Clinical, Housestaff Wellness, Psychiatry
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A Tale of Three Continents: A Resident Physician Perspective on the Pandemic

“The United States reports first death from COVID-19 in Washington State.”

It was the end of February as I glanced over this news alert. For the past month, my inbox was flooded with emails regarding the COVID-19 outbreak. I saw my patients as usual throughout the day, albeit washing my hands and using hand sanitizers more often.

The next two weeks saw the world bracing itself for the inevitable, with the World Health Organization labeling the coronavirus outbreak a pandemic. Several countries started imposing travel bans and forcing lockdowns to contain the spread. Non-essential businesses were being shut down and people were getting laid off as economists talked of global economic collapse. American stores ran out of toilet paper as people hoarded them in preparation for an apocalypse.

I canceled my tickets to Philadelphia as the American Psychiatric Association announced the cancellation of the conference. The implementation of social distancing perturbed me as I thought of my sister’s wedding getting affected by the crisis. The ceremony was to be held at the Triyuginarayan temple of Uttarakhand, the ancient temple where Lord Shiva married Goddess Parvati.

While I planned to visit India for the ceremony from the United States, my sister herself was planning to fly from the United Kingdom. “I hope things improve in the next few weeks so the wedding can still take place,” she said, disappointingly.

The prime minister of India, Narendra Modi, asked for a self-imposed public curfew on March 22. The country of 1.3 billion people came to their balconies, clapping their hands and ringing their plates to salute the service of health care workers. Two days later, he called for a 21-day total lockdown — the world’s largest coronavirus lockdown.

At work, we were going through formidable transitions while confronting a new reality, just before the wave of infection and death hit. We attended endless meetings where we talked about switching to telemedicine to reduce iatrogenic COVID-19 infections. Committees for workforce wellbeing were being designed to alleviate the moral injury among frontline providers. I found myself checking the latest numbers on COVID-19 cases multiple times a day as I advised my patients to take a break from the news.

As a psychiatry resident, we were asked to prepare for the possibility of being deployed to the emergency department if the need arose. As we tried to bring different perspectives to the table, we were told that we were in an honorable position as we were entrusted with helping others with the mental health ramifications of this pandemic.

I saw my patient for therapy via telemedicine, worried about her OCD flaring up from pandemic. “How is your family in India and the UK, Dr. Sinha?” she asked.

My parents, who live in Bangalore, India, told me of the deserted streets. Doctors were being shunned on streets as they were asked to vacate their rented homes by their landlords. My mother, who is a bank manager and a Type II diabetic, continued to go to work for at least three days of the week. My brother, a fitness coach, posted home workout videos to continue to motivate his clients. Worried about each other’s health, we had been video chatting every day across three continents, begging each other to stay safe.

I hoped I had avoided the virus for one more day, as I walked out of the hospital each day without a mask.

As we welcomed spring, the flowers bloomed on the forlorn trees while we reached a million cases worldwide. A massive $2 trillion relief package was signed into law while many filed for disability. The hospitals continued to scramble for N95, ventilators and hospital beds. Tents were set up in Central Park to triage patients — a medical warzone. The licensure requirements were being relaxed as states asked for more volunteers to manage the overflowing patient load. Europe fast-tracked its medical students into an early residency. The Educational Commission for Foreign Medical Graduates (ECFMG) pleaded the Department of State to consider the impact of the suspension in visa issuance on more than 4,200 foreign national physicians, the lack of which will result in a devastating shortage of workforce in the United States.

More than 50 doctors died in Italy, and 2,000 were infected. The morgues ran out of capacity and funerals were being held without loved ones. As Pope Francis prayed at the famous crucifix that helped to save Romans from the plague in 1522, intensivists threw hydroxychloroquine, remdesivir, tocilizumab, and ECMO, expecting some miraculous response. Some ethicists discussed a mandatory DNR status for all COVID-19 patients. The future felt bleaker as Dr. Fauci predicted up to 200,000 deaths in the United States by the summer.

In the face of this pandemic, I worry about a surge of mental illnesses in our population. I worry about my significant other, a hospitalist and a frontline provider. I worry about my mother who has diabetes. I worry about my sister who is separated from our family in a foreign country as her wedding lies in limbo. I worry about frontline providers who are struggling every day and quarantining in their garages after work. What if they rebel and refuse to be martyrs in this battle? Will that be enough for our administrators to understand the critical shortage of PPE?

Part of me hopes for a silver lining amid the cloud of this catastrophe. I hope we will redesign our health care policies. I hope we will focus on the health impacts of the climate crisis. I hope we will research the viruses that are transmitted to humans from animals. I hope we will invest more in the public and preventative health care that comprises our social immune system. We will recognize the selflessness of the heroes in scrubs.

Maybe an invisible enemy was needed to dissolve the manmade borders, uniting all of us to find a common purpose. We will tell our children of the power of human resilience and when the threat of pandemic looms again, we will be ready.

Image credit: Rainy Night by Naveed Dadan licensed under CC BY 2.0.

Akriti Sinha, MD (1 Posts)

Resident Physician Contributing Writer

University of Missouri School of Medicine

Dr. Akriti Sinha is currently a third-year psychiatry resident at the University of Missouri, Columbia. She will be the chief resident for academics next year and plans to practice Consultation-Liaison Psychiatry after graduation. She loves karaoke, 80s music, photography, and dancing. She has no disclosures and no conflicts of interest.