The New Definition of Courage

To the Editor: The novel coronavirus disease (COVID-19) pandemic has affected all aspects of the health care system. As the pandemic has evolved, so too have trainees’ clinical responsibilities. Many, setting aside their subspecialty training, were reassigned to different rotations based on systemic need. For many in the procedural specialties, these reassignments raised trepidation over losing valuable opportunities to acquire and hone skillsets. The pandemic has also taken providers out of their comfort zones—whether into operating rooms or into outpatient clinics—to learn to care for patients with this highly communicable and potentially lethal disease. The donning of personal protective equipment has taken on an entirely new meaning for those in surgery, one that has shifted from safeguarding the sterility of an operation to protecting oneself from a virus that can kill. In the beginning, it was easy for us cardiothoracic surgical residents to view this transformation negatively, as a disruption taking us off our chosen paths. However, over time we began to realize that we are changing for the better, perhaps in ways we would never have actualized if it were not for COVID-19. The culture in surgery often defines courage as being independent and projecting confidence. Many of us surgeons prescribe to the notion that stoic, solitary struggles help build strength, and we seldom reach out to others for help. Courage is often viewed as the opposite of vulnerability. Given the worldwide calamity, we have had to adapt our definition of courage to best care for our patients, serve their families, and preserve ourselves. We have learned to demonstrate empathy, to lean into emotionally challenging conversations (often concerning end-of-life care), to acknowledge that we do not have the solutions, and to be vulnerable with each other. Courage is no longer the antithesis of vulnerability; rather, the pandemic has taught us a new definition of courage: courage is the ability to embrace and be at peace with vulnerability. One of the interns on our team texted the group after losing a patient to COVID-19. “I just called the family,” his text read, “The son’s response was, ‘You will always be my hero. Thank you for all that you do.’” He shared the vulnerability and loneliness he felt in that moment. We all replied with words of encouragement. I wonder if, months ago, before the pandemic, we would have been as willing to share our feelings so openly. Acknowledgments: The authors would like to thank their colleagues for their willingness to share their stories.

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