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

Holding On

Anna Delamerced
Warren Alpert Medical School at Brown University

Gloved hands. I wonder if there are
Wrinkles from decades worth of
Injecting a needle of lidocaine
To ease the patient’s pain from surgery
Invasive, tearing at the fascia 

Blue, gray. Whatever color it is
Masks their grief, the smiles they
Long to show to the fearful.
Large, small. Whatever size it is
Hides blue veins, scars and dry skin. 

We live in times where holding someone’s hand
Could be fatal, deadly. I look back to the times
I was too afraid to reach out and hold someone’s hand
Laying there, supine, right before the push of anesthesia
I could have offered to let them grip my hand as hard as they could
Until slowly the numbing sensation bids them to let go 

Where for a moment we are neither
Patient nor medical student, but two people
In the thick of a storm hanging onto the boat
Gripping the wooden rails, searching for an anchor

The History of Magic Bullets: Magical Thinking in Times of Infectious Diseases

Angie Wan, BA1 and Amy Zhang, BA2

1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
2 University of Chicago, Chicago, IL 60637, USA

“It will be wonderful. It will be so beautiful. It will be a gift from heaven, if it works,” said President Trump of hydroxychloroquine, an antimalarial drug that has mixed initial data supporting its usage with COVID-19 [1-2]. Despite the limited evidence, President Trump has heralded hydroxychloroquine as a miracle drug, asking, “What really do we have to lose?”

The siren draw of miracle cures and magic bullets has long been a fixture of medicine and public attention. Never was this more so than in the late-nineteenth and early-twentieth-centuries where advancements in medicine made Thomas Huxley’s vision of a “cunningly-contrived torpedo,” able to hone in on and destroy particular pathogens without harming the human host, seem more within the realm of reality rather than the science fiction of his grandson Aldous Huxley’s works [3].

Among the physician scientists of the time working on such targeted medicines for the treatment of infectious disease was Dr. Paul Ehrlich. Inspired by his research in immunology and the properties of certain dyes that could selectively stain cells, he coined the term, Zauberkugel, or “magic bullet,” and applied it to his new miracle drug, Salvarsan.

Discovered in 1909 by Ehrlich and Sahachiro Hata, Salvarsan, a derivative of arsenic, was the first effective treatment for syphilis, at the time a devastating disease. Left untreated, syphilis can cause significant disfiguration, aortic aneurysms, and perhaps most feared of all, a paralytic dementia. In some estimates, complications of tertiary syphilis accounted for around 10-30% of mental hospital admissions across Europe and the United States at the time [4].

Yet Salvarsan, while being a vast improvement on older mercury treatments, was as historian Allan Brandt put it, “no magic bullet” [5]. Salvarsan had a litany of potential side effects ranging from limb loss to multisystem failure and shock. Some of these side effects were the result of its difficult administration. Chief curator of Case Western Reserve University’s Dittrick Museum of Medical History Dr. Amanda Mahoney notes that in the nineteenth century, intravenous access often required venous cutdown by a surgeon, which carried its own risk of complication including cellulitis, hematoma, phlebitis, venous thrombosis, and venous/nerve/arterial transection. Additionally, even with perfect administration, Salvarsan could only prevent transmission and progression to later stages of syphilis. It was less useful if the patient had already reached the later terminal stages of the disease.

Salvarsan was not the only “magic bullet” discovered by Ehrlich, who also applied the term to two dyes, trypan red and methylene blue, the latter which was identified as a possible treatment for malaria. However, methylene blue was still less effective than the reigning antimalarial of the day, quinine from the bark of cinchona trees, which in turn was supplanted in the mid-twentieth century by the discovery of chloroquine and hydroxychloroquine [6].

Even so, neither chloroquine nor hydroxychloroquine would fit the true definition of a magic bullet or torpedo, as they both came with a bevy of known adverse effects ranging from most commonly, itching, headaches, dizziness and stomach upset, to most seriously, fatal heart failure and irreversible vision damage. Both drugs additionally have narrow therapeutic windows and long half-lives, making careful dosing crucial in avoiding life-threatening side effects [7]. 

Trump was correct when describing hydroxychloroquine as “one of the biggest game changers in the history of medicine," but not for its potential in COVID-19 treatment as the President claims. Rather, chloroquine and hydroxychloroquine were essential to the modern treatment of malaria, preventing Allied troops from being decimated by the tropical disease during WWII, when Axis occupation of the South Pacific led to a shortage of cinchona-derived quinine. Despite the revolutionary nature of chloroquine and hydroxychloroquine, malaria in the United States was not eradicated by a miracle drug, but by public health measures. Established in 1947, the National Malaria Eradication Program’s coordinated federal and state effort to distribute mosquitocides across endemic areas was what finally led to the elimination of malaria in the United States [8].

Of course, when considering infectious disease epidemics, what comes to mind is usually not malaria, but the much more recent HIV/AIDS epidemic. Yet the promise of a single magic bullet did not deliver in that crisis either. Azidothymidine (AZT), the first FDA approved drug for AIDS, was heralded as the light at the end of the tunnel when initial efficacy trials showed promising results. Pressure from activists and growing desperation from the public led to AZT being fast-tracked for approval despite major issues with the efficacy trials [9]. Similar to how Ehrlich promoted Salvarsan as a “magic bullet” and downplayed its myriad side effects, the company responsible for AZT routinely played up studies with positive results and excused those that showed potential negative results [10].

Patients who bought into the myth of AZT as a miracle cure suffered through chronic headaches, nausea, and muscle fatigue, only to face disappointment when later trials showed no significant differences in mortality between the drug and placebo groups after three years [10]. Even Dr. Jerome Horwitz, the scientist who first discovered AZT, acknowledged that the drug only “buys time” for patients [11]. Though it paved the way towards the newer combination therapies that have changed AIDS from a death sentence to a manageable chronic condition, AZT was not the cure people were hoping for in 1987.

Absent a cure, public health efforts have proven to be critical in preventing and limiting HIV outbreaks, even to this day [12]. While national rates of HIV have declined, opposition to such efforts have led to outbreaks, including one in Indiana in 2015. The state’s strict drug policies made needle exchange programs illegal, despite numerous studies indicating needle exchange programs do not increase the incidence of drug use [13]. It took two months of convincing by county, state, and federal officials for the then governor (now current Vice President and head of the US coronavirus task force) Mike Pence to sign an executive order allowing the distribution of clean syringes [14].

Today, as the result of the US sluggish response to the coronavirus pandemic, the Trump administration is facing similar criticisms to those levelled against the Reagan administration during the height of the HIV/AIDS crisis. The public is once more anxious and increasingly desperate for the hope that a cure can bring. Yet as history has shown, this is when responsible messaging is more important than ever.

Similar to Salvarsan and AZT, hydroxychloroquine is being hailed as a miracle cure for COVID-19. The scientific community’s concerns about the validity of Dr. Didier Raoult’s highly controversial study, which boasted a 100% cure rate using hydroxychloroquine, deterred neither Trump’s effusive praise of the drug nor various media outlets’ promotion of the study [15]. On Tucker Carlson Tonight, guest Gregory Rigano, a self-described “Stanford University Medical School advisor” (an affiliation that Stanford has denied), even made the claim that hydroxychloroquine is “the second cure to a virus ever” based on Raoult’s results [16]. Carlson perhaps most aptly tapped into our collective desire for a magic bullet with his reply, “Of course, it's our job to be skeptical of all and any claims. However, I very much want to believe this.”  

Trump’s stance starkly contrasts with director of the National Institute of Allergy and Infectious Diseases and member of the US coronavirus taskforce, Dr. Anthony Fauci’s staunch refusal to promote the drug [17]. Notably, Fauci, who helped loosen FDA regulations that prevented many patients from participating in experimental drug trials during the HIV/AIDS epidemic, has been cautious on hydroxychloroquine due to the lack of definitive studies on the drug.

Dr. Monica Green, a noted medical historian, compared Trump’s evaluation of hydroxychloroquine to those of medieval doctors, commenting that “in the eleventh and twelfth century, the main way to validate the utility of a remedy was to say that it came from a very learned authority.” Indeed, this mindset, borne from a time before modern pharmacology or even the scientific method, seems to be pervasive in the administration. Trump’s economic advisor Peter Navarro said on Fox & Friends, “I think history will judge who’s right on [hydroxychloroquine], but I’d bet on President Trump’s intuition.”

President Trump and Peter Navarro may still have a chance of ending up correct. However, the chances are increasingly slim, as on April 24, the FDA issued a warning against widespread use of hydroxychloroquine or chloroquine for COVID-19 due to reports of serious arrhythmias. The FDA’s bulletin states, “Hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19” [18]. 

If it ultimately turns out that hydroxychloroquine is not effective for COVID-19, it will join the ranks of many other drugs that were promoted as miracle cures, but instead left a trail of dashed hopes and unmet expectations. More than a century after Huxley first spoke of a “cunningly-contrived torpedo” and despite decades of scientific progress since, we remain spellbound by “magic bullet” narratives. As we all do our part in maintaining the public’s health through social distancing and rigorous handwashing, we must also remain clear-eyed about the limitations of any drug promoted as a cure at this stage of the pandemic.

ACKNOWLEDGMENTS

We were lucky to also get the insight of medical historians Dr. Aaron Shakow of Harvard, Dr. Monica Green of Arizona State, Dr. Adia Benton of Northwestern, and Dr. Amanda Mahoney and Dr. Erin Lamb of Case Western in the formulation and execution of this piece.

REFERENCE

Quotes from medical historians were through personal correspondence.

  1. Hamblin J. Why Does the President Keep Pushing a Malaria Drug? The Atlantic Magazine 2020.

  2. Magagnoli J, Narendran S, Pereira F, Cummings T, et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. Unrefereed preprint. medRxiv 2020.04.16.20065920; doi: https://doi.org/10.1101/2020.04.16.20065920

  3. Huxley T. An Address on the Connection of the Biological Sciences with Medicine. Br Med J 1881;2:273

  4. Heynick F. The original ‘magic bullet’ is 100 years old. Br J Psychiatry. 2009 Nov;195(5):456. doi: 10.1192/bjp.195.5.456.

  5. Brandt A. No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880. Enlarged ed. USA: Oxford University Press, 1987.

  6. Krafts K, Hempelmann E, Skórska-Stania A. From methylene blue to chloroquine: a brief review of the development of an antimalarial therapy. Parasitol Res. 2012 Jul;111(1):1-6. doi: 10.1007/s00436-012-2886-x.

  7. Browning DJ. Pharmacology of Chloroquine and Hydroxychloroquine. In: Hydroxychloroquine and Chloroquine Retinopathy. Springer, New York, NY, 2014.

  8. Elimination of Malaria in the United States (1947-1951). CDC. (Accessed April 15, 2020, at https://www.cdc.gov/malaria/about/history/elimination_us.html.)

  9. Park A. The Story Behind the First AIDS Drug. Time Magazine 2017.

  10. Garfield S. The rise and fall of AZT: It was the drug that had to work. It brought hope to people with HIV and Aids, and millions for the company that developed it. It had to work. There was nothing else. But for many who used AZT - it didn't. The Independent 1993. (Accessed April 15, 2020, at https://www.independent.co.uk/arts-entertainment/the-rise-and-fall-of-azt-it-was-the-drug-that-had-to-work-it-brought-hope-to-people-with-hiv-and-2320491.html.)

  11. Concorde Trial. National Institute of Allergy and Infectious Diseases. (Accessed April 15 2020, at https://aidsinfo.nih.gov/news/5/concorde-trial.)

  12. Peters PJ, Pontones P, Hoover KW, et al. HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014-2015. N Engl J Med. 2016 Jul 21;375(3):229-39. doi: 10.1056/NEJMoa1515195.

  13. National Research Council (US) and Institute of Medicine (US) Panel on Needle Exchange and Bleach Distribution Programs, Normand J, Vlahov D, et al. The Effects of Needle Exchange Programs. In: Preventing HIV Transmission: The Role of Sterile Needles and Bleach. National Academies Press, Washington, DC,1995.

  14. Twohey M. Mike Pence’s Response to H.I.V. Outbreak: Prayer, Then a Change of Heart. New York Times 2016.

  15. Voss A. Official Statement from International Society of Antimicrobial Chemotherapy (ISAC): Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial (Gautret P et al. PMID 32205204). (Accessed April 15 2020, at https://www.isac.world/news-and-publications/official-isac-statement.)

  16. Robins-Early N. The Hucksters Pushing A Coronavirus ‘Cure’ With The Help Of Fox News And Elon Musk. Huffington Post 2020.

  17. Cohen E, Bonifield J, Nigam M. Trump says this drug has 'tremendous promise,' but Fauci's not spending money on it. CNN 2020.

  18. FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems. FDA. (Accessed April 26, 2020, at https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or.)

Surgery in the Time of COVID-19

Ashiq Pramchand
The University of KwaZulu-Natal - Nelson R. Mandela School of Medicine

ABSTRACT

I was just about to finish my surgical rotation at Grey's Hospital in the peaceful town of Pietermaritzburg, South Africa before COVID-19 brought the world to a standstill. I reflect on how much this new pandemic has changed my life.

Our first clinical rotation in 2020 was surgery, at Grey’s Hospital--the main tertiary hospital in Pietermaritzburg, South Africa and the surrounding areas. Pietermaritzburg is a peaceful and verdant town in the province of KwaZulu Natal, about a one-hour drive away from Durban--my home city. The air is cool and fresh there and the hills seem to roll on forever.

During our seven-week surgical block, we were to rotate through general surgery, ophthalmology, ENT, urology, and orthopedics. But we were only five weeks in when we received news that COVID-19 had reached South Africa. Our university quickly established a war room, where a select group of doctors and scientists could help prepare us for this new public health threat. Many of the scientists worked with CAPRISA, the Centre for Aids Programme of Research in South Africa, which is situated right next to our university. Preparations moved quickly. Grey's Hospital turned part of its maternity ward into an isolation unit for patients who were infected. Hospitals throughout the country converted wards into isolation units. Field hospitals were established in our World Cup stadiums, and mobile testing clinics were deployed to relieve overwhelmed public health facilities. Meanwhile, we were trained in the management of COVID-19 patients within a few days. Many of us left our first COVID-19 training session with a sense of growing anticipation.

However, everyone was still nervous. Our country has an incredibly high burden of HIV and TB patients, and many of our public health hospitals were already reeling under the pressure of high patient caseloads at baseline. I have had the privilege of working in every public hospital in my home city. Many of these facilities lack sufficient personal protective equipment, medical equipment (including ventilators), and beds needed to meet the daily needs of COVID-19 patients.

Within two weeks, the South African government made a historical decision to institute a nationwide lockdown. We were seeing a new chapter in history unfolding before our very eyes. On the fifteenth of March, our university withdrew all the medical students from their clinical rotations. We had so many questions. We did not know if we would finish our year on time. Many students living in rural areas could not access online lectures or submit assignments, owing to a lack of Wi-Fi at home. We were confused and unsettled.  I was at my aunt’s house in Durban when we heard the president’s address. My aunt’s immediate response was to hoard hand sanitizer and stockpile food and water. She was distraught. I tried to calm her down, but I was struggling to suppress my own anxiety as well. 

On the first morning of lockdown, I awoke to the sound of silent streets--a first for Durban. If you listened closely, you could even hear birdsong--a welcome replacement for the usual cacophony of morning traffic.

Eventually, I worked out a daily quarantine routine. I try to wake up at 8:30 am consistently. Most of my time involves reading my medical textbooks, completing my research, playing the piano, exercising, and chatting with my family. There is a beautiful bird, hadeda ibis, which is native to Sub-Saharan Africa and commonly seen around Durban. They have now started nesting along the promenade, where I enjoy my evening jogs. I even started a medical-themed comedy web show, which serves as my platform for educating the general public about COVID-19 and inspiring solidarity during these uncertain times.

Our university created a series of COVID-19-related epidemiology and bioinformatics webinars for medical doctors and scientists, which I enjoy attending and then reformatting to communicate the information to a lay audience. I often use the “Ask a Question” function on Instagram to hear what my friends and family think about these recent drastic changes in the world and our way of life. I receive many questions like, “Is there a cure for coronavirus?” or, “How long will it take to make a vaccine?” I do my best to answer them and allay their fears.

There are, however, many questions, which I cannot answer, like, ”Will the world ever be the same again?” or, “How do I overcome my fear of death by coronavirus?” Inspiring hope in others and fighting fear with education demands an exquisite emotional and psychological balancing act. I feel that it is an operation just as delicate and complex as the performance of surgery. But…I am not a surgeon. I am a fifth-year medical student whose surgical rotation was cut short by COVID-19. I don’t have all the answers and I still have a lot more to learn.

Neuro during COVID-19

Sarah Cheema
TCU and UNTHSC School of Medicine

“Can you hear me?”
A strange new greeting
as my peers gather around
silent, watching.

“Can you see this?”
A tiny arrow lingers
over a minuscule artery.
I try to imagine where that might fit
in my brain.

“Follow my finger.”
I watch her eyes,
thousands of miles away,
hoping to catch any deviation. 

How odd, as I play doctor
learning to heal
that which we cannot
see, hear, or touch.
Or perhaps, it is fitting.

SARS-CoV-2 and the Duck-Billed Platypus

Rogan Magee
Sidney Kimmel Medical College

Last week, my aunt texted me a link to a YouTube video. In it, a citizen journalist compiled footage of several hospitals, emphasizing the lack of queues to their front doors and how empty their waiting rooms appeared to be from outside. The other half of the thirteen-minute montage highlighted contradictory footage from news outlets that instead showed long lines outside those same NYC and California hospitals. One particularly embarrassing segment caught a channel red handed in redubbing footage of an Italian ICU as scenes from the front lines in NYC. With the video came my aunt’s difficult question to field, “How are things at your hospital?”

I haven’t stopped thinking about that conversation since it ended. My aunt isn’t one for sharing opinions – political or otherwise – and much less one for trying to discuss video evidence. In fact, until this month, her time spent on YouTube had been limited to forced viewings of makeup tutorials at the hands of my ten-year-old cousin. She is, however, like the rest of my family, quite good at converting fear and anxiety into analytical investigation, and I could see the hallmarks of that process in full swing in the texts we exchanged.

My fiancée and I represent our extended family’s only personal connections to a hospital, so the question was well intentioned, but I felt poorly positioned to answer. Unfortunately for both my aunt and me, I am a newly minted fourth year medical student. In effect, I am almost as close to insider information on the pandemic as my aunt. All I could share were the number of ICU and non-ICU cases as reported in a schoolwide email the previous Friday. I couldn’t comment on the state of affairs and definitely didn’t want to comment on the validity of the contents of the video. Understandably, my information did little to assuage my aunt’s fear and one of her last comments has stuck with me, “I just don’t know what to believe right now.”

These words played on my own fear as both a medical student and a quarantine participant. Lack of belief in the threat carries with it the potential to undermine the steps we need to take toward neutralization. If we believe in the capacity for ICU beds to run out and for hospitals to become overwhelmed, we stay home and do our best to never see that potential future. But if we underestimate our vulnerability, we instead take one step toward that future. Belief, for better or for worse, is the single most important tool in our fight against COVID-19.

If you are one of thousands of students who studied biology on your way to medical school, you won’t blink at the fact that there lives a semiaquatic mammal in Australia that lays eggs to reproduce. For those not familiar with the duck-billed platypus, that information sounds closer to fiction than fact as it bends rules about how mammals should pass their time. It might be easier instead to believe it as something from Dr. Seuss. Fortunately, there are plenty of videos of the platypus, pictures of it in its habitat, and field reports that teachers draw on to share the news about this one-of-a-kind creature. Moreover, skeptics may have the privilege to visit a platypus in a zoo or to meet someone who has come face-to-face with one and can vouch for its existence.

Because of medical school, I’m primed to interpret the news on SARS-CoV-2 and process the discussion that is dominating the media. I can dip into preprint archives and try to form a rough opinion on potential treatments, what a vaccine timeline might look like, or where we stand with regard to testing capacity. For those like my aunt, who spend less time thinking about medicine and more time on taxes, law, or other fields, the information is less interpretable. And so the latest pronouncements on distancing guidelines or potential treatments are clouded in mystery, and the dissenting opinions seem less like productive forces in the scientific discourse and more like reasons to panic.

The major reason I find myself unable to leave our conversation in last week centers on good luck. When my aunt texted me, no one connected to our extended family had tested positive. She and I together have zero personal connections from whom to understand the experience. And so the threat of the pandemic might feel more abstract to my aunt. I think I can understand how and why she might be less inclined to believe that hospitals might become overrun and more inclined to believe that ED waiting rooms around the country are empty. Without personal evidence to draw on or trusted data to process, the threat appears ambiguous.

My family is tremendously lucky to not yet have joined millions of Americans who have been personally touched by the virus, something that I remain thankful for with each new day. So I will try to honor that luck by doing my best to keep up discussions on the pandemic, sharing my disposition to believe in expert advice, and drawing on my own training to share with those who are more distant from these ideas. As we adapt to online curricula and virtual encounters, I think taking intentional steps toward engaging in open communication with each other, our friends and families, and anyone who has questions on how to proceed is one of the most accessible ways medical students can fight COVID-19 in our new roles at home. Spreading and encouraging belief in expert recommendations -- to stay at home, to trust the process -- will be our most valuable contribution to resolving the pandemic.

Virtual Praise

Zachary Kahlenberg
UTHSCSA Long School of Medicine - San Antonio

Even from within this prism,
All around I see acts of heroism,
My love, I have not felt her touch in days,
Through a glass screen I try to give her praise,
For she is doing what I cannot,
She even does it without a second thought,
With gear that can no longer be bought.

Anticipating Grief: Bracing for Tragedy in a Pandemic

Bria Adimora Godley
University of North Carolina School of Medicine

ABSTRACT

When my father died one year ago, countless friends told me, “I can’t fathom how you’re feeling.” Some resentful part of me replied, “You will.” Now, as COVID-19 ravages the United States, I watch my friends agonize over the risk coronavirus poses to their vulnerable parent

My mother is an infectious disease physician at UNC. She has not had time to mourn a nation in crisis or recognize my father’s memory on the anniversary of his death. To me, our collective dread is all too familiar––it feels like the month between when my father had a heart attack and when he died suddenly. It feels like the hope for a return to normalcy tainted with the threat of imminent danger.

My grief is no longer fresh, but I am close enough to it to understand what others will experience; I am not yet a doctor, but I identify with their sacrifices; and I am not an expert, but I am living with one. In my op-ed, I compare the unrelenting grief of losing a parent to the anticipatory grief of a nation as we brace for a mass tragedy. And I argue that regardless of the apocalyptic tone of the news, it is our responsibility to stay informed because our actions can still save lives.

After the NBA canceled its season but before officials postponed 2020 Olympics, I went into social isolation with an infectious disease physician. My mother specializes in HIV and AIDS, but now her days are consumed by coronavirus. Every morning between 8 and 9 am, I am woken up by the voice of a stranger on a Zoom call announcing how many people in the health care system have tested positive for coronavirus and how many people are currently hospitalized.

Like most Americans, I spent the early days of March engaging in pandemic denial, insistent that the virus would have limited impact on me and my way of life. A bitter part of me resented that the world would grind to a halt over the possibility of deaths from a virus, and yet when my father died one year ago, the world kept turning, unconcerned.

On a March 1, 2019 business trip in California, my previously healthy father woke up in a hotel room alone in the middle of the night with a crushing weight on his chest and had a massive heart attack.

He recovered slowly. He was in the hospital in Los Angeles for ten days before he was cleared to fly home. Though his cardiologist assured us that my father would make a full recovery, he still tired easily. He slept all day. The man who used to hit tennis balls with me for hours could barely tolerate a walk around the grocery store. We all had the uneasy sense that something awful was coming.

The last time my father called me, it was not my father on the other end of the phone, but my mother, telling me to come home right now. My father’s heart had stopped.

It was March 31, 2019. He was 61 years old.

During the first few weeks this spring, as hard as it is to believe now, it seemed as though Americans had avoided the tragedy that had befallen Wuhan and parts of Europe. On March 5, I ran into an infectious disease physician and family friend at a dinner. He told me he had just been on a call with the CDC and WHO about the novel coronavirus.

“What’s the latest?” I asked him, eager for inside information.

“The coronavirus? It’s a pandemic of a lifetime,” he told me distractedly before wandering away. I wish I could say that I took his response seriously then, but of course I did not. I posted the quote to my Instagram story and let the information dissolve after 24 hours.

Amidst the chaos of the COVID pandemic, my mother is energized. She barely has time to read the news. She fields calls from 8am to 10pm. At night I sit on her bed and read Twitter threads with COVID-19 updates to her as she drifts off to sleep. “This is the reason we became infectious disease doctors,” she tells me. “For a moment such as this. The new, the uncharted.” My mother applied into infectious disease in 1983, at the beginning of the AIDS epidemic. For a moment I see COVID-19 from her perspective––not just as a slow-moving disaster, but a reason to fight.

But I came to medical school to become a psychiatrist, and I did not sign up for a war.

UNC School of Medicine has suspended rotations until further notice. Newly idle medical students scramble to donate blood and form assembly lines to manufacture our own Personal Protective Equipment (PPE). Fourth year medical students have the opportunity to volunteer in the hospital. I have not stepped foot in the Emergency Department. I know young people can get sick. I have heard the reports of patients as young as thirty on ventilators. I do not want to die.

But there is nowhere I can go to insulate myself from the horrors of our new reality. A friend in New York City tells me she now hears ambulances racing past her window constantly. A friend volunteering in the ED texts me that she just witnessed a patient coughing up blood, waving a bloody rag at her like a distress signal. The internet floods with images of doctors and nurses wearing garbage bags and patient gowns as makeshift PPE.

Virtual meetings intended for updates on PPE assembly devolve into existential questions: What are we going to do? What’s going to happen to our families, our careers? What’s going to happen to us? 

For questions on the future, I look to the reporting on the coronavirus outbreak in Italy and Iran. Bodies lined up in hospital hallways, mass graves. I remind my friends that Americans are no exception. And like Italy, we do not have enough masks, ventilators, or doctors.

At dinner one night, I sit at the kitchen table eating leftovers, listening in on my mother’s call with a colleague at Emory. “I have been using the same N95 mask for a week now,” he tells her. I look up so I can catch the expression that accompanies my mother’s silence. For the first time, she looks scared.

When the phone call ends, she says, “That really hurt hearing him say that. It really hurt.”

My med school friends have asked how it is possible that I have maintained relative calm, especially given that I cannot step out of my bedroom without overhearing a coronavirus update. I’ve been grieving for one year now. What they feel, and what has gripped many people across the nation, is anticipatory grief. [1] I know because I felt that same feeling all of last March, when my father would say offhandedly that he had to wear a heart monitor, because his Apple Watch had picked up a “funny rhythm.”

There is always a chance that the United States emerges from this crisis with minimal casualties, but I have seen no evidence to suggest that. Anxiety stems from the ambiguity of not knowing the future. This situation is no longer ambiguous, and I am not anxious anymore––I am angry. I am angry that the failures of our federal government will take people’s loved ones prematurely. I am furious that people will be forced to go through what I went through––what I am still going through––because the leaders elected to protect us in times of crisis do not possess the empathy, courage, or political will to take this threat seriously.       

The amount of confusion and misinformation circulating about coronavirus surprises me. Even among friends in the School of Medicine and the School of Public Health, there is an atmosphere of uncertainty; students complain about the disjointed nature of coronavirus news and of the effort required to synthesize the chaos. Our inboxes are inundated with emails from restaurants and stores that we have not visited since college, assuring us that they are “monitoring the situation closely,” even if we are not. 

Some of my friends avoid the news, citing mental health concerns. I understand this decision, but I cannot support it; I believe we have a responsibility to ourselves and to each other to stay informed, not just as a symbolic exercise of civic duty, but because our actions can still save lives. 

During a rare quiet moment, I check in with my mother to see how she is coping with the pandemic response layered on top of the impending anniversary of my father’s death. “This is such a new disruption that it has forced me to jerk my brain out of old pathways,” she says. “Instead of going through the same self-pitying ‘Oh here I am, it’s Saturday, and I’m alone––‘” she pauses. “I don’t think it’s necessarily as bad for me as it is for some people. It’s strange. It’s not good. But it is different.”

My father was a doctor too. If he were still alive today, I would be paralyzed by the fear of what this virus would do to him and his patches of damaged heart muscle. One of the last times I saw him, he told me, “Goodbye sweetie. I will try to keep getting better, even though you’re not here.” In the weeks and months ahead, more people will lose their fathers and mentors and best friends, but we still have time to save many. We can enact more aggressive quarantine measures, and we can direct factories to produce more masks and ventilators. America is no exception, but we do not have to be a cautionary tale.

 

Bria Adimora Godley is a fourth-year medical student at the University of North Carolina School of Medicine. She can be reached via email at bria_godley@med.unc.edu.

REFERENCES

  1.  Berinato, S., That Discomfort You’re Feeling Is Grief. Harvard Business Review. https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief, 2020.

Anticipating

Palak Patel
Johns Hopkins University School of Medicine

Watching
Pushes the dial of my clock
Yet pulls me in
With a shut door behind me

Waiting
For a signal of freedom
An alert of good news
To notify me of the end

Listening
To the waxing and waning
Of sirens headed to where
I used to walk to school

Thinking
It may be another month
Months
Of this solitude

Questioning
If my distance from others
Could even compare to
A patient’s from their family

Feeling
Guilt from my lack of action
Reminding my mind
Staying home is helping

Observing
The panic that easily ensues
And yet most of their panic
Is rightfully earned

Knowing
The glory for healthcare is broad
And consideration is needed
For the exposed custodians too

Anticipating
Until next time when it’ll be me
On the frontlines
Fighting

April

Monique Sager
Perelman School of Medicine at the University of Pennsylvania

In the first two weeks of quarantine, I scrubbed everything. I became paralyzed with fear when another person walked by me on the street, and I washed my hands until they were raw, wondering if soap did anything to kill the virus. I Lysol-ed the mail. I Lysol-ed my shoes, I wanted to Lysol my hands, but I knew I shouldn’t. I went for a walk along the river and was so terrified by the hundreds of people running by me that I vowed never to do it again.

As the days went by, I have stopped leaving the house, for anything. My boyfriend and I now wait until we are down to our last can of tuna and bag of lettuce and then, together, holding hands, we go to the grocery store, exiting the house as if we are entering a warzone.

As my time in the hospital grows further and further away, I’ve been able to push back some of the immediate fear I felt back in February, the terrified look on my residents’ faces as we all sat in a work room together, coughing and coughing and coughing, with no windows to open or masks to wear. We make our small apartment our whole world, moving our laptops from the kitchen to the bedroom and back again, trying to make it feel bigger than it is. I feel safe inside, shielded from the chaos I had seen in the hospital.

Eventually, I stopped Lysol-ing my mail, my shoes, my keys. If I get this virus from my Amazon package, I’ve found myself thinking, so be it.

My boyfriend and I have waited to get sick, counting the days that go by without the telltale signs. We are suspicious of every cough and sneeze. Any runny nose could be the inevitable, about to hit. But it hasn’t hit, and over a month later, we are both still here, sitting at the kitchen table attending to our respective business.

We are healthy. We are terrified. We are complacent, guiltily enjoying the time off from clinic and from work, the ability to be together. We keep the TV on silent all the time, to anchor us to the world outside. Each morning, we watch the news, check the stock market, watch whatever savings we had grow smaller and smaller. We make each other coffee, fall asleep to the TV, and wake to do it all again.

I’m supposed to be a medical student, but I don’t feel like it. I feel like a shell of myself, devoid of purpose, wandering around my apartment and watching the world grown silent out of my window. The hours pass by, blending into each other, the TV plays on in the background, and I forget what day it is. I am supposed to be studying now, taking shelf exams now, but I forget why that used to feel so important.  My Lysol bottle sits unused on my counter, and I wonder why I needed it so much.

I only exist in this endless cycle. Watch the news, drink my coffee, run out of food, creep from the house, repeat. I watch the cherry blossoms bloom outside my window and realize it is spring. April slides by me, quietly warming air which I will not feel on my skin.

Frustrations and Hope

Anonymous

It is 5:37am. I see open roads ahead. No other cars in sight to break the beam of light streaming out from in front of me. I arrive at the hospital and park right in front. I am here for my volunteer shift where I am taking the temperatures of everyone entering the hospital. As a first-year medical student, I had a sense of guilt staying home while others in the field are risking their lives.

Everyone has a mask on, it’s mandated in New York now, but that doesn’t stop me from being able to see the frustration and fear in their eyes. It’s astonishing how much a third of someone’s face can tell you. Their emotions slide into my recognition like water on glass. I know how they are feeling, because it’s the same subtleties I see in my mom’s eyes when she finds out she is going to have to work with COVID-19 patients from now on. The same I see in my friends who have been laid off, only just having started their careers; the ones who have lost loved ones to the virus and have to watch the death toll climb every day.

As a first-year medical student, I feel powerless in this fight. It is frustrating to watch this unfold before my very eyes and do just that, watch. I have struggled hearing from other students that the state of our healthcare system today, and the cracks that have been exposed during this pandemic, has made them question their careers in medicine and what they have worked so hard to achieve. Personally, I see a system that needs help, and I will do all that I can to ensure that if or when the next crisis comes, I am not just watching, I am doing.