Residents on the Front Lines in NYC

02 Aug 2020

By Tamar Nobel, MD 

“In any given moment we have two options:

to step forward into growth or step back into safety.”

– Abraham Maslow

The darker sides of the COVID-19 pandemic have been well documented in the media by our colleagues. Although the pandemic rages on elsewhere, as New York City enters a recovery phase my objective here is to focus on the ways in which we have grown and the future impact of this experience, from my perspective as a general surgery resident-turned-COVID provider in New York City.

Compassion, collegiality and community

The suffering and loss experienced during the COVID-19 pandemic carried a heavy emotional toll. As providers, one of the most challenging aspects of this experience was the way hospital policies changed our ability to support and guide families through making the most difficult of decisions surrounding end-of-life care. Bans on visitation resulted in virtual solutions to try to ease the pain of family members needing to say goodbye via remote mechanisms, sometimes with little warning prior to changes in clinical status. These heavy moments were juxtaposed with acts of kindness and new palpable collegiality between employees and across specialties within the hospital as clinicians and staff across all departments continued their routine jobs with new hazards to their own health or stepped into new roles. I am hopeful that as we move forward we will maintain this newfound collegiality.

Flexibility to adapt to evolving scheduling and environment

Surgical training is a regimented series of long days in the operating room interspersed with floor, consult, and trauma calls. As our hospitals began to saturate with COVID-19 patients, the sudden upheaval of normal operating procedures required the flexibility to deviate from our sense of normal regulated lives and accommodate near-daily changes to scheduling structures and staffing assignments. More details on our specific program rescheduling can be accessed here. The deployments were also in conjunction with required time off for preservation of the workforce, which challenged our innate desire to help our city at its time of greatest need. I am proud of my colleagues for the way they handled the daily uncertainty and supported one another during this time. 


With the need for judicious use of PPE early on during the pandemic, we adjusted the ways in which we both used available resources and distributed those resources among providers. As teams deployed across our hospital system, PPE was provided to our deployment team leaders to distribute to ensure we were protected. As the pandemic progressed, PPE stations were established throughout each floor, and as we enter recovery, we have maintained an organized and structured approach to distribution of PPE. Furthermore, we have adjusted some of the ways in which we approach surgery, including mandatory COVID-19 testing for all elective patients, and configuration of systems to evacuate laparoscopic insufflation. Through interdisciplinary collaboration, we have been able to proceed with elective cases starting Mid May.

Moving forward

Our experience during the COVID-19 pandemic took us out of our narrow field of training and expanded our horizons. As residents, we do not have as much experience as some of our attendings navigating uncertain situations. The experiences of the past few months have provided us with the toolset, and most importantly, confidence, to face the next unknown. Although training as we know it was completely upended for the last three months, I believe that as residents we will emerge from this experience stronger, more compassionate, more collaborative, and prepared to take on any challenges.

Tamar Nobel, MD, is a general surgery resident at The Mount Sinai Hospital in New York, NY. She is in her final year of residency and will begin thoracic surgery fellowship at Memorial Sloan Kettering Cancer Center next summer. Tamar grew up outside of New York City and attended Case Western Reserve University School of Medicine. You can follow her on twitter @TamarNobel.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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