Growing pains: Clinical training during COVID-19

“Each morning, I make my way to joy – joy that God has given me the breath of life for another day. The process is never instantaneous though. My alarm is usually blaring for five to 10 minutes continuously before I can get up, but sometimes I’m able to jump out within a minute. I purposely place my alarm a physical distance away from me so that I’m forced to get out of bed to turn off the pesky annoyance. And when it’s off, I make my bed, sit at the edge and I pray that I consciously choose joy over the circumstances of my day.” – Feb. 19, 2020 journal entry, surgery rotation, pre-quarantine

***

I forget what day is today. They’ve all blurred together in my mind. The weekends were once a much-anticipated reprieve from a busy week of clinic. Now they’re no different than a weekday. What makes a weekend so special when the entire week is otherwise unremarkable?

My alarm continues to go off. I stumble out of bed to turn it off. My routine had started out with great intentions, but like all habits, motivation started to dwindle after a few weeks. Though I had no clinical responsibilities in my quarantine, I wanted structure in my life. After all, I was still a medical student. I listed out tasks I needed to complete every day: Read my Bible. Work out. Zero out review Anki cards. Do 10 U-World questions. Complete any new Anki cards. By 6 p.m., all work had to stop.

My routine began to devolve into completing the tasks whenever I could (even if it meant staying up late) and soon even attempting to do the work was my only qualification of a job well done. The desire to be productive butted heads with the need to rest. But rest imprisoned in one’s home inevitably brought on a feeling of apathy and lethargy that could only be mitigated by productive work. This was the vicious cycle that lay before me each morning.

There’s a picnic table across the street from an open field that hasn’t been mowed in months. The area lies underneath wooden roofing with a lattice beam structure. It’s the perfect place to hang my gymnastic rings. I’ve never seen anyone else use the area. I found this place after a month and a half of working out in my house when the only daylight I saw was taking out the trash and my 45-minute walks with my roommates. Now, I’ve carved out this little haven for myself to work out in. It’s my one time of the day I’m outside and even in the blistering Houston humidity, I’m still grateful for it.

When I’m out here, I forget for an hour that a virus is ravaging our world both mentally and physically. I forget that the largest medical center in the world is barely keeping pace with the rising cases of COVID-19. I forget that our society’s future looks different than what we ever predicted: a generation of students shifted to an online platform, businesses surviving with employees working from home, and families wondering whether surviving the pandemic is worth suffering through the recession. In that hour, I forget all of that. And I remember what it’s like to soak in the warmth of the sun.

I remember I have healthy lungs to breathe in the fresh outdoor air. I remember that even though it feels like life is on pause, nature’s beautiful symphony still plays on. And the best part is I’m still alive to hear it all.

***

I’m back in the hospital. It’s been two and a half months. They screen every person that enters the building now. Medical students aren’t allowed to see COVID-19 positive patients or PUI’s (patients under investigation). That means any patient with fever, cough, or clinical history suspicious for COVID-19 is off limits.

It feels like I’ve forgotten all of my clinical knowledge, but we’re considered essential workers. I look at the intern who’s already admitted a patient and doing the full work-up. She asks me to go in and take the history of a heart failure exacerbation patient.

“Did you remember to ask about any recent infections?”

No, I forgot.

“That’s fine. Remember that it’s important to understand the underlying etiology of heart failure exacerbation to prevent future recurrence. Were you able to hear the crackles on auscultation?”

Not really.

“What’s your assessment?”

They seem fine.

“What’s the plan?”

I think they’re stable enough to be discharged.

I felt so lost keeping track of these moving parts for this patient. The interns are only three years above me in training, yet they can be in charge of five to six patients at a time. I can’t even imagine myself in their position three years from now.

On the last day before summer break, I get my feedback. It’s surprisingly positive. Somehow in all the fumbling around and self-perceived failures, I’ve grown. The EMR is easier to navigate. A differential diagnosis seems less daunting. The clinical flow and reasoning make more sense. I don’t get as nervous picking up a new patient, realizing my role as a learner does not take away from my role as a provider.

I walk out of the hospital. It’s a sunny day. Another year of medical school has officially passed.

***

Assessment: Third-year med student with PMH of two months of clinical experience s/p quarantine presenting with mild anxiety in the setting of a global pandemic. Labs unremarkable. Physical exam findings likely 2/2 growing pains.

Plan: Reassurance and supportive therapy.

-By Kevin Jiang, third-year medical student at Baylor College of Medicine