March 15, 2020
Dear Residents,
As your program directors and mentors, we have been talking about how we can support you during such unprecedented times. Now that conferences are cancelled, prepare yourselves for motherly texts and e-mails from me, checking in on your well-being. You all have my cell phone number. Please use it, for any reason.
This weekend, as I was driving to work in the COVID-19 screening clinic, if I'm honest, the seriousness of the current moment weighed on me. I thought about the reality of evaluating symptomatic and exposed patients. I thought about the sacrifices my children will make, having 2 physicians as parents during a pandemic. I thought about my patients and how protective I feel of their safety right now. I thought of our colleagues in Seattle, Italy, and China.
But most of all, I thought about you. The same apprehension and protection that I feel for my loved ones and my patients, I feel for you in a special way. I know that these years of residency already exact a high price from you, and I know that more may be asked of you on a physical and emotional level in the days to come. I spoke with a few of you this week and we all shared a palpable feeling of preparation, of a calm before an unknown storm.
The last time I had that feeling was in the weeks leading up to my intern year. I remember that June, being so aware of the looming intensity ahead. Knowing that there was no way to prepare away my inexperience, I coped by going to the grocery store and buying 3 months of toiletries and pre-writing birthday cards for my family for the next year. That July, I started my residency on the inpatient cardiology service. For me, there could not have been a harder place to start, but it was formative in countless small ways.
On one of our first call nights, my team had a lull between admissions in which to run down to the cafeteria for dinner. Just as we sat down to eat, my pager went off. My resident's eyes followed me as I went to the phone, called the nurse back, and then sat down again to eat. “What was that about?” he asked. “Mrs. L. is having chest pain again,” I said, as I picked up my sandwich and took a bite.
“So what are you still doing here?” he said sharply.
I looked at him. We had talked about this patient a few hours ago and agreed that her chest pain seemed atypical and unlikely to be ischemic, and she was just staying as a rule out.
“I thought we decided her chest pain wasn't ischemia,” I said.
He didn't mince words. “Chest pain in the hospital is an emergency until proven otherwise. When you get paged about chest pain, you go to the bedside. I don't want to hear that you decided it wasn't real without seeing the patient. Now go.”
Chastised, I left my dinner tray on the table with the team while they stayed to eat and I went up to see the patient. You know how the story ends. By the time I had evaluated her, we had another 2 admissions, and then everything happened that always happens on a call night. I walked into the call room at 2 am to find the cardboard cafeteria tray with my cold chicken sandwich and Diet Coke, left there by my thoughtful co-intern. It would not be the last time that sleep and food had to split precious minutes.
I have thought about that call night many times over the years since—mainly admiring my resident's guts to be so straight with me. As a medical student, I had certainly skipped meals many times, and been on call many times, but I internalized something in that moment that changed me for the rest of my training and my career. It was the first time that I, with an MD after my name, was solely responsible to meet a patient's need. In that moment, the patient's medical safety was more important than my meal. It was no one else's job to go but mine. My resident could have protected me by going in my place, but if he had, I would not have learned that lesson when I needed to. He was direct and straightforward with me about many things that month, which started me on the path to becoming the physician I am today.
I know from watching each of you, and seeing you approach your work, that you have already internalized those lessons (though you probably didn't need a resident to bluntly direct you the way that I did). Every page that you answered, every meal that was delayed or missed, every call night in the hospital, every sunny weekend day spent working, and every missed family gathering have been preparing you for such a time as this. Hundreds and thousands of small events in your training have taught you what it means to be a physician, to take on this professional identity. In accepting this identity, we accept that more will be asked of us in times of need. I share your uncertainty about what that will look like for each of us in the coming weeks and months. How much will we be asked to work? Will we get sick? Will our colleagues get sick? How many patients who we care about will be affected? What will happen to our families?
One of the few things I'm not uncertain about in this time is your readiness and your character. I know that you are prepared for this challenge. As things unfold, I want you to remember a few things.
First is that you are not alone. We are all in this together and will support each other. I know that so much in the hospital already falls on your shoulders. Watch for the attendings who are stepping up to support you. We are in this with you. Don't be ashamed to ask for help. Reach out to your colleagues and friends and family for support.
Second is that it is important to take care of yourself. Don't misunderstand the story that I just told. That event wasn't about the meal; it was about a perspective shift in me. In many other moments of residency, I chose to eat first and it was equally the professional thing to do, to make sure that I was thinking clearly to care safely for my patients. I missed that meal, but I ate the next one. Caring for your physical needs is important and benefits your patients. In times of sustained crisis, this is even more true. So eat and sleep without guilt.
Third, remember to notice and appreciate the sacrifices of the nurses, advanced practitioners, and many other hospital staff who are working alongside you. Gentle words and small acts of kindness will sustain you and them.
I'm proud of you already. The coming days and weeks and months will show you what I already know to be true of you.