TO THE EDITOR: The coronavirus disease 2019 (COVID-19) lockdown presented serious problems for neurosurgeons all over the world. I read with interest the article by Cenzato et al.,1 which stressed the importance of the “hub-and-spoke system” (Cenzato M, DiMeco F, Fontanella M, et al. Editorial. Neurosurgery in the storm of COVID-19: suggestions from the Lombardy region, Italy (ex malo bonum). J Neurosurg. 2020;133:33–34). In Lombardy this past February, hospitals were rapidly overcrowded by COVID-19 patients, and all neurosurgical activities (mainly trauma and vascular) were gathered at three centers (Niguarda, Brescia, and Varese), which were chosen based on geographical criteria as well as their receptive capacity, creating a hub-and-spoke scheme. In our hospital, scheduled craniotomies for patients with brain tumor were also postponed. I always experience fear and anxiety with regard to these patients’ outcomes. In addition, one of our neurosurgeons was reassigned to the new COVID wards, adding to the new stress the anxiety and fear associated with potential infection.
One of the oldest neuroscientists may be Hippocrates (460–377 bc). The Hippocratic Corpus is a collection of the ancient Greek medical text attributed to Hippocrates.2 In this text, a typical case report of a man with phobia was described.2 “Nicanor’s affection, when he went to a drinking party, was fear of the flute girl. Whenever he heard the voice of the flute begin to play at a symposium, masses of terrors rose up. He said that he could hardly bear it when it was night, but if he heard it in the daytime he was not affected. Such symptoms persisted over a long period of time.” This phobia and anxiety were labeled as a medical disorder, which was clearly discriminated from major depression.2 Hippocrates taught his contemporaries how to achieve freedom from anxiety in his Hippocratic Corpus in which he mentions treatments including “stoicism,” “peace of mind,” and “freedom,” which are the pillars of today’s cognitive therapy.2 These three pillars would hold us all in good stead as we cope with the ramifications of the pandemic in our personal lives and professional practices. One way to escape from the clutches of anxiety is to devote one’s attention to the present instead of worrying about the future.2
Even so, medical practitioners continue to be influenced by their clinical experience, not least in avoiding doing harm to patients.3 In these days of the COVID-19 pandemic, neurosurgeons must often face uncertainty in their practices when choosing which patients to prioritize for neurosurgical procedures. The advice given to us by Hippocrates even 25 centuries ago can be heeded to this day to enable us to cope with the impact of COVID-19 on the practice of neurosurgery.