Since the beginning of the 21st century, palliative care has emerged as a prominent aspect of medicine. Palliative care focuses mostly on improving the quality of life in severely ill patients, but it also involves comfort-based care for terminally ill patients. Despite increased awareness of palliative care among health care providers, decisions made in respect to end-of-life treatment are often difficult because they can be subjective.
The COVID-19 patient did not speak English, so we communicated using a translator phone. He taught me a few words and sentences so that I could ask simple questions to other patients who shared his native language. “I can’t breathe” were the last words that I could understand before he was intubated. I wondered if he ever imagined that his last words would be spoken to someone who did not speak his language. Did he imagine that he would be taken care of in his final days by someone born thousands of miles away?
I remember hearing on the news that in China there was an outbreak of a new respiratory virus. Shortly thereafter, this virus propagated all over the world. I made video calls to my family members back in Guatemala to discuss the importance of isolation and the use of masks. They were really scared because the virus was killing hundreds of people around the world and had just reached my home country. I was training in Chicago, Illinois at one of the biggest hospitals in the city. Cook County serves a large population of immigrants and non-insurance patients. It was a time of great uncertainty for many. The virus continued to spread and one day I received a phone call from my chief resident, indicating that I would be reassigned to the first medical COVID-19 response team. I agreed without thinking because I wanted to help these patients. After the conversation, I told the news to my wife and she started crying because she was worried about my safety. I decided not to tell my parents because this was relatively new, and they would have been very scared for my safety.
As I sit in a dear friend’s apartment in New York, basking in the nothingness of vacation, I realize that the time left in the intern year of my Internal Medicine training can no longer be measured in months. It has been quite the year and I am part trepid, part excited to transition into a senior role in the next academic year.
This is not the first of such transitions for me, and neither was Match Day 2018 my first dance with the NRMP. I first moved to the United States in 2016 to begin an Anatomic Pathology/Clinical Pathology (AP/CP) residency. I remember putting all I owned into two travel bags – more like haphazardly stuffing the bags – and getting on the long-haul flight to Chicago, to begin the next phase of my seemingly never-ending medical training. I was excited and grateful to be part of the next group of exchange visitor physicians.