Into the Fray, Vermont Medicine Magazine, Larner College of Medicine at the University of Vermont

Champlain Valley Expo Vaccination Clinic Staff

Beginning residency in the midst of a global pandemic. By Erin Post

Medical students in the Larner Class of 2020 celebrated their Match Day on March 20 of that year, just nine days after the World Health Organization declared COVID-19 a global pandemic. Their online Match ceremony—the first of many Zoom events at the College—signaled just how different the start of their medical careers would be from those of previous classes. In a matter of weeks they began residencies at medical centers across the country, as cases surged, and caregivers dealt with a shortage of both knowledge of the novel virus and basic protective gear.

The Class of 2020 physicians felt the anxiety and uncertainty all new residents have, while contending with an unmatched public health crisis. Here, members of the class share thoughts on some of their experiences as the pandemic unfolded around them.

Code Purple

Gesca Borchardt, M.D.'20, began her pediatrics residency at the University of Arizona-Tucson caring for patients much older than she was expecting. When COVID-19 cases surged in her area during the first month of internship, the pediatric wing of the hospital transitioned to treat adults up to 30 years old. When a second wave hit in January of 2021, patients up to 40 years old were in her care.

“We had a lot of instances where we were code purple, which means that all our beds are full,” she says. “Our hospital takes patients from [areas in] the south of Arizona that don’t have hospitals.”

The intensity of the experience resulted in strong bonds with fellow residents. They formed a “COVID bubble,” hosting potlucks and other activities outside of work.

“There’s always one person who is feeling more down than the others,” she says. “So, it helps to bring them up. And then, I knew that if I needed to talk to someone, I could always count on them.”

As Borchardt continues to process what she has experienced thus far, she’s already focused on addressing secondary effects of the pandemic. She’s working with her program to do some outreach to children who have fallen behind with their routine vaccinations. Families with children who have special needs are also a concern.

“All of a sudden, they didn’t have all the services and the therapies their children need, which is physical therapy, occupational therapy, speech therapy,” she says. “It was a lot of communicating with them to see how we can help.”

Beginning residency during COVID-19 has shaped her skillset in specific ways.
“I think I kind of learned my limits in how many patients I can take care of safely,” she says. “Even my decision making improved a lot because, sometimes, you have to act quickly. I’m not sure if ‘relaxed’ is the word—probably ‘more confident.’”

“The Loveliest Lady Ever”

Collin York, M.D.'20, remembers the day one patient with COVID-19 was discharged after a roughly two-month stay in the hospital. As an internal medicine resident at the University of Virginia, he followed her journey through several intensive care units. He saw her intubated and unable to speak. Medications resulted in delirium and agitation. Finally, as she transitioned out of the hospital, he was able to get to know the person who had endured so much.

“As all of those effects lifted…she kind of, it seemed, turned back into herself, and was the loveliest lady ever,” he says. “It was really cool to hear her family, whom I would update frequently, make the observation that ‘mom is acting like herself again.’”

His rotations in the COVID-19 wards highlighted just how much there is to learn about the virus and disease progression.

“Normally, there’s a hierarchy of decision-making and what correlates with that is a hierarchy of knowledge,” he says. “But in many cases, the knowledge would be so new, and there were so many unknowns about COVID, that you’d find yourself in rounds, looking to the ‘expert,’ and they would shrug their shoulders and not quite know what to do.”

As a new resident, York called these moments “very humbling” in that he could read up on the newest research—which was coming at a rapid clip—and bring that knowledge to the group.

Looking ahead, he sees connecting with community members who may be vaccine hesitant as key to bringing the pandemic under control. Citing the long history of systemic racism in medicine, he points to the outsized burden of disease in Black and Hispanic communities as evidence that medical professionals need to commit to outreach. “There are obvious reasons why people in these communities might be suspicious of public health recommendations,” he says. “I think we can’t give up on continuing to engage and meet people where they are.”

“The greater impact of COVID became apparent to me while in internal medicine clinic. The patients I was seeing had been profoundly impacted by COVID; I heard stories of patients losing five neighbors, and one woman who lost seven family members to COVID. Other patients who were ill with COVID in the spring were still experiencing shortness of breath and lung problems three to four months later.”
– Alexa Arvidson, M.D.’20, diagnostic radiology resident who completed her transitional year at Ascension Providence in Southfield, Mich.

“One of the biggest challenges I faced was updating family members about the conditions of their loved ones, especially while I was in the ICU… I would often spend a good part of my day talking to family members and giving updates over the phone. Having to tell someone that a loved one’s prognosis had suddenly shortened or that someone they cared about was continuing to deteriorate felt so cruel. Hearing someone start crying on the phone and to not be there in person to offer them comfort—sometimes that sound still echoes in my head. And yet with all that heaviness, you just have to keep going and move on with your day… That month in the ICU forced me to encounter death and suffering so often and so quickly. It was the most intense way I could imagine starting my intern year, an emotional test of will that pushed me to keep showing up and doing more for my patients and their families. It was immeasurably formative. I couldn’t be more humbled by and grateful for that experience.”
– Megan Kawasaki, M.D.’20, anesthesiology resident at Mount Sinai health system, Los Angeles

“In the weeks leading up to the start of residency, I reached out to many of my mentors to see how they were coping and managing with the current situation. Ultimately, I was just hoping to have a better understanding for the situation I was about to enter. As residency started, I looked up and continue to look up to my juniors and senior with a lot of respect, appreciating their strength for having just experienced several trying months just prior. I can’t start to imagine the sense of fear, insecurity, and overwhelming that they must have endured during the first days to weeks to months of an unraveling pandemic.”
– Ava Bakhtyari, M.D.’20, neurology resident at Boston University Medical Center

Finding Joy

Jasmine Robinson, M.D.'20, keeps artwork from her seven-year-old daughter close during her days as a obstetrics/gynecology resident at Southshore University Hospital in Bay Shore, New York. It’s a grounding force during a fraught and frenetic time.

“I always have a picture that my daughter drew,” she says. “I’ll tape it to my computer or carry it in my planner—just to kind of remind me of the things that bring me joy.”

In an overwhelming year, the goal was to learn as much as possible while also coming to terms with a new role and expanded scope of responsibility.

“I think this year is mostly getting used to being called ‘Doctor,’” says Robinson. “And kind of owning that title, because there is a lot of impostor syndrome that still follows you into residency.”

She began her year on labor and delivery, which meant a whirlwind of competing demands. COVID-19 added another dimension to the rotation, as in certain emergent situations she wouldn’t always know right away if a patient being treated for a complication from pregnancy was also positive for the virus.

“It’s quick, there’s a lot of things happening at once,” she says. “There’s emergencies… there’s urgent C-sections. It’s pretty heavy in terms of the amount of work and multitasking that you have to do.”

Before the vaccine rollout, Robinson said she felt grateful for the widespread availability of PPE and other precautions already in place at the hospital, allowing her to avoid some of the worry very early on in the pandemic about protection for front line workers. As the pandemic grinds on, she’s finding the balance she needs to be at her best for her patients.

“I figured out during this year what makes the most sense for me, in terms of taking on too many things, taking on too many projects, overextending myself in ways that I know might be detrimental in the long run,” she says. “Residency is definitely a very humbling experience, where you have to recognize your own limitations and the things that you need in order to continue at the same pace.”

Engage and Connect

Eli Goldberg, M.D.'20, has witnessed first-hand the health disparities the COVID-19 pandemic has laid bare. As a family medicine resident at UVM Medical Center, he’s worked with patients who rely on translators to communicate with health professionals. Because of COVID-19 risk, it became more difficult to find translators willing and able to enter the hospital, especially for certain dialects. This challenge was compounded by the inability to have a family member present. Goldberg says it’s often helpful for patients using an interpreter to “process what they’re hearing with a trusted loved one who speaks their language.”

“We had a much harder time and they had a much harder time being fully engaged with their medical care and fully informed about what was going on,” he says. “The pandemic exacerbated those language barriers and took away some of the options we would have had for communication.”

He also talked with patients in their 20s who work in customer service jobs and for a time struggled to balance the need to be at work with a vaccine roll-out and lifting of the statewide mask mandate that left them more vulnerable.

“They don’t have the economic stability to leave their job, obviously and because of their age, they were in the last group to be eligible to get vaccinated,” he says. “They just haven’t had a chance to get fully vaccinated and now are in positions where they’re being exposed to customers who aren’t wearing masks and have to take it on the honor system that they’re fully vaccinated. That’s been a huge stressor for a lot of people.”

Despite the myriad challenges, the pandemic has also offered opportunities to improve patient care. The rapid transition to telehealth opened up ways to engage with patients who may be more difficult to reach.

“I have patients on my panel who have a really hard time leaving home because of mobility issues or transportation issues or because they have really intense anxiety and it’s hard for them to show up in person at a doctor’s office,” he says. “For them, telehealth makes a huge difference. I’m able to be in closer contact with them than I probably otherwise would be.”

Goldberg says he’s ready to dig in for the long haul, getting to know patients over time. COVID-19 pandemic or not, it is these connections that stand to serve patients best no matter the challenge. “I think ultimately it’s reaffirmed for me that I love doing outpatient primary care—the bread and butter [of] family medicine I really enjoy,” he says. “I’ve got patients that I’ve seen four or five times over the course of a year, and I’m going to be able to build those relationships for the first time. It’s really rewarding.”