Mona Fayad and Michelle Lee //
We were doctors in the first inpatient COVID-19 unit formed at Mount Sinai West Hospital. At the time, we were undergoing our internship year, which is the first year we practice as physicians after graduating medical school. Needless to say, we were thrown into the fire when COVID-19 hit New York City. We were surprised to find that our identities as physicians solidified more rapidly in crisis than they had all intern year.
We worked alongside each other on our hospital’s first inpatient COVID-19 unit and took care of the same patients: we shared grief at their loss and celebrated when they were safely discharged. As best friends, we combine our experiences here as a single narrative voice.
In the first week of March, there was one confirmed case of coronavirus at my hospital in New York City (NYC). Patient “Zero” was set apart from the rest of the floor in a negative pressure room, but the hallway surrounding his room was filled with the whispers of tense medical staff. Each morning, I passed this room on rounds, and, as a newly minted intern, I wondered what lay behind the door. While I heard news of coronavirus ravaging hospitals around the globe, it felt oceans away.
Things quickly changed on March 11, the day the World Health Organization (WHO) declared a COVID-19 pandemic [1]. After a long day on the medicine floors, my chief resident asked to speak to me privately. “Starting tomorrow,” he stated, “you will be on the first COVID-19 medicine team.”
“Do you have to do this?” my mother asked me that evening. “I feel like I’m sending you to battle.” I searched the sparse literature for guidance, noting high mortality rates.
“Don’t worry. I’ll be safe,” I reassured her.
Whatever worry I felt that night quickly gave way to an unexpected exhilaration in the first days of the COVID-19 team. I had a new attending from California, who brought a boundless energy. Our team of five worked flawlessly together, and we felt ready to tackle COVID-19. After all, this was my home turf—the place where I had trained as an intern for the past eight months. Within two days, I had discharged my first recovered COVID-19-positive patient, and I felt hopeful.
Sunday night, the news bellowed the NYC lockdown. All essential businesses were to close. Lincoln Center, a staple of my walk home—and a landmark that was typically full of canoodling couples—was completely deserted. Ten blocks south, Times Square, normally teeming with people from all corners of the world, was also eerily silent.
In the emergency room, the classic heart failure and cellulitis admissions were quickly overshadowed by an influx of hypoxic patients. With COVID-19-positive patients flooding the hospital, my team had to act quickly. We checked national guidelines hourly and studied literature daily, incorporating new findings into our clinical management. As the hospital underwent massive changes to accommodate the surplus of patients, we debated COVID-19 management, from antibiotics to disposition. I was learning daily, and it remained exciting.
Lines quickly blurred between resident training levels; all doctors carried the same responsibility. There was no longer a distinction between senior resident or junior. I was sailing into uncharted territories, filled with unanticipated responsibility and newfound independence. I treaded carefully with this new responsibility, meeting each of my medical decisions with great scrutiny. Just like those first few weeks of intern year, I still doubted myself at nearly every opportunity. Yet with the ever-changing climate of COVID-19, I was forced to rely in a new way on my developing clinical acumen. Just as I was learning new information about COVID-19, I was also learning about myself as an intern.
Donning my personal protective equipment became a choreographed dance. Coupled with an increasingly familiar series of targeted questions, I became keen at assessing for clinical progress. Through their oxygen masks and my recycled face shield, I fought to learn who my patients were. They were New Yorkers: cab drivers, bodega owners, and subway operators. Despite the distance placed between us by the protective equipment, I felt a connection to them as I tried to understand their daily lives in our shared home city. I found comfort in discovering some way to connect with these patients, even through the obstructions of masks and shields, by hearing their stories.
A few days had passed, and despite the minimal knowledge we had about the virus, I felt I was taking the work in stride. A sense of confidence settled in, but I questioned how long it would last. The following morning, news spread through the hospital that one of our own, assistant nurse manager Kious Kelly, had died from coronavirus in our ICU. He was an iconic figure at Mt Sinai: local newspapers quoted family and colleagues who described him as “a nurse hero,” a “selfless caregiver,” a man who “ran toward the oncoming enemy determined to bring survivors back with him.” I stood frozen outside my COVID-19-positive patient’s room, feeling doubtful all over again. My knees felt weak, and I opened the door with a heavy heart. Behind that door was a patient in his thirties, recently transferred from the ICU after a tumultuous ten-day course. He looked at me and clumsily smiled beneath his oxygen mask.
“Hey doc, how are you this morning?” he said.
My doubts, the grief at losing a colleague, and the suffocating compression of my N95 mask had to be pushed aside. I asked about my patient’s overnight course, checked his pulse oximetry, and performed a targeted physical exam. We talked about his wife and kids, who lived in Italy. There was always a sense of panic in his voice when he brought them up.
I laid my gloved hand on his shoulder and reassured him to the best of my ability. As I closed the door behind me on the way out, I faced the nursing station, allowing my eyes to well up again with tears. I shook my head and threw myself into a busy day of work.
Fourteen arduous hours later, I trekked home, feeling exhaustion in its rawest form. I laid my sneakers outside my door, like so many of the doctors living on my floor. I removed my scrubs at the door into a plastic bag and showered, scrubbing the invisible viral particles off my body. I laid in bed, as clean as humanly possible, and sobbed in the comfort of my tiny, dark studio. I allowed myself to realize for the first time that, like my colleague who had passed away earlier that morning, I too could become collateral serving on the frontlines.
Yet the numbers of COVID-19 infections kept climbing in New York City. Makeshift intensive care rooms were being made from post-anesthesia care units, holding areas, and offices. Along with my fellow doctors, nurses, and support staff, I worked as fast as I could against the surge. Night shifts were my biggest trial. Like clockwork, patients became hypoxic and pages would flood in:
“Doctor, patient’s oxygen 82% on nonrebreather, please assess.”
“Still hypoxic on High Flow Nasal Cannula. Please come.”
The following morning, taking a cab across a seemingly deserted city, I felt knots in my stomach knowing I had left my sick patients behind. I stayed late one shift to let a daughter speak to her father through FaceTime. I had built a strong rapport with his family since his admission. Hearing his daughter say how much she loved him and how sorry she was that she couldn’t be there prompted me to hold his hand a little tighter. He squeezed my hand in return. The daughter and I exchanged thanks and words of encouragement, each of us grateful for the other.
The next afternoon, I was surprised to hear “Here Comes the Sun” playing overhead. A successful discharge for a COVID-19 patient. For a second, I sat back in my chair and smiled. I walked out the hospital doors that evening, surprised by the last bit of sunlight for the day. Truthfully, I hadn’t noticed the days getting longer.
Fourteen days had passed since I met my first COVID-19-positive patient. My thirty-something patient was now safely discharged, and my elderly patient heard his daughter’s voice once more before passing away peacefully. In a mere two weeks, I cared for many patients as they and their families shared their narratives with me. Their experiences—both discharges and deaths—were inescapably a part of my own journey toward becoming a doctor. In the midst of a pandemic, where distance is key to survival, I had relied so heavily on the physician-patient relationship. Each interaction comforted me, and I hoped these moments also shielded patients from the worst of my doubts.
As an intern physician, I had realized within a few months of practicing how much I didn’t know, and how little medical school had prepared me for the complex practice of taking care of patients. I had come to expect I would only be comfortable with my skills as a physician when I was much older. But the COVID-19 pandemic made me lean on the idea that a doctor’s role is simply to serve—regardless of the uncertainly, fear, and stressful times. I knew that no matter what lay ahead with the pandemic, my fellow healthcare workers and I would be called to find a way to take care of our patients, relying on instincts when we were lacking other guidance. The doubts I initially had in myself as a young doctor had to yield to trust in our collective abilities: because of the demands of the pandemic, I had to learn to act resolutely.
Calling myself a doctor had felt as stiff and unfamiliar as my newly minted white coat. Now, I didn’t think twice before introducing myself as a patient’s physician, nor grabbing my stethoscope hurriedly in the morning. The title MD feels inextricably rooted in my body, too-suddenly natural. Had COVID-19 not happened, it likely would have taken me much longer to come to this realization. I looked out toward the street and noticed the beautiful cherry blossoms that decorated the perimeter of the hospital. As the clock struck 7 PM, the empty streets of NYC filled with a percussion of claps, honks, and vivacious hollers. The seasons had changed in New York, and so had I.
References
- Organization WH. Coronavirus disease 2019 (COVID-19) Situation Report – 74. 2020.
Author bios: Dr. Mona Fayad and Dr. Michelle Lee graduated medical school in 2019 and completed their medicine internship year at Mount Sinai St Luke’s Hospital in New York City in 2020. Dr. Mona Fayad is currently completing ophthalmology residency at New York Eye and Ear Infirmary of Mount Sinai Hospital in New York. Dr. Michelle Lee is currently completing her radiology residency at New York Presbyterian-Weill Cornell Hospital, also in New York.
Image source: Dr. Kousanee Chheda
