Not Your Hero
An essay about the many hidden ways Covid damaged us
Welcome to Brief Op Notes. In this newsletter, you’ll find my explorations on the medical profession, reflections on my residency training, and my experiences in learning to become a surgeon.
There is a long tradition of physicians who are also writers: Arthur Conan Doyle, William Carlos Williams, Atul Gawande, Abraham Verghese - but women are conspicuously absent from this list. I hope to continue in this tradition, while adding my own perspective.
My first few essays here will be from the archive of my writings. I originally published this essay on a previous platform on January 20, 2022, just a few months into my first year of residency, and I am now reprinting it with some minor edits.
Last week my first case of the day was for a recurrent breast cancer. As the anesthesiologist was setting up, I noticed that the patient was shaking her leg nonstop while on the table. I looked up at her face to see that, save for the heavy layers of makeup she was wearing, she would have looked pale. Her eyes sat wide in their sockets staring up at the ceiling. She looked as if she was about to cry.
Ugh, was my first thought. Can we not do this right now? I looked away, avoiding eye contact.
A few minutes later the attending walked in to the room, after the patient was asleep, and proclaimed to the OR staff – “I’m just so depressed about this case. Triple negative, unresponsive to treatment, and now metastatic disease. I want to cry.”
Immediately, I was frustrated by this show of emotion. I then immediately thought how callous, how cold of me – I should have felt terrible for being so devoid of sympathy, but I felt nothing. No tears in my eyes, no knot in my chest. This is a symptom of burnout: when your patients, the reason you chose this thankless career, become, of all things, a nuisance to you.
This is a symptom of burnout: when your patients, the reason you chose this thankless career, become, of all things, a nuisance to you.
This feeling comes in waves. So far, I have wanted to quit three times this year. The first time it was a brief, though persistent thought. The second time it lasted a bit longer, making me dread going to work in the mornings. This time was the worst one. I had just come back from visiting my family, and I really could not see the point in what I was doing. I looked into alternative non-clinical careers, and when I realized that was a dead end, I even fantasized about becoming a radiologist.
But then, miraculously, the feeling passed. It seems that just when I reach a breaking point, when I feel like I might actually quit, I switch rotations, or get to do a cool operation, or finally connect with one of my patients, and the love for my job and my patients comes rushing back.
But in some ways, caring too much is worse than not caring at all.
We are now nearly two years into the Covid pandemic. Every few months a new wave appears, and despite optimistic news forecasts that the new strain is not as virulent or severe, it takes over the hospital. Whole floors are blocked off as Covid floors. There are N95s and gowns outside each room. Elective surgeries continue to be cancelled and we spend most days not operating.
Soldiers carry scars years after they are injured in battle, gashes and bruises strewn across their bodies. I will have mine written across my face, the result of hours and hours of N95 use causing pockmarks and skin breakdown on my cheeks. I will never know the sheer terror and exhaustion that residents experienced in April of 20201 – but now there are new terrors.
Our patients have been moved to a different floor because our regular surgical floor has been converted to a Covid unit. The new floor doesn’t have the supplies we need, nor does it have nurses trained to take care of our patients. And it is getting so bad that the patients are noticing.
One day while rounding in the morning, one of our patients, a very sweet young man, when asked how his night had been, said “Well, it was very strange. I know you all work very hard, but last night.. the staff here.. I don’t know how to explain it. I felt like I was in a college frat house.”
That day multiple patients were in critical condition – as critical as you can be on the regular floor without getting sent to the ICU. Blood transfusions, aggressive electrolyte repletions, frequent vitals and labs, urgent imaging studies – all of this, in addition to the usual workflow, would have been stressful enough. But in addition to trying to keep these patients alive as their doctor, I also had to be a nurse, a medical assistant, and a physical therapist. I left work that day tired and stressed, worried that my patients wouldn’t make it to the morning.
I left work that day tired and stressed, worried that my patients wouldn’t make it to the morning.
“Have you noticed,” one of our surgical nurses asked me, “how ever since Covid, with all the staffing shortages and logistical rearrangements, the patients have been getting terrible complications?”
Ms. M had a low hemoglobin one morning requiring a blood transfusion. At 7am we put in the order for 2 units of blood. At 11am, we called the nurse to confirm that the blood was running – no. There was no IV access. No one had called to tell us this. When we called up again at 12pm, no one answered. Finally in the afternoon, one of the ICU providers had to leave the ICU to come up and put in an ultrasound-guided IV, and it wasn’t until 3 or 4pm that the blood was finally running. We are lucky she was ok. Luck, it seems, has been all we are relying on, and that luck is bound to run out soon.
Mr. S, diagnosed with cancer, does not speak any English and lies in bed all day, progressively looking sadder and more distant. Food sent in from his family has been piling up at the foot of bed, untouched because no one helps him to eat.
Ms. H, who should be healthy after an operation for a benign condition, has not been able to walk since her surgery. Every time I see her, she tells me “I want to walk. I want to get out of bed.” One day I gave up trying to track down overworked nurses and physical therapists, and tried to get her out of bed myself, but she felt too weak to do anything more than stand. Since then, I don’t know if anybody has helped her walk around.
Ms. L was bleeding from her wound and her gown was soaked in blood for over an hour until we were able to leave another critical patient to come stop her bleeding. Nobody was able to clean her up until we got there.
Yesterday when we told one of our patients that he was getting better and could be moved from the surgical ICU back to the floor, his eyes opened wide in fear. “Being up there is.. well, I just like the nurses here better.”
To everyone who is tired of the Covid pandemic – you can’t imagine just how tired we are. Our patients are worried, and depressed, and afraid. They are not getting out of bed. They aren’t eating. They are not healing from their operations – I can see them getting deconditioned, languishing alone in their makeshift double rooms without any visitors. And my heart is breaking.
I was, at this time, a 4th year medical student, and though I did rotate in the Covid ICU in April of 2020, I was not deemed an ‘essential worker’ the way the residents were