The Mask

Alisha Poppen
University College of Cork, Ireland

Wearing a mask has become a sign of utmost empathy one can show to another
We do not wear a mask to protect our self, but rather to protect others
 It is an implicit statement of love, not fear 

I wear my mask to prevent the spread of the virus that can make you sick
Not because I think everyone around me has the virus and wants to infect me
Not because I am afraid of the virus

I wear my mask to comfort you, not to make you feel apprehensive
I wear my mask as a solider in this war against a microscopic threat that spares nobody
It is armor

Six feet apart and a piece of fabric to cover our face
It is all that we have to protect life and prevent death
No borders that separate us, no vaccine to save us
No person too big or too small, too rich or too poor, too red or too blue is immune 

We all play for the same team

The mask, a symbol of unity, a symbol of hope and a symbol of love

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A Month of Reflection: Ramadan, Medical School, and COVID-19

Abdurrahman Abdurrob, MSc
Tufts University School of Medicine

In the space of a few weeks, the impact of COVID-19 has been felt all around the world. Social distancing, face masks, and non-stop handwashing are now the new normal. Thousands of people have tragically lost their lives, many unable to say goodbye to their loved ones. While countless more are struggling to make ends meet as the damage is compounded by underlying systemic problems. Furthermore, as an immigrant to America, I particularly felt how COVID-19 has ravaged our communities here and across the world. Bangladesh, my place of birth, has been hit hard, as millions are forced to choose between safety or food, in what is typically a joyous time – the month of Ramadan.

For those who don’t know, Ramadan is the 9th month of the Islamic Calendar in which Muslims, who are able, abstain from food and drink between sunrise to sunset for the whole month. There are many reasons why Muslims fast this month. Ramadan is not only one of the five major pillars of the religion, but it is also an important opportunity for Muslims to reflect on the struggles of those less fortunate, many of whom have been hit the hardest by this pandemic.

Another major part of Ramadan is community. Our local mosque in Boston usually hosts lectures, prayer services, and dinners with hundreds of people in attendance every night. It is a deeply spiritual time for reflection and prayer. It is also a time of joy for kids who are able to see friends, and an opportunity for families to mingle over dinner. Most importantly, at the end of the month, it is a chance for the community to celebrate the end of Ramadan with Eid, the biggest holiday of the Islamic Calendar. However, mosques all around America, including my own, have shut their doors this Ramadan following guidelines around social distancing. Understandably, communities have had to drastically rethink how services are run as we deal with COVID-19. Instead of community gatherings to break our fast and nightly prayer services, we tune in for a nightly lecture on Zoom and break our fasts from home – the prospect of having a normal Eid is almost nonexistent. While these measures are not the same, we are all having to adapt to this new reality.

As a first-year medical student in Boston, I remember coming into medical school worrying about Ramadan. The prospect of fasting 16-hour days while balancing the workload of medical school seemed daunting. Fasting at this time of year means studying at night, eating breakfast at 3:00am, sleeping through the early morning, then trying to focus on an empty stomach before breaking my fast at 8:00pm. All this without coffee!

However, when our medical education moved online for the Spring semester, we similarly had to adapt. Many of us left campus within the week, packing up, and flying out of Boston to finish the rest of the semester in different cities around the country. While overall the experience has been smooth, and my medical school supportive, there have certainly been growing pains to learning online and a lot more independent studying. And of course, without the physical support of peers, these long hours of studying and fasting have been incredibly isolating.

Nonetheless, many of my professors, friends, and colleagues are on the frontlines, conducting vital research or working in essential roles in various fields. My classmates are mobilizing support and communities are rallying to help each other in these difficult times. Many others are self-isolating at home hoping to help stop the spread of the virus. Everywhere people from all walks of life are making sacrifices during these difficult times. As first-year medical students, we have been told by our school that our main focus should be our coursework. We just finished our Respiratory Block, so having studied Acute Respiratory Distress Syndrome in depth, I am grateful more than ever to have the privilege of studying medicine.

Somewhat fittingly, this “socially distanced” Ramadan has given me this opportunity for reflection. I reflect on all the ways COVID-19 has forced us to adapt to these difficult times: virtual Ramadan, school, graduations, work, and all the social distancing measures that are in place. While we may not be physically together right now, we can all play our part especially as COVID-19 has forced magnified the health disparities in our system. Just as community is important in Ramadan, I believe it is only through community we can address these challenges and adapt to these new changes.  While the future does seem uncertain at times, I hope through these experiences my classmates and I will be able to help bridge these gaps in the not too distant future.

Am I Useful?

Nicholas Bellacicco
Lake Erie College of Osteopathic Medicine at Bradenton

A dusty white coat is what I see
When will I get an opportunity?
To serve and love like I know best
Giving my all, and nothing less.

“Am I useful?” I often think
As I watch my mentors start to sink
I hear of fear in wards I thought immune
Sincere prayers that this be over soon.

We are pulled in two opposite directions
One of battle another of hesitation
We remain at home and do what we know
Reading books until the sun goes low.

Our futures uncertain, our careers in limbo
Secure behind a closed window
We see it all as we shelter in place
Should I take a mask, or would that be a waste?

As the Toll Rises

Rohan Rao
Rutgers-Robert Wood Johnson Medical School

This is a reflective piece about my time volunteering in northern New Jersey in the early days of the COVID-19 pandemic. I worked as a specimen collector at a drive-thru testing site.

A cold, gloomy day was upon us, as we arrived
at the testing site. The sun was hiding
behind ominous storm clouds, as if it too felt
the unease that bloomed within me.
By a pale white tent,
whose flaps thrashed wildly in the wind,
we donned our protective gear. 

Tent B was our assignment. Specimen collection was our role.
A gaggle of new, partially obscured faces,
we unsaddled our unfamiliarity to shoulder a shared purpose.
Swimming, though more aptly it felt like drowning,
through a sea of PPE, emotions were lost beneath the swell.
A tide washing away smiles, ushering in
a foam of gravitas onto our beaches.
With our expressiveness swept off,
a double-gloved thumbs up would have to do. 

Cars arrived, in a trickle that quickly transformed
to a gushing stream. How fitting it was then, that
the sky began to shed tears on the passengers inside,
all anxiously awaiting their turn for testing.
To them, we were a spectacle. Aliens in our white protective suits.
Our approach induced eyes to widen or fingers to hit “record,”
even an audible gasp as I wielded the nasal swab. 

“That goes where?!” she exclaimed. “I think you poked my brain,”
remarked another. But after ten seconds,
which accordingly felt like ten years, they were done and on their way.
With the last car swabbed, we doffed our gear,
careful not to expose ourselves and end up in that very same line of cars.
We laughed jovially, and recounted our dreary morning,
before going our separate ways. 

But frequently, I find myself back in that parking lot,
watching the cars drive off, wondering how their stories ended.
Day by day, as I see the rising death toll in my state,
I strive to maintain my hopefulness, and stave off
that defeated sigh.

Reflecting on COVID-era Abortion Bans

Margaret Okobi, BS1
1 Harvard Medical School, Boston, MA 02115, USA

With the current pandemic, providing healthcare leads to an inevitable tradeoff between serving patients and potentially exposing them to coronavirus infection. Seemingly in response to this concern, there has been immense, state-level pressure within the US, to limit abortion services indefinitely. As of April 30th, 2020, at least 11 states have issued orders limiting or banning abortions [5]. Interestingly, 100% of these states have Republican-controlled state legislatures, and several of them had been pushing increasingly restrictive abortion legislation prior to this pandemic [6,8]. The political undertones of these efforts are clear.

Outside of the political sphere, many organizations have released guidance as to which healthcare services and workers are considered essential during these times [1-4]. The American College of Obstetrics and Gynecology (ACOG) and the World Health Organization (WHO) recognize reproductive services as essential during this pandemic, with the latter explicitly recommending continued “access to contraception and safe abortion” [3,7].

Amid this polarizing debate, we cannot forget the people affected by these new policies. What happens to the women who cannot access safe abortions near their homes? Some will travel hundreds of miles to different abortion clinics. Prior to COVID-19, this was already a common occurrence. In 2018, Dr. Diane Horvath told the story of a 16-year old girl, who drove all night, from Michigan to Maryland, to receive a safe abortion [11]. If they cannot reach an abortion provider, some women will attempt dangerous abortions on their own, harkening back to the “coat hanger abortion” era before Roe v. Wade (1973) [12, 14]. Lastly, women who are unable to access some form of abortion may carry unwanted pregnancies to term and face long-term consequences, starting even before delivery. Unwanted pregnancies are associated with increased interpersonal violence and maternal mental health conditions. Women become less likely to finish college or enter the workforce. Their children are more likely to have social, cognitive, and emotional deficits [13,14].  By limiting access to safe abortions, we are forcing women into unsafe practices and unwanted pregnancies, which have life-changing, multi-generational consequences.  

With all that is at stake, abortion providers and other healthcare professionals can take this opportunity to be advocates, individually and organizationally (9). Providers can obviously contribute to this cause by continuing to perform surgical abortions, but also by challenging their affiliated organizations to take a firm stance on the issue. In terms of combatting governmental orders, ACOG has gathered numerous resources for providers and/or constituents to track legislation, contact legislators, or advocate as state legislators themselves [10]. Providers have powerful insight and authority on this topic, which can make public discussions less partisan and more evidence based [9]. Already, abortion providers and reproductive advocates have successfully resisted abortion-banning orders in six states [5].

Ultimately, as governed by federal law and health organization guidance, we have an imperative to help women access reproductive services, and avoid the emotional, psychological, medical, financial, and social burdens associated with unwanted pregnancies. During this pandemic, we should ensure that women have continued (or even better) access to abortions. Now is not the time for a referendum on the morality of abortion, and it is unconscionable to use COVID-19 as an excuse to block access. Now, more than ever, with a global pandemic threatening our health and livelihoods, women deserve to have control over their health and their futures.

REFERENCES

  1. Department of Homeland Security, Cybersecurity and Infrastructure Security Agency. (2020). Guidance on the Essential Critical Infrastructure Workforce. https://www.cisa.gov/publication/guidance-essential-critical-infrastructure-workforce

  2. Center for Medicaid and Medicare Services. (2020). Non-Emergent, Elective Medical Services and, Treatment Recommendations. https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf

  3. Ford, Liz. “Declare abortion a public health issue during pandemic, WHO urged.” The Guardian. April 10, 2020. https://www.theguardian.com/global-development/2020/apr/10/declare-abortion-a-public-health-issue-during-pandemic-who-urged

  4. “Helping private practices navigate non-essential care during COVID-19.” American Medical Association. April 14, 2020. https://www.ama-assn.org/delivering-care/public-health/helping-private-practices-navigate-non-essential-care-during-covid-19

  5. Sobel, Laurie et al. “State Action to Limit Abortion Access During the COVID-19 Pandemic.” Kaiser Family Foundation. April 27, 2020. https://www.kff.org/womens-health-policy/issue-brief/state-action-to-limit-abortion-access-during-the-covid-19-pandemic/

  6. “State Partisan Composition.” National Conference of State Legislatures. March 31, 2020. https://www.ncsl.org/research/about-state-legislatures/partisan-composition.aspx

  7. “Joint Statement on Abortion Access During the COVID-19 Outbreak.” The American College of Obstetricians and Gynecologists. March 18, 2020. https://www.acog.org/news/news-releases/2020/03/joint-statement-on-abortion-access-during-the-covid-19-outbreak

  8. Panetta, Grace. “The states passing strict abortion bans have some of the highest maternal and infant mortality rates in the country.” Insider, Inc. June 1, 2019. https://www.businessinsider.com/states-passing-abortion-bans-have-highest-infant-mortality-rates-2019-5

  9. Mark et al. “What can obstetrician/gynecologist do to support abortion access?” International Journal of Gynecology and Obstetrics. 131(1): S53-S55. https://www.sciencedirect.com/science/article/pii/S0020729215000909

  10. “Get involved.” The American College of Obstetricians and Gynecologists. (2020) https://www.acog.org/advocacy/get-involved

  11. Frye, John. “OB-GYN advocates for better abortion policy.” The Johns Hopkins News-Letter. April 15, 2018. https://www.jhunewsletter.com/article/2018/04/ob-gyn-advocates-for-better-abortion-policy

  12. Fox, Maggie “Abortion in the U.S.: Five key facts.” NBC News. July 5, 2018. https://www.nbcnews.com/health/health-news/abortion-u-s-five-key-facts-n889111

  13. Bernstein, Anna and Kelly Jones. “The Economic Effects of Abortion Access: A Review of the Evidence.” Institute for Women’s Policy Research. July 18, 2019. https://iwpr.org/publications/economic-effects-abortion-access-report/

  14. “Abortion and Mental Health.” American Psychological Association. (2020). https://www.apa.org/pi/women/programs/abortion/

White Noise

Devanshi Shah, MBBS
Seth GS Medical College and KEM Hospital, Mumbai

The bed is being emptied in front of me.
I sigh, I ponder.
Yesterday his vitals were improving
And today his oxygen tumbled.
He didn't open his eyes.
Neither did his wife, apparently,
In the room next door.
I close my eyes too, the sight too much for me to bear.

There's white noise all around me, a silence which screams, an agony only I can hear.

When I remove my mask at the end of the shift,
The lines are etched in my face.
Not the lines of the mask, no,
Lines of worry around my eyes,
Frowns on my forehead.
I look like I have aged from 24 to 42,
With every death adding a year to my age.

Around me, there's only white noise,
Only weak wails from the heartbroken.

I remove my gown carefully,
A bath from head to toe,
As if the water can rinse the memories,
Which the day has left in me.
As if the soap can erase the claw marks,
Which Death leaves in its wake.

Even when the water tumbles down from the faucet,
I hear nothing, only white noise.

 My heart beats erratically,
Everytime I pass by the ER,
Who will come in now?
Friend or foe?
Will I have to see them in the ICU?
It's as if my breaths are getting shallower,
As my mind rushes through the last few days,
Wives praying, children consoling,
Tears escaping, and hands shuddering.

No goodbyes were said, there were no sounds, only white noise all around. 

I return the next day,
It's hotter than usual, as I don the gown,
Sweat trickles down my forehead,
In anticipation of more deaths.
My chest tightens at thoughts,
Of how dark and empty their eyes look,
As they stare Death in the face.
Even when I'm pumping oxygen into their unwilling lungs,
I'm trying, I'm trying.

I'm shouting, pleading them to come back,
But they can't hear me, it's only white noise all around.

As the cursed clock's hands ticked by,
Nearing noon again,
I decided to confront my demons.
It was what I'd suspected.
I lay down in the very bed I'd seen being emptied,
After all, the very disease I fought against,
Came back to me with vengeance.
I don't close my eyes, worried,
That it might be the last time I open them.
On the other side of the wall,
I see my mother saying something.
She says, she's praying for me.
I wish I could hear her right now.
But it's all white noise around me.

Future Physicians During Physical Distancing— Medical Students’ Roles During COVID-19

Dana Vigue
Harvard Medical School

ABSTRACT

Medical students serve many unique roles in a patient care team. Of great value is the amount of time medical students can spend by the bedside forming meaningful, longitudinal relationships with patients and their loved ones. In the midst of the COVID-19 pandemic, many medical students have transitioned into virtual patient care roles. This article explores how sitting by the bedside can be reimagined in this era of physical distancing.

“Medical students are in the unique position to spend much more time with their patients than other members of the team can. Never take for granted how much care you can provide by being by the bedside, learning about your patients’ lives outside of the hospital, and spending time with their loved ones.” 

My senior resident relayed this advice as she led me through the maze of corridors I would call home during my Medicine rotation. I would immediately forget how to navigate those corridors, but I would not forget her words.

Before my clinical year of medical school, I had only abstract ideas about how such quality time could shape clinical care. I imagined that this link would be indirect; at my skill level, I did not expect that I could meaningfully contribute to anything other than morale. Nevertheless, I appreciated that morale is a critical component of recovery, and I prioritized my relationships with patients. I eventually found myself positioned as an informed patient advocate capable of shaping the care a patient would receive.

In one instance, my daily, hour-long conversations with a patient and her spouse led to my understanding of her life-long experiences with environmental racism which made her wary of undergoing tests that involved exposure to ionizing radiation. I was able to dispel persistent misunderstandings regarding her care preferences and collaborate with members of my team to provide creative, high-quality alternatives for her diagnostic work-up and subsequent treatment.

Like many of my classmates, I have immensely valued my unique role in a care team. As future physicians, we find fulfillment in our ability to alleviate suffering, and we have learned from our mentors that this involves both biomedical and humanistic care.

As the current COVID-19 pandemic began to escalate in the United States, medical students were transitioned out of direct patient care roles. During the first week of virtual medical education, many of us felt a sense of urgency without a clear outlet for action. Thanks to the collaborative efforts of medical students and our dedicated mentors, the infrastructure for critical new health care interventions was built from the ground-up in record time. Many of us quickly transitioned into virtual patient care and advocacy roles, expanding the capacity of our critically strained care delivery systems.

As SARS-CoV-2 rapidly sweeps across the globe, we have rushed to keep up with the spread, stay ahead of transmission, and flatten the curve. As we conduct telehealth visits for patients with COVID-19, call patients with food scarcity to connect them with local meal resources, follow up with postpartum OB/GYN patients, and engage in many other crucial patient advocacy activities, let us not forget that we still occupy a unique role in patient care. Now, more than ever, some of us may still find ourselves able to spend longer with our patients than other members of our team. As I find myself in that privileged position, I am reminded of my resident’s words of advice.

In partnership with the Crimson Care Collaborative at Harvard Medical School, I am currently conducting longitudinal telehealth visits with patients diagnosed with COVID-19. After assessing my patients’ clinical trajectories and attending to their medical concerns, I take the time to ask how they are coping with isolation, how their loved ones are doing, and if there are any resources that they need. In these hurried times, this is a rare moment when time seems to stand still. Patients have expressed feelings of loneliness, fear, and confusion. One patient shared how emotionally painful it has been to isolate from his wife and young daughter for weeks on end. Another patient lacked the resources to isolate from other members of her household and divulged feelings of intense guilt after five of her children had become symptomatic since her diagnosis. In some cases, I am able to collaborate with social workers to connect patients to social supports in their communities. In other cases, I can normalize a patient’s experiences with difficult circumstances and the emotions they bring up. Other times, it is simply my role to bear witness to these challenging experiences during such unprecedented times.

As medical students’ roles shift alongside the rapidly changing landscape of medical care, let us not forget to retain the unique aspects of our roles as caregivers. Although we may no longer be physically present by the bedside, we can find new ways to sit with our patients. I firmly believe that patient care of the highest quality is not possible without meaningful investment in patient-provider relationships. Let us continue to pursue our understanding of each patient as a whole person and initiate critical interventions informed by the context of a patient’s life. It is a radical act of caregiving to halt the breakneck pace of our work and affirm the lived experiences of those who trust us with their health. As the necessity of physical distancing has reduced patients’ access to family support and therapeutic touch, let us also not underestimate the healing potential of medical students’ extended presence and solidarity. In this way, we will carve out our roles as future physicians during this new age of physical distancing.



Diapause

Aishwarya A. Ghonge
Rajiv Gandhi Medical College, Thane, India

Diapause (n)

A period of suspended development in an insect, other invertebrate, or mammal embryo, especially during unfavorable environmental conditions [1]

Diapause.png

Growing up in a country of 1.3 billion people, where 1.3 million students aspire to study medicine every year, you learn to plan your life ahead of time, so you may have a reasonable head start in the brutal rat race. This is why I have always been the kind of person who chalks out detailed schemes in Excel sheets and a myriad of Google docs, planning my life to a tee. My life moves deliberately and with patience--or so it did until a pesky virus brought the entire world to its knees, and me to a rude awakening. In our plane of existence, uncertainty is predestinate.

I have always thought of a pandemic as something that happens to fictitious, two-dimensional people on screen or hordes of masked people from a distant country filling the frontpage of my morning newspaper, true but never particularly real to me. The worst a pandemic ever personally affected me was in ninth grade, when my mum made me live off of vegetables for a whole month because of the ongoing swine flu. The horror! This time seemed no different. When the first whispers of a possible pandemic started, I pictured being forced into submission to a vegetable dominion at the dinner table by a mom who’d sooner let me shave my eyebrows than accept my medical explanations for actual fact. She’d never believe me if I told her that eating a spicy chicken wing wouldn’t in fact kill me, unless I choked on a bone and went too long without a Heimlich to save me.​ ​However, not in my wildest dreams could I have imagined my Mumbai, a city normally pulsing with such life and momentum, would lapse into this sleepless dormancy-- bypassing a better part of 2020 like it may not even be happening at all.

But it is happening-- this time it is very real. Without the usual onslaught of traffic and street vendors screeching at the top of their lungs, our city is engulfed in an unsettling quiet, pressing upon my eardrums like pool water after emerging from its depths for a gulp of fresh air. I am standing in the grocery line, under a glaring mid-April sun, drops of sweat trickling from my brow onto my upper lip under the mask that I’m wearing, tasting of salt and humid desperation. Everyone ahead of me is standing in a neatly spaced line, wearing a mask or a tightly wound scarf, eyes swiveling for someone to betray the slightest sign of dreaded coronavirus. So, when an innocent sneeze comes, I try to pass it off as a loud yawn to suspicious onlookers. I’m even about to rub my knuckles into my eyes for added effect but think better of it, just in time. It is moments like these that scare me. What if I scratched my nose unwittingly and exposed myself to the virus deposited on my hands from touching a tainted grocery cart?

As a medical student, I feel the pressure to follow WHO guidelines with precision more acutely than most. How would I feel, if in spite of my education, I made a stupid mistake and became infected with coronavirus? Or worse, passed it on to my elderly parents? It is out of this fear that I mask and wash and mask rigorously when I head out to buy essentials and perishables, shielding and protecting my loved ones from an invisible, powerful adversary, as pangs of guilt threaten to overwhelm my composure. I should be out there, at the frontlines, helping and fighting. But here I am, stuck in a limbo between pushing myself to keep studying for​ ​an indefinitely postponed Step 1 exam​ ​and a yearning to make a real-world difference, especially during this unprecedented time. I am kicking myself each time I read about the shortage of healthcare personnel and the misery that has befallen them, but the best I can do right now is to keep myself and my loved ones from adding to their burden by following lockdown measures.

In lockdown, life has become routine to the point that I couldn’t tell the difference between yesterday and tomorrow if I tried, as if I were living through an endless rerun of real-life Groundhog Day. Every day, I wake up, brush my teeth, and sit with my glass of milk in tow to make a Skype call to my boyfriend who is studying in Boulder, becoming annoyed when he too has nothing new to offer other than how he napped for two hours instead of three that day or thought he saw a fluffy squirrel butt disappear into bushes. Tensions are running high in our household, with everyone alternating between snapping at each other for walking too loudly or clinging to the latest bits of frustratingly dull gossip for something to do. The most exciting thing to happen in the last few days has been a crow that decided by the occasional act of feeding him, we signed a covenant to adopt him. He now shows up hourly at our living room windowsill, hopping with his beak open, anticipating little bits of food. One of these days, as I am sitting at the window, watching the crow take flight, I wonder about the distant day when the lockdown must end. The day when I must finally appear for my exam, ready to commence my internship year at last, putting my knowledge to actual practice -- saving lives -- possibly in the heat of a second wave of coronavirus. And I swallow the brick of bile refluxing in my throat, feeling not unlike an odd bird afraid of heights.

References

  1. Diapause [Def. 1]. (n.d.). Lexico Online. Retrieved May 9, 2020, from https://www.lexico.com/en/definition/diapause.

Don't Forget

Christine L. Xu
Stanford University School of Medicine

Don't forget. The Christine of the past still lives in this childhood home, tucked away in the crevices of all the couches and in the dust on all the bookshelves. She skirts around you like a shadow, prancing around while you go about your day, but she never comes within reach.

The Christine of the present lives here, too. Don’t forget, she is home, but she is not on break. She studies for the cardiology and pulmonary blocks with a vigor and rigor that she's never experienced before. This is when medicine became real to her, when medicine became magnified in the flesh and blood of her friends, in the news and on TV, in her textbooks and on her flashcards.

She feels torn, too, by her other duties: to be a good sister, a good daughter, a good partner. With her entire family and her boyfriend now living under the same roof, there is never enough time to do anything well, anything as fully. But she soldiers on. Don’t forget­­­—she has to.

‘Do As I Say, Do As I Do’: A Request from Fourth Year Medical Students to Residents and Attending Physicians Amidst COVID-19

Lauren E. Powell, BA1, Will P. Bataller, BS, MS1, and Payton M. Miller, BS1
1 Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA

ABSTRACT

As we plan the future of our medical education following the broad impacts of the coronavirus pandemic, we ask for guidance both in words of advice and modeling examples set forth by our residents and attending physicians. We seek to learn how to better express support to patients who have suffered. We also ask for direction in our medical education to follow, in our careers, and in applying lessons learned to the future of public health. Ultimately, our hopes are that during this unprecedented time our residents and attending physicians will model the phrase, “do as I say, do as I do,” through demonstration of empathy, knowledge, generosity, humility, wisdom, and dedication to the future of medicine to come. 

The foundation of education during the first two years of medical school lies in knowledge from the past. Whether “past” is defined as research published within the past week, or knowledge shared from prior years, decades, or even centuries before, is widely variable; each piece is key to the development of medical student trainees. Frameworks that underlie medicine paint stories of the past, from Louis Pasteur’s 1861 germ theory publication, which set the tone for the study of infectious disease, to John Snow’s breakthrough research of the 1854 cholera outbreak, which provided the premise for our public health course. Medical milestones such as these hold featured slides in our preclinical curriculum, and there is no doubt that the multitude of clinical impacts, knowledge, and reflections from the novel COVID-19 will stand as lessons for medical students to come [1]. As three medical students entering our fourth year in the wake of this pandemic, our reflections are interlaced with hope, as well as concerns, over the future months and years of our education. We write this piece to call attention to the knowledge, skills, and insights we hope to gain from interactions with residents and attending physicians in the clinical experiences ahead.  

A key tenet of medical education is to mold providers who possess maximal “doctor-oriented” traits, such as being evidenced-based, safe and competent, compassionate, reflective, self-directed learners, while resisting internalization of external pressures that may cause self-neglect, emotional detachment, or a debilitating work ethic [2]. The call to this duty is challenging, and our predecessors understand that mastery of said traits requires maximal effort and conscientiousness on the part of the student. As fourth year students embarking on this journey, we have created a list of goals that we hope to fulfill as we advance our education in these unprecedented, unforeseen and unpredictable circumstances:

  1. Practicing empathy while acting as a source of reliable information for patients. While current research is heavily focused on understanding and combating COVID-19, an abundance of ever-changing information is available to patients at the click of a mouse. The ability to distinguish between fact, fiction, and everything in between is a valued asset at this time [3]. Conveying factual information while also being mindful of the physical and emotional distress a COVID-19 diagnosis may cause a patient is a difficult task for new providers. We are asking for your guidance and expertise in building fortified, trusting, and compassionate relationships with this new patient population.

  2. Embracing COVID-19 learning opportunities and pandemic-specific teaching points. Anecdotally, each generation of physicians is shaped by the medical peculiarities that they experienced in real time. COVID-19 will be one of those distinguishing events for us rising senior medical students. We see before us opportunities to have difficult conversations with patients, to consider our local disaster preparedness, and to learn to safely innovate and allocate when resources are limited. From the physicians who came before us, it is our wish that you will reflect on these topics and share the pertinent wisdoms acquired from similar events during your own training. 

  3. Maintaining and developing fund of knowledge when clinical experiences are limited. Clinical apprenticeship has long been a cornerstone of senior medical student education. Thus far, this pandemic has tested students’ capacity to build upon practical knowledge in the setting of reduced clinical involvement, decreased availability of learning tools, and, in some cases, barriers to internet access. [1] Along with our peers, we pride ourselves on being lifelong learners. As such, we commit to taking responsibility for our personal educational growth during this uncertain time. However, we are requesting proper guidance to available resources, along with tried and true methods of retraining and reassessing one’s knowledge while developing new skills. 

  4. Advice in navigating the next steps of our careers. The effects of temporary suspension on medical school curriculum have been felt in virtually every aspect of students’ lives. Those of us who had hoped to complete away rotations, perform at a higher level on the second phase of our boards, and gain exposure to specialties not offered in third year curriculum find ourselves at somewhat of a loss. We ask attending physicians to assist us in minimizing the impact of these lost clinical and educational experiences. For our peers who were reliant on away rotations and improved board scores to be competitive for their desired residency program, we ask that those before us who have had circuitous paths to their specialty of choice share your stories and offer appropriate wisdoms and encouragements.  

  5. Defining and exploring the call of duty for physicians during pandemics. The role of a physician is fluid depending on the environment: at times of calm they may solely focus on the care of familiar conditions, while at times of crisis they may be working on the frontline for highly contagious and sometimes lethal pandemics. Some authors have explored or proposed utilizing incoming medical students as frontline agents to address shortages in public health workers during the pandemic [4]. As students, we are still in the process of learning what constitutes an acceptable role. The desires that inspired us to pursue physicianhood beckon us to the frontline, to fulfill our duty to serve patients. Our eagerness is hampered by thoughts that surely inflict providers senior to us, such as family obligations, awareness of our own mortality, and personal vulnerabilities [5]. Some of us with medical conditions such as diabetes and chronic lung disease may be more susceptible to infection or poorer outcomes, and others are considered less “at-risk”. At what point do we allow unease or discomfort to limit our willingness to work on the frontline, and if we can define that point, how do we retain our ability to assist patients in need of evaluation and treatment? We turn to the leaders in our fields to lead us by example in navigating these questions and uncertainties. 

Conclusion

As we begin to plan our careers ahead, we ask for guidance both in words of advice and modeling examples set forth by our residents and attendings. Many senior physicians are already looking for ways to assist and offer guidance to medical students during this time and have found ways to provide these resources remotely and through modification of future curricula. We hope to build upon this communication through reaching out to students in a face-to-face setting when in-person lectures and clinical experiences resume. 

The healthcare field and vast range of people touched by this pandemic will begin healing and recovering in the months and years ahead. We seek to learn how to better express support to patients who have suffered and to learn how to teach and provide patients with guidance. We also ask for your direction in our medical education to follow, in our careers, and in applying lessons learned to the future of public health. Ultimately, our hopes are that during this unprecedented time our residents and attending physicians will model the phrase, “do as I say, do as I do,” through demonstration of empathy, knowledge, generosity, humility, wisdom, and dedication to the future of medicine to come. 

REFERENCE

  1. Rose S. Medical Student Education in the Time of COVID-19. JAMA. Published online March 31, 2020. (Accessed April 20, 2020 at, https://jamanetwork.com/journals/jama/fullarticle/276 4138). 

  2. Jaye C, Egan T, Parker S. ‘Do as I say, not as I do’: Medical Education and Foucault’s Normalizing Technologies of Self. Anthropology & Medicine. Aug 2006;13(2):141-55. 

  3. Earnshaw VA, Katz IT. Educate, Amplify, and Focus to Address COVID-19 Misinformation. JAMA Network. Published online April 17, 2020. (Accessed April 23, 2020, at https://jamanetwork.com/channels/health-forum/fullarticle/2764847?resultClick=1).

  4. Bauchner H, Sharfstein J. A Bold Response to the COVID-19 Pandemic Medical Students, National Service, and Public Health. JAMA Network. Published online April 2020. (Accessed April 20, 2020, at https://jamanetwork.com/journals/jama/fullarticle/2764427). 

  5. Tsai C. Personal Risk and Societal Obligations Amidst COVID-19. JAMA Network. Published online April 3, 2020. (Accessed April 23, 2020, at https://jamanetwork.com/journ als/jama/fullarticle/2764319?resultClick=1). 

in all my silence

Yasmine Abbey
UCLA David Geffen School of Medicine

Written in the midst of the COVID-19 pandemic, this poem focuses on the strange way in which old memories come flooding back to one's consciousness, especially amidst all this time and self-isolation.

It is important to read the poem from the bottom left ("in all my silence and freedom..the darkest parts of me") and work your way up. That is how I intended the poem to be read, but of course you can read it from top to bottom and perhaps the meaning may change (or it may not).

Will this ever be over
And will I ever be free?

the busyness of my mind
no longer a reprieve

spiriting forward

they lay palpable & grotesque
black & enshrouding

the memories
haunt me

scale the depths
of which I had submerged

In all my silence and freedom
the darkest parts of me