Melissa Brackmann: Cancer and COVID: When ‘first do no harm’ means everyone

(Trent Nelson | Tribune file photo) Annice Sterling, one of a group of ICU nurses from Northwell Health who will support ICU teams at Intermountain Healthcare in Utah, expresses her thanks at a news conference in Murray on Tuesday, Aug. 4, 2020. Last April, Intermountain deployed two COVID-19 Response Teams totaling 100 caregivers to assist New York City-area hospitals during that state’s major surge of COVID-19 cases. Those hospitals planned to return the favor when their surge subsided, which it now has.

We hear the COVID-19 statistics every day: the test counts, the case counts, the death counts. It feels like we’re becoming numb to the numbers. So I won’t belabor numbers, but underneath them lies a growing and urgent problem.

With record-setting days across Utah each week, our hospital talk turns increasingly to our diminishing capacity. If COVID-19 cases continue rising, our health systems may eventually have no choice but to delay care for everything except life-threatening emergencies — including cancer care.

As a gynecologic oncologist in Salt Lake City, I perform surgeries for women with cancers of the uterus, ovary, cervix, and vulva. Many are curable at early stages but, once advanced, they can progress quickly and be fatal. While surgery is not universally necessary, when needed for gynecologic cancers, surgery is often the preferred first step and sometimes the only opportunity for cure.

As COVID-19 cases rise, I may soon have to tell patients with operable, curable cancers that their surgeries must be delayed secondary to a lack of hospital resources. That they must wait.

Health care teams across the state – from the physicians and nurses to the OR and hospital staff – will always work to provide the best possible care. But if we reach the limit of our resources, health systems will have to make difficult decisions. It’s not hard for me to imagine the faces of my patients and their families, distraught and anxious, as I tell them they can’t have surgery now, and I don’t know when it will be. Because the fact is, I’ve lived this before.

Today’s Utah is March’s Michigan. I was in my last months of fellowship in southeast Michigan when the pandemic struck, and our world turned upside down. Michigan was hit harder and faster than much of the country. The health system was in danger of running out of everything: hospital beds, ICU space, skilled clinicians and personal protective equipment.

Testing supplies were limited but anxiety was rampant. We converted surgical recovery bays into ICUs, reused masks, made plans for a field hospital and redeployed staff to new roles. We drastically reduced care for anything non-COVID, including cancer.

In our gynecologic oncology group, we ultimately delayed surgeries for many women. We went from 15 to 20 cancer surgeries per week to few or sometimes none. We delayed chemotherapy, radiation treatments and imaging studies. This went on for months in an effort to protect patients from COVID-19 and the system from collapsing.

Some of these women sought care elsewhere, but most waited. At best, this was psychologically painful and emotionally exhausting. But other patients' masses grew; their symptoms worsened; their cancers spread. We made the best decision possible for each patient, given the circumstances and the risks, but they were not the same decisions we would have made just weeks before.

I think about those patients as I see Utah’s slow action on limiting group sizes, enforcing masks and restricting indoor activities. I see their faces as I watch our people gathering in unsafe ways: exercising at crowded gyms, eating/drinking inside restaurants and bars, attending religious services, patronizing museums, salons, sporting events, political rallies and theaters.

We can’t continue to prioritize personal “freedom” over our community’s health and safety; or soon I will be telling my Utah patients with cancer that they, too, must wait.

Utah has the opportunity to change course and avoid this fate. We know more about this virus than we did in March, and we know that public health measures like masks and distancing work. But we must act before hospitals are overrun, and these decisions are made for us. We must act swiftly and decisively. We must act now.

I challenge you, the next time you consider making a non-essential outing or socializing without a mask, ask yourself: in exchange for this “freedom,” would you be willing to ask your mother, or daughter, or wife to delay their cancer surgery?

I took an oath to “first, do no harm.” Today “do no harm,” for me, means speaking out. But also, today, “do no harm” really applies to all of us: Limit yourself to essential activities. And, when you must go out, keep your distance, wear a mask, and wash your hands.

Melissa Brackmann, M.D.

Melissa Brackmann, M.D., is a gynecologic oncologist in Salt Lake City.