COVID‐19: A Resident’s Perspective

My shifts all start the same way these past few weeks with the collection of my allocated face shield and N95. The same shifts where it feels like the only patients I treat are those with COVID‐19. Faces sometimes not much older than mine. Patients who are tachycardic, hypoxic, and ill. But these interactions are different; physical exams completed under the supervision of a colleague just outside the room, charged to watch my every movement. Vigilance not just for me but for everyone else I could and would come into contact with over the course of my shift. COVID‐19 lingers ¹ on cardboard, steel, plastic, and other surfaces. Even the simplest of acts are dangerous without appropriate precautions.

Precautions helped in some small part by my newfound ritual of talking out loud to myself as I stepwise walk through donning and doffing. Making sure my “soiled” PPE comes off just right. That the outside sleeve of my gown does not brush my scrubs. And that I do not inadvertently touch my face while removing my N95. I cannot tell you how many times these past few weeks I have stopped my hand on its way to my face. An unfortunate, reflexive attempt to push my glasses up that in recent days led me to opt for contacts instead. The glasses now stay at home along with my watch and wedding ring. A difficult decision, but one that means less of an opportunity to take COVID out of the patient’s room or worse—home to my husband.

My coresidents tell similar stories. Newly acquired rituals inside and outside the emergency department. Modifications to the muscle memory of our daily routines all based in the hope of keeping the virus contained. One colleague in particular, appropriately fearful of bringing COVID‐19 home to his small child, strips in the hallway before walking through his apartment door, a postshift act he is quick to convey he will keep doing until his neighbors encourage him otherwise. We do not blame him. We too would be devastated if we were to get our loved ones sick.

Although said with humor, but understood to be laced with fear, these not so small adjustments are reminders of how COVID‐19 has changed what we do and how we do it. The hand sanitizer goes more quickly. People get creative in how they open doors. A sneeze sends staff scurrying and a cough causes a head to raise, a scowl to form.

Last week a physician described how he was washing his hands so much, and for so long, that they were becoming irritated and blistered. He needed recommendations on how to keep his patients safe—but his skin intact. Some of my colleagues upstairs, internal medicine residents in the ICU, took things a step further. On a recent overnight shift together, they signed health care proxy forms naming loved ones who would make decisions for them if they became infected and were too sick to do it themselves. The next day I did the same. It seems far too morbid of a task to do so young. But then again, the faces of some of my patients are not much older than mine. And doctors—residents—have already died.

COVID‐19 continues to spread. At first, we heard the stories; the burden of death and disease our colleagues faced in China. ² Then we read the recounts of our Italian counterparts ³ and saw the bruised faces of their health care workers. Tight masks leave marks, but only if you have masks. We saw how their system was pushed. Hard and fast and over the edge. Too many sick patients and too few resources for them. ³ Colleagues in Washington foreshadowed what we now see on a daily basis. ⁴ Sobering stories from New York are now becoming our own. Unable to sleep last night, I found myself rereading one of the updates ⁵ on COVID‐19 from the Surgeon‐in‐Chief at New York–Presbyterian Hospital and Columbia University, Dr. Craig Smith. A city not so far from here.

Dr. Smith opened this particular update with the want to offer comfort, but instead being only able to offer alarm. An influx of more patients, sicker patients. Made worse by a dwindling supply of PPE. Reading along, Dr. Smith painted a grim picture of what his hospital was seeing. A picture I hope we are able to avoid; but one that I worry we won’t. A picture our hospital has spent the past several weeks and months preparing for. A worry that keeps me up at night. Hoping for the best, we have prepared for the worst.

AEM Education and Training 2020;4:183–184