The surgeons are not OK!

We are surgeons. The pandemic has slowed us down significantly and has shone a light on our lives and on ourselves in ways that we were too busy to stop and take a look at prior to the pandemic. It has increased the daily stresses and taken away the one joyful thing that used to sustain us. After getting through wave 1—personally still operating but very minimally since I do cancer cases—the one thing I realized was that I need to operate to keep living. Not-operating makes me, and I noticed a lot of my colleagues, completely depressed. And when we are depressed we turn into more assholes than we normally are. A normal person (or an intelligent person) would think: what do you mean you need to operate? What do you mean you need to cause trauma to other people? Read: Some suggest surgeons working weekends would help cure what ails Canada's healthcare system What I mean is that to become a surgeon, we live, breathe and dream of procedural techniques. Our brains probably (nice research topic for any neuro nerds) get rewired after five or more years of constant working with our hands to make most memories, feelings and emotions go through the motor cortex. It was one of my excellent ward clerk friends who noticed this long before COVID. With OR resource cut backs, combined with tremendous pressure to save money by not doing after-hours cases (when you have to justify why you need to operate to an administrator who has no surgical training over and over again, it is easier to just postpone operating until patient is on death’s door and save yourself emotional burden), and smarter surgeons who recognized that lots of situations previously ending up in the OR do not need to go to OR, I have been operating a lot less over the course of past 10 years. I am pretty open with my feelings, and apparently I get very grumpy when I have been on call and not operated for a few days in a row. There used to be months where I would not operate the whole month, but then had three days of operating time in one week. On those last weeks of OR less time, my snarkiness and grumpiness would become more manifest. And if I happen to be on call during that week, my colleague would say to me: “I wish you a Happy Appy and Jolly Chole type of call.” Meaning that she hopes I get some patients needing emergency appendectomy or cholecystectomy. I used to laugh with her. The pandemic showed me how true this is. These days, once again on the brink of a fourth wave and looking at OR closures, our collective surgical brain is going into a very dark place. I have no real joy in life currently. There is no joy left in examining patients in office, diagnosing them with issues that can be easily corrected with simple day surgeries and booking them for surgery knowing that my “simple” (non-urgent, non-cancer) patients from March 2020 are still waiting for surgery. I keep making surgical plans, see them back to reassess them, make sure they still need surgery and are candidates for the same surgery. I feel like I am performing futile and busy-making tasks. This is on top of the constant worry we have for our patients with cancer and urgent illnesses. It is the not knowing when you will show up to your operating room prepared for the day, and being told that the cases will be cancelled. It is the having to deal with your disappointment and your patient’s despair. So, the surgeons are not OK. When the ORs open up a little bit, we are fighting more than previously for a piece of ever-shrinking pie. We are disappointing our patients with issues beyond our control. We are being asked to book cases for longer durations while actively operating for shorter durations. We try to help our nursing and non-nursing colleagues to make ORs and wards efficient—and get in trouble for being aggressive. We feel beat and discouraged and morally very much injured. The financial injury is something we cannot even talk about since we are not even facing COVID head on. We are shielded by family physicians, emergency physicians, ID, internal medicine folks, and lastly anesthesiology colleagues from direct exposure to patients’ breathing COVID on us. We are grateful and thankful. But this also has taken away a lot of income for us. We still have to pay our excellent MOAs who are working harder fielding patient questions and frustrations. We still have to pay to keep the heat and lights on. And like all other office-based physicians, we have the added costs of ventilation, HEPA filters and PPE in the offices. But we are surgeons, we learn very early on to “roll with the punches. ” So here is what we are doing: Running, biking and exercising: To a person, all the surgeons I have spoken to have upped their physical activities. I, an exercise induced asthmatic, have taken to running in the morning. In typical surgeon fashion I thought I was barely jogging. But neighbours tell me I apparently am going very fast. Most of us are on peloton. Some are biking so long that they end up in another town altogether. But none of us can outrun our depression or worries. Trying to help out in the hospital: some of us signed up as what we thought was a role of physician assistant on COVID wards, but then got placed as nursing extenders, and got mocked for even thinking we could work in any capacity as physicians on a medical ward. Going to vaccination clinics and really enjoying those. But feeling guilty when we have to abandon them to go back to the ORs. Spending time at home and trying our darnedest to not drown in the ensuing burnout. So, the surgeons are not OK. But we will be. We know we will be once the world gets to the other side. In the meantime, thank you for reading this story. This item was written by an Ontario surgeon.

The surgeons are not OK!

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