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Missing Connections: A Reflection on Residency During a Global Pandemic

May 29, 2020
Written by

Nimisha Bajaj, MD, PhD, pediatric resident shares her experience during the COVID-19 pandemic.

I am a first-year pediatrics resident at Nationwide Children’s Hospital, and SARS-CoV-2 has turned my world upside down. I support social distancing measures, at least until broader public health interventions have been universally implemented. But as a physician in training, the pandemic has affected many aspects of my life, including patient care, residency training and my personal health. Mostly through changes in my ability to connect with others.

Patient Care

Nationwide Children’s is in central Ohio, where there is a low prevalence of COVID-19 in children. I have not personally cared for anyone positive for SARS-CoV-2, but the presence of the virus has drastically altered how we care for all of our patients.

Firstly, our census is quite low on all inpatient services, and a fraction of the typical patients are coming to primary care, let alone specialty clinics. These changes are partly by design – cancelled elective surgeries and procedures, delayed well visits except for the youngest patients – but we also know that even children who need care are avoiding it for fear of exposure to the virus. This can have long-term consequences due to missed vaccinations and missed screenings for developmental delays, child abuse, and mental health concerns for which they are at higher risk in the current climate.

For the patients we do see, the care we provide looks different. We are limiting entry into rooms to only when necessary. In every room, we wear procedure masks and goggles. While I appreciate that we have sufficient personal protective equipment for our staff and that the priority at our hospital is to keep us safe, I feel limited in the human element of care that I can provide. I am minimizing the surfaces I touch, which means I don’t sit down when talking. I am struggling to develop rapport with my patients, and even the nurses, because of my limited nonverbal communication.

We all understand why we need these precautions. But it makes our jobs more challenging.

Training and Education

Because of our low census, our program leadership has been working to optimize clinical time and learning to make sure we meet graduation requirements for residency. I do not envy them one bit. I appreciate that they prioritize our safety and education, which has apparently not been the case at other residency programs. In fact, this prompted the American Medical Association to develop guiding principles to protect trainees responding to COVID-19.

Still, my training is being affected in unforeseen ways. For those of us covering inpatient services, we have been rotating on and off service with “work from home” days to minimize risk of exposure. Some residents on outpatient electives do this for the whole month. It can honestly be nice to have a break from the long days in the hospital and to have the time to read and actually absorb the material. But, like many residents, I learn by seeing patients, which is why I chose to train at such a busy hospital, and I worry about missed opportunities to learn and to accumulate hours of clinical time to meet the American Board of Pediatrics requirements.

A less-often discussed aspect of residency training is the didactic education. Our program has done a great job of converting lectures to online formats. It has been as seamless a transition as one could expect, but like younger students who have transitioned to online classes, there is something missing: in-person connection and discussion that facilitates learning.

Personal Health

One of the best pieces of advice I received when I started residency was to make sure I had a good support network. This is a grueling period of medical training, and the best way to be successful is to build connections with colleagues. It is not hard to do when we see each other every day. We are bonded by our shared experiences, helping each other cope with difficult circumstances. But long gone are the noon conferences, the weekly lectures, the happy hours, the coffee dates, the retreats. While teleconferenced lectures and game nights offer some of the connection, much of it is lost.

The other half of the support network comes from outside the residency program, the loved ones who keep you grounded and remind you of a world outside medicine. Because we live in separate states with stay-at-home orders, I did not see my husband from the end of February until the time restrictions began to lift at the end of May. My parents are both in their sixties, and my brother is immunocompromised, so it has been months since I have seen them in person. We are blessed to have videoconferencing technology, but the only humans I physically touched for two months were my patients.

All of this leads to a sense of isolation and loneliness that is compounded by reports of protesters disobeying social distancing measures and claiming the virus is a hoax. It makes me feel more frustration and sadness about the missed loved ones, celebrations and “my old life.” I know I’m doing the right thing, but it is frustrating when others don’t recognize it.

#OneGoodThing

Where’s the good? I’m finding ways to cope. To move forward. To encourage others. To find one good thing each day and share it with my community.

And so, I leave you with a few good things.

While I still long for human touch, the human drive to form connections is astounding. I have reconnected with friends from a decade ago. My cousins and I speak every few weeks instead of twice per year.

If you only look, you can see fellow humans doing their part to help others: As first responders, providing food to those on the front lines, cleaning the subway, donating convalescent plasma, and traveling to the hotspots of the pandemic to provide relief. Even those who are staying home are doing what they can to quell the possible disaster that lies ahead of us.

Nothing says connection like working toward the greater good. And it makes me feel just a little less lonely.