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May 3: Uncertainty

By Karan Desai, MD

Uncertainty. As a hand surgery fellow in training in New York City, uncertainty has been the overwhelming emotion day in, and day out, during this COVID era. The fellowship year is exceedingly unique in a surgeon’s training as most approach the opportunity with maximum zeal and intensity to hone the craft they have chosen for the rest of their lives. We aim to squeeze out every drop of education possible during this year. As COVID snowballed into a bigger and bigger issue in New York, the sudden freeze on all elective cases and many urgent cases completely took the wind out of my sails. This screeching halt was further compounded by the cessation of educational conferences and conversion of most clinics to televisits. What I was left with was nothing but uncertainty: uncertainty on whether I had done my last elective case of my fellowship, uncertainty if the surgical skills I had developed to date would be enough for my practice in 6 months, uncertainty if my future employer may delay my start date due to financial constraints, and most importantly, uncertainty if this disruption in training would still let me provide the best care for my patients in the future. To add to this doubt, I spoke with several hand surgery fellows around the nation who continued to do cases in less COVID-affected areas, which further increased my apprehension about my current situation. As the COVID numbers climbed daily, so did my uncertainty. Two weeks passed and my wife had her salary slashed in half adding financial stress to an already tight situation as a trainee in New York City. We received an email that we would be recruited to cover ICUs to help out the drowning hospital system killing any hope of doing any emergent hand cases myself. Then I hit rock bottom. I started having high cyclical fevers, myalgias, and the worst headaches of my life. Not surprisingly, I had COVID myself.

As I quarantined at home, barely able to get out of bed, it gave me a chance to reflect on uncertainty. It is an emotion that is born entirely out of the fear of the unknown and often leads to more questions as the fear propagates. As my recovery allowed me to regain a more normal footing, I took stock of my current situation. I set my mind to combat this vicious cycle of uncertainty by focusing on the things that I did know with certainty. I was certain I would return to work feeling very fortunate to have avoided any major medical malady as a result of COVID. I was certain I was witnessing maybe the greatest alliance among all medical specialties that I would see in my life. Internal medicine, neurology, plastic surgery, orthopaedic surgery, and infectious disease, among many others, uniting to provide the best care for New York citizens. I was certain the ASSH was committed to fellow education during this time as they championed a robust lecture series via Zoom that rivaled the didactics I had received during the year. I discovered the ability to learn from the various surgical videos on Hand.E and made an “OR schedule” for each day to walk through cases I had never done before. I was certain my fellowship director and faculty were committed to me by providing biweekly digital lectures and a review of the Self-Assessment Exam questions. I was certain my hand surgery co-fellows and residents were wonderful team-oriented people as they invited me to double and triple scrub into emergent cases so everyone could bolster their education. I was certain orthopaedic industry vendors were helping by organizing and putting on more online lecture series from hand surgery leaders around the nation.

Through all of these unexpected trials, I have learned to look at this fellowship year through a completely different lens. The unity and combined efforts of societies, surgeons, educators, and industry have more than tempered the uncertainty that trainees are experiencing during this historical time. The ways I am learning about hand surgery are different, but it is much more than I ever hoped for.  I have personally witnessed the support for one another in the hand community as we are all banding together to get through this difficult time, and that intangible fact reaffirms every reason I ever had to get into this specialty in the first place.

“Reflect upon your present blessings, of which every man has plenty; not on your past misfortunes of which all men have some.” – Charles Dickens

Karan Desai, MD
Hand Surgery Fellow
New York, NY

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