Feature writing

Coronavirus

‘This is what we signed up for’: meet the med school grads fast-tracked to the coronavirus front line

Website:
The Daily Beast

Date:
April 3, 2020

Med school students have graduated early to head to the coronavirus frontline. They tell Tim Teeman about meeting their “moral obligation,” fears, and why they don’t feel “brave.”

On Tuesday, three months earlier than he expected, Grant Lewandrowski officially became a doctor, ready to serve in whatever way is required at the front line of coronavirus treatment at a Massachusetts hospital.

“As a patient, a health-care provider, or staff, we all have fear,” Lewandrowski told The Daily Beast. “If you don’t have an element of fear, you have a few screws loose. But despite having some fear, this, as medical students, is what we signed up for. It is the purpose we have, and the calling we follow.”

Lewandrowski, who comes from a proud family of doctors, is one of the class of fourth-year medical students at the University of Massachusetts (UMass) Medical School who have graduated early to enter the hospital work force, joining other fast-tracked graduates from Harvard, Tufts, and Boston University medical schools in Massachusetts, and the Grossman School of Medicine at New York University, Columbia’s Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine in Manhattan.

According to ABC News, other initiatives to fast-track medical school graduates are being considered in California, Illinois, Michigan, and Virginia. However, some states like Washington are resisting the move. Licensing requirements and concerns over the availability of personal protective equipment (PPE) have been cited as concerns.

The fast-tracked grad students in New York and Massachusetts will most likely, at least at first, be providing backup to help ease the pressure on frontline coronavirus-focused medics and nurses. But the high-pressure, potentially perilous environments they are about to enter have made the early graduating students confront the raw meaning of their professional calling, as well as issues around their own safety and mortality—and what it will be like to see grave illness and death on a large scale.

“I am preparing for the idea of many people being very sick and potentially dying without family members present,” one New York City graduate, who requested anonymity, told The Daily Beast. “I think the emotional toll of watching someone die and not be able to give them the death they would ordinarily want with a family member present or whatever else they wanted—not to be able to give them those things, and for it to be out of your hands over and over again is something I am preparing for.

“It is something I would imagine to be very challenging. But the current residents feel protective of us and are ready to help us in that process of heavy emotional toll.”

“I think a lot about my own presence when it comes to patients,” Gaby Mayer, a Grossman graduate, told The Daily Beast. “It can be easy, when things are busy, to flit between rooms and run in and out because you want to give all patients an adequate amount of attention. But it’s important to inhabit the mind-set of a patient, especially one who is very ill or dying, who may feel alone or be alone. We are the human connection for so many of these patients. A lot of doctors feel that. I have seen doctors talk about it on Twitter. Sitting with patients in those moments I imagine may be the hardest thing to take home.”

Michael F. Collins, M.D., chancellor of UMass Medical School, told The Daily Beast that the decision to offer the students early graduation to serve on the coronavirus frontline “weighed on my mind quite heavily.” But he and his staff observed the imminent, likely surge in patients and decided to act sooner rather than later when the surge was upon them—and facing the likelihood of a sudden shortage of staff because of sickness or enforced quarantine.

“The time to think about this is not on the day of the surge but in advance. Also, many of students themselves called me and said, ‘Chancellor, we’re just sitting at home watching TV. We could get to work. What about using us?’”

Initially, Collins thought the graduates could staff health-related phone lines but then decided they should be in the hospitals they had trained in, as they knew the staff, systems, and protocols so well. He is “beyond proud” of the graduates but also hopes “this is a once-in-a-lifetime experience that we never have to go through again.”

Collins said he had recently participated in a call with a doctor from Italy, “who said he will be forever haunted for the rest of his life by the decisions he has had to make. He reflected on one 72-year-old guy, who was sick, had diabetes and hypertension, and who he put on a ventilator. Later that day, a 31-year-old pregnant woman was admitted, and he took the ventilator off the 72-year-old guy and gave it to her. The guy died shortly thereafter. He said, ‘These decisions will haunt me for a lifetime.’”

UMass students may not see death so up close, but if they do, Collins said he feels they “are up to it. It is inevitable they will see very sick patients and that will weigh on them. It is never easy to see any patient dying. But many have told me that they recognize the privilege of being with patients at this time.”

 

“Yes, doing what I’m doing could lead to my demise. I’m still wrestling with that”

Many people think doctors and health-care workers are brave. The word rankles some of the graduates.

“I don’t feel brave, I would say I feel scared if I had to describe a level of emotion,” said a New York graduate with a dry laugh. “But it doesn’t matter if I feel scared. It’s the right thing to do. I feel morally committed to that, whether I am scared or not. That moral commitment trumps everything else. That’s professionalism to me. That’s what defines professionalism.”

Lewandrowski once served in the military. He has close friends who still do. “You see a very similar mentality with those in military service, first responders, law enforcement, and health-care providers. Some news stories glorify what we do. For us it’s the day to day. I don’t think we’re brave. I think sometimes it works out that way. I see incredible acts of bravery by physicians, but for them it’s just doing their job. That’s what it means to be professional.”

All the students The Daily Beast spoke to said joining the front line defined the calling that underpinned their chosen careers.

“What I have learned from medicine is that it’s your moral obligation—maybe as a person and certainly as a physician—to do all you can for the greatest number of people you can,” a New York graduate said. “This is a situation where a lot of people have a lot of need.

“Who could possibly be more suited to address that than someone who has been taught, and trained, for years to think about solving as many problems as you can at once for as many people as you can? I couldn’t imagine a situation that requires that level of thinking more than a pandemic that’s really straining all our hospital systems.”

The graduates have had to talk to their own families and loved ones about issues patients themselves confront, and think deeply about their own futures.

“It’s important as medical students to set the tone when it comes to having end-of-life conversations,” said Gaby Mayer. “I have had those conversations in the past with my family and have certainly recently reminded them of those things, communicating my logistical preferences, like what would happen if I needed intubation. My family understood, and it was good. If this should happen, the other person should know what to do and not have the uncertainty of not knowing what my wishes were.”

As a medical student, Mayer did a rotation in an intensive care unit. “Having a loved one who is very ill is always incredibly difficult, and it is even more difficult when it is not known what their wishes are. Taking that tension away is something I wanted to do.”

A New York graduate said, “There was definitely a lot of agonizing based on the fact of whatever exposure I may have to patients in the hospital will impact my ability to see my family and my ability to live my life with my loved ones as I might otherwise do. I was certainly struck by the idea that I might contract coronavirus if I have not already.

“Statistically, as a young person, I should be fine, but maybe not. I will probably not be able to see my elderly parents or my immunocompromised relatives for quite some time. That’s quite sad, but I know that it’s safer for them. I know my parents will be OK without me, whereas the hospital may not be OK without people there to help. The discussions were not difficult because they were very necessary,” the New York student said.

Chancellor Collins’ apprehension about “sending our folks to the frontline” is based “on the notion that we could put these young people, who I am very fond of, in harm’s way because of inadequate PPE.”

But Collins believes that by the time the graduates take on their new roles, PPE—“enough, not plentiful, not perfect, but not absent”—will be in place. He also hopes more testing will also be available by then. “What defines us as a noble profession is that we go towards the sick, not run away from them,” said Collins. “I tell the graduating students here to hold the hands of the patient with esteem, because it’s a privilege for us to care for them. It’s not a privilege for them to be cared for by us.”

The era of coronavirus has reminded Chancellor Collins of conveying a positive result, for the first time in his career, to an HIV patient in Texas in 1984, in the early years of the pandemic when confusion, fear, and prejudice were so prevalent. Collins remembers putting his arm around the male patient’s shoulders, holding him as he cried, and staying with him through his hospital treatment.

Now, as then, Collins said, “is an extraordinary moment in medicine and an extraordinary moment to bring out the extraordinary in people. If people stay safe, we will get through it, and my hope is we will be stronger on the other side.”

A New York graduate told their parents they would likely not see them for many months, because as the student eventually transitioned to their expected residency, that would also involve contact with COVID-19 patients.

“My parents were very sad to hear that, but it seems like a small sacrifice. For our relationship and their safety, it’s the best thing. I certainly have been considering my own mortality a lot more these days, as probably everyone has, not just doctors and nurses. I do have some things in the back of my mind I should probably write down. I have reached the first step of thinking about it, but I have not yet legalized it.”

Blake Foster, a fourth-year UMass medical student who is not graduating early but about to enter his fifth year with a view to specializing in emergency medicine, will also soon be heading to support medics in a Massachusetts hospital. When we spoke, he and Lewandrowski had just been helping build a 250-bed field hospital in the DCU Center convention center in Worcester, Massachusetts.

“These difficult conversations are happening all around the country, whether you work in health care or not,” he told The Daily Beast. “For those of us seeing patients on the front line, increased risk comes with increased responsibility, and it’s important not to have unnecessary contact with loved ones for the duration of the pandemic.”

Foster said that when he first heard of coronavirus two months ago, he assumed, like many young people, it was a “disease of the old. Then I looked at more and more cases. It affects everyone. There is no shortage of 25-year-old athletes intubated in the ICU. So yes, I have been forced to confront my own mortality. Yes, doing what I am about to do could lead to my demise. I am still wrestling with that and thinking about it. But this is a risk inherent to my profession, coronavirus or no coronavirus. A patient could be violent with me, or infect me with something else. This is a risk inherent to our profession.”

The graduates’ parents understand “what their children have signed up for,” said Chancellor Collins. On the first day of medical school he tells parents, “The relationship you have with your child is about to change forever because, as they become a doctor, you will start to ask them things (about ailments and illnesses) that you were responsible for once.”

The parents have told him how proud they are of their children; and pride, for Collins, is an “inspiring” feeling of this moment, as shared by so many fighting coronavirus in whatever way they are—whether medical staff, shop workers, cleaners, and grocery store owners.

 

“I think to have some baseline level of fear is good to motivate me to maintain safe behavior in the hospital”

This fast-track graduation, and coronavirus-related journey, is not what the students-soon-to-be-medics had been expecting. A New York City graduate said they would have been preparing to leave New York to begin their residency in July, in psychiatry. But soon they will start as an internal medicine intern at a New York City hospital.

Chancellor Collins said typically this post-graduation time for medical students was a breathing space to travel, rest, maybe get married, and generally prepare for residencies beginning in the summer.

But even graduation this year was not normal because of social distancing. “I don’t really have nightmares, but if I have one nightmare it would be about giving a speech at a graduation ceremony and no one coming,” Collins said, laughing. “And this year, that is exactly what it was like. It was just the dean and myself in an empty room with a camera, the crew outside to prevent anyone getting sick. It was a little surreal, to be honest.”

However, Collins said the students watching on their computers appreciated “the quiet dignity” of the ceremony and began preparing for their early transition to supporting frontline medical personnel.

“My school made it clear it was voluntary and that we were under no obligation to participate,” a New York graduate said. “It was up to our personal level of risk assessment and comfort if we were willing to help. But this is a big departure from normal, and they wouldn’t ask if they didn’t really need the help.

“The exact roles are not super clearly-defined. We will probably be a general support to the team, making sure the medical workflow of the hospital goes on and the health of non-COVID patients isn’t compromised.”

About the prospect of contracting coronavirus, the New York graduate laughed drily. “I don’t feel great about it, but I think to have some baseline level of fear is good to motivate me to maintain safe behavior in the hospital and follow all the necessary precautions. That fear can be really helpful. The idea of becoming ill by going into the hospital, or becoming critically ill or dying, or becoming asymptomatically ill and infecting others who then become critically ill and die, are incredibly fear-inspiring prospects. But I think it’s the professional duty of a doctor to continue to work in spite of that fear, while also letting that fear protect them.”

Another graduate in New York, who also requested anonymity, said they were “excited about the opportunity to help in a way that aligns with our education and training. These are specialized skills we have gained in training to be medical professionals for the last four years.”

The graduate said that over three-quarters of his classmates have signed up to support medical staff in New York hospitals.

When we spoke, Gaby Mayer had just helped deliver 3,095 masks to 10 New York hospitals in all five boroughs, as part of the PPE 2 NYC initiative.

Mayer is preparing to intern at one, or maybe a combination of three facilities: Bellevue Hospital, Tisch Hospital, and VA NY Harbor Health Care System. She will be joining the same internal medicine residency as she had planned to, just earlier, and anticipates at least at first working on “non-COVID floors and patients” to free up other interns who have been there for a longer period of time and may be needed elsewhere.

“I think I would be remiss not to say I am nervous and apprehensive,” said Mayer. “I am, of course. But two things put me at ease. The transition from being a medical student to an intern is a state of chaos to begin with. Yes, it will be hectic in the hospital, and much more so than normal. But there is something grounding in knowing that amid the chaos you are helping in some ways.

“It’s very centering for me and for a lot of my fellow medical students, and I anticipate it will be something I hold on to even on my worst days on the wards.”

The students are concerned about their safety, but think that by the time they enter the work force in a couple of weeks, the issues around PPE will be resolved.

One New York graduate anticipates that by the time the graduates arrive in hospitals, coronavirus practices will have “adapted” since the initial chaos of the first few weeks. The student said they were reassured by the measures protecting all health-care workers, “although it doesn’t obviate the fact that I am going into a hospital, a high-risk zone of transmission, even though I will have adequate protective gear. Right now, I feel assured. I and so many others want to support our colleagues, provide supplies, and use our training more directly to help.”

Mayer said she was “fully cognizant” of the risks to her own health. “The PPE protocols are changing in a good way. But it’s important to be realistic. I have spoken to my partner (who also works in a hospital setting) about decontamination. Right now, we have two living spaces. So, we will probably use my space to take off our hospital clothes, shower, and then use hers to live in. We will re-evaluate things as time moves on, and when I have to leave that space to find an apartment. We won’t sacrifice safety for human contact.”

For one New York graduate, perfecting the putting-on of PPE garb itself has been “one source of stress.” Another has been ensuring he keeps his partner safe when he comes home from a shift at the hospital. He has spoken to friends in similar situations and taken advice from the authorities.

“I am fortunate that my partner does not have any health risks. Right now, I will be taking my temperature twice a day and evaluating my symptoms. It will be a daily, week-by-week assessment of how safe it is for me to go home.”

Chancellor Collins recently reread a portion of Albert Camus’ The Plague, struck by how the novel’s Dr. Bernard Rieux “discovers this illness killing people, and tries to tell the leaders of the community there’s this big thing going on here. He realizes they will not listen to him, knows people will get sick, and will need someone to take care of them. That’s where we are now. People are sick, and need our help.”

“Obviously, I would feel terrible,” Collins said of the prospect of a UMass graduate contracting coronavirus and falling ill. “But I wouldn’t feel any more terrible if it happened on July 15 when they started their residency programs and when they will still be around COVID patients. We made a career and life decision to care for others. We have all put ourselves on the line. It is what we do. I am so proud of these young people. If they do get sick, you can be sure I’ll be there to make sure they get everything they need. I am very paternal. It matters to me that they succeed in the way they want to succeed.”

 

“It’s an incredible privilege. On the flip side of that privilege comes great responsibility”

The graduates will receive mental health support, and will also have the support of older and more experienced colleagues, yet will still face many professional and personal challenges.

Gaby Mayer is preparing to confront a scarcity of resources, which she has seen before in public hospitals like Bellevue and which she—like many of us—has read and heard about in relation to coronavirus care. “I don’t think any doctor wants to be in the position of triaging ventilators between patients. That’s going to be a challenge. We just want to help. You never want to be creating a value system.”

“Of course there is anxiety,” said Blake Foster. “A person could spread COVID to you, and then who you can spread it too. You just try and be conscious of your hands and where they are, and maintain proper rules. It’s all you can do.”

Lewandrowski said: “The blessings in this profession are that you get to do some of the most incredible things one human can do for another. It’s an incredible privilege. On the flip side of that privilege comes great responsibility.”

A New York graduate said, “I think New York hospitals have weathered many crises over the centuries they have existed. There are really inspiring stories to be found in the history of our city and our hospitals. I hope to be a part of one of those stories, and in order to do so you have overcome an obstacle.

“Here, the volume of patients we will see will likely be the obstacle. New York City doctors and nurses have overcome obstacles like that in the past and I think we can again. Everyone wants to provide the best care they can, and if you prioritize that over and above anything else you might get out OK.

“The physicians in the New York hospitals I know mostly feel safe and emboldened by the leadership of the respective hospital systems to care for patients. They’re working very hard, and part of the reason I feel so motivated to offer whatever assistance I can to those physicians who have remained healthy is that they will have to work harder in the coming months as more colleagues fall ill. Seeing the strain on them, and the amount of hours they’re working, is very motivating for me.”

Those physicians, the student said, have described caring for many more patients than is typical, but they have also described themselves and their teams adapting to this new normal, with more adaptation likely being required as the pandemic continues.

“God has been good to me,” mused Chancellor Collins. “I have a bit of a reverse reflex. The tougher a situation gets, the calmer I become. Hope is not a strategy, but it has been sustaining me during these times. My conviction is that we will get beyond this, and my hope is that we will be stronger.”

A New York graduate hoped the public would consider those most gravely affected by the pandemic.

“The people most impacted by coronavirus are people who are already vulnerable: the homeless, those with substance abuse disorders, and people who don’t have a stable income and housing,” the graduate said. “Those are the people who will become sickest, if they survive. I would hope people donate to organizations who support them, and please call your elected representatives on their behalf, particularly the homeless.”

The graduate welcomed the banging by people of pots and pans, and cheering from windows and balconies, for those working in health care. “I would also say, please donate to those GoFundMe campaigns helping produce PPE for people working in hospitals.”

Whatever Mayer is about to experience, she emphasized the public could make all health-care workers’ lives easier “if you stay home and keep up social distancing. It’s going to be a longer battle against this than we wanted or anticipated. Everyone making a commitment to the effort can make a huge difference.”

“It’s up to all of us, health-care providers, patients, and not-patients to act as safely as possible,” said Lewandrowski. “In three or four weeks, we can’t go back to the malls, bars, and restaurants as normal. If we do, there will very much be a second wave.”

The charged political context of this moment, and remarks such as President Trump’s that supplies may be being hoarded in hospitals, has not been lost on the graduates. But they also say they try to tune out the slurs and debate to focus on their jobs. They also hope some of the debate around PPE and crowded ICUs and hospital hallways focuses attention on long-standing needs within the medical system that need to be addressed.

“We have a shortage of physicians in this country, a shortage of primary care doctors, a shortage of psychiatrists and various other doctors,” a New York graduate said. “Having more doctors wouldn’t have prevented COVID, but it would have helped us respond better and more efficaciously and quickly. The funding available for graduate medical education has been really static for decades.

“New residencies are dependent on the federal budget, and those programs are not being given enough money, so as more medical students are competing for the same training spots, they are not able to meet the needs of physicians in our communities, especially in rural and poor communities and and communities of color. This crisis may make us realize how much we value doctors and health-care workers in general, but this crisis has been going on for a long time.

“President Trump’s comments are certainly very infuriating. He clearly has no regard for our profession, and I wish he would say nothing rather than say such inflammatory, derogatory remarks, but I also have more important things to worry about right now.”

“The reason I chose to volunteer is because I saw myself as having the skill set that I believed to be valuable to the larger health care system, which is incredibly strained right now,” said Mayer. “There is certainly a larger conversation to be had about the lack of PPE, the lack of infrastructure to support the health care system at a time of crisis, and I am looking forward to seeing how protocols and policies change because of this unprecedented pandemic.

“But at the end of day, and this is true for a lot of people working in health care, our primary commitment is to patient care and working as a team and not leaving your team members hurt and strained. That’s what I come back to.”

Whatever politicians say, Lewandrowski noted, those in medicine are determined to stay focused in the job, “to ensure the pandemic doesn’t balloon out of control.”

“We live in an incredibly divided country,” Blake Foster said. “But coronavirus and any pandemic, any virus, any disease, is blind to politics, race, religion, and creed. We have incredibly hardworking individuals in the public and private sectors trying to open the supply chains we need. We have got to make the best of it.

“I came to medical school to help people in crisis—individuals and populations. Right now, we have a global population in crisis. This is exactly what we, as doctors, signed up for, and what we are supposed to do. We are going to learn so much by the global response to this, and have more of an active response should there be there another pandemic.”

“Every generation seems to have their great struggle,” said Lewandrowski. “I see coronavirus as the great struggle of my generation. This is what we can do to leave our mark as best we can, and to serve.”