Table 3

Theme 2: constructive adaptation

Quotation number	Participant ID, US region	Exemplar quotation
Meaning-making
30	Z, Northeast	I have been a medical director of an outpatient home unit for several years, 8 years, and I’ve never in my life done a PD exchange…We’d go every morning with our carts and our bags, and prescriptions …It felt different because you were in the thick of it, as the doctor, you were doing the therapy yourself…And we did save lives. I have to say, for the first time in my career it was very obvious that we saved lives.
31	P, Northeast	I like to be needed. I’m an ICU doctor because I want to be needed and I want to feel like I’m making an impact clinically. And this felt like that. Whereas, I haven’t had that feeling in a while.
32	E, Pacific	I think there’s a group of people that will think about how much they want to risk and then I think there’s this other group of people that live for this, that have that sense of duty…Remember when you said you were going to go to med school and everyone said it was a sacrifice to be a physician? Well, this is one of them.
33	HH, Pacific	As a pulmonary critical care doctor who trained in and worked in an ARDS center, I feel like this is what I trained to do, taking care of these patients. This is my comfort zone. This is what my training is about.
34	EE, Northeast	It’s like maybe not what you went to medical school to do. You’re used to thinking about very complicated things and you’re just sitting here sometimes making phone calls, just giving updates and reassurance. But it’s just as important as our job.
Collaborating
35	Z, Northeast	All of those lectures about coming together as an orchestra…I used to kind of poo-poo that and roll my eyes, and now I get it. So, in that way, I think I’m humbled and have a better appreciation of each person’s role…I think, inadvertently…I was probably discouraging that kind of open collaboration before.
36	U, Northeast	It was really like you see in MASH…It's wartime medicine. And you do what's needed, what the immediate need is, what has to be done. You don't let egos get in the way. You don't get into big arguments. You do just what has to be done, and what's available to be done…In all my time in medicine I've never experienced anything like this.
37	J, Northeast	I dialyze every…person they ask for dialysis for…I certainly changed my attitude regarding my relationship with the ICU people…I did not want to argue with anybody. I wanted to be viewed as a cooperative and collaborative person…They’re so adamant and dedicated, and interested, and motivated to do the right thing. Under those kinds of circumstances, it’s kind of hard and I didn’t want to spend time arguing, it’s just kind of like, “ok, let’s just do this, because we’ve got to get on to the next patient.”
38	Z, Northeast	We also had a lot of help from our surgeon, who put in the Tenckhoff [peritoneal dialysis catheter]. We would just text him and literally, the Tenckhoff catheter would go in 2 hours later…We really came together, it was impressive. Never had I experienced that, being here for 20 years.
39	FF, Midwest/Mountain West	The dialysis unit nursing advocate called me up and said I just don't have enough staff to get through everybody…My first initial reaction was anger. You know, like figure this out please! Why are you bothering me?…Why do I have to make these decisions? But then after I gave my mind a minute to think about what's going on around us, then I calmed down. I realized that it was much more important that we collaborate.
40	CC, Pacific	We're [nephrologists] kind of bit players. You know, this whole situation is largely under the control of the intensivists…Their priorities are really different…I didn't always agree but I had to respect it, the decision.
41	H, Pacific	We’re all in it together. All of us, whether we’re working for a 29-state large dialysis organization, for profit, vs a non-profit. A lot of us have to address the same day-to-day issues as chief medical officers.
42	AA, Northeast	One of the [dialysis shifts] was me, our division chief, and two fellows…My division chief did a great job sort of leading by doing. And not just sort of talking about it, but actually participating in it.
43	S, Northeast	These are the people running the program and we’re the ones doing the work, and that’s the relationship, like a hierarchy. But I’d say it did feel, during the peak of the pandemic, a lot more collaborative, and less hierarchal, because they needed us. We're the ones on the ground…Our perspective became a lot more important when we’re dealing with something that’s changing and evolving so rapidly, that they need our input.
44	DD, Northeast	When decisions are made on anything, we have to do it together…I'm not at the bedside as much. These nurses are the ones at the bedside, and they really really know what’s the best practice, and what's safe…I don't care how many books you read, experience will trump most things.
45	II, Pacific	The right people weren't always at the table at the right time. But I think that's what early on we figured out as colleagues. We’re like okay, who gets it? Who understands what's happening? Who lives and breathes the hospital?…They're not always the people in direct leadership.
Building mutual respect and empathy
46	B, Pacific	[Our hospitalists] were able to see what we were doing in the ICU firsthand and go around on rounds, which really helped. I think they have more respect for what we do. And you get to see them in a different role temporarily while they are not as comfortable. It does kind of even the playing field. Everyone's wearing blue scrubs, and we're all trying to help each other get through this.
47	AA, Northeast	When I got sick…I slept really late and there were like three missed calls from my division chief wondering if I was okay. So, I think there were a lot of people caring for each other…We sort of got together and became much closer than we would've otherwise.
48	MM, Pacific	I think if we have someone who is concerned about an aspect of the response, like the PPE they’re wearing…You’d always like to talk to them face-to-face. It’s just going to be more profitable. I think it puts people at ease…they know that it’s not just some faceless, nameless email box.
49	H, Pacific	Of course [patients] were fearful; some people had anxiety attacks. But they weren’t angry at us. They were thankful that we were willing to be tough and swallow whatever it is in terms of our own anxiety and sit with them and talk with them.
50	T, Pacific	A number of my patients who fell ill happened to come into the hospital while I was inpatient.…[I was] able to have that continuity and be there at some of the most harrowing and intimate times of their lives, and at a place and time where they couldn’t be with family, they didn’t have family.
51	A, Pacific	We always try to be strong for our patients and their families…It felt like it was either more frequent or that I noticed it more, that families, they were really grateful, and they acknowledged that it was hard for us too.

ARDS, acute respiratory distress syndrome; ICU, intensive care unit; MASH, mobile army surgical hospital; PD, peritoneal dialysis; PPE, personal protective equipment.