COVID-19: a medical resident’s tale of sign-outs and ID bands

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Two-paged signouts

This was the picture of the unusually higher than normal patient load we have in the wards. The hospital looked grim and eerie. Gone were the days when we would start with morning report and see plastered smiles on colleagues’ faces, relaxed and ready to conquer the day.

I saw patients without visitors. I’d hear rapid response teams more frequently – so I made a habit of memorizing what rooms my patients were in, as code blues were called in more than usual too. It was utterly nothing like I’ve ever seen before. It broke my heart that patients were dying alone. It was devastating, but I can’t let my emotions get the best of me. I need to protect my sanity. If I took everything to heart, I would have PTSD – because we have to admit it, we are at war here.

I would be a hypocrite if I said I didn’t go to work fearful for my life. Seeing colleagues fall ill, knowing people personally who are doctors too, in critical condition – made me wonder, is still it worth it? I did not sign up to die, nor to be a called a hero.

It is beyond my wildest imagination to actually live through a pandemic. Knowing that this virus targets the lungs made me anxious. I have a history of asthma and had been hospitalized for pneumonia twice. So I made sure I was on top of my physical health – I practiced mindfulness and prayed a lot.

I could vividly remember my first suspected COVID-19 patient mid-March, amidst the stress of having to fight for PPEs. He said something I’ll never forget: “Thank you for taking your time with me. You are the only person who stayed with me the longest – everyone seems to want to leave the room immediately, and I cannot get any help.” To which I replied, “You are welcome, sir, I hope you understand we are in unchartered territories right now, but everyone is doing their best to take care of you.” That encounter didn’t make a mark on me – until I was the patient myself.

Two ID bands

To my disbelief, I had two ED visits on the same day. My symptoms started with fatigue, myalgia, and anosmia. I got swabbed and self-isolated. However, I had progressive dyspnea and cough, which prompted my ED evaluation. Everything looked fine then, so I was sent home.

I thought I was doing well until my sats plummeted to 86 percent. I knew something was wrong. This didn’t feel like an asthma exacerbation. I struggled to go to the hospital, stopping every 20 steps to catch my breath. At the triage, I could barely speak – I was tachypneic to 30s. My BP shot up to 170s. I was using my accessory muscles to breath. I was being dragged by the arm to get me to a bed – I felt like I was about to faint. I was terrified not of dying – but tears were streaming down my face as I was thinking about my family and how I wasn’t able to see them. That seemed like the worst way to go.

Later on, my vitals stabilized. I had labs, another swab, and imaging. My lung point of care ultrasound demonstrated sub-pleural thickening consistent with viral pneumonia. However, my chest CT was spotless. My ED attending wasn’t comfortable with my tachypnea despite my perfect sats; he said he had seen too many cases like mine, who also insisted on going home, only to have patients come back worse. So I stayed.

I’m deeply grateful for my colleagues who didn’t mind exposure and went inside my room just to make sure I was comfortable. I realized how daunting and distressing it must be for patients – to be alone, clueless, and to face the fear of not knowing if you’ll ever get to see your family or loved ones again.

The PCA kept me sane the entire time. She didn’t mind staying 10 minutes in my room. She was nothing but a ray of sunshine and encouragement in a forbidding emergency room. I realized how little things make all the difference. When she stepped out, I started to cry. I felt so guilty – because, in the wards, I was spending less time with my patients. I assess them quickly to ensure they are not in significant distress, and their sats are stable. I started to question myself: Where was the person who asked about their breakfast, queried about how the weather made them feel, made a comment about how we wanted them better so we can send them out as soon as possible? Has that been replaced by fear? At one point, I let fear get the best of my compassion. That’s why I salute nurses, other ancillary workers who actually speak and spend much bedside care with the patient. I knew once I get back on my feet – that is going to change. Fear shall hold no greater power than my compassion in patient care.

Even though I cannot reconcile my symptoms and the seemingly normal labs and imaging – more than anything else, I am grateful. I feel like this is my second life, and only God could have given me this gift.

Being on the other end of the stick, as a patient, changed my perspective to a humbling one. In distressing times like these, it is so important to still be kind because one small act can make a world of a difference. And just like every battle, there will be an end. That’s why we must never lose sight of hope. My ultimate takeaway? Never forget to always treat patients with dignity and respect.

As hospital beds increased, so did the teamwork multiply a hundredfold among my colleagues. We developed a heightened awareness of each other’s needs. Everyone stepped up, set their differences aside – because only we can get through this is together.

And yes, it is still worth it.

Bea Leal is an internal medicine resident.

Image credit: Shutterstock.com

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