It is so funny how some people just fail to use the brain cells available to them when it comes to risk-benefit analysis and opportunity cost calculations when making a decision. Over a lifetime these skills, repeated over tens of thousands of big decisions, make a big difference, especially when you get good at doing these calculations in the background. Kudos to the OP for putting in the effort. FT is full of people who value this kind of empirical decision-making.

Will the surgery potentially reduce your travel in 2025? Because if you are certain you will not qualify for more SC entries, do you expect to use all 15? If so, will that organic MQD spending enable you to reclaim PM status with a meager Reserve spend? If so, then you really don't need this charge on the AMEX. You have a long time to consider other equally punitive charges later in the year like putting property taxes and/or rents on the Reserve card when you know more specifically what the MQD deficit might be.

If you value requalifying for PM early and getting those RUC's faster, then sure, load up on the Reserve and put it away once you cross the threshold needed to requalify for PM.

Don't forget to factor in taxes for that short-term S&P 500 gain.

Good Luck!