Contributing Writer
Johns Hopkins Bayview
Sagar Chapagain, MD is an internal medicine resident physician in the General Internal Medicine/Primary Care track at Johns Hopkins Bayview Medical Center. A Jack Kent Cooke Scholar, his written work on health policy, health care disparities, and higher education policy has been featured in national and regional publications. Follow him on LinkedIn for updates.
Third year feels different. Intern year taught me how to work. Every note, every consult, every long night sharpened the mechanics of patient care. You learn to move efficiently, anticipate needs, and steady your hands when everything feels new. It is a year of doing, of survival, of quiet endurance.
It is very difficult to believe that I am already more than halfway done with residency at this point, and that it is time to figure out what I want to do after these three years are up. Once again, what’s surprising and different to me is the structure for training in the United States: having to apply at the end of year 2 for a fellowship that will start after year 3, seems so early, but I am learning to accept that these are the American ways.
The second week of September was the epitome of emotional whiplash. Monday the 12th, we celebrated our one-year engagement anniversary in the ICU. We had gotten engaged in an apple orchard, so I brought in apple cider and cider donuts. She still wanted to keep fighting and didn’t want her doctors to give up on her. She was on four mcg/min of norepinephrine to keep her blood pressure up.
I had just started my residency in Burlington, Vermont when she started having symptoms again. She was to receive her treatment in Rochester, New York, which meant we were apart most of the year. I had been planning to propose in October, but now all plans were out the window. Despite the fear that swelled inside, I made sure to propose before she started chemo, to show that I would be with her no matter what.
Residency is hard. Anyone who has gone through it can attest to that. While I was getting intimately acquainted with this reality in August, 1.5 months into the first year of my internal medicine residency, my soon-to-be fiancé was diagnosed with cancer.
In my last installment, I mentioned I would like to write about my process of getting into a residency program in the United States. As soon as I promised this, I remembered the number of steps involved, so please forgive me if I forget to mention something. The path has substantially changed since COVID and differs greatly by individual circumstance. What made the whole process so confusing was having to create multiple accounts and profiles for multiple websites; the next step was often unclear until I called the Educational Commission for Foreign Medical Graduates (ECFMG) and explicitly asked for instructions.
A few months have passed since I wrote my last column article, so now it’s time to get back into it. What has happened in the meantime? Well, I had baby #2, which meant I was lucky enough to take seven weeks of maternity leave from residency.
Let’s start with a very brief introduction: Hello! My name is Aline, and I am an international medical graduate (IMG) from Germany. I used to work in Germany in internal medicine, where I have completed four out of five years of training. I would like to share my experiences, thoughts, and later also some of the processes and steps that got me here over the course of this new column.
It feels odd to have family members in the hospital regularly again. My patient’s wife approaches cautiously; for a second I pretend not to see her. She looks like she wants to talk and I’m afraid she wants good news I can’t give, promises I can’t make, and time I don’t feel like I have. She wants time to tell me her loved one’s stories.
The novel coronavirus pandemic (COVID-19) has drastically increased the number of critically ill and dying patients presenting for hospitalized management of dyspnea, acute respiratory failure and other serious complications. The emergence and spread of SARS-CoV-2 has created unprecedented demands on all avenues of inpatient hospitalist medicine. One of the many services in high demand includes palliative care, with increased need for complex end of life planning.
In my home city of Washington, D.C., citizens have taken the changes brought on by COVID-19 very seriously; social distancing, masking and frequent hand hygiene are now routine. These days, I am startled when I see the bottom half of someone’s face out in public. Our homes have become our sanctuaries. In the hospital, however, much of our work continues unabated. Orders are written, notes are signed, lab work is drawn, imaging is performed. Housestaff are on the front lines with nurses, respiratory therapists and patient care technicians taking care of the sickest patients day-in, day-out.
Earlier in February of this year, before COVID-19’s onslaught in London, UK, I was covering service on a respiratory ward when a young medical student made herself known to the physician’s office. “Could I borrow your stethoscope? I’m here to practice my respiratory examinations.”
Fellow Physician Contributing Writer
Junior Clinical Fellow in London
Grace is a UK-qualified physician and holds honours degrees in both pharmacy and medicine. She has worked as a research scientist in the fields of drug delivery, gastroenterology and hepatology; runs two organisations pertaining to sustainability in healthcare; and holds fellowships with both the NHS Clinical Entrepreneur Programme and the Royal Society of Arts. In spite of all of this, she still can't afford London house prices. It's a mad world.
