Neurosurgery

Main Content

February 2021 Article

Ben CarrollA Year Later

I’d like to reflect on my experience with COVID, but to be candid, compared to other departments, this last year has brought relatively little change to the neurosurgery service. Certainly, we maintain our distance, wash our hands more often, and don our masks. Sure, our weekly educational sessions look different now, and, like the rest of the University system, we have developed a fulminant case of Zoom fatigue. But on the level of day-to-day clinical care, most of the diseases we treat have not had the common decency to wait for vaccine distribution. Brain tumors still need prompt resection. Aneurysms go on rupturing. Helmets and seatbelts continue to be neglected. So we have not slowed down. We only became more cautious: in a small, efficiently-scheduled department that must keep 24-hour in-house coverage for UMMC to classify as a Level 1 trauma center, even a small outbreak can prove disastrous. And when the early published data showed that endonasal cases like the pituitary tumor resections we do weekly – sometimes urgently – had a near 100% COVID transmission rate for everyone in the OR, we knew that continuing our work through this time would be a serious matter.

But even while we kept our noses to the grindstone, questions swirled over our heads: How dangerous is this virus? How bad could the situation get? Whose information can we trust? Who is in charge? What is their plan? What is their plan B? Does what we are doing work? How do we know? What is my role in it all? What is my risk? These weren’t only questions of clinical importance. They were questions that pierced your very marrow, questions that struck at the heart of who you would choose to be.

And what would we do if the situation became dire, as it did in Italy or New York City? In April of last year, I found myself on a team of UMMC practitioners who were tasked with creating a protocol for how to allocate scarce resources – ventilators, PPE, blood products – should we reach a time when we had to decide who would survive and who would not. How do you measure a life? Who “deserves” to keep breathing? Do certain people get priority? Who is qualified to make that kind of decision? And how do you begin to speak to a family when you just sent the last ventilator into the room next door? The meetings with this group were the most honest and provocative conversations I have had in the hospital, and I walked away from that taskforce with immense respect for its members who were willing to immerse themselves in such difficult questions. We can all be thankful the protocols and rubrics created by that group have never been needed.

Then we saw how the world changed. My grandfather, a Methodist pastor who found his vocation advocating for “God’s older children,” used to say that dementia takes our most deeply engrained personality traits and multiplies them by ten. You could say the same for pandemics. It was instructive to watch what a crisis brought out in the worlds both around and within our hospital system as well as what it brought out within myself. In some places, you could see fear taking hold, paralyzing whole groups of people. This wasn’t the job some of us signed up for. And the unhealthy emotional reactions were oh-so-tempting, convenient even. You could easily respond to all the uncertainty by retreating into cynicism or sowing more distrust or pointing fingers or hunkering down into a self-preservationist mode that left others to shoulder the burdens. But then you watched as so many duty-bound people faced their very justifiable fears and braved what they couldn’t be sure about. So many others were able to locate joy and hope when the road ahead was clouded. So many relationally gifted people were bastions of encouragement, pulling others out of loneliness, despair, and streaming service rabbit holes. My wife works with the hospital’s palliative care service, and during the early goings, I saw the sense of purpose on her face as her team patiently and compassionately called the family of every ventilated COVID patient not once, but twice every day. Courageous people showed up every day having seen the healthcare lives that were lost elsewhere in the world, some of them coming to work even while their own relatives doubted the very existence of the entity they were risking their lives to stop. Wisdom and moral fiber of that caliber is inspiring.

We also felt the pandemic alter the very nature of the way we interact as humans. When Brooke and I got engaged last March, we began planning a big blowout wedding weekend that would show our joy and gratitude to all the people who had shaped us significantly and shepherded us to each other. Then everything changed. And while the pandemic didn’t stop us from making the most important vows of our lives before a small group of witnesses and while the extra line item in the budget for PPE at our COVID wedding wasn’t too burdensome, we lamented having to mark so many cousins, dear friends, and mentors off the list of those who could celebrate with us in person. When was the last time you shook a hand? Or gave a hug? Or walked into a grocery store without your suspicions raised? How we relate to each other has changed.

So has how we hurt. I can’t count the number of families I’ve had to inform that they couldn’t visit their dying loved one until the final moments. And that even then, only one, sometimes two people would be allowed. You feel the pain and frustration as you tell a man he can’t see his wife after her all-day craniotomy for a tumor resection. Or when you have to postpone spinal surgery for a woman who hasn’t been able to work because of debilitating neuropathy. It has even changed death itself. Just this past week, we held a family funeral that at any other time would have drawn dozens of relatives from around the country. Instead, I led a short, socially-distanced graveside service for a dozen shivering people on a bleak Delta afternoon. This pandemic has shifted the way I experienced the most soul-shaping events of life – getting married, the death of a family member, a hymn at a church service, a visit with friends. And as it has for most of you, the pandemic has changed how I express even the most basic of human emotions: love, joy, friendship, grief, loss, and hope.

The other day, while cleaning out my grandfather’s bookcase, we found an old manila folder containing newspaper clippings and some of his correspondence from the early 1960’s. At the time, Pop had been a young Methodist minister serving the small town of Eupora. The shreds of paper in that folder involved one particular event – the violent riot that erupted at Ole Miss on September 30, 1962, after the enrollment of James Meredith. As I sifted through his letters responding to local newspaper editorialists who advocated for segregation and states’ rights, as I found the words of encouragement he wrote to a friend in the ministry who had been beaten while wearing his clerical collar as he stood up to prevent violence in Oxford that night, as I read his church newsletter the very next week advocating for non-violence and justice, I was reminded that Mississippi has been through uncertain times before. Times when the world seemed irreparably divided. Times when we were unsure of who to trust, what was right, and what our place was. Times when your own life could be on the line. Times when you had to take a measure of yourself. And I am reminded that while we are up against a formidable virus, this is not the first time Mississippians have had to reach deep for wisdom, goodness, and courage. And it won’t be the last. Because even after we come back together, there is still much that holds us apart. But through this crisis and tomorrow’s, I’m proud to work with you. I’ve seen so many of you at your best.

-Dr. Benjamin Carroll, PGY IV