Hospital emergency rooms are chaotic in normal times. Try being an emergency medicine resident during a pandemic.
As the nation’s healthcare system deals with COVID-19, UCF-HCA Healthcare physicians in residency training find themselves on the front lines of a novel virus and new ways of learning and caring for patients.
Emergency medicine residents have had to master “donning” and “doffing” complicated personal protective equipment so they don’t infect themselves or others. They have watched COVID-19 cause devastating illness to patients of all ages. Due to hospital visitor restrictions, they have counseled terrified family members isolated in a hospital parking lot waiting for word on their sickened loved one. Psychiatry residents are helping veterans combat drug and alcohol addiction when social distancing prohibits them from gathering for 12-step meetings. They are guiding patients who struggle with anxiety and depression during the best of times and now must cope with COVID-19 stressors like fear of being exposed to the virus while buying groceries and losing their jobs.
“We are facing something no one has ever faced before.” – Michelle Hernandez, emergency medicine resident
“We are facing something no one has ever faced before,” says emergency medicine resident Michelle Hernandez. “I’m working alongside attending physicians who have been doing this for 30 years and have never seen anything like this. So we’re learning side by side.”
UCF is training more than 450 residents and fellows across Central and North Central Florida in partnership with HCA Healthcare’s North Florida Division, the Orlando VA Medical Center and Nemours Children’s Hospital. Medical school graduates must complete residency training in their specialties before they can care for patients on their own. Because much of residency training is hospital-based, UCF’s young doctors and their training physicians are learning together how to treat this novel virus.
One of the lessons, residents say, it managing their fears as they care for others. Jessica Houck, an emergency medicine resident at Osceola Regional Medical Center, has a three-year-old son. The toddler and Houck’s husband returned to Kentucky to stay with family rather than risk being infected by their physician wife and mother. Another EM resident had been living with his sister and her child – his beloved niece – but moved in with another resident to reduce the risk to his family.
Dhara Shah is a UCF psychiatry resident. Her family lives in New York City – the epicenter of the nation’s COVID-19 outbreak. She worries about them as she worries about her patients at the Orlando VA Medical Center who are struggling to overcome addiction in the middle of a pandemic. Alcoholics Anonymous and Narcotics Anonymous are cornerstones of addiction therapy. But social distancing means veterans can’t gather to seek guidance from others battling substance abuse. Instead, they work through their therapy online and through programs on YouTube.
“They have persevered,” she says. “I have told several of my vets that their self-motivation and discipline are helping them get through this.”
She notices some of her patients have used their time in isolation to finally realize they need help and to seek it. Some have found it’s easier to quit smoking when they are living under stay-at-home guidelines and can’t dash to the store to buy cigarettes. Others are smoking more as they struggle with anxiety. “I worry about my veterans,” she says. “I start every telehealth meeting with the question, ‘How are you maintaining your sanity?’”
Amid the fears of COVID-19, UCF psychiatry resident Hassan Kanani says he has tried to offer perspective to his patients – to help them see there are alternatives if they are afraid to go to the store for food, that their home and the hospital are indeed safe places. His words of guidance seem wise for everyone going through the pandemic: “We all need to look for the gems in difficult times.”
David Lebowitz leads UCF’s emergency medicine residency program at Osceola Regional Medical Center. He says when COVID-19 began, physician educators worried about having residents care for patients suspected of having the virus. But they determined that senior residents – those in their last year or two of training – needed to participate in COVID-19 care. “They need to be sure they’re well prepared,” he says. “Some of these residents are going to graduate in two-and-a-half months and we don’t know when this will end.”
He says the pandemic has offered unique learning experiences that will ultimately make residents better able to cope with public health and other emergencies in the future. And he says that the community’s support has also been an important message for the young physicians. Recently, Emergency Room physicians and staff were honored by Osceola County law enforcement, firefighters and ambulance drivers with their sirens on in recognition of the healthcare heroes on the front lines.
“Their sirens made a big difference,” Houck says, “because they made us realize we’re not alone.” COVID-19 has given new meaning to being alone. With Houck’s own family separated, she is communicating with family members of suspected coronavirus patients who feel their own sense of isolation. They drop off their loved one in a secure section of the emergency department and then wait in their cars in the parking lot to get word of the family member’s condition. They can’t enter the hospital so some wait in the parking lot for hours afraid to go home. “I go out there and talk to them to give them updates,” she says. “I think they really appreciate seeing the face of the person who is taking care of their loved one.”