In March of 2020, as COVID-19 cases continued to exponentially rise, elective surgeries were stopped in the state of Pennsylvania. I was in my PGY-5 year of Plastic and Reconstructive Surgery residency, a specialty that relies heavily on elective surgeries. My case volume came to a halt and by early April 2020, I found myself, at home, calling every plastic surgeon I worked with asking if they were performing any emergency cases and if I could join them. The answer was a unanimous “no.” With the constraints on personal protective equipment, the push across many hospitals was to conserve all available masks and gowns. This even led to some hospitals restricting the number of participants permitted in each case. Plastics is a hands-on specialty, and to master the art and detail of each case, the individual must be able to operate.
With no elective cases and limited emergency surgery, this significantly cut down on my case volume for the six weeks that the elective surgery ban was implemented. Under this context, many patients were afraid to come to the hospital and delayed any non-emergency surgeries and procedures. Furthermore, many surgical programs were reduced to a skeleton crew. Residents found themselves working half the number of days as cases dwindled to 25% of the pre-pandemic cases due to the cancellation of elective surgeries. This cut was especially devastating to senior residents who view the last few months of their training as a chance to “take off the training wheels.” This is normally the time to make a smooth transition from resident to attending. During this critical time in their residency journey, many residents found themselves covering emergency departments (EDs) and intensive care units (ICUs) as opposed to their core caseloads. A peer plastic surgeon resident spent the last few weeks of her training helping the ICU in a heavy-hit COVID area—it was an all-hands-on deck effort.
The Accreditation Council for Graduate Medical Education (ACGME) response to the COVID crisis was sympathetic to the dire healthcare situation and its impact on resident training across all specialties. Their policy stated, “GME programs continue to be disrupted by COVID-19 in Academic Year 2020-2021. We recognize that typical metrics, such as time, volume, and specific rotations completed, may be unavailable for all residents and fellows. The principles provided are the minimum required to make a defensible, high-stakes entrustment decision for an individual to complete a residency or fellowship and advance to the next stage of one’s professional career during this period of disruption … The ACGME will work with programs, CCCs [clinical competency committee], the Review Committees, and ABMS [American Board of Medical Specialties] certifying Boards during this disrupted period to learn about what works for the implementation of CBME [competency-based medical education] over time.” For many surgical and procedure-based specialties, this alleviated some of the anxiety surrounding graduating with enough cases.
I had another perspective on this time, and it extended beyond the requirements of my residency training. I was in my first trimester of pregnancy and the uncertainty of COVID-19 and its impact on pregnant women worried me. I continued to search for surgical cases, but every time I went into the hospital, I entered with trepidation about what potential risks awaited me. I wore all the personal protective equipment (PPE) I could get my hands on and friends reached out to donate masks and gloves to our hospitals. However, the fear of what the disease could do to me, and potentially my child, made it all the more daunting. Many of my colleagues in frontline specialties began to feel burned out by the pandemic. The lack of PPE, coupled with the unending surge of patients in the EDs and ICUs started to take a toll on everyone in healthcare. As residents in training, this was unlike any of the previous challenges we faced. Though we were on the brink of contracting the virus, we still battled COVID-19 for others. The line between doctor and patient became blurred.
Now, as we near close to a year since the pandemic started, I can’t deny that this past year has changed me as a clinician, and even more so as a surgeon. I can no longer continue to practice medicine in the ways I previously had. I wear gloves and double masks with a face shield, my own identity in some respects limited to the scrubs and the white coat I wear. Before COVID-19, I could offer my patients comfort with a smile or a gentle pat on their shoulder, whereas now I hope that they can see the compassion through my brown eyes smiling at them and the concern and support in my voice. COVID-19 created a new norm as many plastic surgeons transitioned to virtual consultations, limited staff, and new, more strict infection control protocols in the office.
While our case volumes began to return to pre-pandemic numbers, our healthcare system has shifted. I now sit in on telehealth appointments and consultations. Patient appointments are widely spaced out with pre-appointment screenings and day-of temperature checks with strict hand hygiene. As COVID-19 continues to dominate our healthcare systems, the promise of new vaccines finally brings hope for taming a disease that ravaged many lives. After my first shot of the vaccine last month, I finally began to feel more hopeful for the overall future of medicine as I held my son who was born during the pandemic. I will be graduating from residency June 30, 2021, and despite my worries about having enough case numbers, I will be fortunate enough to graduate with extensive surgical experience. One day, I hope that we can return to practicing medicine as we previously had, close to our patients, smiling directly at them with a gentle pat on their shoulder.