Editor’s Note: In November 2019, we published an interview with Michael Duong, a second-year medical student at the University of Pennsylvania and a caregiver for his grandfather, who is living with Alzheimer’s disease. After UPenn canceled in-person classes for the remainder of the year, we asked Michael to reflect on his personal experience of the last two months.
By Michael Duong
While the sun shone brightly outside, an unsettling stillness filled the hospital floors. I could hear my footsteps echoing, which normally only happens on night or weekend shift. It was mid-March here at Penn and outpatient clinic visits, elective surgeries and emergency department visits were becoming less frequent. I saw firsthand the concern for COVID-19 ramping up over the course of two months, on my emergency medicine rotation in February and then my psychiatry rotation in March. At that time, medical schools across the country told us students to stay home and flatten the curve, even though there were split opinions. Some of us wished to serve on the frontlines and continue learning in person. Others wished to help limit exposure to COVID-19. Both perspectives were valid and we waited anxiously to see how medical schools would respond, what provisions would be provided for our education. How could we help the medical community when we just started our clinical learning? How would our learning be affected?
Through creative rearrangement of our education, students gained opportunities to start online elective courses, such as anesthesia, geriatrics, and neurology. Some courses were already structured this way so the transition was relatively simple. For other courses, professors had to quickly design a comprehensive online educational plan. We are extremely thankful to our professors at Penn for their innovation and quick turnaround time, continuing to support our education and endeavors. The caring and timely response our school has mobilized reinforces my pride as a Perelman student. Our education system has protected and supported us, giving us the room to grow as students during this pandemic. I am also grateful of our student body for collecting personal protective equipment (PPE; like masks and gloves), mobile devices and supplies and volunteering on many fronts.
The fear of contracting and spreading illness as a student is valid, and so is the fear of patients contracting the virus while being in the hospital. While telehealth communication platforms have helped to reduce fears by limiting hospital visits to serious conditions, people that are hospitalized may be uneasy. From my psychiatry rotation, I met patients with delirium or neuropsychiatric conditions, who were very agitated about being in a hospital and possibly contracting coronavirus. I remember one patient, laying calmly in bed. When the team asked, “How are you feeling?”, the patient immediately became animated and yelled, “I’m worried about the coronavirus! You think I have it, but you all are the ones who have it!” Reflecting on this, I see the validity in the palpable emotion that pandemics can elicit, especially in people with neurological and psychiatric illness.
Due to cancelled clinical rotations, students were able to help flatten the curve and hopefully with less students around, patients can be more at ease about exposure. Many of us were able to go home to continue online training but also spend time with family, which I am enjoying. While at home, I am also able to utilize knowledge from medical school to answer my family’s questions. ‘’What is the difference between ‘a’ coronavirus and ‘the’ coronavirus in terms of COVID-19? What has medicine done to treat SARS and MERS? How far away are we from having an FDA approval for an anti-viral medication and vaccines for COVID-19? This person has a sneeze, that person has a runny nose. Is it allergies or coronavirus?”
Caring for my loved ones lead us to some difficult questions. I’m a caregiver for my grandfather with Alzheimer disease. Possibly a silver lining of his dementia, grandpa is unaware of the turmoil that the pandemic has caused. However, my family and I now utilize PPE when caring for him. In general, older adults are at greater risk of complications of infections, including COVID-19. I have an older relative who recently had a non-COVID health problem that required hospitalization, and it was an admittedly stressful discussion. She had experienced several episodes of chest pain that felt like immense radiating pressure, without any shortness of breath, coughing or vomiting. She had prior heart arrhythmias, but these episodes felt different. I was concerned about a cardiac issue such as a heart attack, but she was very worried about going to the hospital and potentially getting COVID-19. As a family, we had an open discussion but quickly came to a consensus that the risk of COVID did not outweigh the benefit of going to the hospital to work up the cardiac chest pain. We quickly went to a local hospital.
Upon arrival to the emergency department, the first thing that staff did was ask screening questions.
Nurse: Are you worried about coronavirus?
Me (helping to translate): No, it’s chest pain.
Nurse: Is the chest pain associated with cough, shortness of breath or abdominal pain?
Me: No, just chest pain.
Nurse: Did you go anywhere outside the country in the last month? Were you or anyone you know exposed to COVID recently? Anyone close to you diagnosed with COVID recently?
Me: No.
Then, we entered the local hospital and had our temperatures checked. Although the emergency department was fairly empty, the atmosphere was fairly tense. Ultimately, the care providers excluded a diagnosis of heart attack through cardiac enzyme tests and electrocardiography, and her symptoms were treated. However, she had to stay overnight for repeat tests and was subsequently anxious about it.
Understandably, COVID-19 has instilled a lot of apprehension among patients, the medical community and the public. However, this fear has driven us to develop necessary precautions to keep us safe. Ultimately, I am hopeful and proud of the medical community on the front lines. Now more than ever, I am reminded by lines of an English poem from Samuel Rogers.
The Good are better made by ill,
As odors crushed are sweeter still.
Adversity spurs growth. Learning about and treating illness can help everyone. In a matter of weeks, Penn Medicine and the medical community as a whole has strengthened telehealth capabilities, rallied efforts to gather resources and developed virtual education for future healthcare professionals. I am thankful as a caregiver and doctor-in-training as the medical community rises to face this challenge together.