Resident perspective on COVID-19
LT Danielle Wickman, MD
Life has definitely changed over the past few months. When I started this year, I was full of excitement and relief. I am two months shy of finishing residency at one of the most notoriously grueling residency programs in the country, and as a fourth-year resident, I looked forward to this reprieve. However, as we know, things do not always work out as planned, and we must be adaptive to change.
Because of the COVID-19 pandemic, I have had experiences I never thought I would. As ER doctors, we know and willingly accept the risk that we will be exposed to many infectious diseases. Initially, I mainly felt fear of the unknown;fear for my family, friends, and colleagues. I spent hours online daily, trying to best understand this new virus, how we could best protect ourselves, the clinical picture that patients would present with, and what therapies we could offer. Did my hospital have a plan? How would I best serve my patients while ensuring I was protected so I could continue working? In the very beginning, our hospital had limited access to testing, and PPE was being distributed on a “need” basis without clear guidelines of what PPE was required for each patient encounter. It was initially deemed unnecessary to wear a face mask at all times. We were reusing certain PPE items due to concern for future shortages. Luckily, my colleagues and I voiced our concerns and now have much improved access to PPE.
Information on COVID changed on a daily, even hourly basis, and we were inexperienced and unprepared to deal with a pandemic of this magnitude . My generation of physicians had not experienced a true pandemic. My residency program initially had only attendings seeing COVID rule outs, but when it became apparent that the numbers of these patients were increasing, this soon stopped. Our current policy is to try to stick to senior level residents seeing and performing high risk aerosolizing procedures on these patients, but as we know, there are many asymptomatic COVID carriers.
I personally had a COVID exposure and became sick with URI symptoms after attending a conference in New York. Initially, I was unable to get COVID testing myself. I felt guilt for calling off work and after working with symptoms and possibly exposing my patients without knowing if I had COVID myself. I chose to stay home, and found alternative ways to get tested. I ultimately had a negative test, but during my weeks of quarantine and isolation, I found myself feeling scared, anxious, and frustrated. Seeing our lack of access to timely testing made me wonder how we will handle this pandemic as a medical society. Who do we test? What is the policy if residents become sick? What is a high versus low risk exposure?
This pandemic has affected us all differently. The fear I initially felt has decreased as more access to appropriate PPE became available. However, one shift, while working in our “COVID” pod , I noticed my mask leaking. I have had colleagues whose mask straps have broken while intubating patients. I was able to get fit tested and found that none of the masks we have available for our staff fit properly to protect me from aerosolized particles. I now wear a PAPR if performing high risk aerosolizing procedures. While our PPE situation has improved, the initial lack of appropriate PPE caused a large sense of fear and frustration.
The social aspect of being a provider during this pandemic is something that has had profound impacts on physicians. I don’t know when the next time I will be able to see and hug my family will be. Living alone is a blessing and a curse. I am lucky that I do not have to worry about exposing others on a regular basis, but I also find myself feeling isolated on days off. Being away from my support system has been mentally taxing. I know many of my colleagues are in the same boat, especially those who have had to isolate themselves from their spouses and children. I can only imagine how hard that must be. I am grateful for ACEP and the number of housing resources that have been made available to ER providers. I urge residents to seek out healthy methods of coping with this difficult time. Therapy can be immensely helpful, and I encourage others to seek out care for your mental health. We have technology that allows us to connect with each other. While it isn’t the same as being in person, it is something.
I am due to PCS as a new officer in the Navy this summer. COVID-19 has created a large amount of uncertainty for medical students, residents, and current officers. The most recent guidelines have established a “stop movement” order until June 30. There are exceptions, which are listed in the current NAVADMIN guidelines. An important exception to note is that “travel associated with uniformed personnel recruiting and accessions activities, to include accessions, basic training, advanced individual training and follow‐on travel to the first duty station” is exempt from this stop movement order. As of this time, ODS is still occurring, but I have not heard formal details if there are modifications being made to promote social distancing. I would recommend reaching out to your respective command for further specific details.
At the end of the day, this pandemic will bring its challenges. I urge you to come together as a team and continue to look out for one another. We can choose to accept that this will be present for the time being and learn how to bring out the best in ourselves during trying times. Let us continue to be the leaders and make a positive impact in our society and in our profession.