Cardiac care physicians and researchers bring confidence to their work – an expectation borne of experience about what can go wrong and right. When COVID-19 began to spread globally early in 2020, it upended the playbook that accomplished physician leaders knew.

“As a leader, there’s no precedent for what we’ve just gone through,” says Rakesh Suri, MD. “To pretend at this point [that] we always knew what was going on would not be true. We were frightened. We were confused. We wanted to call someone for the right answer.”

In February, Dr. Suri was named to the newly created role of President of International Operations. He previously served as Chief Executive Officer and Chair of Thoracic and Cardiovascular Surgery at Cleveland Clinic Abu Dhabi.

In an interview with Brian Bolwell, MD, for the podcast series Beyond Leadership, Dr. Suri describes what influenced his goal to make an impact on healthcare at the global level, and the strategies his teams used when COVID-19 arrived at Cleveland Clinic Abu Dhabi.

Early inspiration

During his teen years, Dr. Suri says he developed a vision to work with teams and with people around the world.

“My father came from India in the ’60s and my mother’s family was Ukrainian-Canadian, and therefore the appreciation of what it took to establish a life in a new country was very real,” says Dr. Suri. “The plight of the human condition globally was also very much front and center. And with traveling the world at a very young age, it became clear that the inequities in healthcare were very real. I think these came together in my young mind to set me on a course to working with teams to impact humanity.”

A mentor told him that if he wished to have an impact on a global scale, he needed to develop expertise at one of the iconic centers in the U.S. During his thoracic surgery residency at the Mayo College of Medicine, he received training by world renowned cardiac surgeon Hartzell Schaff, MD.

Click to listen to the podcast

Podcast excerpt

Dr. Brian Bolwell: Going back to January and early February [2020], what happened in real time at Cleveland Clinic Abu Dhabi with respect to actually seeing patients?

Dr. Rakesh Suri: Our first patient came to us on March 1. We were managing patients remotely in Dubai and other cities around the nation. There are some rather famous cases of athletic teams who came to Abu Dhabi from hotspot areas, and were infected, that we managed and it’s in the media. I don’t want to sort of recapitulate it here for the privacy of some involved. But the point is, is that we were managing patients in ICUs, deploying and recommending prone positioning, giving advice on antiviral and anti-inflammatory drugs, and advising on ECMO placement or avoiding ECMO placement via video conference and telephonically early in the pandemic. At that point we had had no cases in the Emirate of Abu Dhabi, and therefore we were reluctant to transfer cases in when we could manage them remotely.

Once it became clear that that was not going to be effective — and the cases started to increase in Abu Dhabi in March — we very quickly pivoted to meet the needs of the forthcoming patients and the extrapolated wave as the modeling was becoming available. So what that looked like for us is we stood up our disaster mitigation plans.

And that set us up very well for doing the following. We established a split-flow in the emergency department very early on. That not only kept our suspected COVID patients in one part of the emergency department and our non-COVID patients in the other, allowing us to continue our Center of Excellence care. But it also allowed us to protect our caregivers and ensure that we were going to be on the front lines and in the fight combating this disease as long as we were able to, and we would not put our caregivers at risk, this was extremely important.

Of course, we’re a patients-first organization. But as part of Cleveland Clinic Abu Dhabi, one of our key strategic objectives, and we take this very seriously, is caring for each other. And therefore there was no way we’re going to put our caregivers at risk. So the split-flow is very important in that regard. Very quickly that became overwhelmed. And we set up a small tent on the outside to triage, and then very quickly that moved into a bigger tent, probably one of the most amazing and well equipped tents I’ve ever seen with air conditioning, electrical outlets, multiple swabbing stations, PPE available everywhere, which we’re blessed to have through the pandemic in more than sufficient amounts.

So that was pivot number one.

For the same reasons I mentioned in setting up split-flow, we recognized that we needed to be able to care for COVID patients when our isolation room capacity became overwhelmed. And this was again, looking at the modeling that was coming out of Imperial College in London and the Hopkins model. Madhu Sasidhar, who is deeply involved in modeling, was working very closely with the department of health and these two groups in imagining what our extrapolated wave would look like. And they were pretty much spot on. We had a peak that hit us in about in May and into June, and we were ready for that peak with our split-flow in the emergency department, our COVID units, dedicated COVID ICU units and our COVID floors. And very importantly, we were part of an Emirate-wide effort that had field hospitals being created into the convention center.