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Coming Full Circle: Training During COVID-19

By Dr. Jonathan Paul Donnelly

Unlike many of my colleagues in the medical field, I took a very unconventional path through my postgraduate training. Throughout medical school, I was convinced I was destined to be a surgeon. I loved anatomy, loved my surgical rotations, and thought that this was my destiny. Then on my first day as a house officer in general surgery, I stood for 9 hours in a laparoscopic hemicolectomy, without any breaks for eating or going to the bathroom, and suddenly my life choices became much less clear. I struggled a while longer, but eventually I put away my scalpel, took up my neglected stethoscope once again, and I took up a formal internal medicine training post in New Zealand, starting on another journey. Everything started to make sense for a change. The flow of hospital medicine, the critical thinking, the lack of having to stand in an OR for several hours with a full bladder and an empty stomach, it all finally came together. As it turned out, one shake-up was not enough, and as I rotated through stroke and neurology, I found a hidden interest that I wished to take further. Being inspired by some American mentors, I decided to apply for training in the USA, and began residency at the University of Texas (UT) Health Science Center, San Antonio Texas in June 2018. After all my continent hopping and specialty changes, at last I seemed to be on the right track.

A trip to Hobbiton before leaving New Zealand
A pre-pandemic picture with my awesome Neurology class

Of course, I’m sure a lot of people thought the same thing before 2020. As I was making my way through my PG2 year, taking on QI projects, thinking about fellowships, dealing with stroke alerts, and managing a busy inpatient service, my medicine years felt far behind me. Sure, I felt a little more comfortable than my colleagues did when managing my patients’ diabetes, hypertension and UTIs, but neurology was my new focus in life. As the reports of this “novel coronavirus” started to pop up in late 2019, it probably wasn’t on too many neurologists’ radar. As it rapidly progressed to become a global pandemic, we started to hear stories from other hospitals of dermatologists rounding on medicine patients, urologists working in the ICU, general surgeons in the ER, and many more examples of the dissolution of the boundaries between specialties. It became clear that this would be the case for us too, so we mentally prepared ourselves to take on internal medicine patients once again. This was more anxiety-inducing for some residents than others, depending on the post-grad year, and certainly some of our “more mature” attendings seemed uneasy. We were assured there would be online courses, refreshers in internal medicine, and critical care tips for “non-ICU physicians,” but it was still daunting to have to re-enter a specialty after as much as 20 years away (for some attendings).

A photo I took for UT Health’s WhyIWearAMask promotion

Personally, I had a mixture of emotions. On the one hand, COVID-19 was frightening. I had heard stories of cross-covering residents in New York getting critically ill, even dying, from this disease that we initially thought would only be a real problem for “vulnerable” patients. But on the other hand, I felt an undeniable sense of duty to help in this time of crisis. Of all my colleagues, I was the only resident who had spent any significant time in internal medicine beyond the required preliminary year, even taking board-style exams (the MRCP) before starting my neurology residency. So, when my program director redeployed myself and my co-residents to fill the new “covid schedule,” I was up for the challenge. My co-residents and I were ready to step up and be there for our community when it needed us most. We only hoped that whatever we could do to help our thinly stretched hospitalist colleagues was enough. Enough to allow them to help a few more patients on that day, enough to allow them a much-needed breather, any positive thing we could bring to these times.

The difference of a year: a post-pandemic socially distanced year-end photo

I felt a sense of fulfillment from my work on the COVID-19 response team. Given my non-traditional path, from my disastrous attempt at a surgical career, to my country-hopping internal medicine training, to settling in Texas as a neurology resident, I sometimes wonder how much time I could have saved if I’d been able to settle on one thing a little sooner. But when the time came to take care of patients with infectious disease, gastrointestinal and endocrine problems once again, it didn’t feel like any of my time in medicine was wasted after all. My non-traditional path through medical training was part of a greater purpose. It prepared me with the skills I needed to support my adopted community during this unprecedented time. I was also emboldened by the tenacity of my neurology colleagues, who were unafraid to enter the fray regardless of their medical background, exemplifying that one of our program’s many strengths lies in its diversity. As the pandemic rages, the time may come that I will need to dust off my old internal medicine books for another round, but I will be happy to use my skills as many times as are needed, until we can finally close the book on COVID-19—whenever that may be.