By Dr. Jinendra Satiya
December 2019, the month a mysterious viral outbreak was first reported in Wuhan, China, will be forever remembered as an important moment in history. The COVID-19 pandemic has dramatically changed our lives, and strained the healthcare system and economy like never before. At the heart of the pandemic in New York City, we faced the worst. Originally from Mumbai, India and a Grant Medical College alumni, I moved to New York City for chief residency after completing my Internal Medicine Residency from JFK Medical Center, University of Miami. In this blog I describe my experience as an Internal Medicine Chief Resident working in New York City, sharing the difficulties encountered and the lessons learned.
New York City, and the world, was facing something it had never seen before. Resources were stretched. We soon realized that we were up against an aggressive disease and dealing with the sickest of patients. Families not being able to bid farewell to their loved ones added to the agony. Keeping up with new information everyday was a task. It soon became clear that society had a big role to play in controlling this disease. Social distancing and wearing masks soon became the norm. Individuals were increasingly being required to stay in their homes, away from their family and friends, a degree of isolation incompatible with basic human nature. This was our new normal.
Running a residency program amidst a pandemic poses unforeseen challenges. Striking a balance between service and safety is key, as is ensuring the physical and mental well-being of residents. The daily struggle to obtain adequate personal protective equipment (PPE) was one of the crucial roadblocks we faced. We owe thanks to the altruistic individuals who donated PPE supplies, what little we had was monitored under lock and key. Keeping our residents and their families safe was our top priority. Daily news, events around the world, and stories from colleagues at other hospitals added to their fears. While all of us worked tirelessly trying to alleviate the fears of our patients, we dealt with our own. New Yorkers coming out in support of healthcare workers with a daily 7 PM clap was invigorating. As many of my colleagues put it, we felt as if we were in a war zone.
One of the major issues was bed availability at different hospitals in the city. This meant a great influx of patients from other facilities to ours. A timely and safe discharge of patients who did not require inpatient services was essential. The initial unavailability of test kits hindered the care of these patients. The recruitment of additional physicians and nurses from other states was vital. Our intensive care unit was running at maximum capacity. We faced an impending shortage of ventilators and medications. Physicians were staring at the unprecedented task of deciding which of two patients needed a ventilator the most. This was not easy.
Didactics for our residents underwent a major reform during this pandemic. A lot of the education was now virtual. Zoom meetings became the norm. Although initially strange, we soon realized that being able to attend a lecture in the middle of a busy inpatient day, from your own work room, had its own advantages. This led to more widespread participation and resulting stimulating academic conversations. This form of education, meetings, and recruitment is something we might see increasing use of in the coming years.
The COVID-19 pandemic, likely the toughest period in our careers, has taught us numerous lessons. Every generation has its challenge—be it the Spanish flu or the HIV-AIDS epidemic—and this was ours. It has brought about a sense of reflection across professions, none more so exemplified than for us, physicians. All of us, international medical graduates, are proud to be able to serve the American community in these troubled times. We were at the epicenter of this pandemic, living out the Hippocratic Oath that we took while graduating medical school.
We learned that teamwork and stepping up for your colleagues was the only way to get through this. Every individual realized what was important to them, as a human being and as a physician. It reinforced that knowledge is power, and being well-informed is the first step in ensuring the safety of our patients and colleagues. We have learned adaptability. We learned not to take anything for granted in life, particularly the love and support of our friends, family and co-workers. This pandemic was a strong test of the reason we chose to enter this profession.
Telemedicine became more important as we continued to adapt during the pandemic. Medicine and sub-specialty clinics opened, providing routine care to patients via video calls. We have learned that certain tasks such as providing refills, referrals and ordering tests can be accomplished via telemedicine. This, in turn can reduce burden on patients and the healthcare system. While it is important to keep in mind the situations where a patient should be evaluated in a clinic or a hospital, telemedicine may very well be the way forward.
Mortality from this infectious disease has varied tremendously in different parts of the world. This depicts the contrasting approaches employed by countries to combat it. Outcomes reflect the initiatives, or the lack thereof, on the part of the local health authorities in every country. COVID-19 has reiterated the importance of the existence of a pandemic task force in every country. When we recover from this pandemic, we expect to see an influx of patients with chronic conditions who did not have access to routine care. It will be important for every institution to have standard protocols in place to help transition to normalcy, providing care to patients in a safe and timely manner. We will likely employ a new system of didactics for the remainder of 2020. It will be paramount to monitor the well-being of all residents with a special emphasis on mental health. As we hope to soon return to some sense of normalcy, in the meantime we have all recognized that regardless of our training and specialty, we are doctors first.