Are You Aware? Front Lines

This is part IV in our “battlefronts” Awareness Wednesday series. Read the other posts in the series here.

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My favorite toy as a 4-year-old was a little black doctor’s bag. It included an orange reflex hammer and a yellow-and-blue shot and stethoscope.

I took a first-aid course my freshman year in high school and was chosen as one of six first responders for the junior high. Our advisor would call us out of class, then we’d triage the situation and get started on taking care of our patient. We’d fill our advisor in once he was able to get his class situated and come join us. We also served as the trainers for the sports teams — and taped a LOT of sprained ankles over the course of the year.

Somewhere along that year I decided I wanted to become a doctor. My Dad’s response? “I wondered when you’d make that decision.” Apparently, that little doctor’s bag had been a bit of a giveaway to everyone around me.

After finishing a degree in chemistry at BYU and a degree in Spanish at UVU, I traded my little yellow-and-blue stethoscope for a burgundy Littman and moved to NYC for medical school.

I’ve seen a lot of hard firsts over the last few years.

The first time I stopped doing CPR so we could call time of death because the family had arrived and declared the patient DNR.

The first time I stopped doing compressions because we had been trying to revive the patient for over an hour and there was still no spontaneous cardiac activity.

The first time I told someone she was a widow.

The first time we told someone their loved one had cancer.

The first time we took a patient who was experiencing an ectopic pregnancy to the OR because she hadn’t gotten the medication she needed in time and her fallopian tube had ruptured.

The first time we took someone experiencing infertility back to the OR for a D&C because she was having a miscarriage with what they had hoped would be their miracle baby.

The first time we told a patient her cancer was inoperable and there was nothing more we could do for her.

The first time a rape victim turned down emergency contraception or STD testing because she didn’t want her parents’ insurance to be billed.

The first time I had to call authorities and/or social services because we suspected child abuse or my patient needed help getting away from domestic violence.

The first baby I saw born addicted to drugs and taken into state custody only a few hours after birth.

The first NICU baby I helped treat (for 11 days) before we lost him.

Nothing really prepares you for some of those hard firsts, until they arrive. But at least I knew those firsts were coming.

What I didn’t expect?

I didn’t expect the surgeries I scrubbed into in late January and early February to be my last in medical school. (A big deal for a wannabe surgeon who’s really missing the OR right now!) I didn’t expect the 9.1 million gown recall that almost kept me from scrubbing into my first kidney transplant to start us off on the wrong foot for a worldwide pandemic that’s been complicated by a shortage of supplies and personal protective equipment.

I didn’t expect to see stories from fellow LDS female physicians about how they carefully wrapped their dirty masks each day to be reused the next day, because their hospital administrators had been unable to secure enough supplies to keep them safe. I didn’t expect my city to be the recipient of emergency UN aid as people around the globe rallied to get as many masks and necessary supplies to our hospitals as they possibly could.

I didn’t expect to find myself fighting tears of gratitude upon hearing that Oregon Governor Kate Brown had sent 140 ventilators to NYC about 48 hours before we were expected to see our first deaths due to lack of ventilators. Nor did I expect to be nearly as excited as I was when NYC was able to send 100 ventilators to Michigan and 50 ventilators to Maryland, signaling the worst was behind our city.

I didn’t expect to have to leave Cleveland Clinic in early March where I was doing research on school shootings and marijuana because I was afraid that airports were going to shut down if I waited any longer to get home to NYC. I didn’t expect to have my neurosurgery elective rotation in Kentucky or my internal medicine sub-internship at Weill Cornell canceled. I didn’t expect to have our match day celebration canceled. (Where we find out where we’re going for residency and celebrate with our classmates and a guest or two. This day is a bigger deal for many medical students than graduation itself.) I did not expect to have a month of elective credits waived nationwide for my graduating class, and I did not expect to finish the last month of my medical degree online. And I most certainly did not expect Governor Andrew Cuomo to announce on April 4, 2020, that my class and I were being given emergency permissions to begin practicing as resident physicians before we finished our degrees. And yet, all those things happened.

I was supposed to have my degree conferred on June 1, 2020, with a graduation ceremony on May 21. The current plan is for my diploma to have May 1, 2020, on it and for a virtual graduation to be held instead.

I was supposed to begin residency on June 22, 2020, at Inspira Health in New Jersey, though I may find myself on the front lines here in NYC before that. I’m waiting to hear back from the hospitals closest to me.

I did not expect to have two professors battle COVID-19 before I graduated. Nor did I expect one of the residency directors that I interviewed with last fall to die last week. (He oversaw the ICU at one of the hospitals in the Bronx during the outbreak.)

I did not expect to enter the physician workforce with a physician shortage of 29,000–42,900 doctors, which is predicted to continue to grow over the next decade.

I did not expect to enter the physician workforce while our governors, hospital administrators, and the federal government bicker over supplying front-line healthcare workers with personal protective equipment. Nor did I expect to enter the physician workforce while my fellow Americans protested staying home where we could keep them safe. (When the people responsible for helping ill people recover are asking you to treat them as your last resort, not your first line of defense, you’d think people would listen!)

I’m bummed about the canceled graduation trip to Orlando and my parents and sisters and best friend not being able to fly in for graduation. And, I’ll continue to face my own moments of imposter syndrome and aspirational shame, and I know there’ll be plenty of emotionally hard moments ahead. But even in these unprecedented times of COVID-19, I’m ready and willing to answer the call and go be the doctor I’ve always wanted to be, come what may. And I’m grateful for the men and women across the nation who are doing the same, and for the men and women who are supporting them in doing what we do each and every day. Healthcare is a team sport. And right now, our team appreciates all the support it can get.

I am hesitant to speak for other people, but my experiences have also made me increasingly aware of the other healthcare professionals working on the front lines.

My rotation in November was in a hospital in a poorer area in Queens called the Rockaways. We didn’t have the phlebotomists, the CNAs, the EKG techs, the lab techs, the administrative assistants, the nurses, the dieticians, the physical therapists, the janitorial or maintenance staff, the pharmacists, the speech therapists, the occupational therapists, the respiratory therapists, the social workers, and other crucial ancillary staff that we needed to do our jobs effectively and efficiently. (I would not be surprised if these staffing shortages are contributing to some of the disparities we’re seeing across various demographics during this pandemic.)

Instead of being able to order a lab and check back in an hour or two, a medical student or resident often had to go draw the labs and deliver them to an overworked lab ourselves. This easily added an hour or two to our morning routine, as every patient needed their lab work drawn. That doesn’t sound like much, but for a service that was already stretched beyond capacity, it added up quickly. And if we didn’t have someone trained to perform a given test? We had to send that lab to a bigger hospital, which would guarantee we didn’t have results for several days. (Assuming it made it to its destination and back safely. I spent many hours on the phone with various labs trying to find my patients’ samples.)

(The test used to determine whether or not someone has the SARS-CoV-2 virus is called a PCR. It takes about six hours to run, and only certain labs are able to perform the test. Waiting on lab results is a huge time suck in medicine when everything is running smoothly and we’re not in the middle of a pandemic. I’m sure you can imagine how much extra work these poor lab techs are having to get done right now. Unfortunately, it can take 1–3 days or longer for people to get their results, which leaves people unsure of what care they need and whether or not they are safe to return to their daily activities. This is especially problematic for those who live with someone in a vulnerable population or who is considered an “essential worker.”)

I also spent many hours on the phone with various nursing facilities, subacute rehab centers, home healthcare workers, and pharmacies working to make sure my patients would have the care they needed once we discharged them from the hospital. These underpaid and underappreciated angels have really been left between a rock and a hard place as they’ve tried to find ways to continue caring for their patients while also keeping themselves and their families safe. Unfortunately, this burden has largely fallen on the shoulders of women and individuals living paycheck to paycheck who have not been left with many satisfactory options that allow them to provide care for their patients, put food on the table, and keep themselves and their families safe.

While I wrote this piece from my experience as a med student transitioning into life as a resident physician, please know I cannot do what I do unless each of these vital team members does what they do. Medicine is truly a team sport.

How can you support the front-line healthcare workers in your life?

• Follow the CDC guidelines and your local public health department’s recommendations.
• Listen. You don’t need to know what it’s like to be on the front lines to be able to sit and listen as healthcare workers process the emotions they’re feeling and the experiences they’re having. (If you have the relationship to suggest they see a therapist, you wouldn’t be amiss to recommend they do so, in addition to talking to supportive family and friends.)
• Remind them it’s OK to feel their feelings, whatever those feelings are.
• Remind them it’s OK to not be perfect. We call it “practicing” medicine for a reason. (Especially when we’re dealing with a novel virus we won’t truly understand for years to come.)
• Educate your neighbors about the importance of following the CDC guidelines and your local public health department’s recommendations. Find ways to make it easy for your neighbors to follow their advice.
• Help neighbors who are concerned about the economy understand we need to think “saving lives” AND “reopening the economy” not “saving lives” OR “reopening the economy.”
• Ask if there are ways you can help them keep their families safe while they’re seeing COVID patients or if their families have specific needs.
• Ask if certain Church or neighborhood assignments are helpful for them right now, or if they’d prefer you find someone else to take some of that stress off their shoulders.
• Call your state and federal officials and express the importance of waiting to reopen and relax restrictions until we can do so safely. (And then get your flu shot this fall, because this second round of COVID-19 is likely to overlap with flu season, and you need all the protection from either disease you can get.)
• Find out what your local hospitals need and what you can do to help meet those needs.

Here are a few more resources from NYC doctors that might give you an idea of what it’s like on the front lines:

• ER doc Cleavon Gilman at NY Presbyterian (Columbia’s hospital) is posting awareness videos regularly
• ER doc Jason Hill at NY Presbyterian
• Time Magazine had a great piece on healthcare workers’ mental health a few weeks ago that may interest some as well

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Kaitlyn Brower Dressman is a Utah resident who will graduate from medical school in NYC next week. She serves as the moderating team research lead for Mormon Women for Ethical Government.

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