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A Profile in Courage: Covid (+) Returning to the Heart Team

Covid19: A Transformative Beast…

I kind of feel like we are curving up from that BOTTOM of the slippery slope that we have been on for the last 1 ½ years- at least I hope so.  We are no longer frightened. We are no longer obsessed with the fear of exposure or how it relates to our patient interaction while we are doing our job.  We function unafraid and we remain vigilant.

Covid19 has clearly impacted our clinical lives and has been very transformative in terms of how we have revisited the concepts of spatial interaction between all of us.

If we were not well on our way to becoming a noncontact society – in other words 75% of our social interaction having been already transferred and filtered through “Smart Devices”, COVID has transformed the remaining social elements associated with personal connections from a meet and greet to taking the risk of a quick dip in a pond that may or may not be a home to nesting water moccasins. 


A Profile in Courage: Covid (+) Returning to the Heart Team

It was one of those days when so many factors come into alignment to form a confluence of cause and effect- where bad things happen to good people, lives are permanently changed, and the rest of the days clinical events all seem to teeter on the edge of a knife where you are close to crashing someone on bypass- or a myriad of “other” interventional procedures.

So on this day- I find myself kicking back in the pump room- rehashing the last days events even as another potential intervention raises its pernicious head in the cardiac cath lab.

In this world where we worry about the bills, the missed social events, stupid political theater, social media, and god knows what else that keeps us up at night, I can think of 2 people in my immediate sphere whose lives have been irrevocably changed due to no fault of their own, and now face uncertain futures completely superseding the whimsical things that we allow to bother us.

One, is a young patient fighting for a toe hold on life- in truly dire straits due to an unexpected accident that no one could have possibly foreseen.  An accident that has absolutely changed their future as they may have imagined or dreamed it to be.  I have been in medicine my entire life- but this particular event has seared it’s way into my soul because of the pitiful and uselessness of the causal events that led to this abrupt and certain break from the bright future any teenager has a right to expect.

The second person, for whom this chapter is titled, truly enunciates the tenets of Grace under Pressure.  

Let’s call her Mary- K?

I met Mary at Hospital 57 somewhere up North.  She stuck out because she was so genuinely kind and gracious to a total clinical stranger such as myself.  She is on the heart team, and at this institution Nurses for the most part rotate between scrubbing or circulating when we do heart surgery of any kind.

That’s a first, but there are so many “firsts” that I have seen at this heart program- all of which are a positive reflection of the institution and it’s core values.  There are not many people I meet that that I could in all honesty categorize as “SELFLESS”, but in Mary’s case she epitomizes selflessness.  I’m not easily moved to write about random acts of kindness that I encounter in the cardiovascular arena, but there was something about Mary that was different.

We talked, and she shared that she had gotten sick with COVID several months before, and was just now on the edge of recovery.  I was shocked, because here it became obvious that she was a “long hauler” a term used for victims of COVID that suffer long term bouts with post COVID related sequelae with multi-organ implications, none of which are predictable and with no algorithms by which to chart a course of management or treatment. Since there is no body of research established yet that could lend us enough clinical insight to predict or compartmentalize an effective medical plan for full recovery, everything going forward in the life of a “Long Hauler” is a future dotted with question marks. This disease is too new and aggressive for us to establish any sort of coherent regimen or clinical pathways- and has now accounted for far more than the currently stated figure of 600,000 American lives lost. It has :culling of the species” implications…

Is there a stigma to having survived COVID- yet not overcome it?

In essence- when you are categorized and determined to be a “Long Hauler” your fate is to be set aside.  You become a diagnosis yet to be determined.  You become a question mark on multiple levels- from a medical perspective in terms of prognosis, to the question of how will this impair or hamper your ability to come back to work and still do your job at the incredibly high rate of efficiency that cardiac team members are required to perform at.

On our team, there is only one status quo:  Consistent and superior performance and judgement. 

 Tragically labeled and yet avoided, because for many of us- it’s like looking in the mirror and seeing something you don’t want to see.  The potential end of each of us, or a profound loss of physical or mental function to the point of impairment.

Mary scrubs and circulates open-hearts.  After realizing she was in recovery from COVID, I naturally paid more attention to the details of how she processed things during open heart cases, both from the perspective in her role as a circulating nurse as well as observing her right across the table from me- when scrubbed in on an open-heart procedure.

As a scrub she was not at all tentative.  Her hands are steady, good anticipation- and she follows the course of the operation smoothly.  There are countless permutations one can encounter when scrubbing a heart. and none of them seemed to phase her.  She could follow the natural course of events during the cases and as well- could adjust on the fly when unexpected events interrupted the natural tempo and rhythm of the operation.

What I did notice was that she was definitely concentrating a lot- a subtle shift from natural rhythm to concerted effort.  It seemed like she was concentrating a little more in order to compensate for whatever she was dealing with in terms of COVIDS’ subtle after effects and after-shocks.

She herself stated that some days were better than others.  But she never used or mentions COVID as an excuse.

I can look at her and can tell as soon as we speak if she is struggling or not.  She never speaks of it- unless of course we decide to talk about it.

My take on this? 

She is overcoming the shackles that COVID tends to impose- by sheer kindness, honesty, determination, and courage.  She does not quit. 

To see her courage I am truly humbled.

Thank you Mary- I’m glad to be a part of your team 🙂

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