Residents in hot spots offer comfort to grieving families

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In honor of AMA’s resident recognition week, AMA Chief Experience Officer Todd Unger discusses with residents about spikes of COVID-19 in California and Texas, and how they provide comfort to grieving families.

Learn more at the AMA COVID-19 resource center.

Speakers

• Aleesha Shaik, MD, MPH, internal medicine resident physician, Mount Sinai Hospital
• Paul Guzik, DO, internal medicine resident physician, University of Texas
• Daniel Udrea, MD, emergency medicine resident physician

Unger: Hello, this is the American Medical Association’s COVID-19 update. This is the fourth episode in our week-long series focused on residents, part of AMA's Resident Recognition week to honor and thank residents for all they've done and continue to do to care for our country. Today, I'm joined by three residents who've been on the front lines treating COVID-19 patients throughout the pandemic. Dr. Daniel Udrea, an emergency medicine resident physician in Loma Linda, California, Dr. Paul Guzik, an internal medicine resident physician at the university of Texas in Austin, and Dr. Aleesha Shaik an internal medicine resident physician at Mount Sinai Hospital in New York. I'm Todd Unger, AMA's Chief Experience Officer in Chicago. We've watched as hotspots have moved from the East coast to the South and West. Dr. Udrea, Dr. Guzik, you're in two states, California and Texas that are seeing surges right now. Can you describe the situation at your hospitals?

Dr. Udrea: Yeah. You know, it's quite busy, Todd, it's getting busier. As each day passes, we're encountering more and more COVID-19 positive patients. This requires intense dedication from our team to both don and doff the PPE appropriately to take care of all these patients. And as each patient comes forward, they're screened and move to the COVID suspect or non-COVID suspect parts of our ED. And we've been focusing on cleaning and providing PPE for everyone, which has been really good, but it is a daily challenge.

Dr. Guzik: Yeah and to kind of build off of that, on the hospital wards, a lot of our resident-run teams have shifted actually to COVID only teams, which has been kind of a big shift that's really occurred over the last couple of weeks. I think the shift has gone well. And I have to give credit to our leadership for that. But it's definitely been a big, big, big change from what we're really used to.

Unger: How are you doing capacity-wise?

Dr. Guzik: So our hospital has approximately 220 beds. I know that we are really at capacity and we've actually gotten to the point where we are shipping out patients who do not have coronavirus so that we can make more capacity for folks who are COVID positive. I think about two-thirds of our hospital right now is occupied by COVID positive patients which has increased dramatically in the last two to three weeks.

Unger: Yeah only three months ago, I was interviewing another resident in the hotspot of New York City about being on the front lines. Now, Dr. Sheik, a couple of months later, how has the situation changed in New York? And is there anything that you've learned that you can share with others are now facing record increases?

Dr. Shaik: Yeah, as I was hearing the others talking about what it's like now, I was honestly having flashbacks and just picturing how crazy things were even just a few months ago. So it's definitely been a big change between then and now. As we were talking about earlier, I honestly can't remember the last time that I had a COVID patient, which seems like such a distant future just a few weeks ago. But most of the patients that I'm seeing now still in their one-liner, says has a history of COVID-19. So it's definitely an inescapable reality that happened.

But in terms of lessons, I think I have three lessons that I can take away or have taken away from this pandemic, at least in New York city. One of them is that, especially and I'm sure this is the case with you guys too, that during COVID we didn't have visitors that were allowed into the hospital to see patients, so no families. And the hardest thing for them, of course, is not being able to get updates from us and also not being able to see physically how their family or loved ones were doing. So it's really, really important just calling families every day, even though it takes time. FaceTiming them as much as possible when you're in the patient's room. It really does make a difference.

And then the other thing is that it's become more important than ever that we share our stories with the public, not just everything we see. It's really easy for us to talk about amongst ourselves, but it's not so easy for the public to imagine. And that can lead to more fear, uncertainty and maybe even not taking this as seriously, because they're not surrounded by everything that we're seeing as much as we are. So just sharing the reality and sharing best practices, things like that is really helpful.

And then the last thing is, this is such an overwhelming time. It really doesn't get any easier. You might get more used to it, but it's definitely overwhelming emotionally and physically. And it's really important that you just take time to take care of yourself.

Unger: It wasn't hard enough to be a resident already, was it? So New York has been one of the few states that have kept its numbers relatively stable. Why do you think that is, Dr. Shaik?

Dr. Shaik: I think part of the benefit to having had the peak early on in the pandemic as that there was still a lot of, and there still are a lot of anxieties surrounding the pandemic, but people were more likely to follow recommendations. Right now, there's a lot of fatigue about pandemic, quarantine, wearing masks all the time, and so that's been part of the struggle in other areas of the country. But here, having had that early on, when people were more likely to actually follow those recommendations. In New York city, I think it would be hard to find someone who hasn't experienced COVID, other family members or loved ones in some way. And so that's why people are more likely to follow the safety recommendations.

Unger: Dr. Guzik, what are you seeing in terms of increases in your neck of the woods?

Dr. Guzik: Yeah, so just to build off of what Dr. Shaik had mentioned, seeing the surge that originally happened in New York was a huge warning sign to the rest of us throughout the country that this could be us at any moment's time. And I think we actually benefited from that in a way to make sure we were adequately prepared for that surge whenever it may happen. So I think that helped all of us as residents, or even as attending physicians, or even as support staff to be prepared at any moment's notice for that surge. But when it happens, there's still a lot of stress and anxiety that comes along with it. And I think Dr. Shaik hit on a lot of points that for me, what's been helpful is to take time to relax and do something that I enjoy in a safe way, of course, so that I can be prepared to go to work and to continue fighting this as we continue to see more and more cases each day.

Unger: You talked about preparation, what do you think were the key aspects of getting ready for what could and did happen?

Dr. Guzik: Well, so of course it's making sure you have adequate PPE, making sure you have adequate staff. Most hospitals don't employ enough staff at a moment's notice for 100% of their beds to be constantly occupied. And so there was a lot of preparation that I know happened behind the scenes from the leadership standpoint, to get us prepared for really, an emergency situation. But I think from a resident perspective, the way that I prepared myself was the old saying of expecting the worst, but of course you hope for the best. And the first few days that I was on the COVID service, I was stressed out, of course. It's this completely new phenomenon that none of us had really been exposed to. And there are still a lot of uncertainties with how this is going to spread and what the future of the coronavirus is really going to be. And so I think there's a lot of mental preparation that goes into preparing yourself for how busy it has gotten.

Unger: Yesterday I had a chance to talk with Dr. Bradley Dreyfus in Arizona. And one of the key things he said in terms of preparation was building out the infrastructure to support health care teams during this time including housing and childcare, mental health support. Have you found that kind of industry infrastructure in place for you that might not have been there and some of the early centers of pandemic?

Dr. Guzik: I have to say that we have excellent social workers and case managers, and they are absolutely essential to making sure that discharges are efficient, especially for our patients who are more vulnerable and have a very difficult social situation, whether that be because they're homeless or whether that be because they just lack resources to get adequate followup. One of the main things that's been keeping a lot of patients in the hospital is just the hypoxia. And so getting our patients who are stable on low amounts of oxygen home oxygen has been vital in clearing up beds so that we can admit more patients because they continue to come in masses.

Unger: Dr. Udrea, I'd like to talk to you a little bit about your experience as a resident and what you're finding to be the most difficult challenges for you and your fellow residents in terms of treating COVID-19 patients.

Dr. Udrea: Yeah, no, that's a great question, Todd. The most challenging aspect for me is just you do everything you can to save some of these patients and you meet their loved ones over the phone. You give them updates every day. And things are going well. And then all of a sudden, sometimes things don't go well and you've exhausted all of your medical expertise, all of your medications. And then it becomes this very difficult conversation with family regarding goals of care and shifts to comfort, which is at least for me personally, you can deal with it, but when it happens day in and day out and it's happening more and more frequently, it takes a toll on me. And it's even more difficult when family can't visit them because we're limiting their exposure to COVID-19, so it's really important. The FaceTime thing, we started doing that, and that's been very helpful for family, but it is tough. It is tough.

Unger: Dr. Shaik, how about you?

Dr. Shaik: Actually, I think what Dr. Udrea said is very in line with what I was thinking as well. I think building off of that, the biggest challenge for me, in addition to the toll that it takes just having to break that bad news to families, is after breaking that bad news, despite being in such a state of grief, they actually take the time to thank me and thank us for the care that we're providing for families and for our patients. And it's really hard, I think for me personally, to be able to waive that gratitude and kind of feel undeserving of it when you weren't able to save their loved one. And I think that's where like Dr. Udrea was saying, and as we've all been talking about, just taking some time to yourself is really important.

Unger: I'm curious who taught you how to have that kind of conversation with somebody? That seems pretty difficult.

Dr. Shaik: You know, you'd think that four years of medical school, some classes and some small team room would be enough, but unfortunately this pandemic has really just forced us to get good at it by having these conversations countless times. I don't think there's really any other way to do it.

Unger: Well as front-line physicians, you've been likely in situations where you need to correct a lot of misinformation or a lack of information. What do you want other people to know, other residents to know, the public to know? What should we be hearing more about right now? Dr. Guzik, why don't you start?

Dr. Guzik: So I would like other residents know, and in particular the public to know, we really need to seek out reliable sources of information. We live in this day and age where technology is incredibly prevalent. There's almost this sense of information overload. There are so many different sources and so many different people who have opinions, which of course can be beneficial in some ways, but there are places where you really need to take the time to find reliable sources of information. And even though this virus is novel, there have been previous pandemics and epidemics that have involved viruses. And so there's epidemiologists and there's other physicians who have experience with prior outbreaks. And so even though this is a new virus, there's a lot of knowledge and education that already exists out there. And I think those are the sources we really need to turn to and people we need to turn to to really trust what their recommendations are right now.

Unger: Dr. Udrea, what's your top piece of misinformation you'd like to correct?

Dr. Udrea: I think I'm disappointed to hear that there are individuals that believe that masks are not safe. Masks are very safe and they can help protect you as well as others. Masking in combination with good hand washing as well as social distancing is going to be probably the best thing you can do to protect yourself and others. And I think that's something I really want to drive home today.

Unger: Dr. Shaik, do the folks in New York seemed like they've gotten that message?

Dr. Shaik: I think we're finally getting there. Even now, I still see people wearing masks, which is a really good sign.

Unger: Well, we have a new class of residents that are starting their training. Dr. Guzik, what would you say would be your top piece of advice to them right now?

Dr. Guzik: I think my top piece of advice is to take things a day at a time. Residency can be very overwhelming, even outside of being in a global pandemic. And unfortunately they're coming onto their training in an extremely difficult time that's straining pretty much everyone in the health care industry and quite frankly, everyone in the world. And so taking things a day at a time and ask for help. When you need help with anything, that's what we are here for as senior residents. That's what your chief residents are there for. That's what your attendings are there for. We are a family and we're here to support one another as a health care community.

Unger: Dr. Udrea?

Dr. Udrea: I think that's really good advice. The asking for help is probably the single most important thing. It's quite the transition from medical school to residency in of itself, but jumping into residency in a situation where now we have to deal with significant changes to how we interact with patients being fully in PPE or having a piece of tape over your gown to say your name because they can't see your face or your smile is significant and has completely changed how we interact with patients from what we learned in medical school or residency. And so I think it's important to lean on our attendings and our senior residents and our nurses to get the expertise in how to engage with our patients.

Unger: Well, a number of different issues have really surfaced through this pandemic. And of course a lot of the existing problems in health care have been exacerbated. Has caring for patients on the front lines, made you more aware or passionate about any of these issues? And what do you see as the responsibility of today's residents in shaping the future of health care? Dr. Shaik?

Dr. Shaik: Yeah, Todd, spending every day ion the floors taking care of patients, I think it's impossible to not see the health disparities that we're seeing, especially in New York city. We saw that and the data has shown that the vast number of people who got really sick from COVID, who died from COVID, were African American, were Latino. And this is not okay. And as physicians, we have to be leaders and it's not something that you need to wait until you are an attending physician to do. As a resident physician, you can speak up on the issues that you're seeing. You can make health communication a priority and talk to the public about what you're seeing and just break down the complex science to them to make it more understandable. But I think that's a responsibility that we all have to take starting now.

Unger: Dr. Udrea?

Dr. Udrea: It's clear to me that we need to bolster our social safety net to better protect our patients. Preventive medicine and our focus is on proving health care disparities that we've been doing for a long time with the AMA has really led to improve outcomes for all communities. But it's even more clear to me now that we still have work to do, and we have the team to do it. And I'm really looking forward to working with everyone in the AMA to continue on this journey. And I encourage everyone if they're not a part of the AMA to get involved because we need to be in this together.

Unger: Dr. Guzik, final comments?

Dr. Guzik: Yeah. I think Dr. Shaik and Dr. Udrea had some really nice comments there. As someone who has spent all of residency working with primarily underserved patient populations, for me the pandemic has really only magnified what I already knew to be present. Unfortunately, when times are tough, it just really kind of widens that gap in care. And I think now more than ever is the time where we need to step up as a big community, as one world, as one country to care for everyone and to be selfless in our actions. If you're sick, you should stay at home and you should follow the appropriate isolation precautions because you might save someone's life by doing that. Wearing a mask is not just about me. It's not just about you. It's about protecting other people, too, and protecting the most vulnerable people in our population. And so I think the most important thing for me about this global pandemic is we need to be in this together. That's how we will overcome this is by working on this together.

Unger: Well, thank you, Dr. Guzik, Dr. Udrea and Dr. Shaik. I really appreciate you being here, especially during our resident recognition week. Thanks for sharing your perspectives and for all you've done to care for patients during this pandemic. We'll be back tomorrow with another COVID-19 update. And for resources on COVID-19 visit ama-assn.org/covid-19. Thanks for joining us today and take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.