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Medical Residency at a Dedicated COVID-19 Care Center

By Dr. Magdi Zordok

On March 17, 2020, our institution was designated as the nation’s first dedicated care center for Coronavirus Disease 2019 (COVID-19). Our patient population would now be only individuals who tested positive for COVID-19 and required hospitalization, either from our emergency department, or from other hospitals within our network. My experience with COVID was, at that point, scarce and limited to discussions with my senior colleagues and the case reports from China and Italy.

A COVID testing tent was set up outside the hospital and news reporters lined up in the parking lot the next day. Soon enough, the patient count ramped up, which required modification of our existing wards and intensive care unit (ICU). More beds were added after negative pressure rooms were installed in pre-existing and under-utilized units to double our bed capacity. With the new COVID-only designation, our institution had an influx of patients from all over the Boston area.

Today, as the number of cases in the region plateaus, it’s time to reflect on the last couple of months which, to me and to a lot of my colleagues, were pivotal in shaping our careers and us as physicians.

As I heard the news of our hospital’s dedication to COVID I was overwhelmed with a myriad of emotions and mixed feelings. I was petrified for one, as we would be coming face to face with a new archenemy. I was not entirely sure how prepared I was, in terms of infectious diseases knowledge let alone COVID management. I worried about my wife, given my heightening risk of exposure, and in the back of my mind always had an evacuation plan to isolate myself the second I started showing symptoms. I managed to hide the news that my institution was becoming an epicenter for COVID care from my family abroad, and did my best to keep a positive attitude to help keep me and my family strong. I knew that this was my time to serve and hold down the fort with my colleagues, and I felt a sense of honor to be entrusted with this mission.

During one of the COVID-19 days

The COVID-only designation at our institution meant that, as residents, we would become more involved in COVID care than most other facilities. We would be in direct contact with COVID patients after being trained to use personal protective equipment (PPE). Besides the increased exposure to new and novel medical information, COVID also revealed to us greater insight into the non-medical aspects of clinical practice. Virtual meetings, either through phone or video calls, became part of our daily routine to update patients’ close family members and loved ones who were not allowed to visit. With time, the families became acquainted to the medical team and, as the patients would get better, the calls would be very rewarding. Especially after a long day of work, they would bring about a great sense of joy, as they were filled with positive vibes and energy. Other calls were heart wrenching. Discussing goals of care or end-of-life decisions became daily conversations that, unfortunately, had to be done. I remember being part of final goodbye phone calls between patients and their families, or arranging and participating in virtual end-of-life prayers for patients. While it was an honor to be asked to be part of these important moments, they were painful to witness.

During table rounds before going to the floor

As a COVID-only institute, we also learned quickly that there is no rule or any way to predict what is about to come next in regards to who gets better and who does not. I remember very well a 46-year-old gentleman whose past medical history was significant only for asthma, and whose clinical course suddenly deteriorated, requiring intubation after initially being stable on 3L of supplemental oxygen the day before. The patient had to be transferred out of our facility, as his condition continued to deteriorate and at the time was requiring extracorporeal membrane oxygenation (ECMO) and he required almost a month-long stay in the ICU. Conversely, an 88-year-old lady with a very extensive medical history and multiple comorbidities made a very significant recovery with less than a week-long stay. The 46-year-old patient at the time was the sickest I’d seen, and during the peak of the disease, we had 16 more similar patients in our ICU. The use of new ventilation techniques, as well as paralysis induction, were new treatment modalities which until that time I had only read about. There were no clear guidelines or playbook to go by, as everything was still under trial. Around our institution’s busiest point, when our ICU bed capacity was at max, ICU-level of care was being administered on the medical floor. If not for the nursing staff going above and beyond, none of it would have been possible. To buy time when no ICU beds were available, it was a common practice to prone patients who were on max oxygen supplementation and still hypoxic.

Our class on orientation day

COVID also impacted my personal life. It stole many of life’s simple joys, like family get-togethers, a wedding plan, a graduation ceremony for my wife, and much more. It taught me that even a walk on the beach is a simple pleasure that should not be taken for granted. It gave me a better insight into the spiritual aspect of medicine and how there is more to patient care than just science. A smile, heartfelt wish, positive thoughts, or a prayer can go a long way.

Looking back now after several months, I won’t forget the feeling of going home and seeing the scars of the N95 mask on my face. I would say no matter how the pandemic changed me, or my life, I will forever be proud that I was on the frontline. This is a very humbling experience to everyone in the medical field. It teaches us all that no matter how much we know, there’s still more that we do not know. Now, more than ever, I feel close to my coworkers and would trust them with my life.