He successfully underwent surgery on November 19 near his home in Minnesota and is reportedly doing well, although he will be away from the podium for three weeks.

According to the Times Dispatch, Smith seemed fine during the concert, using a score to accompany guest soloist Haldan Martinson in Dvoršk's Violin Concerto and conducting Shostakovich's Fifth Symphony from memory.

Smith was replaced for the weekend's remaining concerts by conductor David Hayes, music director of the Philadelphia Singers and a staff conductor with the Philadelphia Orchestra and Curtis Institute of Music. Hayes only had six hours to fly to Richmond and meet the orchestra (but not rehearse with it) before leading a concert Saturday night (November 18) at First Baptist Church.

The Times Dispatch quotes Hayes as saying, "Saturday was definitely a high-energy day. This is the shortest notice I've ever gotten" to guest-conduct.