I wanted to write a little about what it was like to work in the hospital as this whole pandemic was unfolding. That itself was kind of crazy.
For those that don't know what a residency is: residents are doctors, we have graduated medical school. We, however, still require essentially on the job training to become specialized in our field. Being a resident means that you are still learning (that being said, learning as a physician is never truly done). But there is actually a formalized educational component to our training, which includes various rotations at different hospitals, apprenticeship models with different attending physicians, weekly didactic sessions. All of this is now gone. Being an ENT resident pretty much ended. Now I am a COVID resident. This is how that happened.
As an ENT resident at Elmhurst our role is pretty broad. We run a clinic almost daily seeing all forms of ENT problems from cancer to hearing loss. We perform surgeries a number of days per week, run an inpatient and consult service for the hospital. And we also cover facial trauma and emergency airways for Elmhurst since its a level 1 trauma center. As COVID unfolded, we were still doing all of these things. We saw it all coming our way, and talked about "what may be" for us, but kept working as if nothing was different.
Then it started. NYC numbers started rising. Still we continued business as usual but were more paranoid about what was happening around us. You see, ENT's, by the nature of our job, are at very high risk for contracting COVID. Our world is the upper respiratory tract--the nose, mouth, and throat. This virus lives there. The diagnostic procedures and surgeries we do aerosolize the virus and thus can greatly expose us.
In another country, for example, when doing a sinus surgery, an entire OR (10+ people--the surgeons, technicians, nurses) ended up getting COVID from the exposure. Anecdotally, from the reported doctor deaths in other countries, ENT's have commonly been represented. Our national organization started releasing guidelines suggesting limiting unnecessary procedures and increasing the amount of protective equipment when we had to perform our examinations.
Conversations on what we should do with our ENT clinic and surgeries began. Could we bring patients into the hospital for elective surgeries (even cancers) knowing they might be exposed to COVID, or expose others, worsening the pandemic. Our clinic, serving many patients without insurance, is usually packed--60-70 patients for a half day, maybe 100 for a full day. As the country started to say we should reduce gatherings of more than a few people, we were creating dangerous situations, having packed waiting rooms of patients. And we started to worry, even at the early stages of the spread when limited numbers were reported, did our patients have COVID? So many times the chief complaints of an ENT patient is "cough"! One day I had a patient who was coming in with shortness of breath and a dry cough. After seeing this patient, our team had a large debate on whether or not I was just exposed (without an N95 mask, since this was so early in the pandemic), and whether or not I had to take time off to quarantine.
And this brought up discussions about what to do for our residency. What would happen if I got sick? If I was sick it meant I would have exposed other residents who would then have to quarantine. Theoretically, in that scenario an entire hospital system could be missing ENT coverage. An entire residency could be put out of commission (and as the primary work force in our hospitals, this could be catastrophic). Our leadership developed a contingency plan to limit our exposure to patients and to each other. Surgeries were cancelled, clinic was converted to telehealth unless in person visits were necessary. At Elmhurst we allowed only one resident to come into the hospital at any one time. I would come in, lock myself in call room which I had disinfected thoroughly, only to come out for a consult. At which point I would gear up and head down into the disaster zone that our Emergency department had become.
Whenever I was on call for facial trauma, I would have to go down into the emergency department in the middle of the night. The Elmhurst ED is normally a picture of controlled chaos. I was always amazed at how crazy and crowded it was but how well it functioned. Slowly though, I saw this change. Usually, as a point of curiosity, I would look at the reasons people came to our ED. Over the course of 1-2 weeks I saw the patient lists convert from the usual chief complaints--chest pain, alcohol intoxication, headache, fall--to the key words "fever, cough, shortness of breath." Our ED slowly just became the hospitals first COVID ward. One by one doctors were wearing masks, gowns. Wings of the ED got converted to isolated COVID units with plastic barriers placed up like were blocking off radioactive sites. My friends who worked in the ED noted to me that normally they would intubate a patient now and then for respiratory distress--now so many had to come in and get immediately intubated because of profound respiratory failure. One night my buddy said he just intubated the most he ever had in one day, maybe 5 or 6. What's sad is this was the first weeks of March, just at the beginning of the tidal wave swell. Those numbers only increased.
Over time, crazy ethical discussions I never thought I would have started to come up: should I actually see a patient? Should we treat that bleed or abscess? Prior to this the answer would 100% be yes--we would never refuse a consult, it is our responsibility to help out. But now, we had to think about exposure risks, limiting consults that could maybe be taken care of (albeit with less expertise) by other specialists, ensuring that our residents (as emergency airway specialists) were still present for those emergencies. Our clinical duties rapidly halted to almost nothing. I would come into work and be "on call" but I basically hid out in a call room.
We started having "off weeks" and "on weeks" to limit times in the hospital. So I started to be on a sort of "vacation" in the middle of this whole thing. I watched my friends get hammered on the front lines. I watched the country get taken over by the pandemic. And I was essentially hiding. I, and others, really wrestled with this feeling of uselessness. And many of us couldn't take it. It's why we volunteered to be in the ICU, or wherever we were needed. Eventually, or our entire residency changed so most are now deployed throughout the system to help in some way. I'm stationed in a COVID ICU at Elmhurst (where the need was the greatest, and where I thought I could do the most good). But for a time, I could not explain how frustrated and useless I felt. I wanted to help, but was also afraid. For a week or so, I was safe; I could limit my family's exposure. But I would hear people cheer essential workers on the streets at 7pm. I was getting emails and texts from family telling me I was a "hero", but did not earn that designation (really none of us are heroes, we are truly doing our jobs). I felt that if I did not volunteer, no matter how scary it was, I could not call myself a doctor, and wouldn't respect myself. I wanted to "get into the fight" and feel like I was helping in some way.
I had no idea what I was getting into.
More on that in another post.