Fellow Physician Contributing Writer
Virginia Commonwealth University School of Medicine
After completing a pediatric residency, I've been enjoying fellowship in allergy and immunology at Virginia Commonwealth University. My main interests include primary immunodeficiency, severe asthma and food allergy. When I'm not in clinic, I enjoy cooking with my husband (usually while chasing our toddler around).
I’m a soon-to-graduate allergy and immunology fellow and the circumstances surrounding the COVID-19 pandemic have catapulted every single physician into uncharted, and sometimes strange circumstances.
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.
It is difficult to put into words the level of frustration and despair that I have felt over the last few days watching the schizophrenic national response to this COVID-19 crisis and its detrimental effects on the work conditions of my colleagues. As an internal medicine physician working in Utah, it feels like it is the calm before the storm as emergency room and urgent care volumes are down as people try to socially distance to correct the spread of this virus. Other areas of the country are not so lucky.
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.
It was a beautiful late winter Sunday, and my husband and I decided to drive to Plum Island, in the quaint sea town of Newburyport just north of Boston, for some bird-watching and ocean views. I wondered how my sister-in-law was doing — her wedding was scheduled in just seven days, and she and her fiancé had already been faced with tough decisions because of the coronavirus pandemic.
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.
As a program director, I am worried about my trainees who are already challenged with the usual stressors of graduate medical education (GME). This new illness is threatening to upend and disrupt our program in ways that I cannot even imagine, and therefore cannot plan for.
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.
In America today, history is repeating itself with ardent voices calling for division between “aliens” and “nationals,” instilling an “us” versus “them” mentality. What is happening under our watch is eerily reminiscent of the internment camps of World War II and the separation of individuals based on ethnicity that we have seen throughout history. We have created a climate of widespread fear, detaining immigrants and asylum seekers in abhorrent conditions, without a basic standard of care, and separating parents from children.
Softly and subtly, the rustling of the leaves quickens and a cool breeze sweeps across the town. A child rocks gently on a swing and a father stands in the bazaar bartering for the best value for vegetables for dinner. His wife is hospitalized with hemorrhagic dengue; shivering with fevers that rise and fall as do her blood counts.
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.
