"Every horizon, upon being reached, reveals another beckoning in the distance."
– W. Eugene Smith

The early career stage is difficult to navigate, and all of us go through some difficulties as we set out to establish our careers, whether it's in academia or private practice. But the pandemic presented an added challenge for everyone. It was a difficult time with unique challenges posed to early career professionals, but we got through it by carrying out our innovative ideas and creating new opportunities for ourselves.

After graduating from my advanced heart failure and transplant cardiology fellowship, I took a sabbatical to travel and unwind before starting as faculty with the advanced heart failure department at an academic high-volume tertiary care center. As fellows, we are used to dealing with heavy volumes, but being an attending brings a lot of added responsibility.

As I dealt with impostor syndrome and tried to learn the system while assuming the role of a team leader, clinician, and educator, I was entrusted with a responsibility to establish a cardiac amyloidosis and sarcoid program at my institution, which involves a multidisciplinary team and multiple resources. Starting new research projects was one thing on my mind to further my academic career and provide research opportunities to residents and fellows in my program as the Covid-19 pandemic emerged as a significant crisis.

But with Covid-19, everything took a backseat, and all of us became focused on fighting this pandemic. As an ELSO platinum center of excellence, our center was also exposed to increasing referrals and transfers from hospitals in the periphery for advanced support. Grappling in the dark with lots of misinformation, all systems were overwhelmed with the added clinical responsibilities for all of us. There was no time to think about what this will mean for our careers as the destruction was beyond anything we had witnessed thus far. Other challenges included burn out, low morale with no end in sight, isolation, ethical dilemmas to optimize overstretched resources.

However, various skills and expertise came to our rescue amidst these challenging times. Our familiarity with social media, audiovisual portals and telecommunication tools were very useful in this pandemic to stay connected and disseminate information in developing countries. Licensing in respective countries was an issue, but immigrant clinicians were able to provide virtual consultation in countries where they held licensure. The destruction this pandemic brought to these communities was beyond what we witnessed in our hospitals.

We started virtual clinics so that we could provide care to our patients with chronic cardiac conditions and ensure they have access to care without exposing themselves to the virus that was rampant in hospitals, clinics, and emergency rooms. We realized there was no better time to utilize remote monitoring using implantable hemodynamic monitors and to spearhead telehealth and medical therapy optimizing clinics during this time. By virtue of being on the frontlines, we were able to step into administrative roles and lead various taskforces required to navigate the pandemic and its aftermath.

Transitioning most educational activities to a virtual platform helped us repurpose our time and spend more of it learning. We were able to attend conferences virtually and disseminate new information online, which was welcomed by the community, particularly via social media platforms where we could foster research collaborations and open communication dialogues. For instance, women in heart transplant and mechanical circulatory support came together and created a collaborative network which has provided multiple academic opportunities to early career members and fellows, including locating mentors across the country.

Together, with our nurses and ancillary staff who were the backbone of the pandemic, we pulled through some of the toughest times. We had many successes which kept us moving forward, and we also dealt with some losses that will haunt us forever. The pandemic brought us closer and reinforced the importance of human connection and collaboration. And while this is far from over, as major challenges lay ahead of us, we remain optimistic that we will continue to succeed as we discover opportunity amidst adversity.