When the director of my general surgery program asked for a report on how the pandemic was affecting the residents, I queried my colleagues, promising anonymity to encourage candor. I received a wide variety of responses and reactions. Some are thriving; others are not.
Overall, everyone understands that this is a historic crisis that we will recount at the end of our careers. All are grateful to face the challenge at an institution where we are protected and supported. We admire the efforts of colleagues – ER doctors, anesthesiologists, and others – who answered the call before us. These include our own emergency surgery faculty. Watching the “elective” surgery attendings take trauma call while burn/plastic surgeons become COVID intensivists has been remarkable and inspiring. Indeed, the camaraderie throughout the hospital is energizing. We knew our nurses would stand out, but we were also amazed by the hospital support workers. Our cleaning staff demonstrate their bravery daily and sacrifice as much as any of us.
Despite the show of unity, the pandemic has had its challenges. Most residents experienced some fear about getting sick, and many contemplated their own mortality as much as their patients’. As the first COVID wave came to our hospital, articles were published about residents dying in other cities. We wrote down passwords and discussed whether we would want tracheostomies or what to do if we suffered brain damage from hypoxia or stroke. The potential shortage of ventilators was concerning both for our patients and for ourselves. Otherwise, routine patient care suddenly required courage, yet when people started cheering for us, it felt undeserved. Too many patients were not improving. Other healthcare workers were contributing more, earning less, or juggling more outside responsibilities. The level of psychic stress varies among residents, but it is often greater than the physical.
For residents serving in research positions, labs shut down in mid-March. Our role quickly transitioned to fully-staffing a pop-up COVID ICU. Although this requires the commitment of multiple full-time residents per week, most feel deep satisfaction in helping any way we can, particularly when the rest of our lives are fraught with uncertainty. We value working closely with nurses, respiratory therapists, and burn and pulmonary critical care attendings as we all learn together. We review the literature to keep up-to-date with guidelines. We organize weekly video rounds to discuss changes in our COVID management. We collaborate to give a consistent message to the patients’ families, who hang on to every word in our daily calls. And amid all the discouraging cases, the opportunity to extubate a patient we thought would die is transformational.
A major stressor for research residents is that although the doors of our labs have closed, research continues. Many labs still expect productivity from residents who are now working full-time clinical jobs, and we still need to be productive for our own careers. The work-from-home days are challenging: switching from clinical to research duties each week causes deceleration, which is compounded by lost income, family responsibilities, coursework, and the uncertainty of the crisis. This creates a negative cycle of guilt at the “wasted” days spent recovering from the emotional and physical toll of working in the COVID ICU.
Clinical residents also describe challenges and silver linings. One of the most common reactions is “we miss operating.” Surgical services remain condensed as residents are redeployed to other departments. Some residents selected for redeployment felt undervalued by our department, although ultimately, those services were incredibly welcoming and grateful to have us. Those remaining on surgical services are frustrated by working more hours than redeployed colleagues. Morale is lowest on jobs that seem least relevant to the crisis, amplified by the lack of ability to plan for the future when the schedule changes weekly. The ICU census is now decreasing, and the city is considering reopening, but we have yet to see signs of our lives returning to something recognizable. We worry about surgery ramping up just as we burn out. We worry about a “second wave” happening before we have a chance to recover.
A new role for surgical residents is the team to place and troubleshoot central, arterial, and dialysis lines for COVID patients. Many participants have remarked how refreshing it is to enter the ICU and be greeted by excited nurses who need our help. We enjoy working with friends in the time of social distancing, and for many residents, this is the only opportunity to perform procedures.
Senior residents, by contrast, struggle to apply and interview for fellowships through Zoom without ever seeing the hospitals or cities in person. Chief residents expected their year to be packed with the best cases and the most independence. Instead, very few cases are performed. Seniors also missing the celebratory events to round out their time in our program. We all understand how deflating that feels.
Finally, we all have families; spouses and children (including three or four in utero) for some, or parents, grandparents, siblings, or long-distance partners for others. We worry about their health and, in some cases, wonder when we will see them again. Several residents have made the painful decision to live separately from their families while working in clinical positions. Others fear daily that they are bringing COVID home to loved ones. This fear is by no means unique to residency, but it adds to the burden of doing this job.
In the end, I cannot decide if things are going well or not. That may be because everything still feels uncertain and, at times, overwhelming. Parts of our health system are shining, and others need improvement. As residents, we’re frightened; we’re fearless; we’re overworked; we want to work more. But we are all proud of our work, our colleagues, and our institution. Generations of doctors have lived and died without facing a catastrophic health event quite like this one. Our institution and our forebears have faced many. This is our time.
Maggie Connolly is a general surgery resident.
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