Wednesday, April 8, 2020

Family medicine resident perspectives on COVID-19 (March 24-29)

- Enkhee Tuvshintogs, MD, AFP Resident Representative

In the following weeks, I will share the experiences of residents at my program from interviews as we live through this pandemic together.

“[You] have to take it day by day. ... We signed up to be doctors knowing that there may always be a disaster,” said Dr. Ashley Rubin (AR), a resident rotating in the Intensive Care Unit (ICU). “You either have to embrace it or you freak out. ... You have mixed feelings about it. Right now it’s not that crazy, but it could be at any time.”

In California, Governor Gavin Newsom issued a Stay-at-Home order on March 19. We were one of the first states to implement this public health measure. The gravity of the announcement prompted an onslaught of changes in hospital policies, set-up, supplies, and personnel.

Daily interdepartmental virtual meetings continue to tackle the “moving target” of the pandemic and create real-time operational changes. The personal protective equipment (PPE) discussion is ongoing. Given the limited supply of PPE nationally, hospital systems are seeking creative in-house solutions, such as finding ways to sterilize masks in-house and choosing to limit patient contact by moving IV poles outside of rooms. Entire hospital wings have been reorganized for patients under investigation for COVID-19.

Still, COVID-19 can feel somewhat abstract at times. Dr. Natalie Morgan (NM), one of our incoming chief residents, said it only “becomes more real when a patient suspected of COVID-19 in the hospital suddenly goes in respiratory distress in front of you.” She lamented that in these moments, family members have to make decisions about intubation and goals of care over the phone or through a video call. “It doesn’t feel real until then.”

Given the confirmation of community spread and gray areas of initial symptomatology, AR admitted, “it is scary; we don’t know what we’re getting ourselves into.” As family medicine residents, we are familiar with the various illness processes that can present to the Emergency Department, inpatient pediatrics and adult medicine, obstetrics, and ICU floors. However, now, we have to be “more thoughtful about which [illnesses] are COVID and which are not.” The constant vigilance can be emotionally and mentally challenging for all.

Personnel in our hospital system support one another. Our attending physicians have set up Facebook support/wellness groups and are individually reaching out to residents to support them. Even during large scale “tele-meetings,” facilitators try to take a moment to reflect on the positives they’ve seen.

“We do find things to be thankful for in this situation,” says AR. As family doctors, we draw strength from the breadth of work we do. “We know the hospital system as a whole.” We are able to help different departments recognize supplies and resources that each area can contribute. We also ”know how to talk to families.” As family medicine residents working in all parts of the hospital, dedicated to the breadth of human experience and life, we are able to provide the attention and care that families need in these difficult times.