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.
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.
Dakor (Kheda District), Gujarat, India December 1, 2019 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. The surroundings quickly transform from the afternoon’s thick, sweltering …
Residency is a challenging time plagued by long hours, overwhelming clinical service loads, escalating documentation requirements, and inadequate resources for support. A recently published study in the New England Journal of Medicine illustrates how mistreatment in the training environment takes an additional toll on medical trainees.
I had just started my first clerkship of third year at a nearby hospital when the news broke. Hahnemann Hospital, the main teaching hospital of my medical school, was closing. More accurately, the hedge fund manager who purchased the hospital a year earlier was filing for bankruptcy. He separated the valuable Center City real estate from the hospital itself to ensure a tidy profit for investors at the expense of patients and staff.
The National Health Service (NHS) is the overarching employer of medical graduates in the United Kingdom. The first two years of any new doctor’s training within the NHS is known as “foundation training” (in the United States, this would probably be equivalent to the “rotations” typically completed before obtaining an MD).
It wasn’t caterpillars turning into beautiful butterflies, that’s for sure. “The Change” was when a bright-eyed, optimistic female junior resident turned into an angry, and sometimes mean, senior resident with very little patience for anyone.
During residency, do you ever stop to think why you wanted to become a doctor? What were your reasons? I wish I could remember mine. I could have pursued so many other careers. I used to be a director of a non-profit organization, helping individuals from low socioeconomic backgrounds attain technical skills. I do not recall being at my current level of mental, emotional and physical dysfunctionality while working that job.
Last week, the resident physicians and fellows of the University of Washington collectively decided to walk off the job for a 15-minute “unity break” in protest of unacceptable working conditions and stalled contract negotiations.
In my first post in this two-part series, I presented an argument for why physicians and administrators need to work together to develop small-scale interventions to bring meaning to medicine while we continue to push for larger systemic change. In this post, I will explore some effective (and some less effective) themes for interventions for residents.