Why This Penn Surgeon Is Worried About Appendectomies and Shootings During the Coronavirus Crisis

Penn surgeon Elinore Kaufman, who is concerned about a lack of appendectomies and a surge in shootings during the Philadelphia coronavirus crisis. (Photo courtesy Elinore Kaufman)

Last week, Penn surgeon Elinore Kaufman wrote a moving op-ed in the New York Times entitled “Please, Stop Shooting. We Need the Beds.” In her op-ed, Kaufman pleaded with the public to lay down their guns and other weapons so that doctors and nurses can concentrate on the coronavirus and other non-violent medical emergencies. We caught up Kaufman, a 37-year-old Gayborhood resident, to learn more.

Philly Mag: Your title is “fellow in surgical critical care and trauma surgery” at the University of Pennsylvania. Can you briefly explain exactly what that means?
Elinore Kaufman: Three things. I take care of patients who are in the surgical I.C.U. These are patients who need intensive care, perhaps because they are recovering from surgery. Then I also do trauma surgery. These are patients with severe injuries, like gunshot wounds. And I do general surgery — your appendectomies and things like that.

You’re obviously very busy. But you took the time to write this New York Times op-ed. Why?
We see about 10 to 20 gunshot wounds at Penn each week. About two-thirds go to Temple, about a third come to us, and the remaining are smattered around. And, well, then there are all the people who die of gunshot wounds without even making it to us at the hospital.

Firearm violence and COVID-19 are very different. And by comparing them, I am not saying one is better than the other or that one is worse than the other. But there are parallels. Anybody can get COVID-19. And anybody can be affected by gun violence. Everyone is at some risk. And despite that they can both affect us all, they affect those who are generally most vulnerable in society.

And you’re still seeing a lot of gunshot wounds even though people are supposed to be social distancing?
On the trauma side, we are seeing the effects of social distancing. We are not seeing as many patients falling down the stairs or as many pedestrians being hit by cars. We may not be seeing as many car crashes in general. These are just a set of things that happen when people are out and about.

But we have not seen any slowing in our violent injury rate — the shootings, the stabbings. And unfortunately, there are lots of reasons to think that these injuries will continue. They’ve become a higher proportion of what we do, because there are fewer falls and car crashes coming in.

You said there are reasons to think these injuries will continue. What are those reasons?
Well, there are four axes.

The first, you have domestic violence. People are at home. And they are under stress. You are telling people to stay home, to shelter at home. But for so many, home is not safe to begin with.

And some of these same stressors and factors put people at risk of suicide. We are at a high risk of seeing that, thanks to the economic stress, the emotional stress, and people not having support to the access that they normally have.

Third, we have seen, at least anecdotally, troubling trends of people lining up outside of gun stores to purchase firearms. Unfortunately, plenty of data tells us that having a gun in the home puts people at higher risk of not just suicide but also of firearm assault or homicide.

And then finally, there’s the community violence. The interpersonal assault involving firearms. There are contributing factors like society-level stressors, depravation, systematic racism, and a lack of opportunity, among others.

When did you realize that this coronavirus was the real deal?
We started hearing from colleagues in Italy — there are lots of experts in respiratory illness in Italy — we started hearing from them that they were in a position that we never ever hoped to be in. They were not able to save people, not just because of a severe illness but because systems were overwhelmed.

How has the coronavirus changed your job?
I am not yet taking care of COVID-19 patients. I expect to be as more and more of the hospital becomes devoted to that.

What’s changed for now is really the human aspects of practicing medicine. I’m not shaking a patient’s hand. There’s no hand on the shoulder. There are no hugs to comfort them.

The most striking thing right now in the ICU is the absence of families. It may not always feel this way when you are visiting an ICU, but we really pay a lot of attention to keeping family members at the bedside when we can. But that’s all out the window right now. The rules are really, really strict.

And how has coronavirus changed your life outside of work?
Well, my partner Maria Alvarez and I, we have a five-year-old and a one-and-a-half year old. Maria is a grad student in the School of Education. But now, instead of doing her own teaching, she’s home, teaching our own two children. So I’m very lucky for that.

Penn doctor Elinore Kaufman (right) and her partner, Maria Alvarez | Kaufman and their two children outside their Gayborhood home during the Philadelphia coronavirus crisis (Photos provided by Elinore Kaufman)

The hospital is flooded with coronavirus patients. And you’ve told us that things like pedestrian-involved car crashes are down, while cases involving violent assaults remain abut the same. Any other major changes to your caseload that you didn’t expect?
We’re seeing less things like appendectomies than we should. And so, we are worried that people are scared to come to the hospital for things like that. And we are worried that we are missing people that do need care. It’s far too soon to say this with confidence, but we think that patients are staying home when they shouldn’t be. This could come with some very unfortunate side effects.

How are Philadelphians doing in terms of taking the coronavirus seriously?
I feel like we are doing pretty well, and we have been for the last couple of weeks.

Early on, when this really started in Philly — around the time that they canceled the St. Patrick’s Day Parade — there were still way too many people out.

We’ve seemed to have caught on now, but… I don’t think this will go on forever. But it will go on uncomfortably long. And I worry that we’re not going to be able to stick with it. My hope is that people are going to be able to feel that it’s not that bad.

Our worry is that people will think it’s time to stop social distancing when it’s not.

I’m also worried that we’re not doing enough for the people most affected by the economic consequences, those low-wage service workers, those small businesses, those who don’t have the protections that some of the rest of us have.

A lot of people seem to be looking at doctors and nurses the way that some might look at war veterans, firefighters, or police officers. I’ve seen people post things like “Thank you for your service.”
At the hospital, not a day goes by without free food. It is meaningful, because it’s hard to find the time to get good food. But it’s incredibly meaningful because we know that people are thinking of us and trying to take care of our community. It’s a really scary time, but it’s beautiful to see the strength of our community. I’m sorry, this is getting very cheesy.

It’s fine. I think we could all use a little cheesy right about now.
Yeah. That’s true. Cheesy is good.

This interview has been condensed and lightly edited for clarity.