"I relish returning to the wards"

On Saturday, March 14, I spent twelve hours at New York Presbyterian Hospital, A third-year medical student on the vascular surgery service, it was my weekend call day. The day started with an emergency: a woman, who was at risk of acute limb ischemia, needed an operation to re-perfuse her leg right away. Not realizing the gravity of the situation, she had not called her son, and as we made our way to the operating rooms from the preop area, I noticed forgotten hair berets. In what was normally a confusing yet, predictable route, the anesthesiologist and I pushing the hospital bed found our path blocked; there was construction underway. After discovering an alternate passage, we arrived to the OR suite, only to find the surgical masks usually plentiful had been locked away. Once the operation was done and the pulses palpable on the woman’s previously cold foot, I went back to the floor to check on patients I’d seen throughout the week. I pretended as if nothing were out of the ordinary—not the masks, the construction, or the many contact isolation signs I’d passed in the hallway. I alerted the resident-on-call to one postoperative patient’s painful and swollen knee (gout, quite possibly), I said, ‘See you Monday!’ to Ms. B, an elderly woman recovering from a skin graft, and ‘Hasta lunes!’ to Mr. P, a young man about to undergo a limb amputation due to complications of diabetes. It was my hope that my words which implied a common future carried weight. In the preceding weeks as news of the novel coronavirus spread from China, to northern Italy, where my sister was studying, to New York, and then to our Intensive Care Unit, I much preferred being within the hospital than outside. Perhaps this preference was adaptive—I was required to be there almost 90 hours a week, and why not choose to be in a place generously equipped with hand sanitizer elsewhere in short supply? But if I’m being honest the reality was less pragmatic: the hospital is a city where I felt safe because I was ‘in the know’. Each day in the preop area I queried my classmates on anesthesia—the team in charge of intubations—for the latest scoop; over the operating table, I pried my attendings—surgeons in regular contact with hospital administration—for any news. This insider knowledge was an emollient for my mind, even as my skin fissured dry from practicing obsessive hand hygiene. That Saturday I learned elective surgeries had been cancelled to make beds available for COVID patients, so it came as little surprise when I received an email from the Dean the following day, March 15, announcing that all clinical education was suspended. What was a surprise was the overwhelming sense of loss that I felt in light of this communication. I missed my patients--individuals with whom I felt a connection created by our participation in the pre-round, a comical routine which occurs in the intimate, odd hours each morning; strangers who had become warm constants in a blur of long, adventurous days; patients like Ms. B or Mr. P, who at first merely a name, age, and premorbid conditions, had become through caring interactions, embodied, fellow humans with feelings, anxieties, hopes and dreams. Since then, I have gone through various stages of grief--from disbelief to acceptance--missing the hospital, from which I am excluded due to an administration's fear of liability, to finding meaning in teaching and research outside my normal medical student routine. When I reflect upon past patient encounters, I am motivated to keep my clinical knowledge fresh. Although sobered by the insensible losses our community has experienced in the past two months, I relish returning to the wards in a near-future era when donning and doffing PPE sets the scene. - Fourth year medical student at Columbia University Vagelos College of Physicians & Surgeons

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