I would like to blame my prolonged absence again on COVID-19. To be fair, it does dominate about 95% of my work life and probably 50% of my personal life, but honestly, I’ve just gotten lazy.
The last time I published here was March 5, where I started with “it seems like we are inevitably headed for a massive, global pandemic.” For once on this blog, I get to say I WAS RIGHT ABOUT SOMETHING IN RESIDENCY! No attending or dad can correct this.
As of this writing, my area’s daily hospitalization rates look like a Space-X rocket launch. We’re out of ICU beds, regular beds, gurney, cots, sleeping bags, and patience. The worst is somehow yet to come. I am coping with this impending doom by playing with my dog and, finally, writing again.
2020 has lasted approximately eleven years, and to sum up all the darkly comic events of the past eight months would take a Netflix special (I’m available!). Here are a few personal and global highlights:
Immediately before the pandemic hits full force (actually, right around the time I wrote that last post) I was elected one of the chief residents for the upcoming year. For the nonmedicals, a chief resident is supposed to be:
- a reflection of clinical skill and readiness, to the point where a chief can take on additional responsibilities
- an administrative workhorse with decent organizational abilities
- a leadership middleman that conveys resident concerns up the chain and leadership concerns down it.
In reality, I possess none of these qualities. Truth be told I’m an average resident, although I do have a filing and color-coding system on my computer that would make my grandmother proud. I suspect I was selected chief resident because I sought the job. Also because the program leadership probably felt bad that residency turned me into a depressy sad Jewish Eeyore for most of second year, and I made sure that everyone knew it.
My first responsibility as a chief was to attend a conference of residency leadership people (program directors and assistant program directors, other chief residents, and program coordinators) to learn and network from each other. This conference was in mid-March of 2020. In New York City. In the beginnings of the pan-
You see where I’m going. It didn’t end well. Although the conference turned out to be a super-spreader event (yes, really), at least none of us ended up in a refrigerated meat truck.
Upon my return, my very first job as a chief resident was creating a massive backup plan that we thankfully never used, called “CoronaGeddon Jeopardy.”
Jeopardy (RIP Alex Trebek) is just a medicine name for backup, since we narcissists never admit to actually requiring help. The CoronaGeddon pool went eleven residents deep in anticipation of a bunch of us falling ill with COVID-19.
Everyone loved my plan, especially the part where I got to tell the entire residency they weren’t allowed to go anywhere farther than an hour outside the city. I immediately become the most beloved chief.
As the virus took hold, you may remember public health messaging to stay at home unless you were violently ill and truly required medical attention. This was probably good advice in general, since the American hospital is probably the single worst place in the modern world to be in a pandemic.
Unexpectedly, people listened to this advice. No one expected people to actually listen (in fact, it turned out to be the last time this year people did).
ER patient volumes cratered and hospitals actually cut down on ER staffing, furloughing or firing ER doctors. This created a rough job market for new graduates and instilled a whopping dose of fear in our class, since we would be entering that market just a year later.
So, being the scared little child that I am – especially after my initial post-college job search resulted in a yearlong stint working for a borderline sociopath in an office full of militant vegans* – I decided to apply for a fellowship in toxicology. This had two major benefits:
- I would gain additional training in an area of interest, broaden my career arc and post-fellowship options, and turn myself into a more well-rounded physician;
- I get to hide out from a real job for two years while the pandemic blows over.
*not an exaggeration
I was lucky enough to match to fellowship recently. My first job, and the additional training that comes with it, is secured for at least two years. And yes, mom, I will continue to write.
My suspicion is that ultimately, my class’ fear of a depressed job market is needless. The reason for furloughs and cutting shifts is that the financial success of a hospital depends almost entirely on elective procedures – regularly scheduled operations, in other words. As the pandemic floods hospitals, they must cancel these procedures to free up beds. COVID volumes are likely to drop by summer enough to allow hospitals to make money again, restoring shifts and fully staffing money losers like emergency departments.
A more proximate fear now faces us all. Because we Americans possess the same degree of collectivism as a sack of onions, we traveled and gathered for Thanksgiving and spread COVID around like mashed potatoes. As of this writing, my region is experiencing its worst surge of patients yet. Hooray! Hope the turkey stuffing was worth it. I heard we got our refrigerated meat truck delivered to the back of the ER yesterday.
It’s for the leftovers, you morbid jerk.
On the flip side, the vaccine is here! I got my first shot yesterday. The incredible speed with which an effective vaccine was produced is an absolutely mindblowing, historic achievement. It’s a genuinely outrageous triumph of science on par with the polio vaccine, the discovery of pasteurization, and ether anesthesia. It’s probably second only to the discovery of penicillin and the concept of vaccination in general in terms of its rank in the science pantheon.
If you think this hyperbolic, consider this:
- Virus discovery to vaccine distribution was barely a year from start to finish
- The vaccine uses a totally novel method (mRNA enveloped in lipid micelles made of nanoparticles, and if you understand that, you’re a nerd) to stimulate an immune response, never before used in humans
- Research was supported by the U.S. government, a kakistocracy that employs science deniers, actively spreads COVID misinformation, and whose boss possesses the intelligence of a stick of rancid butter
The fact that some enterprising scientists, as part of a huge and fragmented global effort, managed to cobble together a functional vaccine in twelve months is bananas. These vaccines will unequivocally save millions of lives.
Anyway. I received my vaccine yesterday. The sense of psychological relief was instantaneous. Never mind that I knew, logically, that I would not mount any kind of serious immune response for 48 to 72 hours. I was ready to rip my mask off right then and run to a 40,000-person celebratory ragefest. I’m ready to party like it’s 2019 (none of us will be partying like it’s 2019 anytime soon).
Over the next few weeks, most of the ER staff at my hospital will get vaccinated, as we should. After us and the ICU staff, the rest of the healthcare workforce and nursing home residents are next in line (I think).
I understand the public skepticism and fear over the vaccine. The government has done an excellent job of making the situation far worse than needed, so I understand if you don’t trust public health officials when they tell you it is safe. I understand the fears over a novel vaccine concept – the mRNA delivery vehicle – and the speed at which the drug garnered FDA approval.
Get the vaccine when it’s offered. I have to go staff the meat truck next week, and I would rather not see you there.
Here’s a picture of Otis.