Residency Diaries Series #7: COVID Part I
The next few entries are about my experience through the COVID pandemic— which, as it turns out, is still very much going on almost 8 months from my very first entry about the pandemic. There are some outdated information in these posts, as they were being written in real time.
For example, it’s true that initially only the attendings were seeing these possible COVID patients. The residents helped with putting in orders and calling the Department of Health (DOH) to ask if the patient met criteria for testing. Few days into that system, it became clear the attending-only system was going to be impossible. There were way too many patients. Residents started seeing these patients as well.
Another big change is the way we were testing these patients. Early in March, we were sending out these tests to the DOH. Almost everyone patient I called DOH for testing got refused. Either they weren’t sick enough or they didn’t have the “right” history. IF they were accepted for testing, we collected both oropharyngeal and nasopharyngeal samples… soon we only needed nasopharyngeal and the tests became “in-house,” meaning we didn’t have to send them out anymore.
Initially hospital staff were being told to quarantine if they came in contact with a patient who later tested positive for the virus. Soon, you only had to quarantine if you were not wearing proper PPE during that encounter. So no matter how many contacts you had, you still worked. This made sense to me— you simply can’t quarantine everyone for every potential contact. It just became common place that everyone wore full PPE with every patient encounter, whether the patient had COVID symptoms or not.
My hospital and our emergency department was fortunate in that we never completely ran out of PPE but they were harder to come by. As mentioned by several healthcare workers, the N-95 masks and surgical masks were meant to be a ONE time use. Meaning before the pandemic, if we even wore the masks at all, we would change the out after every patient encounter. It became common practice for many staff to wear the same mask during the WHOLE shift and reuse them for several days if not weeks.
3/11/2020 Wednesday 12:11pm
We’re in the thick of the COVID-19 pandemic. In reality this is probably just the beginning. In NYC, testing has been very limited, especially compared to countries like Korea where my parents are. Because of the limited testing, there are just more cases out and about in the community and therefore more transmissions happening in the wild.
As an evidence of how tired, overworked, and also young we as residents are- there is a privately discussed sentiment that it would actually be really nice to be quarantined for 2 weeks. To just sit at home, watch Netflix, rest, sleep… and just focus on ourselves. To finally have some time to cook, catch up (over the phone, I suppose) with friends and family, read some books-- I mean, that does sound nice.
Don’t get me wrong. That doesn’t mean we want COVID. Last week I admitted a 39-year old man who had a fever and a concerning travel history. He was initially breathing on room air when I admitted him but then he ended up getting intubated that night. COVID-19 positive. His only risk factors were diabetes and hypertension. So being 31 (at the cusp of turning 32), that does sound a little scary. The virus can affect us all.
The hospital is trying to minimize resident exposure to possible COVID patients by only allowing attendings and a limited number of nurses to go into the room. On one hand, this is very nice- but in reality, any patient seen by a resident needs to be seen by an attending so eliminating that resident contact just makes sense.
Also, I have no idea how a hospital would run if a large number of residents got quarantined. I did not realize this before residency but the hospital is basically run by residents. Yes, attendings sign off on major decisions (or little ones, depending on how micromanaging they wish to be). But the day-to-day tasks of talking to patients, communicating with nurses/other consults/radiology/other healthcare facilities and providers outside of the hospital, putting in orders (which is the only way things get done), and much more are all done by residents of varying levels of training. If a significant number of residents became sick or even just quarantined, the hospital just would not function.
All that said, I am grateful for all my attendings who took the risk and entered an isolation room to chat with patients, listen to their lungs, and collect their oropharyngeal and nasopharyngeal samples for the Department of Health. They did not sign up to do this, and as far as I know, the hospital did not ask for volunteer attendings to do this. There are attendings who are silently pregnant, attendings with underlying health problems that they haven’t discussed with everyone because they should not have to, and those with elderly family members and littles ones at home. They dutifully donned 2 masks (N-95 and a shield mask), a gown, and a set of gloves every time they entered a potential COVID patient’s room and spared us residents. I am truly grateful for that.
What really infuriated me during those initial weeks of the pandemic was that some of our consults would simply refuse to come down to the ED to see patients. At one point, we had a large number of orthopedic residents and PAs who had to quarantine after one of them tested positive. After that incident, if we (ED) called ortho for a consult, they would tell us that they weren’t allowed to come see the patient. I remember begging an ortho resident to come, offering all the PPE that we had. I told him the patient had ZERO COVID symptoms and all she had was a broken bone. I had to move the patient OUT of the ED to the waiting area (where there were no other patients) for the ortho resident to finally come see the patient.
I’m not sure if the “stay away from ED and don’t see consults” was ever an official rule (are they even allowed to do that?). But it implied something to me. I felt like they’re saying to me: “I know we are both doctors but I do not want to be exposed to this disease the way you are. I chose a specialty where I can refuse to see these sick people who can potentially get ME sick. My life is more valuable.” Eventually the department chairs got involved and all consults were told they had to come do their job.
I think the next few entries will be quite dark. I counted 10 total entries from beginning of the Pandemic to when I finally write about something other than COVID. I don’t think I’ll post every single one of them— but I really am glad I kept a record of what it was like. When you’re going through something traumatic, that is all you can imagine your life to be like. It doesn’t feel like there is ever going to be a different outcome. It has only been 8 or 9 months since the pandemic started but I already know that the way I feel during a difficult time isn’t going to last forever. I think that’s why these reflections and journal entries are helpful. It’s just like how knowing the history can help us see the future. If there is another terrible COVID peak, I know that I will come out on the other side and it won’t always feel like hell.