July 16, 2020

From Surgery to Self-Digitization in the COVID-19 Era

Caleb Busch, MD, is a radiology resident at Emory University in Atlanta.

Graphic monochromatic image of tree

In medical school I preferred the concreteness of anatomy to the variably more abstract and oftentimes complicated lessons taught on medicine rounds; I was a simple medical student seeking a simple education, and so I pursued a preliminary year in surgery. Through the crucible of my surgical internship I learned and grew abundantly. I found myself by the demands of circumstance refining two particular qualities: efficiency and equanimity, the one to parry the blows of Time and the other to handle gracefully the challenges it harbored. It now seems that both of these generalize to radiology and to life. This was, in my opinion, the greatest opportunity for growth during internship year: development of the self. In regards to the acquisition of medical knowledge, by working and studying in the surgical context I was disposed to a rigorous examination of anatomy, the understanding of which now constitutes a crucial ground truth, that to which my intuition refers each time I must discern an object indirectly through two-dimensional shadows.

This year also served as a vivid reminder of the beauty of medicine and of human nature: there are few things as sublime to the well-trained eye as, after the meticulous dissection and clear definition of anatomy, beholding at last the pale sheen of one’s target vessel come into relief against the surrounding tissues, for example, in preparation for a carotid to subclavian artery anastomosis. In this instant my attending surgeon and I stopped, appreciated the art of creation so manifest in ourselves, and at length performed the anastomosis. Similar fleeting glimpses of beauty will doubtless present themselves to us in medical images, but if we are not looking, they will pass, and they will not return.

However, juxtaposed with feelings of contentment were those of discomfort. During those times of profound internal struggle, in working by necessity to find correct solutions to consequential problems, this was unmistakably when quantifiable personal growth occurred; and when, after earnest deliberation and exhaustive investigation, those instances that I would succeed, and I would grow, the words of the great poet of antiquity, Aeschylus, echoed in my mind an unsettling truth, that “wisdom comes alone through suffering.” In this way I worked as a surgical resident for one year, but even all good things must come to an end.

I then set out on a trans-continental journey east across a COVID-19 stricken landscape, my belongings packed with me into a small car, and arrived at the glorious notion of radiology residency; but what I experienced was quite different. As if Odysseus, returning home at last from the perilous trials of internship only to discover great affliction, I now faced the bloom of a deadly virus propagating through the metropolis in which I was to live. I had driven from the nadir in the west to the zenith in the east across the very epidemiological plotline that had been burned into my retinas over past months of virus-related briefings.

Lockdown impositions were in place as the contagion flourished; residency orientation was transitioned to a virtual experience. At the time of this writing I have met vis-à-vis a small fraction of my co-residents and colleagues; and the extent to which I will, for the foreseeable future, interact with my fellows is rather via a computer interface. Presently, we are to engage in didactics independently and remotely by virtue of software that encodes and transmits our interactions by the simple ones and zeros of human logic. Readout is often performed utilizing integrated screen sharing, remote-control, and telecommunication capabilities to review and discuss patient images; and the functionality of this paradigm is nearly seamless. My physical interactions have given way to abstract ones; my concrete experiences have been diminished. Yet, at each virtual readout or didactic session, my attending radiologist’s personality kindles and, despite the lack of her physical presence, the good of human nature reaches me. Before my eyes, the COVID-19 pandemic, it seems, has induced a profound digital transformation.