Mid-level surgeons during pandemic: The unsung fingers and forceps

As the grave coronavirus pandemic (Covid-19) haunts the health care delivery system globally, the health care workers are combating with immense stress and hectic pressure for the last 15 months. In Bangladesh, the mental crisis is more prone and sophisticated for mid-level doctors. 

Surgery exposes a surgical team to blood, contents of the alimentary system, and body fluids of infected patients. To be precise, this is unavoidable in surgery (laparotomy, amputation, wound debridement, abscess surgery, etc) whatever the set-up is. 

The profound effect of this virus has left mid-level surgeons, i.e. registrar, assistant registrar, indoor medical officer, and surgical residents of surgery and allied discipline (I don't prefer to use the term 'junior surgeons') and their workload in a critical situation. From the beginning of the pandemic in our country that is in early March 2020, mid-level surgeons were still working brave-heartedly in the frontline, promising a fair surgical service to people who were in despair with their surgical health issues. 

No telemedicine will satisfy you if your ailments demand surgery and that is where mid-level surgeons are incomparable in designated facilities. Mid-level surgeons, whether in a course of MS, FCPS, or in Diplomas, are a well-designed skilled icon for relatively all sorts of life-saving surgeries. 24 hours a day and 7 days a week, these surgeons keep our medical college hospital or specialized centres thrilled with their captive hard work, maturity and devotions.  

Roughly speaking, our hospital environments are truly 'unsafe' in this pandemic and we function as super-spreaders to our friends and families in this coronavirus pandemic, but this hasn't shaken our responsibility and passion for surgery. 

Surgeons are always under stress while operating and managing increased concern for surgical modalities of treatments as general people tends to google every alternative. Dealing with pre-operative evaluation, resuscitation, reaching a provisional diagnosis and post-operative complications are routine surgical traits for a mid-level surgeon that hasn't reclined to any level even in the hours of hectic wearing the N95 respirators. This is quite a devastating physical and mental hardship for all of us on the frontline. Despite all these glooms, the show must go on. You cannot prescribe an alternative to patients if he/she absolutely possess an indication of surgery. 

The 'new normal' hasn't offered us any comfortable option for prescribing modalities for surgical disease. Young doctors in surgical discipline are facing mental hardship. Since the beginning, the foremost strategy has been to limit direct and close physical interaction between doctors and patients. But is relatively impossible to reach a surgical diagnosis without examining the patients in close proximity just as before the Covid time. 

Photo: Collected

Yes, these efforts also end up in unprecedented pitfalls when we project the statistics of numerous mid-level surgeons in Bangladesh being affected by Covid-19 with hospital admissions and dreadful hours of breathlessness and/or isolation.

Despite all our possible safety measures, how were we destined for such a horrible health catastrophe? The answer is embedded in our bold dedication to our patients even in this fearful pandemic. To be true, in OPD, in admissions rooms, in specialized one-stops, in Covid wards, or in the OR, we never left this battle. We spent more hours together in a team, to arrange the most feasible surgical care for our patients. We kept on working even overnights to keep hospital admission of patients to a liberal number. We cared for wounds, for tissues, and whole-heartedly for the sufferings of our patients. While the attendants of these patients were in dilemma whether to come close to patients or not, we acted proactively to unbracket the earliest cure for patients. We arranged the regular Covid tests in wards and preoperatively to keep other patients safe.

To be precise, we were the warriors for IPC in every aspect, even compromising our safety to whatnot limits. We also hold the responsibilities of our fellow team-mates, our interns, and nursing staff who also fight relentlessly with us in this coronavirus service hours. 

It is true that this virus is not dealt with surgically, but while the virus is literally everywhere and still a surgery is obligatory, nobody can deny the role of a surgeon. Mid-level surgeons hold the most unsung fingers with forceps in this coronavirus grief. Nobody would care for the number of emergency surgeries that were undertaken with great and utmost care from the beginning of the pandemic, but we did it and still on work perpetually. Incentives, thanks-giving, rewards are simply ways of boosting our spirits, but unfortunately, we haven't seen such a good morning.

Surgery is a passion and you cannot name an alternative for that and so is for mid-level surgeons of Bangladesh. The changing clinical scenario of coronavirus infections offers more challenging roles from our surgical community, and undoubtedly, we, the mid-level surgeons are ready for emerging. 

Dr Rajib Dey Sarker, Registrar (33 BCS) Shaheed Suhrawardy Medical College Hospital. Email: rds@mis.dghs.gov.bd