You must be thinking “Another story about the coronavirus?” But before you think any further, I would like to share with you a perspective on the pandemic from a family medicine resident physician.
I started in the emergency room in February and have been working with hospitalized patients from March up until June, which was not how it was originally planned. My outpatient clinic rotations were deemed “non-essential” and were unfortunately cancelled. There was a need for more residents to work in the hospital than previously scheduled, so I rose to the occasion. I am a firsthand witness of how my hospital changed due to the coronavirus and dealing with the anxiety that hospitalized patients and hospital workers feel. I never thought that we would be hit hard being in the suburb with my patient population. Most of our patients are local. I could tell because patients’ families that I call rarely have out of state area codes. They are as well on the most part non-travelers and have family who live locally.
When I was on night shift in mid-March, there was initially no clear administrative protocols between COVID versus non-COVID patients. Since family medicine attending physicians are not in-house during nights, I had to be the only hospital physician to see any patient. A few nights later, specific COVID versus non-COVID hospital teams were established. Our family medicine hospitalist team was eventually called a non-COVID team from mid-March until June. I have had a low census at the end of March because patients in our community, mostly the elderly with chronic diseases, refuse to go to the hospital due to the fear of COVID. These patients can be acutely suffering from various consequences of chronic diseases such as myocardial infarctions, pulmonary embolisms or COPD exacerbation. They die at home or are so ill when they finally go to the hospital, ICU admission is indicated. However, the ICU is full of COVID patients on ventilators and usually cannot accommodate those patients. As a provider working in a non-COVID unit, I felt the unpleasant tension and fear of my patients and their families due to the pandemic.
During my three months on inpatient medicine, I heard nearly daily code blues either coming from the COVID unit or the ICU. But I also rejoiced when the tune of “Here comes the sun” was broadcasted throughout the hospital, meaning that a COVID patient was successfully extubated and therefore no longer needs a machine to help them breathe. There was also my favorite, a comical “Hallelujah” tune played every time a COVID patient is discharged from the hospital. I have been thankful to have always been in good health despite working in what my patients and their families call nowadays “the most dangerous place in the world.” It was rewarding to have cared for COVID survivors who were extubated, tested negative and transferred to our care. They get so weak and are unable to even sit up for a lung exam. However, they are so grateful when they are transferred to inpatient rehab then home with a “Hallelujah.”
With the limited time I had outside of work, I found it difficult to maintain health and fitness, but strived to do so to “practice what I preach.” Despite what was going on in the hospital, I still saw so many cars on the street and people not social distancing in public, but I applauded seeing more people than usual outside in the nature trails before 6:00 a.m. when I drove to work. I used to run on local trails, but now still hesitate to run past someone and potentially spread the coronavirus with how little space there is. Therefore, I now run on the highway sidewalk where I encounter one or no people on a given run. Or I run alone on a local track before 5:00 a.m. to avoid wearing a mask while running. I also had to shower immediately after every inpatient shift Every time I changed out of my scrubs in the hospital or cleaned myself, I felt like I was removing COVID germs from my body. I think about how people with obsessive compulsive disorder or generalized anxiety disorder might be struggling right now. Exercising and hygiene during the pandemic for me has been inconvenient. But it is a new normal.
Despite gyms being closed and stay at home orders, the inclusion of regular exercise during the pandemic helps boost immunity and more significantly decreases stress in an anxiety-filled world. Triathlon communities have set up group virtual rides through online applications, running groups have set up virtual races and there are a variety of great home indoor workouts one can do. There are suggestions in fitness blogs to use bags of rice for weights and other ways to be creative. I fully support physical activity while social distancing and share that with my patients.
Outside of medicine, during the pre-COVID era, I was an avid triathlete who on my free time enjoyed competing in local races. I am also determined to get involved with more medical coverage of sports events for my own personal development. However, everything but one of my coverage events arranged pre-COVID were cancelled. Since races are cancelled, I still find myself trying to learn about sports medicine online during my days off and also trying to maintain fitness in a safe manner.
I am a resident physician with a unique circumstance and prior residency training who took an off-cycle family medicine position thousands of miles away from family so that I could graduate next year. I sympathize and empathize other resident physicians who also live far away from their loved ones and are unable to fly home due to the coronavirus. I had previously tried to fly out every other month at minimum to visit my folks.I have not seen any of my family or my significant other since February, and I yearn for the next time I can see them. I ask from time to time “Would you feel comfortable with me visiting if I completed a month of telemedicine and have zero patient contact?” And the response is always somewhere along the lines of “No honey. But we will see.” And that is while we eagerly wait for new public health recommendations.
Starting June 1, our hospital has finally been slowly returning back to its normal function. All residents are to resume their previously scheduled rotations, even outpatient rotations. Only one family medicine resident was needed in the infectious disease service. I rejoiced when I heard the news the last week of May that family medicine is to resume their rotations as usual. My main reason for going into medicine, which is to become an outpatient physician focused on prevention and slowing progression of chronic disease, was severely derailed due to COVID. Diabetes, obesity and hypertension are a few risk factors for poor COVID outcomes. As a family medicine physician, I now have a new sense of motivation to maximize outpatient care. Specifically, I will be soon finishing my culinary medicine certification and wanting to revive the “Walk with a Doc” program with my hospital administration.
What kept me sane during these past few months was a calling to "flatten the curve” and educate others on healthy lifestyles in order to make my community a safer place.
Adrienne Law, MS, DO, is a resident physician at Franciscan St. James Hospital, Olympia Fields, IL.