“When the sun is coming up/And the world has come ashore/If you're hoping for a harbor/Then you'll find an open door/In the winter, from the water/Through whatever's in the way/To the ones who have come from away/Welcome to the Rock!”1 

The subwoofer in my parents' living room boomed with the complicated choreographed stomps that accompany the first song in Come From Away. In December 2021, our second COVID-19-disrupted Christmas, my musical-theater-loving family was streaming this award-winning musical inside what we thought was our protective holiday bubble. As a residency program director, my yearly escape to my hometown with my family for the holidays is a welcome bolus of relaxation and distraction in the middle of the intense recruitment season. Decorating sugar cookies, singing carols, and wrapping gifts are a perfect counterbalance to being up to my eyeballs in ERAS applications, milestones, and pre-planning the next academic year's resident schedule.

Like so many of us, the members of my family have continued to struggle with the changes to our lives 2 years into this difficult pandemic. This musical, about the residents of Gander, Newfoundland, welcoming and supporting passengers from 38 diverted planes after the US airspace was closed on September 11, 2001, uplifted my family: “It's so nice to remember that most people are good.” I too was choked up, but not thinking about all the good on display in this show. Instead, I was feeling more despair than hope—just where was that spirit of community now after 2 years of our new global disaster? Where had my optimism gone?

In the spring of 2020, this program director had felt more like Tom Hanks' Captain Miller in Saving Private Ryan—supervising and coordinating the actions of a group of people being sent on a nearly impossible rescue mission under extremely adverse conditions. My hands shook at times as we planned for any number of contingencies—what if case numbers spiked and we had to pull all residents to care for wards full of COVID-19 patients? How many residents might be out sick at a time? I knew our internal medicine residents were truly at the front lines of caring for the patients to come, so how could we keep them safe with the shortages of PPE?

Thankfully, in Minnesota, we had had more time than other parts of the country to prepare for our first waves of cases, and we were able to keep our residents protected and with minimal disruptions to their learning. By December 2020, we were in our biggest surge of cases to date and under Accreditation Council for Graduate Medical Education (ACGME) emergency categorization. When we asked for volunteers to help in the ICU over those holidays, many of our residents volunteered. By that point, I was emotionally frayed after the wild swings of 2020 but so thankful that our first shipments of vaccines had arrived and were being administered in the arms of my colleagues and residents. As I tried to relax and recharge during that first COVID-19-disrupted holiday season, I thought surely 2021 would be better. Like the citizens of Gander, our residents were running toward our own “38 planes,” bringing all their extra capacity to help, regardless of the disruption to their own lives. And our local community was responding by enthusiastically anticipating their own vaccinations.

If I had been watching Come From Away during Christmas 2020, my response would have been so different than it was in 2021. In 2020, I would have wholeheartedly agreed with my family about this uplifting musical and its message about humanity. By December 2021, however, we were on the upslope of yet another spike in cases, under yet another ACGME emergency categorization, and Omicron had finally caused waves of illness among our vaccinated residents, just as I'd earlier feared. Our residents were continuing to volunteer to care for extra ICU patients and cover their sick colleagues' shifts, but the broader community was no longer coming together to run to our newest “38 planes.” Vaccine mistrust and politicization of the pandemic were inescapable on the news. Epidemiologists had given up any hope of achieving herd immunity. The “health care heroes work here” signs in front of clinics were faded and ragged. While precepting in resident clinic, I overheard the residents' resignation to anti-vaccine sentiment: “I was talking to her about getting her COVID-19 vaccine, but once she started talking about the fake pandemic, I just stopped and talked about something else.” My debriefs after these encounters did not feel fulfilling. I was so tired of still not knowing what to say.

Almost 2 years into the pandemic, I realized that we as program directors had been acting in all the roles in Come from Away: air traffic controllers, rapidly redirecting large groups of planes (residents) in a time of crisis; supportive local citizens, assisting those (residents) whose lives had been disrupted by forces outside their control; the diverted pilots, trying to keep order, to lead, and to communicate in an unanticipated situation, and then get back to doing the jobs they trained for (teaching and caring for patients); and also passengers on those planes, living disrupted lives as humans imperiled by a pandemic. We were drained by arguing with hospital leadership about why our residents weren't available to redeploy to the ICU, trying to connect to applicants via video interview, and caring for patients who were themselves exhausted by the demands of the pandemic. People all over the world showed that same generosity as those in Gander did throughout the spring of 2020, banging pots in the streets for first responders and health care workers. But would any community have been able to do the same, if that wave of “38 planes” kept coming every couple of months? Can anyone keep up that level of generosity for years? If our fellow citizens are being asked to help yet again by masking up during another variant-fueled wave of new cases, have they instead turned their backs on us, rather than rushing in to help? What would the pilots of those planes do, if denied a safe place to land or a community to welcome them?

In the second half of the musical, pilot Beverley Bass sings about her love for flying, how it has driven her since childhood, how long she worked to get to where she is today, and then how someone twisted what she loved into a weapon. Just as September 11 drastically changed the aviation industry, COVID-19 is changing health care. How will COVID-19 scar our learners? How many will make career detours? Will we lose so many experienced clinicians that safe patient care is at risk? How will our COVID-19 trauma affect how we teach and mentor?

For how long will we be running to those planes?

“We all looked the same/But we're different than we were/Something's gone/Something's over/Something's done/Something's missing/…Something's lost/Something's cost/…Something's changed/Something's rearranged/And wherever you are/(Something's gone)/You are here.”1 

Where is “here”? And where are we going next?

Genius. Come From Away (Original Broadway Cast Recording).