Clinical, Featured, Intern Year, Internal Medicine
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Internalizing Medicine: Starting Intern Year in the Time of COVID

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. The mayor recently issued a ban on all indoor dining. The downtown core of the city is deserted most of the time. Commutes that normally take more than two hours can be accomplished in 20 to 30 minutes. 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. The day-to-day torrent of patient care continues to engulf us, threatening to sweep us away but for the assistance and attention of diligent upper-level residents and attendings. While COVID has complicated the logistics of caring for others, it has largely not changed the substance of health care. It has just increased the gradient on our already precipitously steep learning curve.   

Starting in any new career is difficult. Being a newly-minted doctor in the midst of a pandemic feels nearly insurmountable. Entering residency under the best of circumstances is like going into battle. You do not know what is coming over the hill, but you are standing there together with your colleagues who are feeling the same mix of excitement, anticipation and dread. 

In some respects, COVID has robbed us of that communal solidarity. By definition, social distancing has increased the physical and emotional space between us. This has made it much harder to forge connections between colleagues, both within our immediate cohort and across post-graduate years and disciplines. Typical onboarding rituals like in-person orientations, group activities and welcome parties have necessarily been canceled. Ongoing opportunities to build friendships and professional relationships — grand rounds, morning report, cohort activities — have also been precluded. 

The triple burden of trying to become an independent and functional clinician, watching the havoc COVID-19 wreaks on the human body and on families, all while facing the isolation of social distancing is not a light one. COVID has complicated the process of staying well in intern year, both physically and mentally. Typical outlets for recreation and fun have become few and far between as gyms close, group exercise activities go dormant, and restaurants board up for the foreseeable future. In the dead of winter in the Northeast, even the prospect of a jog through a nearby park seems more daunting than uplifting.     

In medicine, we rely on our colleagues heavily. Not only for their expertise, clinical acumen and deep knowledge of highly specific subjects, but also for their compassion and friendship. It is these relationships that power us through intern year. It is our colleague-friends that we turn to when we make our first patient “do not resuscitate” or make our first big diagnostic breakthrough. We share in each other’s triumphs and commiserate at each other’s losses. In the midst of a global pandemic, these highs are heightened and the lows deepened. Helping a COVID patient walk out of the hospital free of supplemental oxygen is joyful. On the flip side, watching a patient in the ICU decompensate after they develop complications from COVID is heart-breaking. Even as we socially distance, we must turn to our colleagues to avoid social isolation.     

It is my hope that we as an intern class will come out of this experience stronger and more prepared to practice medicine than ever before. Facing the unknowns of COVID on top of the chaos of intern year has required us to be even more flexible, diligent and courageous. Standing right now the “eye of the hurricane,” it may be impossible for us to see all the ways in which the pandemic is impacting our interpersonal and inter-professional relationships. In the midst of this experience, I hope we will grow to appreciate that these challenges are pulling us closer together. That as we share in these experiences, we are forging unique, understated solidarity — a class of physicians coming of age in the midst of an unprecedented pandemic. 

Image credit: Pandemic by Dan Gaken is licensed under CC BY 2.0.

Keanan McGonigle, MD, MPP Keanan McGonigle, MD, MPP (1 Posts)

Resident Physician Contributing Author

George Washington University School of Medicine and Health Sciences

Keanan McGonigle is a PGY-1 in internal medicine at George Washington University. He plans to go into primary care and has particular interests in geriatrics and HIV medicine. Dr McGonigle is a 2019 graduate of Tulane University School of Medicine and spent a year working in public policy and medical student advocacy before starting residency.