The Deep Breath Before the Plunge: Reflections of a Canadian Internal Medicine Resident in the Face of COVID-19
March 18, 2020
“It’s the deep breath before the plunge.”
This line by Gandalf the White from the final Lord of the Rings film, The Return of the King, comes to my mind as my hospital and residency program continue to make preparations in light of the continually surging pandemic from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections — the virus that causes coronavirus disease 2019 (COVID-19). Indeed, the hospital hallways are eerily silent as non-essential services are gradually being cancelled and the lower number of admissions over the past few days make us warily uneasy of what may come. Everyone is holding their breath (sometimes literally) in anticipation of what’s to come.
Large gatherings including medical conferences, teaching rounds, and meetings have been cancelled. Outside the hospital, schools, sporting events, church services, and concerts have also been postponed until further notice. Restaurants have either closed or moved to take-out services only. Stores and malls have either closed or limited their hours. Licensing examinations for both medical students and residents have been postponed until further notice. International travel has been heavily restricted. The list of cancellations, postponements, and restrictions go on and continue to grow. Friends from both within and outside medicine are raising awareness to encourage social distancing and “flattening the curve” on various social media platforms. Several healthcare professionals who have had travel history within the past 2 weeks or have developed any respiratory symptoms are being asked to self-isolate at home. To have foreseen this 2 weeks ago would have been unimaginable.
For me and other residents, especially those in internal medicine (IM), it is a unique time to be in health care. We currently experience changes within our clinical work on a daily basis and we anticipate future challenges as the pandemic continues to evolve. While we predicted that an IM residency would be challenging, I’m sure none of us would have predicted that this was what we would be dealing with.
Recent events surrounding COVID-19 have created an uncertain time for everyone — even for physicians in medicine. With that uncertainty comes questions and fears that many can resonate with. I am concerned about how the situation surrounding COVID-19 will progress in Canada and how it will affect those around me. As various measures are being implemented, as more resources are being redirected towards the pandemic, the question on my mind is, “will this be enough?” Like many others, I’m not sure that our inherently constrained healthcare system will be able to manage the additional stress imposed by this pandemic. I worry about our need to make very difficult decisions when resources become very limited. Moreover, if the Canadian experience of COVID-19 parallels that of Italy or China, I also fear that as difficult as it is, it is not unrealistic to think of the possibility that not all of us will get through this pandemic without succumbing to it. Physicians and other healthcare professionals are not immune to the diseases we treat.
As trainees, the future of how medical education moves forward during this time is also uncertain. As half-day teaching sessions, elective rotations, conferences, and examinations are being put on hold, those who are in moments of transition (final year medical students and residents) are especially affected. Everyone’s training is at a complete standstill, with more questions than answers about how academic progression will continue in the coming months. Moreover, as we anticipate an increase in service requirements, both from the absence of our medical student colleagues and an increase in patient load, I worry for the stamina and overall well-being of a group of residents who are inherently at risk of burnout.
Outside of medicine, the pandemic has caused us to appreciate the simple things in life that we have taken for granted. Even for those simply self-isolated at home, there are concerns. I wonder when we will be able to share the same space as our loved ones, enjoy a meal in a restaurant, watch a movie, see a concert, watch a hockey game, and attend a church service again. I’m also concerned about those who are unable to support themselves through layoffs, lack of employment, and lack of various “non-essential” but much needed services.
Notably, in the middle of Lent, we are being asked to give up much of what we enjoy for the greater good to flatten the curve. All the recent happenings in the world bring to mind questions on suffering and how to make sense of it, regardless of your belief system. Indeed, much ink has been consumed in contemplating this question with no easy answers or solutions. However, as a Christian, it is in this season that I am encouraged and motivated through the reminder that Christ — though not explaining our suffering — came to share in it instead and gave up everything so that we might be comforted.
Amidst all of these concerns, it is rewarding to be a resident at the forefront of learning about and managing the complications of a novel disease that we knew nothing about only 3 months ago. The collaboration within the medical community surrounding this disease and the spread of information is as unprecedented as the disease itself. Seeing various colleagues come together to put forward creative solutions to new problems we face and to volunteer more of their time has been inspiring. I am similarly inspired to see medical students — whose training has gone to a standstill — volunteering their time to help health care professionals with child care and errands.
Around the world, people have made efforts to adapt what would normally be a large gathering to online platforms, doing their best to stay connected with each other. Moreover, there are countless stories of people doing what they can to support people directly and indirectly affected by COVID-19. Over the past few years, many of us have grown disillusioned by a world that appears to be increasingly divided. Moreover, times of crisis can certainly bring out the worst in us, just take the recent reports of hoarding and increased racism as examples. However, the various ways in which people have supported each other suggests that these times of crisis can also provide adequate soil for us to renew our ability to work together despite knowing our differences.
At the end of The Return of the King, Aragorn, neither overconfident nor despondent, faced insurmountable odds and brought together those around him to face a foe that defined their age. My hope is that we are able to muster the same courage in the difficult days ahead:
“I see in your eyes the same fear that would take the heart of me. A day may come when the courage of men fails, when we forsake our friends and break all bonds of fellowship…but it is not this day.”
