July 27, 2020
It’s the eve of my first block of family medicine, the field of practice I have chosen to dedicate my professional medical career to (with the caveat of also training in public health, of course). I’ve been meaning to reflect upon a busy and fast-paced first month in residency starting in the inpatient wards with the general internal medicine service. Today also happens to be the day I wrote my MCCQE Part 1 – one of many tests that I have the privilege of completing on a journey to become a well trained and independently practicing physician.
Early on during the pandemic back in March and April, I had heard from colleagues and friends that the hospitals were seeing fewer patients come from the emergency department and consequently fewer patients were also being admitted to hospital. One thought-to-be contributor to this phenomenon was community members keeping their distance from the hospital system, knowing this was where sick patients were (including those with COVID-19). Along with community members doing their best to stay home and follow public health advice, sometimes irrelevant of most likely requiring prompt medical attention for issues unrelated to COVID-19. As much benefit as we have already seen with virtual care and adaptations to ensure access to primary care physicians with phone visits and video teleconferences, there are limitations when there are time-sensitive medical issues and in-person diagnostic and treatment plans that ought to take place. However, as our communities began to re-open in a phased approach over these most recent weeks, the hospital too saw a steady flow of patients that required admission to hospital and good medical care to put them on the right track back to their homes, if they have one.
The last time I was in the hospital and caring for others, was back in mid-March. Stepping into the hospital and caring for patients again, now in July, was an experience that would demonstrate to me much of what I read and learned about the changes in healthcare due to COVID-19, and importantly, the challenges that patients and their loved ones would continue to also face. I returned to a familiar environment of inpatient medical care – the obvious changes were apparent such as, universal masking for healthcare professionals, a revised visitor policy that continues to adapt and change, and discharge planning from the hospital that often would involve ensuring a negative COVID-19 swab test.
The issues and differences that were less visible on the first impression, but became quickly apparent as the days went on, were how healthcare professionals had been dealing with a new reality, how patients had been coping over the past few months sometimes in unhealthy ways (alcohol and other substances), and again, the acute reminder of what matters most in times of suffering and grief.
With increasing clinical workloads, I saw resilient, strong, and compassionate healthcare professionals adapt and continue to care for very sick patients (but also recognizing that they too have been impacted in different ways from the pandemic – including at times being separated from loved ones and unable to travel to spend time with them). From my own experiences and clinical encounters, anecdotally, I heard about the incredibly difficult mental health challenges that patients faced over these past few months due to personal and professional stressors often beyond their control. This, along with preexisting pain management issues or substance use issues, that they were already working on, but such issues being exacerbated in recent weeks and months led to them requiring acute care in the hospital.
During these past weeks, I’ve also met and cared for patients at the end of their life, and how allowing for loved ones to be with a patient to share moments of connection with one another is again a reminder for what matters most. When visits to hospitals from loved ones of a patient aren’t able to be accommodated or not preferred, updates from the medical team by phone calls on a daily or almost daily basis were critically important – now more than ever. I can imagine the feeling of unease that someone might have if their loved one was admitted to the hospital and being unable to visit for any reason.
These past few weeks have been a lot of ‘firsts’ for me in some ways and some ways not. Medical school has prepared me well in many instances, through a step-wised or graded approach to responsibility in patient care, holding family meetings, and discussing goals of care. All of which again felt incredibly hard and difficult to do from first glance, but upon reflection, I realized I had the tools and skills to manage certain situations appropriately and knowing my limitations to call and ask for help. Also, I recognized, there were some situations that no amount of preparation would have made me feel prepared to handle, but these were such situations that didn’t call upon my medical knowledge or expertise, rather was an exercise of shared and common humanity, compassion, and kindness. Instead, I drew from my experience as someone that lost a loved one, and the interactions with healthcare professionals that I would have wished to have had when I was in that position.
The ‘firsts’ of introducing myself as a doctor or signing off on my first prescription as a doctor – I did not feel entirely ready for or deserving of at the time (imposter syndrome never really goes away, or so I hear), but in wake of a pandemic nevertheless, I can’t imagine myself doing anything else. To be practicing and learning clinical medicine as a public health resident physician, alongside other dedicated and compassionate healthcare professionals, is a tremendous privilege to spend my hours and days doing.