Fellow Physician Contributing Writer
Stanford University School of Medicine
Megha Shankar is a health services research fellow at the Palo Alto VA and CHP/PCOR at Stanford University. She completed her undergraduate degree in anthropology and biology at the University of Chicago, medical school at the University of Illinois at Chicago College of Medicine, and internal medicine residency at the University of Washington.
This elderly yet jolly gentleman answers our unending questions about his physical health, but it is his question to us that makes me pause. Do I have time for a poem? This busy clinic day, I stop reflecting on why his heart stopped beating and instead what motivates his heart to beat in the first place.
No one had told her how difficult the fight after COVID would be. Of course, few in her community had lived to tell the tale. And then again, precious few people had expected her to survive at the ripe old age of 86.
In medical school, I was taught to sit at eye level when speaking to patients, ask how they would prefer to be addressed, and ask open-ended questions to allow them to express themselves. I learned to interject with “That must be really difficult for you,” or “I can only imagine how that makes you feel,” as a way to show empathy and foster better connection with patients.
I was appointed to do the morning shift in the COVID ward of our respected hospital. The unit is a negative pressure area and, to us doctors, it is comforting as we embark on the Icarus flight.
As I enter rooms filled with aerosolized forms of the coronavirus, realizing that I am at high risk of catching this highly contagious disease, I set aside my fears to hold the hands of patients — strangers and friends, all alike. I love what I do.
When I first met Rita, she didn’t make things easy. She fired a barrage of questions at me, punctuating her litany with the dreaded blow to every resident’s ego — “Are you a student?” — before slouching back on her bed, sweat glistening on her gray-streaked temples as though she had run a marathon.
As I check in on my patients each morning, I wonder if some will unexpectedly decompensate and die over the coming weeks. I think about myself and my co-residents who are in the hospital all day swabbing patients for COVID-19 without adequate personal protective equipment. Many of my co-residents are on home isolation as a result of this exposure, waiting for their test results and praying that our government will step up and fund more mask production, or civilians will return the N95s they’ve hoarded, or the set of a TV medical drama will donate their props to us.
Earlier last week, one patient had been referred in from their family physician, and the onsite senior resident, Adam, had been the doctor to assess them. Symptoms were vague — generally unwell, off food, bit of a cough, possible headache. Viral swabs were taken, because pretty much anyone that had lately walked through the hospital door with even a suspicion of sepsis now had samples sent off.
As an internal medicine resident working at Mount Sinai Hospital in Manhattan, COVID-19 has taken over our workroom conversations as the number of new cases enters exponential growth. As an anthropologist who lived in Wuhan for a year and has regularly kept in touch with physicians there since the city was placed under lockdown on January 23, 2020, COVID-19 has proved to be an unprecedented crisis.
You could feel it in the air, in how the nurses double-checked the orders, how the attendings’ notes bloated in size, and even in how the patients, despite their general lack of knowledge towards the inner workings of the hospital, exuded mild apprehension. It was day one of the academic year, the day that the new interns — my new interns — started.
Caffeine’s effect waned, stomachs rumbled, attention spans faded after rounding on nine acutely ill patients on university wards. It was nearing lunch. I was the senior resident, so I chose the order in which we saw patients. As we arrived at our last patient’s room, I snapped out of my under-caffeinated daze and realized I had made the rookie mistake of leaving our newest and sickest patient for last.
When I am asked about my future plans, my response is rightfully met with confusion. I am entering the workforce as an academic internal medicine physician devoting my practice entirely to the outpatient setting. Yet, two-thirds of my residency training has been managing patients within the walls of a hospital. That disconnect raises interesting questions about my career choice, and, naturally, makes me an anomaly among my peers.
Resident Physician Contributing Writer
OU School of Community Medicine
Ryan is a second-year internal medicine resident at OU School of Community Medicine in Tulsa, Oklahoma. He had published a few articles for in-Training as a medical student and wishes to continue writing during the busy times of residency and beyond.
