The Beginning

The patient had been in China. And- she had respiratory failure. This basically meant that she required a tube to help with breathing. The intensivist wanted to send for COVID 19 testing but- his efforts were blocked by the county health department. Only certain patients could be tested- there were specific symptoms listed (the patient checked that box) but- also- the patient needed to be exposed to a patient with a known, proven case of COVID. Commercial testing was not available- so- we were all at the mercy of the county health department. Three doctors- 2 intensivists and an infectious disease specialist- had all tried to get the patient tested. But- this was to no avail. The patient did not have documented exposure to a documented case. 

Furthermore- the county health department was dictating that we remove the patient from isolation. (She was in an isolation room.)   In order to get to the patient I had to pass through one door- close it- then- pass through a second door. Negative pressure. There was a closet sized room in between the first and second door. Inside there was a sink and boxes of masks. N95 masks, specifically. The family came to visit frequently. And- each family member dutifully donned one of the masks prior to seeing the patient. One family member's mask was tilted slightly- providing no real protection. Open at the top, open at the bottom. The nurse was wearing a CAPR (Controlled Air Purifying Respirator)- one of very few in the hospital.  This looked like a helmet with a facemask attached.  

"I think I'm going to cry," the nurse said, emerging from the room. She was trying to get the family to stop poking at the patient. The trash can in the small in-between room was overflowing with used N95 masks.  

I'd read a post on my Facebook group November 2019.  Someone's husband was an epidemiologist and he had issued dire warnings. "He said it's going to be like the movie Outbreak."  I could see that this was happening in China- far away.  I recalled Severe Acute Respiratory 

I'd been sick that January- I medicated my 102.1 degree fever, I'd put on a mask, and I'd dutifully gone to work. My eyes were red- like I'd been crying. "A bad cold," I thought. Nurses gave me a wide berth. Nobody sat near me when I stopped to pound out my notes at one computer terminal or another. This was par for the course- doctors didn't take sick days. My "bad cold" had resolved when I saw the aforementioned patient. My husband had proudly shown me the dining room table- in early February of 2020. There were paper towel rolls, toilet paper rolls, hand sanitizer, bottles of sanitizing spray. A giant, shapeless mound of cleaning products. I'd walked past- thinking that we were set for the next decade. 

My "bad cold," the mystery patient, the pile of cleaning products, the Facebook post- looking back- this was The Beginning 

Not sure where to start

I'm not sure whether anyone reads this- I'd forgotten that I had a blog. It's years later- I finished medical school, internship, fellowship. I was never the *best* resident. I was hard working, reliable, knowledgeable. I lacked the Perfect Resident Gleam- the intangible qualities that lead to awards a chief position. I lacked the Bad Resident Tarnish as well. I wasn't somebody on the Program Director Radar. Late for morning report? Nobody noticed. We did have a Bad Resident- when she was late- this further bolstered the PD's characterization of her.  When she did a good job- attendings never seemed to notice.

I spent several years self employed before switching to the safety, security, and predictability of a w-2 position. I'm married- in a nice house in a nice town. My student debt went from a high of around 250 k to under 60 k. I'm doing well

Internship

I'm now a nearly two months into internship and what a ride it's been so far. My program is better than most when it comes to hours, but my longest shift thus far was 33 hours. We have a night float system, but we still do 24 hour calls occasionally. The ACGME rules allow for the extra 6 hours for transfer of patient care, bringing the total to 24 + 6 (or 30) but my program supposedly abides by a 24 + 3 rule. In other words- 27. It's like they think we won't realize we're working more than 24 hours if instead of saying that the shifts are 27 or 30 hours, they say "24+3" or "24 + 6." Managing my medication on long calls is tough, and I have to make sure I don't flip into hypomania so I HAVE to take my evening dose of Seroquel, even if I'm going to be staying up all night. I take less of a dose, and make sure I get sleep when I return home. So far, so good. No hypomania. Just exhaustion- like all the other interns.

I keep my illness a secret from other people- sneaking pills from inside my Coach wristlet- and I don't think anyone I work with now would ever guess in a million years that I'm hiding something. If you met me now, you'd have no idea. It's nice to be out of medical school because my hospitalization is now a nearly three years in the past. I just tell my peers that I did a research year if it comes up that I was in medical school for 5 years. Of course when I was interviewing, I didn't lie- when asked I said I was on medical leave and then did research. But now, there's no reason to discuss this with my new friends. I just say research year, leave it at that, and I don't have to answer uncomfortable questions anymore.

It's great- sure I do struggle- but I'm so happy to have made it. Sure, there are sucky parts of internship. I had a 24 hour call last night and a nurse called me at 2:30 am to say the BP was 180/80 when it had been that way all day. But, despite these annoyances, I don't regret going to medical school.