Diary of a Surgeon During COVID: What the OR Looked Like in 2020

The Operating Room in a Pandemic

The protocols changed weekly. Sometimes daily. A surgical team that had operated together for years suddenly found itself following procedures that no one had practiced, wearing equipment that no one had trained with, and making decisions that no textbook had anticipated. The pandemic did not shut down surgery. It transformed it into something that surgeons who had practiced for decades did not recognize.

The N95 mask changes the way you breathe during a procedure. The face shield fogs. The double gloving reduces tactile sensitivity. The gown is heavier. The room is hotter because the ventilation system has been modified. Every physical sensation that a surgeon relies on for precision — the feel of tissue through the glove, the clarity of the surgical field through the loupe, the ease of breathing during a long case — was degraded.

Triage in Real Time

The first question every morning was not which cases to schedule. It was which cases to cancel. Elective procedures — the word elective doing enormous damage, because a hip replacement is not elective to the person who cannot walk — were postponed indefinitely. Cancer surgeries were triaged by urgency. Trauma continued because trauma does not respect a pandemic.

The ethical weight of these decisions was carried by individual surgeons and hospital committees making choices for which no training had prepared them. Which cancer patient gets operated on this week and which one waits? The answer depended on tumor biology, patient fitness, available ICU beds, and the current COVID census. The calculus changed daily.

The Human Cost Behind the Statistics

The statistics reported deaths in aggregate. The surgeon experienced them individually. Each patient who contracted COVID in the hospital — who came in for a gallbladder and left in a body bag — represented a specific failure of a system that was designed to protect them. The guilt was institutional but it was felt personally.

Colleagues got sick. Some died. The ones who survived often came back diminished — short of breath, easily fatigued, cognitively slower. Long COVID in a surgeon is not an abstraction. It is a specific reduction in the physical and mental capacity that the work demands. A surgeon who cannot stand for four hours cannot operate. A surgeon who loses concentration cannot be trusted with a scalpel.

Why Surgeons Should Document

The pandemic will be remembered through epidemiological data, policy analyses, and political narratives. What will be lost, unless someone writes it down, is the granular reality of what it was like to practice medicine during those months. The specific smell of a COVID ward. The sound of a ventilator alarm in a hallway of ventilator alarms. The expression on a family member's face during a video call that both parties know is the last one.

Surgeons are trained to document. The operative note, the progress note, the discharge summary — these are forms of testimony that the profession has practiced for centuries. Extending that documentation beyond the clinical chart and into the literary record is not a departure from surgical tradition. It is the fulfillment of it. The surgeon who writes what they witnessed during the pandemic is doing what surgeons have always done: recording what happened in the body, under pressure, in real time.