RVU Alumni Weigh In: How Does a Pandemic Alter Patient Care?

On her fi rst day as a Physical Medicine and Rehabilitation Intern at Mayo Clinic School of Graduate Medical Education, Melanie White, DO ’20, found herself in an unusual situation. Her patient, an elderly man with a terminal illness, had been brought into the hospital from his nursing home and his condition was quickly deteriorating. In a pandemic, however, the obstacle she faced wasn’t how to provide him with the medical care he needed—it was following protocol.

The coronavirus’ ease of spreading, especially in how it remains airborne indoors for long periods of time, has triggered a slew of protocols over the past seven months that diff er from one healthcare facility to the next. Navigating that process on the fi rst day of a medical internship was no small feat. In addition to discussing her patient’s goals for care over the phone with his family—which she did not feel equipped to do on her fi rst day—Dr. White also needed to coordinate family visitations.

"We did everything that we possibly could to get him into hospice to be closer to his family," said Dr. White. However, because of his comorbidities, her patient could not be transitioned from the care he was receiving at the hospital to another facility closer to home. For days, while she advocated for her patient and coordinated with others in charge of his care, she watched him diminish without his family to comfort him. Sadly, in the end, the patient passed away before his family could see him. "That really has aff ected me," said Dr. White. "When we previously had a patient in this situation, it would not have been a problem to get them closer to home or have family come in." This inability to off er patients the comfort of having their family with them, an important part of healthcare delivery, has been one of the more heartbreaking outcomes of the coronavirus pandemic.

Dr. White shared her story with students, faculty, and staff from both RVU campuses as part of an Alumni Panel discussion held in late September. The panel brought together four of RVU’s recent graduates—Dr. White; Shayna Popkin, DO ’19; Alexa Tyler, DO ’19; and Kashyap Kaul, DO ’20—to talk about their experiences as residents during the pandemic.

"The patient aspect of it [is] defi nitely jarring," said Dr. Kaul. As the Resident Medical Director of Northern Valley EMS and LVHN-MedEvac, he has seen cardiac arrest patients during the pandemic that have much worse outcomes than before. "We are not even transporting these patients [in ambulances] because we [would not be able to] resuscitate them," he explained, as it would take ambulances—which now need to be deep-cleaned aft er each usage—out of service for longer periods of time. In the Emergency Department, where he is also an Emergency Medicine Resident at Lehigh Valley Health Network, "We have to stop and think [with every patient]: what is this going to do for our exposure? What is this going to do for the exposure of every nurse?"

Another outcome of the pandemic has been prolonged work hours, sometimes up to 100 hours a week, according to Dr. Popkin, currently a Psychiatry Resident at George Washington University. With physician burnout a concern before the pandemic, it’s now more important than ever for residents to spend time on self-care. Dr. Kaul emphasized that fi nding alternatives for relaxation is an important way to maintain one’s sanity. While part of a physician’s skill set is to be adaptable, it should never come at the cost of one’s mental or emotional health. For Dr. Tyler, Family Medicine Resident at Oregon Health and Sciences University, it’s important to remember that "you are a human in a profession that is oft en asking you to be more than that."

Read more about the thoughts and experiences of completing residency during a pandemic at htt p://bit.ly/RVUalumniforum