Post by Jeremy Fish, MD, Program Director, John Muir Health Family Medicine Residency
Residency training remains one of the most transformative experiences of the modern era. We begin life as ordinary human beings, become witnesses to medicine and health care as medical students — and then enter into several years of intensive training that turns us into physicians. It is one of the few modern rites of passage — a painful, sometimes death-defying adventure that challenges us to put others before ourselves and expand our capacity to serve our communities in profound and impactful ways.
Pandemics create chaos, confusion, fear, and opportunity for growth. When the transformative force of residency converges with the chaotic energy of pandemics — a truly rare and painful opportunity arises that is often lost in the stress and anxiety produced. Our world is facing a new and perilous infection, with no treatments and no vaccines. We don’t know who will become infected and how, who will live or who will die. In these moments the world turns to us as physicians to step forward and risk our lives to assure everyone is cared for, even those infected with new contagions.
Being a resident physician during a pandemic is uniquely stressful and meaningful. Residents are called to participate in the care of people when they have little more than supportive care to provide, while potentially risking their careers and lives. The entire ecosystem of residency programs can be altered by these pandemics — with hospitals, emergency departments, and primary care centers overflowing with the new illness.
I was a resident when the HIV pandemic burst into hospitals across the nation in the late 1980s and early 1990s. It is challenging to quantify the impact this had on me as a resident — night after night caring for men my age withering away and dying despite everything we tried. Staff so fearful of becoming infected, only residents would draw their blood or get that sputum sample early in the pandemic. Orthopedic surgeons refusing to operate or only operating in Haz-Mat suits. Calls for quarantining even though it took sexual or blood-routes to become infected. Fear dominated, yet we residents knew being a physician meant stepping forward while others step away. Classmates were accidentally stuck with needles — a potential death sentence in the early days. My years of residency were filled with the heartache of caring for young people I knew would not live long with medications having limited to no benefit to them, yet they came from miles around to seek our care.
Yet, we also experienced a wide array of conditions no physician had seen for decades — Kaposi's Sarcoma, once a rare disease, became a routine condition, including in respiratory conditions. Candida became a common foe, invading our patients in ways no one had ever seen. Valley Fever, CMV, PML, Cryptococcemia, and the dreaded Pneumocystis became routine conditions while we honed our clinical skills. It’s been decades since I’ve cared for anyone with these conditions — thank goodness, I hope I never do again.
Today we face a pandemic of epic proportions — not because of its death-sentence for all who become infected — but because COVID-19 is an even more successful viral opponent than any pandemic we’ve seen for decades. It is highly contagious through droplet contact, can be deadly for the vulnerable elderly and immune-impaired, and we currently have no therapeutic treatments for the fight. So, we are left with massive public health interventions that have driven up fear. Like the early days of HIV, we lack necessary testing capabilities, so many fearful they are infected are going untested and potentially spreading the disease without knowing it. Our nation tries to limit the infection through Medieval means — by pulling up the drawbridge to other nations, hoping to stem the tide of infection, while the infection has already become American and is racing across the nation like a grass-fire.
Once again, our residents will be called to care for people who may be dying and who may infect them. We will all do everything we can to protect our residents, knowing physicians in China were some of the early fatalities. Hand hygiene is taking on a new meaning and power to protect us. N95s are now part of our neighbors' conversations with us. I actually had to ask one of my neighbors if my wife could get an N95 from him as he had several boxes he’d ordered at the onset of the pandemic. Why was he so wise to purchase all that toilet paper, rice, water and N95s? He is a gay man who lost most of his dearest friends in the HIV pandemic. Never again, he says as he tells me “the N95 is the social condom of this damn COVID-19, I’m wearing one everywhere I go. Who knows who is infected?” As a brave and resilient warrior of the HIV pandemic, he is more ready than anyone else I know — and kindly sharing with his physician neighbor who won’t take N95s from work, knowing our limited supply and the need for those caring for COVID-19 patients to be prioritized over all others.
Yes, pandemics are disruptive, chaotic, frightening, and ultimately many of our fellow Americans and world-friends will become very ill or die in the coming months. Our resident physicians are on the front-line, stepping up while others step away. We must encourage them to embrace their role as frontline warriors in the battle against COVID-19 — while providing them all necessary protections to assure they will be here in the decades to come to save lives in less dramatic, though no less important ways — one patient at a time.