Courtesy of the Yale New Haven Health System

Balancing intense patient care with demanding research projects has always been intrinsic to the life of critical care physician-scientists. But against the backdrop of a relentless pandemic, 2020 saw an intensification of the challenges that accompany this dual role.

Strenuous hours at the hospital, spending time away from loved ones and grappling with uncertainty about the future were some among many challenges faced by medical professionals. But despite these obstacles, by the end of the 2020, Yale’s pulmonary department had published 232 research articles, besting last year’s 134 publications — all while they staffed the medical intensive care unit and took care of COVID-19 patients. According to Chief of Pulmonary, Critical Care and Sleep Medicine Naftali Kaminski, as days turned into nights in the MICU, many papers were being written at the crack of dawn.

“There were some papers that came out of our section that I literally know people were writing between 11 p.m. to 3 a.m. in the morning,” Kaminski told the News.

Making sure that no one was left behind was essential in ensuring the department’s success, he stressed. Kaminski explained that everyone there was very mindful of the fact that if they had time to do research, that was only because someone else was in the COVID-19 wards treating their patients.

Keeping the collaborative spirit alive — be it through working together in research projects, sharing credit for different papers or simply by letting each other know that they had friends in their colleagues — fueled the department’s sense of camaraderie and strengthened what was already a robust emotional support network.

Maor Sauler, assistant professor of Pulmonary Medicine and a critical care physician at the Yale New Haven Hospital — who currently divides his time between pulmonology clinics, MICU shifts and lab research — expressed his gratitude for his colleagues.

“When everyone was home, we got to go to work and spend time with amazing colleagues and do the things we were trained to do,” Sauler said. “In many ways, that’s allowed us to sort of shoulder the burden of all the patients and all the illness that we had to deal with.”

When the summer came and COVID-19 case rates started to drop, that infused many with a reinvigorated focus on their research, Sauler explained. With more time to work on their projects and less critical patients in the MICU, it was easier for them to pick up where they had left off.

Kaminski noted that, at one point, it almost seemed as if people were having a “second honeymoon” with their research careers. But many early-career scientists were also concerned about what the time they had spent away from the lab could mean for their tenure track.

“The research cannot stop, the clinical work cannot stop, and we will always find a way to make it work,” Clemente Britto-Leon, assistant professor of pulmonary medicine and YNHH critical care physician, told the News. “But there are tradeoffs that have to be made, there are maybe a few more hours that you have to materialize in the middle of the day to make this happen.” 

To Britto-Leon — who has also been working in the MICU, seeing patients in the cystic fibrosis clinic, doing research and treating post-COVID-19 patients — these tradeoffs ranged from missing out on quality time with his family to being unable to pursue some of his cherished hobbies, including bird watching and visiting art museums.

Nevertheless, despite these difficulties, his motivation to help his patients and continue his research kept him and his coworkers going.

“It’s sort of in our nature, in the medical field, to help in any way we can, so lots of people wanted to contribute,” Sauler said.

But beyond contributing to the overall knowledge of science, Britto-Leon stressed, research often lays the groundwork of the medical practice of physician-scientists.

While the coronavirus spurred many scientific unknowns, because of the way it assailed the respiratory system, pulmonologists were able to refer back to their experience with acute lung injury and disease to anchor their understanding of COVID-19. As it turns out, a lot of the research they had been doing long before the pandemic started helped guide how they approached COVID-19 patients.

“Sometimes I stop to think how much my clinical practice is informed by my knowledge of fundamental mechanisms of inflammation, of injury and repair, and how that translates into how I care for my patients,” Britto-Leon said. “And the opposite is true, too, I draw from my translational research for many of the questions that I find in clinical practice. It makes me a better doctor.”

He said that his experience studying cystic fibrosis, for example, had prepared him to look for markers of inflammation and understand how they could affect the lungs in the context of COVID-19.

In a similar way, Sauler explained that the years he had spent studying cellular stress responses in acute and chronic lung illness has informed the way he views the devastating effects of COVID-19 on the respiratory system.

“In many ways, we’ve been just doing the work that we’ve always done in trying to understand mechanisms of acute and chronic lung injury,” Sauler said.

Another key factor in enabling the department to continue their research projects was the funding provided by the Yale School of Medicine Dean Nancy Brown’s office to early-career scientists. In a statement to the News, Brown wrote that YSM leadership wanted the funding “to serve as a catalyst for increased mentorship during this difficult period.”

Sauler and Britto-Leon both emphasized the importance of the grant in keeping their respective research projects going and were both grateful to have had this support. Kaminski also highlighted that it had a positive impact on the department’s overall morale.

However, Britto-Leon stressed that because the pandemic is giving more visibility to struggles that physician-scientists have to grapple with even outside of international health crises, he hopes that this will reinforce the need to always support those at earlier stages of their career.

“Even in large academic institutions like Yale, we still face many challenges,” Britto-Leon said. “We cannot prioritize our clinical activities over our research activities because they are both essential pillars of everything we do and everything we are. At times, we struggle to balance the requirements of our academic lives, with our clinical activities and our personal life.”

Total funding for research at the Yale School of Medicine jumped from $612.9 million in 2010 to $671.2 million in 2019.

Maria Fernanda Pacheco | maria.pacheco@yale.edu