An international medical graduate’s COVID reflection

A new year, a new beginning, and the start of the final year of an eventful decade began with rumblings about a possible disease that would later spread rapidly around the globe to cause catastrophic devastation, lifestyle changes, closure of borders, while at the same time, begging for a desperate need to find a solution. COVID-19 soon got categorized as a pandemic in March 2020.

As an international medical graduate (IMG) pursuing her first year of residency here in the United States, I was just getting comfortable with my role of taking care of patients while staying away from family several thousands of miles away. As the news of the first outbreak in Washington state unfurled, sending news channels and social media into a tizzy, I knew it wouldn’t be too long before I see my first patient with COVID-19. Lockdowns were already in place as the United States braced itself for a historical calamity of a worryingly uncertain outcome.

The first crisis for health care workers revolved around the shortage of personal protective equipment (PPE) and guidelines to use them. The Centers for Disease Control (CDC) was beginning to issue guidelines that changed with every new update, making me wonder, “Could I have been exposed since I did not use PPE for that one patient.” As COVID- 19 related hospital capacity issues and shortages of ICU beds in New York City surfaced, health care providers dealt with ethical issues related to ICU bed allocation.

Graduate medical education (GME) departments for residency programs across the country scrambled to make decisions to determine if residents should be treating COVID-19 patients or not. The first trainee residents to directly have an impact were from internal medicine and emergency medicine. As physicians, nurses, and other health care providers began to fall ill, in cities like NYC, trainee residents from other specialties were pulled in to meet the burgeoning needs of care providers. GME’s across the nation had to come up with their surge plans and changes in curriculum and, at the same time, meet ACGME standards of postgraduate medical education.

As cases rolled in through our ER, a few staff physicians and trainee residents had to be quarantined. The entire model of staff and residency rotation had to be changed with hopes of conserving staff and residents for future needs in the case of more providers needing to be quarantined. I wondered what would happen if I get infected. We had already heard about sporadic cases of young and healthy people dying of COVID-19. I knew I would not get a chance to see my family if I was admitted to the hospital. My family, who live thousands of miles away, were extremely worried after seeing news reports of COVID-19 in the U.S. My physician husband, working as frontline staff for COVID-19, was in another state and was mandated against travel. I worried about physicians like my husband on visa, whose dependents (like me) risked being deported, should the primary visa holder die as a result of COVID-19. Almost a third of U.S. trained physicians are immigrants, with the majority of them at the frontline fighting the COVID-19 pandemic. Multiple news channels portrayed front line physicians and health care workers to be the soldiers of the pandemic. The thought of visa renewals, visa denials are additional stressors to immigrant trainee residents and staff physicians, especially when new restrictive immigration rules and regulations loomed large.

Every time I think about the negativities in my head, I remind myself about the very reason I signed up to be a doctor. This is not the time to complain or vent anger and frustration. This is the time to put our knowledge and experience into practice in the best way we can, even with the limitations around, while ensuring our safety, so that we are available to care for the next patient. Every human was affected in a unique way, unbeknown to others.

While the number of testing, confirmed cases, and deaths related to COVID-19 increases across the country, we are still far from herd immunity. No convincing study exists that specific medicines work. The discovery of a vaccine is still a work in progress.

Amidst the chaos, there are multiple acts of kindness. Local organizations have come forward with packed meals for health care workers in the hospital. There is dedicated support for the emotional and mental wellbeing of resident physicians. Our program continued to pursue resident teaching with daily virtual morning and noon conferences.

While we are almost certain about a second wave of the pandemic and a possible third wave, and acute presentations of chronic medical conditions, we hope to be better prepared. In that, we ought to be reflecting on our experiences and come up with innovative methods to face the inevitable. The new cohort of resident trainees is getting all the support and guidance we can offer as we continue to better ourselves in dealing with COVID-19 for patients and for ourselves. There is likely no end date for this in the near future and no guarantee that another form of health emergency will raise its ugly head. The only certainty is that medicine is an imperfect science, filled with uncertainties and unpredictability. Our role as physicians is to deliver the best care we can offer with the available knowledge. Thanks to the technology of today’s world. Information is available at the fingertips, even if it was just released minutes ago. While I am thankful and scared, I am happy that I can FaceTime my family every day, who live thousands of miles away.

Madhuri Chengappa is an internal medicine resident.

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