Many months have passed between my last post in this digital space and now. In the midst of turbulence (in many domains), the desire to share in this space has been minimal. It seemed silly to say (and echo others) with a statement about how challenging / frustrating / confusing it is to be a trainee during a pandemic, and so I didn’t. Now, on my day off, I wanted to take the time to reflect and to share.
Today marks the start of my second week in the pediatric ICU (PICU). The PICU is a whirlwind of a space: acuity, turnover, harrowing stories, victorious recoveries, and 28 hour calls. I have never been one to enjoy call (quite frankly, I don’t believe they benefit trainees or patients) and I did not fall in love with the PICU when I made my first pass in February of this year (just before lockdown began in Philadelphia). I can’t help but compare my life in February to my life now. In February, I planned the perfect post-call treat after each of my calls which varied between boxing/spin workout classes with friends, interactive art exhibits, dinner dates with my then-boyfriend, and poetry readings at my favorite gallery in Philadelphia. The medicine was hard but my life had such rich balance.
Post-call days are different now. I nap. I cook. I workout in my apartment. I chat with loved ones over FaceTime or Zoom. I interview for jobs (whew another long story). I nap again. I sweep. I pack my lunch for work. The end. The medicine is still hard with new features: new pathologies (MISC), new garb (goggles and masks), and new expectations. The balance feels off. Two days ago, one of my co-residents took a moment to discuss the hardship of the pandemic as providers and as humans. She shared that she felt behind. I told her that I felt the same. In what feels like a never-ending lull, it often feels like we are on “pause.” Some of us have faced grave disappointments in both the personal and professional domains. I’ll share that the cancellation of my opportunities to do global health work (and some pediatric global oncology) which impacted projected research projects and etc. felt like the universe was saying “no” to my hopes/dreams. I’ll share that the impact of COVID on the job market has caused me to question my decision to defer fellowship applications for a year. I’ll share that I wanted to accomplish far more this year than I have.
My co-resident and I made the effort to point out joys (some small, some large) from this period of time. I’ll list mine here to refer back to on a day when I need the encouragement of my own words:
For majority of the pandemic, I worked from home. That may sound like a dream for a pediatric resident who had a front-loaded PGY-2 schedule, but it was anything but that. My plans to go abroad (to Botswana) to engage in global health work were deferred; my projects and events and travels were cancelled. I can’t highlight how nice it was to be involved in the Human Side of Medicine project at that time. I believe strongly in the power of words and the importance of maintaining one’s own wellness in order to be an empathetic and appropriate provider.
Check out the interview here. Thanks for your support!
She was perched on one of the two chairs at the front desk of the apartment building lobby. There were a myriad of unsorted boxes stacked in front of her. It was a Wednesday afternoon and I was surprised to see her there, but it was another example (albeit a small one) that everything had changed in the space of the pandemic, everything including staff schedules. It was atypical for there to be one individual at the front desk. It was atypical for me to be home on a weekday afternoon. I craved familiarity: she wore the black hijab that was a staple and greeted me with the same upward lilt in her voice — “hey AJ.”
I was uncertain whether AJ was an intentional moniker or if she had forgotten my name. “Let me get your packages, you had a couple arrive today.” I smiled — it was forced. In the packages were masks that my parents had ordered on my behalf with the anticipation that they would be necessary. I had teased them but they were right. The other packages had the treasures of a good skincare regimen, delicious books, and clothing items for another time and place.
She was nine years young with a complicated diagnosis — neuroblastoma/pheochromocytoma. “Medically interesting” is the term I used as a euphemism for “I am terrified to be involved in her care.” After all, she was dying. I knew that. The team knew that. Her father refused that.
Still now I wonder, did she know?
A week later, I was in Iceland: far from PCAs, codes, and secret tears in the call room. I opened my laptop in the airport on my way home to update her discharge summary (after all, I was delinquent). Signed, just two days prior, was a completed death summary. I read it. I read every progress note. I looked through her vitals. I looked through her laboratory studies. Her imaging. I shut my laptop and boarded the plane.
I cried on the plane. The stranger who sat next to me asked me what was wrong and I said I was afraid of heights. She held my hand until take-off.
Later that evening, I found myself in my apartment complex elevator – it stopped on the 6th floor and I rolled my eyes. One floor away from my apartment. He, the father of the patient who occupied my thoughts on the duration of my flight, walked into the elevator.
“Hello doctor,” he said.
His eyes were bloodshot.
“Hello,” I said. I shifted my weight side to side; the space felt heavy with uncertainty and discomfort.
We reached my floor. “Goodnight” he said.
I rolled my luggage behind me. “Goodnight” I whispered as the elevator doors closed. Still now, I think about the words left unsaid. In the hospital, we used Google translate to navigate the divide between English and Arabic.
How do you say I’m so sorry for your loss in Arabic? And would that even be enough.