In gratitude to our nation’s residents [PODCAST]

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“Most residents are young, often in their mid to late 20s, having spent years ensconced in libraries, research labs, and classrooms learning pathophysiology and pharmacology. Upon graduation from medical school, they are now drafted to the front lines of a generational pandemic, working long hours, often in cities where they are strangers (the process of “matching” into a residency program is one where residents are not in full control of their destiny or geography). They do so while putting their own health in jeopardy. The resident’s experience of the COVID-19 pandemic has been unlike any other, because on average, residents spend almost twice as much time at work as other providers. Residents are allowed to work 80 hours a week on balance, which means it’s fine to log 90 hours in the ICU if the following week is a mere 70.”

John P. Murray is an internal medicine physician.

He shares his story and discusses his KevinMD article, “In gratitude to our nation’s residents.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have JP Murray. He’s an internal medicine physician, and he wrote the KevinMD article “In gratitude to our nation’s residents.” JP, welcome to the show.

John P. Murray: It’s great to be here. Thanks so much for having me.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?

John P. Murray: I had a bit of a circuitous route to medicine. I am the son of two philosophy professors, and so I kind of always imagined myself as having a career in the humanities. I was in graduate school for literature, going to get my PhD, and had a younger brother who was in medical school at the same time. We were very close, and in talking to him on a day-to-day basis about his life, I sort of decided that maybe medicine was going to be my path.

So I left after two years of grad school, went back and took my science classes, did my medical school training at Loyola here in Chicago, and completed residency at Emory in Atlanta, which was wonderful, working at Grady Hospital down there especially. I’m in my second year of doing hospital medicine here at the University of Chicago, which has been a great home so far.

Kevin Pho: So you work for an academic medical center, and of course, you work with a lot of residents. What do you say are some of the biggest challenges that residents are facing, especially during this past year of the pandemic?

John P. Murray: That’s a great question. I’m only a year and a half out of residency myself, so I do feel a little bit closer to some of those challenges, I think, than some providers. Residency is obviously a very demanding time, no matter when you train. What’s been especially difficult for residents over the last 12 or 13 months has been some of the isolation, as you can imagine. Especially for interns or second years, moving to a new city where you might not know folks, and then having to work on the front lines of a pandemic when you’re not allowed to socialize or be with people or meet people in whatever new city you’ve moved to can be extremely challenging, especially when you’re already doing such demanding work.

So I think residency is a tough time. You work hard, but a lot of times folks get through it in part because of that resident community, and they can draw on the strength of that. I think that’s been a lot more difficult over these past 12 months.

Kevin Pho: And what are the ways that you are seeing these residents overcome that obstacle during the past year? What are some of the things that they’re doing that have inspired you?

John P. Murray: Pretty much everything that they’re doing has been pretty inspiring over the last 12 months in particular. One of the things about being a health care provider in general throughout the COVID pandemic is that while so many folks are working from home, residents, nurses, physicians, techs, and everyone in the hospital system have had a place to go to as far as work. They’ve been going into work.

So I’ve really seen the residents be there for one another, support each other at work, and provide that community within the hospital, because of course they can’t really spend time together outside of the hospital as they otherwise normally would. So they’re really banding together, trying to support each other as much as possible. And just the fact that they are able to be together, at least at work, I think they can draw upon that and support one another. Of course, it is still very difficult.

Kevin Pho: All right. Let’s talk about that more in your KevinMD article that’s titled “In gratitude to our nation’s residents.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

John P. Murray: At the University of Chicago, we were one of the hospitals that did set up a dedicated COVID ward for about four months, from March to June, and I was one of the providers that worked on one of the COVID wards. It was staffed primarily by hospitalists and some APNs, and then there were a few wards that were also staffed exclusively by residents and teaching attendings. So we were working very closely with the residents.

I think this article sort of came out of those nights where we were working closely with the residents, all suited up in our N95s or PAPRs, and working together overnight very, very closely. It’s a little bit lonely on the wards those evenings, but a lot of folks there. And I was just so impressed by their resilience, their energy, and their dedication.

And also, I know there’s been a lot written about health care heroes in general. So many folks have stepped up and made incredible sacrifices: nurses, respiratory therapists, physicians, and ancillary staff across the board. But sometimes I found that the residents, who in my mind have been the true workhorses of the pandemic, have perhaps been a little bit lost or left behind. The residents just spend so, so much time in the hospital. It’s incredible: 70, 80, 90 hours a week.

And I just don’t think people really understand that. I don’t think people know that. Even some people within the medical community who are a little less familiar with what happens at teaching hospitals, I don’t think they have such a sense of the commitment and time that the residents spend in the hospitals. 25, 26 percent of the hospitals out there in this country are teaching hospitals, but maybe 50 percent of the admissions of patients who are admitted to hospitals are admitted to teaching hospitals. So residents are just providing so, so much care for patients, and especially over this past calendar year.

Kevin Pho: Take us through a typical day of house staff during the height of the pandemic, perhaps last March to June. How many patients would they see? And paint a picture of some of the challenges that house staff were facing, especially during the height of the pandemic, when there were so many unknowns on an inpatient COVID ward.

John P. Murray: The biggest unknown, especially in the first couple months of the pandemic, was what sort of therapies we have to help people with COVID. It was very, very unclear at that time. There were thoughts about maybe Plaquenil helps folks, maybe steroids help folks, maybe remdesivir helps folks. It was just so, so unclear from a therapeutic perspective what interventions had meaningful benefit.

And then beyond that, I think there were just some very granular things that were very challenging. Fortunately, we were at a hospital that always had enough PPE. We were very, very lucky in that regard. The University of Chicago did very well in making sure that the staff stayed safe.

But just from a logistical perspective, you had the residents who were on these essentially secured wards who couldn’t really leave them for 12-hour stretches. How do you get food on and off? You’re essentially wearing your PAPR for eight, 10, in some cases 12 hours a day. Where do you find the time and the space to eat safely, to go to the bathroom? You’re essentially on these locked wards for 12 hours straight, six days out of the week. Extraordinarily challenging. These residents aren’t seeing daylight. They’re entirely existing in these inside spaces where they’re wearing their PPE essentially at all times. It was very, very challenging, but they rose to the occasion wonderfully, and they provided excellent, excellent care for their patients.

Kevin Pho: Now, during that time, it would be totally understandable to see some trepidation or some hesitation among these residents, especially going into the unknown, and they truly were at the front line on an inpatient ward. Did you see any hesitation on the part of the residents?

John P. Murray: I was in residency less than two years ago. I mean, even as a third-year, more experienced senior resident, there were always nights, I think, where I felt concern or worry or trepidation. And yeah, it’s definitely something that they experienced. I don’t think it was something that they showed too often, and that’s just incredibly admirable.

I think they saw this moment for what it was, a generational moment in the history of health care in our country. I think they really understood that and stepped up and knew that it was going to be a uniquely challenging year, and they rose to that occasion across the board.

But yes, there would be times where we’d be in the locker room taking our scrubs off, and you’d just see the fatigue on people’s faces. They’d have a tough night. They’d have three, four, five ICU transfers, and they were just tired. They were just tired. But it was never something where. I think they always sort of recognized the moment they were in and how important their contributions were.

Kevin Pho: We’re talking to JP Murray. He is an internal medicine physician, and he wrote the KevinMD article “In gratitude to our nation’s residents.” JP, if there’s something that you’ve learned over the past year, a few tips that you could share with these beleaguered residents, what would that one tip be?

John P. Murray: Things that I did, especially in the first four, five, six months of the pandemic and the lockdown: I tried to be outside and tried to get a little sun on my face, even during the winter. I’d make a point on my days off to bundle up. We’ve got the wonderful lakeshore here in Chicago, and I’d try to make my way out of the apartment down to the lake just to be outside, these sort of sterile fluorescent environments that we spend so much of our time in.

Spending time with friends and family on Zoom, over the phone, has always been very, very life-giving and restorative. Making time for some new hobbies: reading, writing, puzzling, things like that.

I’m fortunate in that my fiance and I got married last year, so there was always someone for me at home, and we had a community at home. And I know that many residents who are living alone weren’t that fortunate, to be able to come home to someone to share their stories, their frustrations, their highs and lows. But trying to make space for any type of community, whether that’s someone that you’re sheltering in place with, a partner, or just close friends that you can be in touch with over the phone or Zoom, is more important now than ever before.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

John P. Murray: I think I just want to re-emphasize just how much residents across the country have done for all of us over the last 12 or 13 months. I don’t think we can say enough for all of their sacrifices: the residents in the emergency department who were for months seeing folks with COVID, sometimes without the proper PPE in certain hospitals; the anesthesiology residents who were intubating folks with COVID; the residents who were working in the intensive care units, who were holding goals-of-care conversations with family members on the phone, on Zoom, who were trying to make families present as much as possible throughout the final days of their loved ones’ lives, who were trying to bridge that connection as so many hospitals weren’t allowing visitors over the last 12 months. I just don’t think that we can say enough for the work that residents have done.

I truly think that this is sort of like a historical contribution to the well-being of our country, and it really deserves a thank you from the country as a whole, whether that’s loan forgiveness. So many residents have hundreds of thousands of dollars in debt, and I think as a country, it would be appropriate to step up, to think about ways to forgive that debt or help so many of these residents out who’ve made incredible contributions that we can never really repay. But I think there are ways to start and ideas to start, and I think a lot of those ideas revolve around loan forgiveness or debt forgiveness.

Kevin Pho: JP, thank you so much for sharing your stories, time, and insight, and thanks again for being on the show.

John P. Murray: Thank you so much. It was great to be here and have this conversation.

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