Graduating Early in the Time of COVID-19

The e-mail from my Dean made it exceptionally clear: early graduation, to be followed immediately by employment as a doctor caring for patients with coronavirus disease (COVID-19), was voluntary. Despite tireless efforts to expand capacity, the New York University hospital system was outmatched by COVID-19. As an unrelenting deluge of acutely ill patients surged into our emergency departments, floors, and intensive care units, many doctors and staff were themselves falling ill. We were needed to bolster the ranks. On reading the email, my stomach turned with anxiety, but I knew what I would do. Courage is not a personality trait but a decision.

I was propelled to accept this offer by a burning desire to help and a love of medicine. I was also plagued by doubt, fear, and a sense of loss. Did I have the clinical skills to care for these patients? Would I be a help or a hindrance to those already fighting? The fear of contracting COVID-19 and becoming critically ill was and remains very tangible. The sorrow I feel at the prospect of more months without seeing my family is exacerbated by the comparison with what this time should have been. Although these concerns never abated, a more powerful understanding slowly moved to the forefront of my mind, with the calm and clear ring of unavoidable truth. The people on the front lines were my residents, my colleagues, and friends, and they were stretched to their limit. Simply put, no matter my fear, my team was asking for help.

When I reflect on the particulars of my medical education, it is not a classroom or textbook I remember. Rather, my mind plays a reel of moments in the hospital working alongside house staff. Almost anything I know to do, I know because a resident showed me. They patiently demonstrated how to perform an arterial blood draw, auscultate a murmur, ultrasound an abdomen, place an order, and sign out safely at the close of the day. They exemplified with actions above words how to bear witness to suffering and hold space at the bedside for laughter and tears in equal measure.

Residents have also provided extraordinary emotional support during the tumultuous and often dispiriting journey that is medical school. My second-year internal medicine resident protected my idealism and took the time to teach me about racial inequity and bias while treating incarcerated patients. My surgery chief, despite my future in psychiatry, afforded me the once-in-a-lifetime opportunity to participate fully in our hospital’s busy trauma service, always making me feel like a part of the team. My medical intensive care unit intern gave me a subtle thumbs-up after a presentation during which my voice shook with nerves. My residents have empowered me, believed in me, and rooted for me. They now found themselves fighting valiantly to stem a seemingly unbreakable tide of loss, pushed to their limits, with no end in sight.

Nagging doubts and anxieties persist. But as I pass each day through the arch to enter the belly of the behemoth that is Bellevue Hospital, I find relief from fear and heartache. The hospital soothes, not exacerbates, my worry. Not because reality is diminished, but because in this building, no one is alone. From patients to the facilities team, from nursing to the employees of Au Bon Pain who power us all with caffeine, we are a team.

There is a camaraderie and esprit de corps that keeps the gears of health care grinding forward for our hospital’s often uninsured, undocumented, or socioeconomically disadvantaged patients. “Care, no matter what”—that is the Bellevue motto, full stop. Never has this been truer than in a pandemic that disproportionally sickens and kills our city’s most vulnerable citizens. Creativity and grit are not new in public hospitals, but they are being tested in ways we never could have imagined. Young physicians are risking our own health to care for the people who need us. We are using personal phones to send video messages from dying patients to their family members, shouldering a crushing load of grief. In addition to early graduates, our medicine teams are reinforced by those working outside of their specialties, because they are doctors first. Chiefs and administration are working around the clock to create space for the tidal wave of patients coming through the door. I accepted early graduation so that I may do what I can to absorb some small piece of this impact, to help my patients and my team survive the flood.

My medical school graduation consisted of a brief, but emotional, WebEx. The 52 early graduates mumbled our way through a chaotic and garbled version of the Hippocratic Oath. Afterward, many of us commented that it may not have been pretty, but it was exactly right for the time. In this moment, in our city, and in our hospital, nothing is as expected. Tense subway rides and empty streets lead us to a hospital with shuttered clinics and masked faces. We were supposed to be living our fourth-year lives free of obligation, enjoying time and travel with family and friends. We have no control over what we have lost. We only have control over what we do next and whose example we follow.

I did not learn the meaning of professionalism from a distorted WebEx version of a hallowed oath. Those words will not be my guiding light through this frightening time. Instead, I follow in the footsteps of the house staff—once my superiors, now at my side. I choose to be with my team. I choose to be courageous. I choose to care, no matter what.