially as it pertains to children. I want to emphasize that the vaccine has been tested and is safe for us, and can protect against severe sickness. Masking and distancing can minimize the risks of contracting or transmitting the virus. Catherine O’Neal, chief medical officer at Our Lady of the Lake Regional Medical Center, the largest hospital in Louisiana, has been pleading for a month that she and her colleagues are having to make decisions that should be unfathomable in the greatest nation in the world.
It’s true that the vaccine is not 100 percent guaranteed against COVID — but what in life is guaranteed, except death? We say, “United we stand, divided we fall,” and yet, I can’t help thinking that we have already fallen.
I wish I could invite those who are resisting anti-COVID measures to spend a day with us at the hospital. The majority of my day seems normal — operations, clinics, rounds — except that none of the operations are for children who require an overnight admission for a problem that is not time-sensitive, because our hospital is back to full capacity. Then I see a car full of kids who’ve been in an accident, and some test positive for COVID. They’re intubated due to other injuries, and I have to tell mom that her youngest child’s respiratory status may decline because of the virus, on top of the bruising to his lungs. Mom also tests positive, and now can only visit her children in the hospital while balancing the need to effectively isolate herself. Meanwhile, the room next door holds an immunocompromised child who does not have the defenses to fight a viral infection.
I walk to the intensivist’s office to discuss our other COVID patients. Is the toddler on a ventilator getting better? How about the baby who has been on the most intense form of life support, extracorporeal membrane oxygenation (ECMO)? How do we balance the increased risk of blood clotting due to COVID with the fact that he has developed a brain bleed secondary to this life-sustaining therapy? This little guy only weighs a few pounds. He has required so many blood transfusions that it’s putting a strain on our already depleted blood bank. There is another baby who got COVID from a visiting family member because they didn’t want to miss out on snuggling even though they felt sick, and now is further isolated from his family. We have 15 to 20 other COVID-positive children who are currently admitted to the hospital.
I know how to deal with stress. I completed five years of general surgery residency, two years in a research lab, and two years of pediatric surgery fellowship. I have seen death. I have learned from my complications. But this is different than stress. As doctors, we talk about wellness and resilience, moral distress and second victim injury. These are all real – the majority of us entered medicine because it was a calling, because we wanted to be healers. But it turns out we can’t save everyone by ourselves. We need all of your help to prevent the spread of COVID, so these beds, nurses, and resources remain available. Because each ECMO circuit, every ventilator, every bed that is taken up by COVID is going to be away from a baby with heart disease, a cancer patient, a child who needs surgery but can’t get it right now because we have no more staff. If you saw what these nurses saw and how hard they worked for the last year, you would understand why so many are leaving their calling. Morally, how am I supposed to choose between your child and someone else’s baby when we only have one ICU bed left?
Every ventilator, every bed that is taken up by COVID is going to be away from a baby with heart disease, a cancer patient, a child who needs surgery but can’t get it right now because we have no more staff.
What haunts me most are the children I never get to meet. The other night, I had to say no to a transfer because area hospitals are full for ECMO capability, and we were also reaching capacity. It reminded me of the time, as a fellow, I received a frantic call from a nearby hospital of a toddler who had been shot in the abdomen. The desperation from the other ER physician as he described the distended abdomen, most certainly full of blood, in a small body that he was doing his best to pump blood back into. “What can I do?” he asked. I attempted to talk him through a resuscitative thoracotomy. “Cut his chest open. Open the pericardium. Cross clamp the aorta and keep doing compressions. If you get a heartbeat back, send him here as fast as you can.” I never met that child, but I will never forget his parents, frantically looking for their baby boy in our hospital hallways because they were told he was coming to us. They were covered in blood, pleading for any information anyone may have, unsure of where to go to find their baby — and their eyes emptying as I had to tell them that he never made it to us.
If you know me, you know I’m arrogant enough to think I can fix almost anything. However, I can’t fix someone that I never get to meet. Many hospitals are at the point where we have to say “no.” North Texas is out of pediatric ICU beds. University of Mississippi is setting up patient care areas in the parking garage. Patients are getting ICU level care in the ER hallways. In Baton Rouge, Dr. O’Neal has been unable to accept transfers for a month — 20 to 25 “nos” a day. My vascular surgeon colleague at the same hospital in Baton Rouge could not accept a transfer of a patient with a clot in the leg because the hospital was full. I can only imagine that without the time-sensitive intervention required, this person has lost their leg. They never got to meet the doctor who could fix their problem.
I am a simple country surgeon. I am not an expert in public health or infectious disease, but I am pretty good at fixing kids with a scalpel. Help us to keep helping these kids, your kids, by allowing me to do my job to the full capacity I can. Please, vaccinate if you qualify. Continue to wear a mask and wash your hands. Stay home if you’re sick. These are clear ways to save children’s lives — and prevent their lives from being endangered in the first place.
