key: cord-0756722-3lxcbl2l authors: Lazzaro, Richard; Patton, Byron; Inra, Matthew L. title: Commentary: Coronavirus disease 2019 (COVID-19) and the thoracic surgeon: Choose wisely and preserve good judgment date: 2021-02-02 journal: J Thorac Cardiovasc Surg DOI: 10.1016/j.jtcvs.2021.01.109 sha: dab0de597879b43eb50442ce60bfde9e6bb76b05 doc_id: 756722 cord_uid: 3lxcbl2l nan Since January 20, 2020, when the first patient in the United States was diagnosed with coronavirus disease 2019 (COVID-19), the United States and health care providers have treated, protected themselves from, adapted to, and learned from the virus that has caused the most significant pandemic of our generation. The pathophysiology of COVID-19 infection and its sequelae has not only required the expertise of internal medicine specialists, but all specialists. The experience presented by Chang and colleagues 1 describes surgical outcomes of a selected group of patients who had developed complications requiring thoracic surgery. The authors are to be lauded for their work operating, healing, and protecting the team. The authors have made an important contribution to the literature, having demonstrated that thoracic surgery can be performed safely on patients positive for COVID-19. We must also remember to stringently assess the risks and benefits of surgery. Some "patients were in progressive respiratory distress that would have resulted in death without surgical intervention," 1 but did surgical intervention hasten this inevitable outcome? Not all "Hail Mary" passes travel 48 yards with 6 seconds left and result in victory. Predetermining futility is difficult; the decision to proceed with surgery is associated with high stakes, strong emotions, and sometimes opposing opinions 2 that can influence the decision-making process. As COVID-19 continues to surge, along with viral mutations compounded by limitations in vaccine supply, and while vaccine distribution has been associated with inefficiencies, real or perceived, in the absence of a specific treatment for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, thoracic surgeons must anticipate that they will be called upon more frequently to evaluate and manage complications of disease and/or disease management, which will ultimately lead to an objective indication for surgery, which can be performed safely. The surgeon must evaluate each patient and assess indications for surgery, the risks and benefits of such intervention, while balanced against alternative treatment strategies. As Shakespeare said in Hamlet; "there is nothing either good or bad but thinking makes it so." 3 Additional caveats exist regarding management of these patients and include viral load, aerosol-generating procedures, as well as optimization of personal protective equipment for the entire team to mitigate further transmission of SARS-CoV-2 to health care providers as well as patients with whom we interact who have not been exposed to SARS-CoV-2 and to our families and community. We wish to share a quote from John Whitehorn, who was describing the residency program developed by Dr Edward Churchill, "Frightened and over-anxious awareness of uncertainty is of little use, for it hinders the operation of good judgement." 4 Extrapolating from this, we recognize that the uncertainties of SARS-CoV-2 virus, and evolution of the disease can be addressed with the following principles to preserve good judgment: (1) As the Grail Knight once said to Indiana Jones, "Choose (your patients) wisely." 5 (2) Personal protective equipment works. Thoracic surgery outcomes for patients with coronavirus disease 2019 (COVID-19) Crucial Conversations: Tools for Talking When Stakes Are High The Tragedy of Hamlet, Prince of Denmark Life is short and the art long, the occasion instant, the experiment perilous, the decision difficult Indiana Jones and the Last Crusade. Los Angeles: Paramount Pictures (3) Take all precautions to contain the virus while doing what is best for the patient. (4) Stay safe and protect yourself and your staff.