COVID-19 Trilogy in 17 (Haiku)

by Hedy Wald

 

Civilization

No longer as we knew it

Rainfall hits dry ground

 

Stripped down to essence

We treasure touch of cool breeze

When hug cannot be

 

Pause, unmask to breathe

Hope sustains as the tree bud

Bursts forth in Springtime

Hedy S. Wald, PhD is Clinical Professor of Family Medicine at the Warren Alpert Medical School of Brown University and Faculty, Harvard Medical School Global Pediatrics Leadership Program. She presents internationally on interactive reflective writing-enhanced reflection supporting professional identity formation, promoting resilience and wellbeing, and Holocaust and medicine in health professions education and practice.

Being a Medical Student During the COVID-19 Pandemic

By Michael Bertenthal

As a kid, I was a devoted soccer goalkeeper.  I lived for the opportunity to step in front of an oncoming shot to protect the net.  I loved the action of diving to make a save, getting my knees skinned and uniform muddied, and occasionally colliding with oncoming players.

When I entered high school, I encountered players senior to me who had the skill or physical stature that I had not developed, and I was asked to be the team’s backup.  I made a mental list of my roles on the team.  I told myself that if I practiced hard, I was not only preparing myself to enter a game when my number would be called but that I was also pushing my teammates to improve in their roles. I was even voted a team captain because of my encouragement to others and served as something of a player-coach role through my guidance from the sidelines.

As a fourth year medical student set to graduate in May, living through the era of COVID-19 has me again considering some of these roles.

I pursued a career in medicine for some of the same qualities that attracted me to goalkeeping.  I enjoy working on a team and doing whatever I can to protect—patients from disease.  I don’t mind putting in the hard work, to get dirty in the pursuit of a cause greater than myself—helping people, my patients, in some of their most difficult hours.  Like goalkeeping, it is sometimes necessary to put one’s self in harm’s way to do this.

As COVID-19 has developed into a pandemic, we medical students have been left in its wake.  Throughout medical school, we have learned to walk an unusual line between student and doctor.  This crisis has now bolded that line.  As universities across the country sent their students home, we too have been told to stay home.

There are many reasons for this. Our roles as student doctors require supervision, which is difficult in these hectic times.  Our very presence in clinical settings utilizes precious masks, gowns, and gloves.  Beyond that, what unique responsibilities and liabilities do universities face to protect their students from harm, and how is that distinct from that of paid employees, such as residents?

Setting aside the idea that students miss out on observing and partaking in clinical activities during this historic moment, the fact remains that fourth year students are merely weeks away from being considered competent to care for patients as house staff.  What practical sense, then, does such an artificial line between student and doctor now make?

For this reason, political leaders across the country are calling on medical personnel who are currently outside of the workforce to begin seeing patients. Medical schools in some of the hardest hit areas have obliged by expediting graduation and licensure requirements to call fourth year students, suddenly, new residents.

For the rest of us, we wait.  It’s now again useful for me to consider my goalkeeping days as I sit here on the sidelines of the health care system.  As students in an uncertain time and in an ill-defined role, we can build our knowledge of the pathophysiology and epidemiology of SARS-CoV-2.  This will make us better equipped to treat patients when our “numbers” are called.  Students have even carved out opportunities to assist clinically, if remotely.  We can serve in other vital roles in the community: in food provision, child care, and housing services.  These are familiar protector skills that many of us have mastered over the years.  We can be captains of encouragement by supporting our loved ones emotionally, and we can also support them medically by providing guidance on best practices. We too can step back and focus on aspects of ourselves that, upon reflection, need tending.  We can practice much needed self-care prior to the next onslaught of training ensues.

Invariably, sitting on the sidelines is an uncomfortable and disappointing position. May it help cultivate a fire that will burn inside of us to do our best for our patients when we return to action.  May it help us consider what is the best version of ourselves that we can contribute—now and in the future.

 

Michael Bertenthal is a 4th year medical student at Loyola University Chicago Stritch School of Medicine.  He recently matched at the University of Chicago in pediatrics, where he is excited to continue to serve in Chicago’s communities by contributing to health and wellness opportunities for children and families.

On Being a Doctor and a Human in the Pandemic: Connection and Vulnerability

By Amy Blair

With each passing 24 hours, my roles of physician and physician educator and mother (and human of the planet Earth) have been taxed in complex ways. The problem-solving demands are intense and the solutions often feeble, weakened by uncertainty, if not paralyzed. It feels as if the rug were pulled out from under my stable pillar of work-life balance and I teeter and totter as the emails, announcements, protocols, and crash courses in new technologies try to blow me over each day. It is a new flavor of exhausting. A sympathetic overload (as in autonomic nervous system).

Of course, my patients are facing new challenges for which there is little precedent and for which they have few relevant experiences to draw on. They face many pressures such as a devastating loss of income from which the more privileged are insulated. Thus, they can underreact and indulge denial rather than think like the epidemiologists we would have them be.

For instance, I accompanied one of my patients as she tried to come to terms with her COVID19 positive test and the need for home quarantine. She asked me how she could return to work at a downtown office, needing the income.  I explained the CDC guidelines which include quarantine for 7 days. Then she asked “…could I still do my (GrubHub) food delivery?“Read More »

Look for the Helpers

by Justin Triemstra

“When I was a boy and I would see scary things in the news,

my mother would say to me, ‘Look for the helpers.

You will always find people who are helping.’”

                                                                                                                                                   -Fred Rogers

 

Scary things in the news…

Look for the helpers…

You will always find people who are helping…

These 3 phrases could not be more descriptive of our current world, nation, state, city, and health systems. We have all seen the scary things in the news over the past 3 months and have watched our colleagues care for the ill and vulnerable who have been affected by this pandemic. At first, it seemed like a distant threat, yet, we all knew it would come to our institutions in time.

New York City, Seattle, New Orleans, Detroit, and countless other cities have already seen the waves this pandemic can bring to a community. In Grand Rapids, Michigan, the pandemic has now reached our doorstep. Our frontline colleagues have begun to see the first set of ripples, and now, we all wait for the waves that may follow.

This period of waiting brings out emotions of nervousness of what is to come, worry about whether we as health care providers will get infected or even worse, bring it home to our loved ones, or fear over the possible lack and rationing of PPE.

Nonetheless, we know our helpers have begun helping. Nurses. Physicians. Advanced Practice Providers. Respiratory therapists. Physical Therapists. Occupational Therapists. Speech Therapists. Patient Care Technicians. Pharmacists. EMT’s. Social Workers. Pastoral Care. Medical Assistants. Environmental Services. Food Services. Operation staff and leaders. And all other health care workers are being the helpers.

So, when we hear (or see) scary things in the news (or in the hospital), look for our helpers (colleagues) because you will always find (your friends) who are helping.

 

Justin D. Triemstra, MD, FAAP is an Assistant Professor of Pediatrics and Human Development and Associate Program Director and Helen DeVos Children’s Hospital and Michigan State University College of Human Medicine.

Called to Serve: A Medical Student Response to Canceled Classes and Rotations in the Pandemic

By Elizabeth Southworth

“So what’s the plan for the students” asked my attending during morning rounds on Monday March 16th. We were discussing the many changes that had already occurred over the past several days; the rooms in the Surgical ICU that had been sequestered for possible corona virus patients, the restrictions on visitors to the hospital, and the impending decision regarding 3rd and 4th year medical students on clinical rotations. Moments later the email came in – “All M3 and M4 students will immediately stop participating in their clinical clerkships or those electives that involve patient contact”. With those words, my 4th year of medical school came dramatically to a halt.

An email like that can be taken one of two ways. It can give you permission to relax and take a long break before residency, or it gives you permission to leverage your skills during an uncertain time in medicine. I am proud to say that my colleagues at Stritch School of Medicine choose the latter and began working together to fill unmet needs.Read More »

My Covid Epitaph

If I do not survive Covid

Please note the hopes we shaped before

The concerts, hikes and family feasts

Still on schedule, still in store.

 

I can write my colleagues’ tributes now

I hope you will be flattered,

How you toiled, co-authored, supported staff.

You smiled when it mattered.

 

But we will die. I’m sorry, friend,

That for us it could be

Sharply, while we labor on

Do you think that’s as it should be?

 

In the hallways, exam rooms, and clinics

Doctoring amid pain and tears

Shared mission, on-call nights, holding,

Kind gravitas calming our fears.

 

What I left of me at the hospital

Created a void we sensed elsewhere

Keying our door, scratching sweet Maggie

In my lap, iPhone, my comfy chair.

 

They bravely passed with no regrets.

We salute them now

We loved, respected and mourn them

But whom did I fail and how?

Michael F. Bierer, MD, MPH, FASAM is an internist and addictions specialist at Massachusetts General Hospital and an Assistant Professor of Medicine at Harvard Medical School. He is a Public Voices Fellow with The OpEd Project. Dr. Bierer is a member of the Massachusetts General Hospital Addiction Consultation Team and faculty of the Addiction Fellowship. At Massachusetts General Hospital, he is part of a large primary care practice that has been transformed by the COVID-19 pandemic. 

The Guilt Does Not Go Away: A Physician’s Tribute to Elephant Mothers

By Maha Mahdavinia

It started almost from the moment my son was born, after I held that precious little breathing miracle of life in my arms and he stopped crying right away. I was filled with joy and love, as if beautiful, peaceful music was playing in my ears. I wanted to hold him all the time and never leave him. Then I remembered: My maternity leave was only six weeks. All of a sudden, the music stopped. It was replaced by a gnawing pain in my belly. Not from the unexpected ruptures of birth — I couldn’t care about those less at that moment. The pain came from guilt. In six weeks I would have to leave my baby every day, from very early in the morning until six or seven at night, when I came back from the hospital. I was a medical resident, and my work hours were long and uncompromising. As I sat in the recovery room of the maternity ward, my mind turned from awe and wonder to anguish and doubt. What was I thinking having a baby? I was so busy with work, and my job was very stressful. Surely I wouldn’t be a good mother.

Life went on, but the guilt did not leave me. It just changed shape, then doubled when we had our second child. It became sharper any time they fell and I wasn’t there; when they got sick or misbehaved; when they were late to school and I thought I should have pushed them to get up earlier; on the mornings when I was in hurry to get to work and had to raise my voice or give them lectures in the car. Those times the guilt crawled all over me and took control of my day.

At times I thought I should have quit residency, but then I asked myself: What about my other responsibilities to society? I take care of children with severe allergies, asthma and immunodeficiency – that work is also important. If I had quit residency, would I even be a better mother?Read More »