Sai Santhoshini Achi, MD
Internal Medicine Resident at Harlem Hospital Center, New York
“This is to notify you that your flight is going to be delayed,” blared the airport announcement. It was around March 2020, and I was traveling back to New York after visiting my parents. My fingers were drumming on the seat handles. I just couldn’t stay with my family any longer and keep listening to the news coverage of this new coronavirus disease. How could I be on vacation when there were talks of barring flights to and from New York? I just couldn’t rest. As I boarded my flight, I had no idea what was going to happen when I got back.
It was my second year of residency, and as I returned to work, I was assigned to the COVID-19 team. The team consisted of six residents with a census of ten patients, all with the primary diagnosis of COVID-19 infection. It sounded okay at the time. I mean, how hard could it be to take care of ten patients? I should have thought again. I found myself donning and doffing personal protective equipment (PPE) every five minutes and searching the hospital for a N95 mask. The same mask that was abundant just a week ago. After what seemed like the blink of an eye, the number of patients with COVID-19 quadrupled in the hospital within hours. New wings and floors of the hospital were opening up to accommodate the patients. I remember patients who had come in for what they thought was a simple cough dropped their oxygen saturation below 90 percent while walking to their bed, and within hours admitted to the intensive care unit. I was updating family members about their loved one’s critical conditions minutes after they had just spoken to them.
All of this became the norm. As I walked to work each day, countless questions continued to torment me. What exactly are we doing? Is what we are doing helping? How are procalcitonin levels and another million lab tests helping? It didn’t matter what I did for patients. The disease had its own mysterious, disastrous course. I felt weary and useless. I didn’t know what to tell patients and family members about the risks and benefits of proning, starting hydroxychloroquine or remdesivir, or how to answer the question of when toclizumab was considered a therapy. The morbidity and mortality of this disease outpaced our ability to assess the effectiveness or lack thereof of different therapies. We just didn’t know.
But the most important question families asked me, given that they couldn’t visit their loved ones in the hospital was, “Is my loved one going to be okay? When will they come home?” I found that I became the support system of the patients, who were battling this monster of a disease every second without being able to see their loved ones. I would check in on them, talk to them, be with them at their bedside, and try to offer comfort with what little knowledge I had. I was also the support system of the family, who were terrified by all the evolving news surrounding the disease. I would pass messages between the two parties.
As the weeks dragged on, each shift became harder and harder. Telling families their loved ones were declining or had passed away became harder. I would get nervous when my pager rang. Watching my peers contract the COVID-19 infection served as a wake-up call. Walking to the hospital and being notified that two of our nursing staff had passed away was incredibly painful. I couldn’t believe it. I had talked to them the week before on the wards, and I asked if they were staying safe and how their families were. I was terrified. I couldn’t exactly communicate my feelings to my own family because I didn’t want to worry them, but I was terrified. I tried to be a pillar of strength for my patients and their families. I tried to plaster on a smile and kept telling myself to take one minute at a time, but the emotional toll was immense. I remember breaking down on the phone while calling the family of a young patient who was sick with COVID-19 infection. That could be someone I know. That could be me.
It was a life-altering experience. Spending some of my formative years in the field of medicine in the middle of a pandemic has completely changed the way I view what matters and the art of medicine. I understand that we may not have all the answers and that’s okay. I understand my limitations. I am human, and it’s okay to feel scared, to feel vulnerable, and be in touch with my feelings. I can rely on my colleagues, friends, and family to care for me, and I received some great support from all of them and the nephrology community on social media. It helped me appreciate the beauty of medicine. Although it is a science, it is also an art rooted in empathy and self-reflection.
As health care providers, I believe it is crucial to understand that despite the limitations we may have in terms of knowledge, guidelines, technology, etcetera, a core of the practice of medicine is to be your patient’s advocate, to be present, and truly listen to them. As health care workers, we are given the opportunity to comfort and care for people in their most vulnerable states.
The pandemic continues to teach us lessons and presents unique challenges for everyone. It has changed not only the way we view medicine but also how we view ourselves and each other. I realized how much I took for granted and how far a simple “good morning” or a smile can go. How the medical field and the world have come together in these tumultuous times is nothing short of remarkable. The key thing is to continue learning,adapting, and to keep marching forward with hope. Stay safe!
Reviewed by Matthew A. Sparks, Amy Yau, Sudha Mannemuddhu, Anju Yadav