A mentor of mine once told me that I would look back on my intern year of residency and it would all seem like a blur. Those foreboding words have most definitely held true. Intern year has been simultaneously exhilarating and terrifying, and although the day-to-day memories have already started to blend together in a pool of physical exhaustion, there are certainly some moments I will never forget: being called “Dr. Henna” for the first time, performing my first spinal tap on a febrile infant, grieving with a family over the loss of their child, and most recently caring for adult patients during the COVID-19 pandemic.
The past two months have been filled with a multitude of personal and professional decisions in the face of an unprecedented, rapidly changing pandemic. Our news feeds have been flooded with descriptions of rising clinical volumes and acuity needs, with a diminishing and overworked pool of adult health care providers. When the opportunity arose at our institution for pediatric trainees to volunteer to help carry the adult clinical load, I asked myself multiple questions: Was my clinical knowledge base and judgement applicable and useful to others? Would it be appropriate and ethical to have a pediatrician provide care to acutely ill adults? What personal risks and self-isolation measures would await me after being on service? As these questions repetitively circled, harrowing stories of my peers battling COVID-19 continued to surface, making my decision to volunteer increasingly clear. Not easy, just clear.
Thanks to the tireless efforts of the residency and nursing leadership, an adult COVID-19 unit staffed by pediatric care teams came together in a matter of days. Support staff, nurses, residents, and attendings migrated from the West to the East Pavilion and prepared a new unit for operation. Patient rooms were set up, surfaces wiped down, and on the morning of the unit opening all staff members gathered to review correct donning and doffing of our personal protective equipment, commonly referred to as PPE. Before we broke off to accept our first patient, Dr. Doolittle, one of our attending physicians board certified in both Internal Medicine and Pediatrics as well as an ordained minister, offered up a blessing. His words filled the room with equal parts apprehension and determination. Shared looks around the room signaled a collective anxiety as we prepared to face off against an unfamiliar disease and care for a patient population that many of us had not interacted with in years.
As our group assembled in our new workroom, we all engaged in pediatric humor when reviewing the charts for our first adult patients. “Do you think I should look into this 74-year-old’s birth history?” “How do you think this 50 year-old-patient will tolerate tummy time (aka proning)?” These moments provided necessary levity amongst the anticipation of the relevancy of our pediatric experiences. The utility of our pediatric skill sets and values quickly became apparent as we set off to care for our first patients.
Given the no-visitor policy and strict infection control measures, we met our first patients in hospital rooms where they were isolated to minimize spread of disease. Our brief initial encounters felt physically and emotionally distanced and there was a noticeable absence of family members at the bedside. As pediatricians, we are trained to embrace family-centered models of care and have a deep appreciation and understanding of how the health of one individual can often affect the lives of many. Instinctively many of us turned to video and telephone conference calls to incorporate our patients’ spouses, partners, children, and even grandchildren into our daily bedside visits to help families stay connected and informed during such an uncertain time.
Our ability to navigate moments of familial crisis was challenged when the decision was made to accept “CMO” patients to help offload clinical volumes from other adult units. CMO was an unfamiliar acronym and I was quite confused when I was told that the next patient I would be taking care of was classified as “Comfort Measures Only.” My adult colleagues explained that while CMO patients would be dying from complications of COVID-19, our goal would be to alleviate distressing physical symptoms, while addressing the psychological and spiritual needs of the patient and their family. In some ways, these goals seemed like a perfect fit for a nurturing pediatrician, but in other ways it seemed intimidating given my pediatric training did not consist of processing death on a regular basis. In my short tenure as a pediatrician, I had experienced the loss of three patients, and each has stayed with me as a vivid memory associated with an extended period of mourning and processing of a life that was cut short.
As pediatricians, we are trained to embrace family-centered models of care and have a deep appreciation and understanding of how the health of one individual can often affect the lives of many. Instinctively many of us turned to video and telephone conference calls to incorporate our patients’ spouses, partners, children, and even grandchildren into our daily bedside visits to help families stay connected and informed during such an uncertain time.
Henna Boolchandani, MD
I was nervous when I called a patient’s family for the first time to review her end of life wishes and goals of care. I was unsure how to best navigate them through this largely uncharted disease process. I had anticipated a back and forth about the specifics of clinical care, but the conversation transformed into an expression of needing reassurance that their mother’s dignity, identity, and wishes would be respected at the end of her life. It was challenging to fight off emotions as the family went on to describe who their mother was, what gave her life purpose, and how much she meant to her loved ones. The death of a child is arguably different than the death of an adult, but my experiences on the adult unit brought to light how death across the lifespan can be a profound moment to honor an individual and reflect on moments that provide life purpose and meaning.
Intern year has definitely spiraled my life into a predictable “blur” of fatigue, stress, and self-doubt, but the COVID-19 pandemic has drastically changed the landscape of my experience as the capacity of hospital infrastructure, resources, and personnel has come under significant stress. On top of the changes at work, the pandemic also disrupted many aspects of my personal life. My fiancé and I had to make the difficult decision to postpone our upcoming wedding, something I had spent all of intern year looking forward to, while talking through what challenges our relationship would face if I decided to care for sick adult patients. Being able to volunteer on the frontlines in a time of great need was a great privilege, but also an exercise in self-sacrifice.
Although this crisis has brought to light multiple shortcomings of our current healthcare system, it has also encouraged global collaboration and extraordinary access to knowledge to allow providers to research, execute, and adapt treatment plans in an unprecedented fashion. COVID-19 may have taken over both our personal and professional lives, but it did not put a stop to the inspiring initiative of our med-peds residents and program leadership, the acts of kindness from the community that filled our days, the moments of dignity honored for our patients and families, or the moments of solidarity and camaraderie that were born out of necessity and vulnerability. I leave the COVID-19 adult unit behind with great admiration for my pediatric colleagues and hope that we can bring forward this teamwork, collaboration, and humanistic patient care approach when we return to the West Pavilion to care for our pediatric patients.
Henna Boolchandani, MD grew up in Guilderland, NY before she moved to New York City where she completed a B.S in Finance and International Business from the Leonard N. Stern School of Business at NYU. After working as an investment banking analyst at J.P. Morgan, she decided to pursue a childhood dream to become a physician and completed a post-baccalaureate program through the University of California, Berkeley. She then moved back to New York City to obtain her M.D. from the Albert Einstein College of Medicine. Henna is currently a PGY-1 resident in the Yale Pediatrics Residency Program and is actively exploring different career options and interests.