Op-ed: Residency during COVID

COVID has been a defining feature of residency training since 2020. A lot has been written about the experience of frontline health care providers, but as the pandemic drags on, the narrative of the #HealthcareHero deserves to be updated with a more nuanced reflection on what being in residency during a pandemic has been like, and how the ongoing crisis is shaping the newest generation of American physicians.

I started my family medicine residency in Providence, Rhode Island, in July 2019. I was an intern, still grappling with the basic skills needed to be a doctor, when the pandemic hit. I was on our family medicine-obstetrics service when the first case of COVID was reported in Rhode Island in March 2020.

The first wave

The first time I entered a COVID patient room felt like a scene from a sci-fi movie. The ambient noise faded away and I focused on my own breathing through my many layers of PPE. I went through the motions of assessing my patient, but mostly I was distracted by the sweat under my gown, and the fear that I might contract COVID.

The first wave of the pandemic was a scary time marked by uncertainty, scarcity and disruption. As residents, we were often the first line of contact with COVID patients. We were typically the ones spending the most time in COVID patient rooms and calling families to give daily updates.

With families not able to visit the hospital, residents also functioned as de facto support systems for both patients and families, and we took pains to process the emotions that were unloaded onto us every day.

We carried our precious PPE around in little paper bags, found creative ways to prevent pressure sores from wearing N95s all day, and constantly debated the newest data about what we should do to keep ourselves and our patients safe.

Without clear protocols, we based our treatment as much on what the ID team recommended as what we heard from colleagues across the country and read on physician Facebook pages.

But the spring of 2020 was also a time of solidarity and gratitude, filled with frequent family check-ins, no traffic and health care worker discounts at Rothy’s and The North Face. It was a time when bags of hand-sewn cloth masks appeared in resident call rooms, and donated surgical caps covered our long unkempt locks.

It was a time of so much fear and change that we clung to each other and felt grateful for one another, like any of us could be the next to die. The New York Times article about two young Chinese health care workers hospitalized in Wuhan with COVID did little to assuage these fears.

We stayed home. We masked. We enthusiastically jumped into new roles like “door screener” and “Quaranteam Leader.”

We also delighted in Zoom happy hours, drinking wine and playing online interactive games like Drawasaurus. It was a time well before the term “Zoom-fatigue” was on anyone’s lips, when we thought the pandemic might end if we could just flatten the curve.

The breakdown

As the fall of 2020 approached, that balance of fear and gratitude began to break down. Infrastructure was crumbling, supply chains fell apart and we started to see tears in our social fabric. This was happening in every corner of society, and health care and residency programs were no exception.

Hospitals closed. Programs closed. Our program merged with the other family medicine program in Rhode Island. We experienced staffing shortages and pervasive burnout. The risk-benefit calculation for so many people in health care no longer made sense in the wake of that first wave.

As we realized that COVID was the new normal, compassion and gratitude were replaced with fatigue and frustration. Call rooms overflowed with old, abandoned PPE bags, names scrawled across them in black Sharpie. Bags once so precious, now an annoyance, and a sign of disregard for collective spaces.

“Take care of yourself” started to mean very different things for different residents. Some doubled down on caution and protective measures, ever-vigilant on behalf of themselves and their families. With a sense of public responsibility muddled with righteousness, they stayed home with that new sourdough starter and continued to avoid group gatherings.

But for other residents, suffering from the effects of isolation and burnout, it meant seeking out human connection, whether that meant re-entering the dating scene, hosting house parties or sneaking away for a flight to see family.

For residents who moved to new states for residency in the middle of the pandemic, a sense of unrooted isolation was particularly suffocating – and not helped by performative corporate attempts at promoting “wellness” that shifted the onus of well-being on to individuals.

I bounced between these two camps, as did so many of us, some days feeling a righteous rage about people not wearing masks and gathering in “unsafe” ways, but at the same time I flew to the Netherlands in October – a relative was dying of cancer and it felt important to see her before it was too late – and a co-resident and I invited people over for a joint 30th birthday celebration – numbers were low in Rhode Island, and I was embracing a joie de vivre after my pandemic divorce.

We each had our own ways of justifying certain activities and judging others, some people contorting their logic more than others.

Interdependence in residency

People’s individual needs broke down the collective sense of solidarity. The Brigham & Women’s Hospital outbreak, caused (in part) by co-workers eating together in break rooms, made hospitals institute harsher restrictions around gathering and eating and fueled residents’ judgment of one another. If only we were more careful, this all would end, they thought.

At our community hospital, monitors would pop their heads into work rooms unannounced, and chastise anyone with their masks off. And one senior resident told interns that if they wanted to have a shared meal, it would have to be outside … in December … in Rhode Island.

Being a resident is different than simply being a doctor. In residency, there is an inherent interdependence. You work in teams, you share patient panels, you cover for each other when someone is out. You are also expected to learn from each other, mentor one another and provide emotional support for each other during tough times.

So one person’s decision to have a small party, or one person’s decision to forbid eating in the workroom, has a much broader impact on the team. We lost sight of COVID as the common enemy, and it became easier to direct our anger and frustration at one another.

What now?

The social and infrastructure breakdowns caused by COVID continue to affect us, but with the arrival of the vaccine and the subsequent waves of COVID being less overwhelming to the health care system, we’re at a point where we can take a breath. PPE is bountiful. Protocols for treating COVID are well-established.

But things are certainly not back to what they were pre-pandemic. The thought of a program-wide party is still highly controversial, and nostalgia for pre-pandemic pre-interview recruitment dinners is strong.

We worry about whether the overwhelming amount of COVID cases has undermined our learning; we worry about how to maintain program traditions and a sense of community; and corporate roundtables on wellness do little to address the true sources of widespread burnout. But is there a silver lining?

Shaping the practice of medicine

COVID made us look at medical knowledge and institutional policies differently. As learners, we watched medical knowledge and protocols take shape around us, and many of us were directly involved in COVID-related research and policy formation. It became clear that medicine is not static, and that shaping the practice of medicine is not out of reach for early-career physicians.

We also navigated these ever-evolving circumstances in the face of intensely personal and impactful social dynamics: dynamics that caused burnout to run high and solidarity to run low. The dragging on of the pandemic led to a unique kind of isolation and despair.

But ultimately this may have created the circumstances that allowed residents to come together, and they did so to advocate for themselves and each other. On small and large scales, residents advocated for their safety, their wellness and their learning, and they did so with great success around the country.

The pandemic reshaped residents’ understanding of their own power to change systems and oppressive structures.

In the end I imagine the experience of being a resident during COVID will contribute to a generation of doctors who are not only more ready to challenge how we do things in medicine but are also more compassionate and diplomatic in their delivery.

We were deeply challenged by this virus, by each other and by our inner selves, and the rhetoric of #HealthcareHero is far removed from that reality, but I hang on to hope that some good will come from having been a resident during this pandemic.

Related reading:

Cracking the Match: Everything a current (or future) residency applicant needs to know about the Match algorithm

Why you should consider living in a tiny home during residency