On Becoming A Doctor: Facing COVID-19

It was almost ten months into intern year of residency and I was on my second block on the General Medicine team. General Medicine at a tertiary care pediatric medical center covers a broad range, from patients with seasonal respiratory illnesses to those with complex medical conditions requiring an extensive coordination of acute care and chronic management. It was one of my favorite services as an intern; we had the greatest autonomy – with appropriate supervision – and could develop and execute patient plans, while having the privilege of consulting virtually every additional specialist service. I felt this privilege – of being able to practice medicine with an abundance of resources, with a wealth of support from co-residents, seniors and attendings and with a diverse patient population from all over the country – and appreciated it.

It was with this sense of privilege that I walked into my patient’s room on a cold and surprisingly quiet evening in March. There was a wealth of significance of that day; it was the anniversary of when I found out I would be matching at my current program, it was the day our current medical students found out that they matched through the NRMP (they sent us text messages with the news), and it was the first day following the official announcement that the virus known as COVID-19 was designated as a pandemic.

As a pre-medical student I always imagined being a doctor; wearing a white coat, diagnosing ailments, and making people well again. As a pediatric intern, I only wore my white coat when required, preferring my program’s Patagonia fleeces while in the hospital. I had certainly diagnosed quite a number of ailments, and I had hopefully helped make a few people feel better than they did prior to meeting me. The reality of practicing medicine was not something I fully conceptualized in my pre-medical days, or even as a medical student. Medical school taught me to think a different way about disease, wellness, and patient care. Now, residency is teaching me how to implement those thoughts into actions; how to turn the rapid sequence of pattern recognition from differential diagnoses into practical guidelines for patients that also consider social determinants of health, language differences, insurance costs, and parental fears.

As I walked into the room – having donned the appropriate PPE – I thought about the social determinants of health that will define the spread and impact of this novel coronavirus. I thought about the calls for staying at home that could not be heeded by my patients’ parents who were either essential workers or unable to appropriately distance themselves while depending on public transportation. As I completed my patient assessment, I forced my thoughts into a corner of my mind as I talked my patient’s parents through our plans for the night. I left the room after removing my PPE and disinfecting my hands.

In medical school, and even as a pre-medical student, the thought that socioeconomic status and zip code were determinants of health were concepts that bore further study. It was the basis of my research interests throughout medical school. Now as a resident, a new physician, I witness it play out before me. I see it in patients who present to the emergency department because outpatient primary care is not in their budget, in patients with a reduced ability to adhere to medications due to financial insecurity, in patients with vitamin deficiencies and electrolyte abnormalities due to food insecurity. I admit, I’m worried about these concerns.

My patients – mostly under eighteen – appear to represent a lower percentage of those with the virus, and also seem to have less overall morbidity even when affected. However, as the pandemic grows, what will the impact on their communities look like? With schools closed, will they have the appropriate resources to continue e-learning, and will that be enough? Will the financial impact of furloughs, unemployment and closed businesses be borne by their families? Will they feel safe enough to travel to clinics for vaccinations, or for the management of chronic illnesses?

When I was a premed student working through biochemistry, and then a medical student studying pharmacology, I didn’t have this same feeling. I recognize it as concern, even fear, for the wellness of my patients. And I see now how all-encompassing wellness really is: how school and social support, food and clean water, insurance and access to nearby pharmacies play such a vital role in how my patients thrive. I didn’t realize how much more there is to medicine than simply diagnosis and treatment. I didn’t understand what it meant to be a doctor the way that I do now.

As we work through this pandemic, slowly flattening the curve, I know these questions will resurface. And I know the answers will likely cause more worries. I know my patients’ families will worry about these questions as well. And I know that, as their doctor, I have the privilege and responsibility to worry with them.

But worry is not my only duty. Nor is it the only duty of my resident family who are rallying together to gather resources for our local food banks, our local schools, and our clinic families. On a weekly basis we review our roles as advocates for our community, identifying ways in which we can serve beyond the hospital walls. We are embracing our role as doctors caring for the whole patient. I am almost a year into being a doctor and I finally understand what that means.

*Pictured above: Ogochukwu at Lurie Children’s Hopsital in Chicago.