By Alexis Ramos, MD

COVID-19 Generation of Residents

By Alexis Ramos, MD

oday is my first day of residency, the day all medical students dream about. I imagined waltzing into the obstetrical wards for my first rotation, donning a long white coat and a new pager. My patients would ask me medical questions, and I would shake their hands and greet them with a smile, responding with confidence.

Times are vastly different. Instead of a white coat, I wear scrubs, which are easier to wash off the day. Instead of healing and rebuilding, we are living in a declared health emergency.

Entering the wards for the first time was not exactly how I envisioned. I am greeted by nurses asking for my signature to prescribe medications. The upper-level residents are busy in deliveries, and four of my patients need discharge orders in the computer system. The sense of urgency and stress are entangled in the air. I breathe in the large expectation to retain knowledge quickly and perform efficiently, which is even more pressing in the COVID-19 generation of residents. We can’t escape the vast differences of social distancing COVID-19 has created, even at work. We are constantly reminded by the screening nurses that take our temperature before each shift, by the increasingly high patient volume with masks and personal protective equipment (PPE) and by the code blues that ring throughout the hospital.

All of this sets the stage as I start work in the obstetrical emergency room. Two patients in active labor burst through the double doors. The experienced resident tends to one and I am assigned the other. I freeze. I clumsily flip through a few stacks of paper that outline the crucial steps and common orders to place: Normal saline, UA, CBC and a COVID screen. The nurse and I quickly initiate a digital exam. The patient is dilated to 8 cm. She is visibly scared. I cannot tell whether her emotion is moving through me or if I am transferring my emotion onto her.

I sit on the edge of the bed and express as much understanding as possible with two thirds of my face covered by a mask. We cycle through some deep breathing exercises. I also attempt to distract her with small talk about her husband at home and their two children. I

Tknow they all cannot be present for the birth because she is only allowed one visitor. I assure her we have great doctors here who perform routine deliveries around the clock, but that does not seem to ease her fear. I exit the room and place quick admission orders. She is whisked away to a labor room. The day continues and when I look up, it is past my time to leave.

I leave, feeling that I am bringing the unknown to my family and unsuspecting cat. I shower as soon as I get home, using Lysol on my shoes and book bag. I have just enough time to eat dinner and prepare my patients’ notes for the next day in order to get a solid six hours of sleep. I remind myself it is okay to grieve the loss of normalcy. The uncertainty in duration is what truly unsettles me. How long will the state of emergency last? The notion of taking each 24 hours as they come has become my mantra. I open the remote-access charting system to begin looking at the postpartum patients for tomorrow. My mind wanders back to the kind lady who came through the obstetrical emergency room. I notice a red flag next to her lab values; positive for COVID-19.

Alexis Ramos, MD is a second-year family and community medicine resident at UT Health San Antonio. She is a resident member of the Bexar County Medical Society.