Manpreet Basuita is a first-year resident in internal medicine and William Silverstein is a third-year resident in internal medicine, both at the University of Toronto.
Our day as on-call medicine residents began like any other. After morning teaching, our hospital’s Medical Director of Infection Prevention and Control (IPAC) addressed residents and faculty. He outlined the protocols our hospital was rolling out to investigate anyone presenting with possible COVID-19. We weren’t that worried – there wasn’t a single case reported in the country. What were the chances we would admit the first one?
That evening, we received a page from the same IPAC Director. When we answered we realized this would be a shift we would never forget. He asked us to evaluate a man with fever and non-productive cough, one day after returning from Wuhan, China. His chest x-ray was concerning for viral pneumonia which made us highly suspicious he might be Canada’s first case of COVID-19.
As we meticulously donned our personal protective equipment (PPE), we felt many emotions. Angst. Curiosity. Compassion. Anticipation. Our patient was apprehensive, and also suspected COVID-19. We did our best to answer his questions. How could we reassure him when we were just as worried – not only for his health, but also ours? We were concerned that his uneasiness was compounded by the loss of person-to-person interaction because of our masks, gowns, and face shields. How can patients feel taken care of when they don’t even know who is taking care of them?
It was all a bit surreal. Would our patient live? Did we treat him properly? Were we diligent enough with donning and doffing? Should we be around our family and friends? We worried about the implications for our health.
Four days after first seeing our patient, one of us awoke with diaphoresis, myalgias, and a fever. He tried to be rational, but still couldn’t shake the worry that he might be infected with a virus that had only been identified a month prior, with a poorly known illness course and no proven treatment. The uncertainty was terrifying. Within an hour, he was on the phone with the IPAC Director who confirmed there had not been any breaches of donning and doffing during the resident’s clinical assessment. He recommended that the resident self-isolate pending the results of a nasal swab. The swab was delivered to his home. Despite ordering hundreds of these tests, he had never done one on himself. Thank goodness for instructional YouTube videos! How many other experiences had he subjected his patients to without knowing what they are like?
Hours later, his phone rang. He hoped for the best and prepared for the worst. He swiped the bar on his iPhone. “You have Influenza B!” the IPAC Medical Director exclaimed. “This is not usually desirable, but in this case, I hope you are reassured.” A crushing weight had been lifted. He didn’t have COVID-19! Four days and a course of oseltamivir later, he returned to work. His initial excitement was sobered by the uncertain reality our patient was facing. What he would have given to deliver our patient that “good” news too. Fortunately, our patient made a complete recovery from COVID-19 at home.
As we reflect on our experience, we would like to share what we have learned. During this pandemic, healthcare providers and society alike are experiencing similar feelings of uncertainty and anxiety. This can help doctors sympathize with our patients, which should enable us to deliver more person-centred care. We are connecting to patients in ways that weren’t previously possible. In this time of chaos and uncertainty, perhaps feeling heard and being more kind is exactly the therapy that our patients (and us) need most.
As healthcare workers on the frontline of the biggest public health battle in a century, we are all too aware of the risks that we face. The lack of control over what each day brings is palpable on the wards. We are worried about our friends, family, and colleagues. Underpinning all of this is a sense of vulnerability – how can we care for someone with a new disease with no proven treatment? Will we run out of ventilators? Maybe even PPE supplies? Some of us may even become critically ill from COVID. While the ambivalence of what the future holds during this crisis can be unbearable at times, it also reminds us of the immense privilege it is to be a physician, taking care of people who need our help. It is humbling.
We wish you all luck. Stay healthy. And – please – wash your hands.
We thank Drs. Lynfa Stroud and Jerome Leis for their support throughout this pandemic, as well as their editorial assistance in writing this piece.