As we embarked on the one-year anniversary of the COVID-19 pandemic in Alabama, we asked people from across the School of Medicine to take part in conversations about what they had learned from the past year, and what they see when they look ahead to the future. The following are excerpts of those conversations, which have been edited for clarity.

Kevin Leon, M.D., is a professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and serves as the associate dean of Undergraduate Medical Education for the School of Medicine. Aditi Jani, M.D., is a PGY-2 resident in UAB’s Tinsley Harrison Internal Medicine Residency Program. A native of Pelham, Alabama, and a UAB undergraduate and School of Medicine alumna, she was chosen as chief resident for 2022-2023. We asked them to discuss caring for COVID patients, the strain of being a resident and physician during the pandemic, and what the pandemic means for medical schools.

Jani: When it comes to the actual medicine, I would say that COVID care is not necessarily difficult. What I mean is, there are only a handful of things you can do, and a lot of that we’ve known for decades, but the patients are profoundly sick and can have a number of complications. I think what makes it challenging is the unknown of it—we’re still discovering so much. Granted, a year in, we have a lot more data and evidence now.

For me personally, the most challenging part is seeing the isolation that COVID patients face. You get attached to these patients in ways that I don’t think I necessarily have before, because often they’re in the hospital for weeks at a time and you see them every single day. You can see the fear on their faces, the fear of, am I getting worse, will I have to be intubated?

Leon: I agree 100 percent. As a critical care physician, one of the reasons I came into this field was when I realized we can’t save everybody, but at least we can make the process respectful and dignified and pain-free, in an environment with family and friends around. And that’s something we weren’t able to do. We’re trained to be there when patients need us, not to be distant when they need us the most.

Jani: In terms of preparing us to provide COVID care, what struck me most is how fiercely protective our program leadership is of residents. For a long time, residents weren’t actively seeing COVID patients—our attendings in the ICU or on the floors would go into the room, and we would do the legwork outside. That went on while we had the luxury of not having an overwhelming number of COVID patients. Then late in 2020 and the early part of 2021, the surge got to a point where that was no longer manageable, so the program created surge teams staffed by residents on lighter rotations or elective months or volunteers. It was incredible, the number of people who volunteered willingly to go into the ICU and the acute care floors to take care of COVID patients.

Another example: Every Thursday afternoon, our program director, Dr. (Lisa) Willett, would hang out in our residency lounge area and teach donning and doffing of PPE to anyone who wanted to learn or get a refresher, so we would feel prepared going into the wards and the ICU. And, just getting us access to testing and vaccinating us early—there were programs around the country where residents weren’t prioritized to get vaccines. So it’s been an institution-wide effort, where everyone has done an incredible job supporting us.

Leon: I think what I saw both in the hospital and in the medical school that impressed me most, is that everybody came together, regardless of department or division. And not just the physicians—the respiratory therapists and nurses were really taking the brunt of the risk doing the day-to-day, even the maintenance crew.

When this first started, we had dedicated COVID teams in the ICU. When the second wave hit after Thanksgiving, our pulmonary fellows did a phenomenal job but they were overworked because they were the ones intubating and doing the coding. So with the second surge, we were pulling in fellows from all of the Medicine divisions to take care of the COVID patients. We were pulling in cardiology attendings and fellows, endocrine and nephrology fellows, and I never heard a complaint from a single faculty member, resident, fellow, nurse. Everybody just stepped up, and it made the stress manageable, because everybody was feeling the same thing.

Same goes for the medical school. We had to change abruptly to a fully online remote curriculum and remove the students completely from clerkships and the hospital. That’s very disruptive. And again, I was incredibly impressed by how they took it in stride. As soon as COVID hit, they wanted to know how they could help. Caroline Harada, who oversees service learning here at the medical school, took on that role to find safe opportunities for students to participate, like working the COVID line notifying patients of their test results, and now they’re volunteering at the vaccination sites. Because that’s what we look for in our medical students as part of the holistic admissions process. We’re looking for students that have a strong sense of service, a strong sense of community, a strong sense of leadership, those other aspects of being a physician.