At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.  The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.  After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted.



I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils.



I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind).  One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.


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Those who had just recently moved to the area experienced the greatest disorientation, isolation, and difficulty focusing. Couples who are married with children had a much harder time finding resources for childcare during the pandemic, faced with the indefinite closure of daycares and schools across the country.

Some immigrants and those of minority status, already facing the challenges of fitting into a white dominant culture, experienced the strains of their previously- stretched social support system.

Doubts about career choice arose for some residents and medical students. Some developed because of anxiety about the pandemic and the uncertainty about whether they wanted to deal with something of this scope going forward; others because they were suffering from social isolation, particularly those who were living alone and far away from family.

Sleep deprivation magnified stress reactions and limited hours off-duty prevented the utilization of usual coping methods. Those who had a history of anxiety and depression, even when they hadn’t had problems for a long time, were surprised at the recurrence of these issues. Not expecting to ever have to deal with it again, they were dismayed and felt like failures. Reframing their experience helped. It was useful to recognize that these reoccurrences were just like having a weak ankle that gives way again under too much stress.

With no access to gyms, many exercise routines came to a halt, resulting in a more sedentary lifestyle. Those who adapted and found other ways to exercise and move their bodies, seemed to navigate the stress with greater ease. For those who did not, the resulting weight gain, lethargy, and sleep issues were further complications that added to their experienced stress levels.

Some residents were concerned because the reduced patient volume during the pandemic limited their opportunities to perform essential inpatient procedures. They were apprehensive about not achieving proficiency in essential medical procedures.

In general, levels of anxiety were heightened, not only by the many factors already mentioned, but also by being forced into situations that were not of their choosing. One such example were residents who were trained to step into front-line roles should the system become overwhelmed with Covid patients. Not all residents were psychologically prepared to deal with dying patients and in some cases, they had specifically chosen specialties that would spare them of that experience. Fearing having to do so raised their anxiety levels.

As you can see, there were many challenges during the past year and we are very grateful that the University Kentucky College of Medicine offers psychological support for their fellows, attendings, graduate students, residents, and medical students. Serving those who reached out to us during this trying time has been an honor and privilege.


About the Author

Dr. Steven Smith along with Dr. Sandra Hough are licensed psychologists with The Woodland Group and they are administrators of the LMS Physician Wellness Program.

One of those adaptations required learning remotely. Missing the stimulation of being in classrooms and interacting with a “live” person made maintaining a focus a challenge for some. They found it much harder to look at a screen for hours on end than to be able to break up the monotony with live person interaction. Isolation from faculty made it more difficult to ask questions and discuss the material they were learning.

As therapists working with this population, we too had to experiment with new ways of connecting and communicating with our clients. With very little prior experience using teletherapy, there was a learning curve for both clinicians, residents, and medical students. By most reports, this new digital avenue for dialogue proved to be not only workable, some actually preferred it. With no travel time required, the session could take place from the comfort of a home environment, perhaps with a cup of hot tea.

There were many and various challenges that residents and medical students reported as a result of the pandemic. This population is normally at risk for psychological distress such as burnout, but with the added impact of COVID-19, they experienced an even greater degrees of stress. Residents reported trauma reactions to heartbreaking work in Covid units early into the pandemic. The unpredictability of the course of the disease was particularly difficult for them, especially so for first year residents. The emotional impact was particularly challenging. Experiencing patients’ long-term hospital stays, the resulting


 attachment to their patients, and then helplessly seeing them worsen, and sometimes dying, was traumatizing for some.

Some clients reported seeing multiple members of the same family simultaneously hospitalized for Covid, and the understandable heartbreak those family members felt because of their inability to be together. They were so very close— and yet so far. Some found it profoundly difficult to give heart-breaking news to patient families so early in their career.

Social isolation was difficult for all but the most extreme introverts. First-year medical students were unable to meet their classmates and create new friendships. They were in a new cohort, but separated from one another in ways that did not allow for a connection. It was like going to a party with a blindfold on. It was disorienting.

In addition to being cut off from their peer group, most felt it unsafe to visit their parents and extended family. Some couples who were not living together, but in a committed relationship, were forced to stay apart for many months until they were vaccinated.