The Panicked Medical Student
March 4, 2020:
“This is Mark, he’s our 43 yo male with aspiration pneumonitis. He is on day 3 of Unasyn. When I saw him this morning, he was satting to 96% on 4L, RR = 25, T = 38.2, Pulse = 105, BP = 158/102. On exam, he has increased work of breathing, lungs sound the same as yesterday’s exam; bilaterally there are diffuse wheezes with scattered ronchi. There are bilateral opacities on CXR today, changed from unilateral findings yesterday. Bacterial cultures all negative. Plan is to continue broad-spectrum antibiotics while weaning oxygen”
After Bill, the intern, finished presenting Mark to the team on rounds, the whole team, all 6 of us, entered his 12 by 8 foot room in the emergency department to listen to his lungs. One by one, we lined up, sanitized our hands, gloved up, placed a bare stethoscope on his back, listened to his wheezes, exited the room, removed our gloves, sanitized, and dangled our dirty stethoscopes back over our neck.
After the choreographed dance, Maria, the senior resident, pulled up the CXR on a computer and asked, “It’s worsening with new bilateral findings. Can you guess what I’m thinking? What am I concerned about?”
“ARDS,” the team whispered as a choir.
“Right, exactly,” she said. “I think it’s time to reconsider what’s going on. This patient has a really great story for aspiration pneumonia; he’s coming from a group home and one of the staff members reported a choking episode right before this all happened. If that’s the case, though, he should be getting better on antibiotics, not worse.”
I get lost in the conversation between the attending and the rest of the team about what to do next. Microorganisms and antibiotics go over my head. Maybe I should have watched Sketchy after all. Instead, I start daydreaming about yesterday’s Grand Rounds presentation on COVID-19.
Afterwards, Maria asked us medical students if we had any further questions about the patient. I nervously asked, “At what point should we test for COVID-19?”
She chuckled. “That’s a good question. I’m not sure”.
Ryan, the fourth year medical student on the team, quickly pulled up the picture he took from Grand Rounds about the indications to test for COVID-19. “Fever, high respiratory rate, poor saturation on room air, tachycardia, or unexplained ARDS. He technically meets all the criteria.”
Maria hesitated. “Well, he has no travel history. We’ve asked the group home staff multiple times, and he hasn’t been anywhere”.
Travel history was not mentioned in the indications, and there were thousands of cases in America already without a travel history, the closest one being just a 4-hour drive south. Mark met all the testing indications, yet no one wanted to test him.
It was only my 4th day of my Medicine Clerkship, but I had already brought up my anxiety about COVID-19 to the team multiple times. Every time I talked about it, the team kindly brushed it off with comments like “Everyone will be fine, just wash your hands and don’t touch your face,” or, “Flu kills more people. Worry about that instead”. I had already established myself as the panicked medical student that was giving into the so-called “mass hysteria” of COVID-19. I could already predict that my evaluations would say things like, “Anne should have spent more time reading about her patients instead of reading fake news stories about COVID-19.”
At the end of the day, Maria asked the whole team to meet in the resident room. When I walked in, she was sitting on the couch with panicked eyes. “So,” she started explaining, “It was just brought to my attention that one of the nurses at Mark’s group home just came from Italy and now has flu-like symptoms. We’re not sure if the nurse had direct contact with him or not, but Dr. Lyons is currently at a big department meeting to decide whether or not we should test him for COVID-19. If we test him, our whole team might have to be quarantined for some time.”
My heart sank. How many people have interacted with Mark in the hospital? How many times did I put my stethoscope on his chest? How many times did I sanitize my stethoscope during the day? How many times did I touch other people with my stethoscope? Will I have to be quarantined like the Dartmouth residents for two weeks?
“But, I’m really not sure if the nurse had any contact with Mark. They’re trying to figure that out now.”
I nodded to express my understanding. I wanted to advocate for testing, but I also didn’t want to be stuck in my room for 2 weeks. Without even thinking, I said, “So, I know this isn’t evidence based,” and with that phrase, I could feel my team members rolling their eyes at me. They were probably thinking, “Here goes Anne, again, with her mass-hysteria anecdotes.”
But, Mark needed this testing, so I continued to share even though I had already played the girl who cried wolf and whatever I said about COVID-19 to the team was probably going to be a waste of my breath. “The story is from the NYTimes, which I regard as a trustworthy source. The first two people that tested positive in Seattle, the first one being travel associated, and the second one a month later without a travel history, did not know each other, and had no contact with each other. Yet, when scientists sequenced their viruses, they saw that the viruses had the same genome, suggesting that somehow, through 100 degrees of separation, that the second person acquired the virus from the first person. Thus, I’m not reassured by the fact that the nurse having no direct contact with Mark means that he doesn’t need to be tested.”
“It’s just that sending the test is a big decision, and it means that we all have to be quarantined. That would knock out like 10 employees,” explained Maria.
Well, that’s the point, I thought. I didn’t understand the logic.
March 22, 2020:
10 people quarantined for two weeks? If only.
by Anne Zhang, CC3
*All names, except mine, have been changed to preserve anonymity.
“This is Mark, he’s our 43 yo male with aspiration pneumonitis. He is on day 3 of Unasyn. When I saw him this morning, he was satting to 96% on 4L, RR = 25, T = 38.2, Pulse = 105, BP = 158/102. On exam, he has increased work of breathing, lungs sound the same as yesterday’s exam; bilaterally there are diffuse wheezes with scattered ronchi. There are bilateral opacities on CXR today, changed from unilateral findings yesterday. Bacterial cultures all negative. Plan is to continue broad-spectrum antibiotics while weaning oxygen”
After Bill, the intern, finished presenting Mark to the team on rounds, the whole team, all 6 of us, entered his 12 by 8 foot room in the emergency department to listen to his lungs. One by one, we lined up, sanitized our hands, gloved up, placed a bare stethoscope on his back, listened to his wheezes, exited the room, removed our gloves, sanitized, and dangled our dirty stethoscopes back over our neck.
After the choreographed dance, Maria, the senior resident, pulled up the CXR on a computer and asked, “It’s worsening with new bilateral findings. Can you guess what I’m thinking? What am I concerned about?”
“ARDS,” the team whispered as a choir.
“Right, exactly,” she said. “I think it’s time to reconsider what’s going on. This patient has a really great story for aspiration pneumonia; he’s coming from a group home and one of the staff members reported a choking episode right before this all happened. If that’s the case, though, he should be getting better on antibiotics, not worse.”
I get lost in the conversation between the attending and the rest of the team about what to do next. Microorganisms and antibiotics go over my head. Maybe I should have watched Sketchy after all. Instead, I start daydreaming about yesterday’s Grand Rounds presentation on COVID-19.
Afterwards, Maria asked us medical students if we had any further questions about the patient. I nervously asked, “At what point should we test for COVID-19?”
She chuckled. “That’s a good question. I’m not sure”.
Ryan, the fourth year medical student on the team, quickly pulled up the picture he took from Grand Rounds about the indications to test for COVID-19. “Fever, high respiratory rate, poor saturation on room air, tachycardia, or unexplained ARDS. He technically meets all the criteria.”
Maria hesitated. “Well, he has no travel history. We’ve asked the group home staff multiple times, and he hasn’t been anywhere”.
Travel history was not mentioned in the indications, and there were thousands of cases in America already without a travel history, the closest one being just a 4-hour drive south. Mark met all the testing indications, yet no one wanted to test him.
It was only my 4th day of my Medicine Clerkship, but I had already brought up my anxiety about COVID-19 to the team multiple times. Every time I talked about it, the team kindly brushed it off with comments like “Everyone will be fine, just wash your hands and don’t touch your face,” or, “Flu kills more people. Worry about that instead”. I had already established myself as the panicked medical student that was giving into the so-called “mass hysteria” of COVID-19. I could already predict that my evaluations would say things like, “Anne should have spent more time reading about her patients instead of reading fake news stories about COVID-19.”
At the end of the day, Maria asked the whole team to meet in the resident room. When I walked in, she was sitting on the couch with panicked eyes. “So,” she started explaining, “It was just brought to my attention that one of the nurses at Mark’s group home just came from Italy and now has flu-like symptoms. We’re not sure if the nurse had direct contact with him or not, but Dr. Lyons is currently at a big department meeting to decide whether or not we should test him for COVID-19. If we test him, our whole team might have to be quarantined for some time.”
My heart sank. How many people have interacted with Mark in the hospital? How many times did I put my stethoscope on his chest? How many times did I sanitize my stethoscope during the day? How many times did I touch other people with my stethoscope? Will I have to be quarantined like the Dartmouth residents for two weeks?
“But, I’m really not sure if the nurse had any contact with Mark. They’re trying to figure that out now.”
I nodded to express my understanding. I wanted to advocate for testing, but I also didn’t want to be stuck in my room for 2 weeks. Without even thinking, I said, “So, I know this isn’t evidence based,” and with that phrase, I could feel my team members rolling their eyes at me. They were probably thinking, “Here goes Anne, again, with her mass-hysteria anecdotes.”
But, Mark needed this testing, so I continued to share even though I had already played the girl who cried wolf and whatever I said about COVID-19 to the team was probably going to be a waste of my breath. “The story is from the NYTimes, which I regard as a trustworthy source. The first two people that tested positive in Seattle, the first one being travel associated, and the second one a month later without a travel history, did not know each other, and had no contact with each other. Yet, when scientists sequenced their viruses, they saw that the viruses had the same genome, suggesting that somehow, through 100 degrees of separation, that the second person acquired the virus from the first person. Thus, I’m not reassured by the fact that the nurse having no direct contact with Mark means that he doesn’t need to be tested.”
“It’s just that sending the test is a big decision, and it means that we all have to be quarantined. That would knock out like 10 employees,” explained Maria.
Well, that’s the point, I thought. I didn’t understand the logic.
March 22, 2020:
10 people quarantined for two weeks? If only.
by Anne Zhang, CC3
*All names, except mine, have been changed to preserve anonymity.
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