Welcome to Invasive Thoughts, the personal blog of Dr. Naidu. All posts are personal opinion, meant to provoke discussion and reflection, and do not represent any institution or organization.
By drnaidu | June 09, 2020 at 07:50 AM EDT | No Comments
The past few months, by any account, have been hard for us all.I, for sure, have always been an optimist.Rarely down or depressed, I’ve always found the silver linings to every situation.But the cloud of COVID was different, perhaps because in its path it also destroyed all the aspects of life that allowed us to weather such storms.Social interaction, hobbies, exercising in a gym, dining out, enjoying the weather and outdoors – all of these were hampered, if not by legislation then by fear of contracting an invisible threat.So, for the first time in many years I found myself working hard still, but without the ability to cope in normal fashion, and hence became a little down.
I definitely recognized this in me.Outwardly the same, but on the inside a quieter time.I retreated into myself more, finding fun things to do alone or with my son - movies, exercising at home or in Central Park, and listening to music.But, for a relative extrovert these things don’t always do the trick.We miss the social interaction, the drive to do something new and exciting, the value of moving forward and not stagnating, not standing in one place too long.
But, there were silver linings, and some of these helped us crawl out and reflect on the good.And as you search for these they were many and quite unexpected.Being at peace with yourself and finding happiness being alone, something introverts have mastered, is a good skill for the extrovert.So, I found long drives in my car to be fun, reflecting on life and letting my mind wander into new territories.I started listening to music more and, yes, even dancing and singing at home to them – flashbacks to my days on an a capella group.I wrote more, a lot more, and now have a dozen papers in various stages of publication.I joked the other day that this is the first time since graduating fellowship that all my academic pursuits are up to date, my table clean!And, of course I’ve relaunched this blog.
But, it was more than these things.Friends near and far were now immediately available on Saturday night video-based hang sessions.One group of friends, those from my hobby collecting original comic book art, includes guys from California, Maryland and here in New York, while my college friends include those from Mumbai India, San Francisco, and Las Vegas.Other friends came out of the woodwork too, like my medical school roommate in Atlanta.Why did we lose track of each other before this and why did we find each other again now?We have all been brought together by the grounding nature of the pandemic - an understanding that relationships and family fundamentally matter more.
And those relationships extended to work as well.Telemedicine turned the tables on us, allowing a glimpse into our patients’ homes.We became their guests for a short time, seeing how they live, letting them invite us in with open arms and a great big smile - a unique angle of the doctor patient relationship we never had.And, also at work, doctors, nurses and all other staff pitched in wherever necessary – the silos rapidly torn down to make way for collegiality and collaboration to get the job done.
Which brings us to now.As race tension heats up nationally and indeed globally, its roots lay here too.The COVID cloud showed us all, whether we realized it or not, that humans are susceptible; all of us, all ethnicities, all ages and gender – because we are all the same to that small unrelenting enemy.And in that moment of realization that we are all the same and all susceptible comes a realization that we mustn’t have enemies within our ranks when there are enemies ready to pounce from outside.
So, here we are.Uncertainty gave way to anxiety, anxiety to fear, fear to depression, depression to hope, and finally hope to awareness and a drive to reimagine ourselves and society.The COVID cloud was the darkest we have seen, at least in my lifetime, but as with all darkness, the darker it is, the more blindingly bright the silver lining is when you finally come out.
Until Next Time,
Srihari S. Naidu, MD is Professor of Medicine at New York Medical College and Director of the Cardiac Catheterization Laboratory and Hypertrophic Cardiomyopathy Center at Westchester Medical Center. He is Past Trustee of SCAI, Trustee Emeritus of Brown University, and President-Elect of the NY Chapter of the American College of Cardiology.
By drnaidu | April 22, 2020 at 09:04 AM EDT | No Comments
There’s a war going on. But, this one has no draft and there are no reserves. Our armor was never ordered, and our soldiers had been scattered across the country. And they weren’t sent off to where any war was expected. They chose where to live, which corps to join, and what type of war they would partake in. Oncologists fought the war on cancer, cardiologists the war on heart disease, neurologists the war on stroke, and so on. Our infectious disease specialists had wars too. There was the war on HIV, a distant memory to most, but recently only minor wars, epiphenomena to the larger wars above. Some worked for hospitals, while others worked alone or in groups, but they all fought in these wars in their own way. And all was good with the world.
Such choice was inherent to a system where physicians paid their own way to become doctors, trained for decades in specialties and then worked for themselves, hospitals or insurance companies on behalf of their patients. The nature of health care delivery in the developed world is highly conducive to this system, where there is excess, in general, and most diseases are chronic, a byproduct of more wealthy societies fraught with obesity, diabetes, sedentary lifestyles and addictions, and their ramifications. And to be clear, we were winning these wars.
But it was not always the case, and in centuries past infectious diseases were the main cause of death, and a quick death at that. This was something the modern world was no longer used to. So what happens when a new infectious disease emerges, like COVID-19, with mass impact on morbidity and mortality? In a health care system not set up for such a vicious and swift enemy, we were utterly and profoundly unprepared and quickly overwhelmed.
The problems were several, and solutions will take time to ponder and develop. Our physicians were not stationed where the war was, for one thing, nor could they quickly get reinforcements. Some had no choice but to participate at the front lines while others had no access to those areas and were unclear of their role. There was no mandate from other areas of the country, for example, or to physicians operating in private practice. Manpower was left up to the hospitals where the emergency rooms were housed. And, even within this workforce, it was not clear how specialists could help. Many had left their basic doctoring skills behind long ago.
Another problem was protection and advocacy. Someone is looking out for our troops when they go off to war, but it wasn’t clear where that responsibility lay with physicians. Do hospitals protect physicians during a pandemic, or does government? Who makes sure we are safe, in this case personal protective equipment, economic guarantees to maintain our income and benefits, and coverage for our families should something happen to us? Who makes sure funding and bailouts for hospitals go to these factors first, covering hospital margins so they can pay those at the front lines? Without these assurances, hospitals are left to worry about their finances, and in some cases have had to institute pay cuts to the very people who are most needed.
If there is one thing that comes out of this it is that we need an emergency plan to respond to new diseases that require massive and rapid reorganization of health care delivery. Physicians should understand that they may be called upon in such situations, and they have to keep their basic skills up, but that their life and their salaries, benefits and families will be protected. And if physicians are going to be asked to serve society as a whole in this way, then there should be loan forgiveness for medical school, limits on malpractice liability, and other concessions in exchange for such national service.
COVID-19 heralded a call to arms, but to do that we have to treat new pandemics as a war and our workforce as soldiers, with all the respect, admiration and protection they deserve. We have to be able to come help if needed, and then go back to our regular war afterwards, all the while not worrying about our personal or financial safety. Otherwise, there will be resentment that we are only looked to for help when needed, and expected to put our lives and our families in jeopardy, without any societal concessions or protections. This is at least one potential way we might do this, exactly.
Until Next Time,
Srihari S. Naidu, MD
Srihari S. Naidu, MD, FACC, FAHA, FSCAI is Director, Cardiac Cath Labs and Hypertrophic Cardiomyopathy Center at Westchester Medical Center and Professor of Medicine at New York Medical College. He is Past Trustee of SCAI, Trustee Emeritus of Brown University, and President-Elect of the NY State Chapter of the ACC. His opinions are his own and do not represent any institution or organization.
By drnaidu | April 19, 2020 at 08:41 PM EDT | No Comments
Hi everyone! Many of you may recall that about ten years ago I wrote a fairly popular blog, long before they were commonplace. I wrote 12 blogs between 2009 and 2012, and they are all still housed on the Journal of Invasive Cardiology website.
I'm planning on starting them up again and will post new ones here going forward. In addition to topics that I generally feel I have something to contribute towards, such as cardiogenic shock, hypertrophic cardiomyopathy and the COVID pandemic and its effects on interventional cardiology, there will also be "water-cooler" type discussions.
For now, please take a look at the dozen blogs. Go easy on me though - I was pretty early in my career when I wrote them!
1. Word of Caution: Proving Less is More is More or Less Easy (2009)
Srihari S. Naidu, MD, FACC, FAHA, FSCAI is Director, Cardiac Cath Labs and Hypertrophic Cardiomyopathy Center at Westchester Medical Center and Professor of Medicine at New York Medical College. He is Past Trustee of SCAI, Trustee Emeritus of Brown University, and President-Elect of the NY State Chapter of the ACC. His opinions are his own and do not represent any institution or organization.
