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A Letter to Internal Medicine Residents Serving on the Front Lines of the Pandemic: We See, Hear, and Feel You

Published:January 30, 2022DOI:https://doi.org/10.1016/j.amjmed.2021.12.022
      There are many professions that deserve recognition for the selfless work of front-line COVID-19 clinical care: nurses, respiratory therapists, technicians, laboratorians, physical and occupational therapists, fellows, among others. Each of you deserves an emphatic word of thanks. This letter is written to honor the internal medicine residents who have been providing clinical care on the wards, in the clinics, in the emergency rooms, and in the intensive care units— not just to people with COVID-19, but to our patients. As a versatile specialty that includes outpatient primary care as well as hospital service, internal medicine has been particularly exposed to the trials and tribulations of the pandemic.
      Dear Front Line Residents:
      No matter how you spin it, being an internal medicine resident can feel like a thankless job. Low pay, long hours, inconsistent meals, all while trying to balance the work of providing care in clinics and hospitals with the need to learn how to take care of anything that can make a human adult sick. For many of us, it is an exhausting and exhilarating time, full of quantum leaps in knowledge, attitudes, and skills. So, when the first patients with a novel syndrome of viral pneumonia that had emerged in Wuhan, China, began to arrive into the clinics, emergency rooms, and hospital wards, many of them were met by internal medicine residents who took the risk, donned the personal protective equipment, and rose to meet the challenge of providing care. Well, it's time to thank you. To the residents that have served on the front lines of the pandemic, this letter is an open letter of gratitude to you.
      Residents, we see you. During this pandemic, we have watched you take excellent care of those who have entrusted their lives to you. You have shown incredible bravery as you put your own fears aside to care for this unknown disease. We have watched you learn new ways to practice medicine and adapt to rapidly changing systems of care. During the surges, you were asked to cover extra intensive care unit and ward services; you were always there, even on your first day of internship or Christmas Day. Despite the extra clinical time, you have taken care of each other. You have taken your team to brunch after having a rough night. You have covered each other on extra shifts when colleagues fell ill. You have bought and consumed large amounts of coffee. Chief residents have dedicated endless amounts of time to surge planning and trying to maintain morale in a socially distanced world. The usual chief resident year of service took on an entirely new meaning. You all have kept your residency programs, your hospitals, and the health system afloat during what has seemed like a steady drumbeat of crisis after crisis. You have taught us so much about resilience and bravery. Residents, we see you.
      Residents, we hear you. During the delta surge, our program recognized low morale among house staff, so we organized an informal debrief session during which residents could express their feelings. You did not hold back. Many of you were experiencing “compassion fatigue” for the hundreds of profoundly sick unvaccinated patients that were flooding the hospitals, many of whom were full of regret for not getting the vaccine but some of whom continued to express disbelief and mistrust about their disease. Many of you were demoralized. Senior residents expressed concern that they had been pulled to do so much work on COVID services that they might not have enough exposure to other aspects of medicine. They were worried about their ability to match into fellowships or practice independently, even their performance on the board exams. Many junior residents were overwhelmed, having spent much of their clinical time in medical school either doing virtual rotations or with limited patient contact on account of restrictions placed on clerkships during the pandemic. Some had never been involved in end-of-life care, and now were suddenly presiding over the deaths of dozens of people, many of whom were not much older than them. Some lost vacation time, everyone lost elective time. Most were isolated from their families and friends. The educational curriculum turned into hours of Zoom and sometimes you are unable to recognize your colleagues without a mask. Residents, we hear you.
      Residents, we feel you. To be truthful, none of your faculty are at our best either. As we near the 2-year anniversary of the pandemic with no end in sight, we are struggling mightily to balance our careers, our families, and our own physical and mental health. For many of us, this is the most challenging time of our entire careers. We may have different roles and responsibilities, but we are seeing and hearing the same things from our patients, from our families, and from members of our community. We are using all the tools at our disposal to combat a seemingly incessant flow of misinformation about vaccines, masking, testing, medications, and other common-sense interventions that never should have been topics for debate. Trust in science, respect for expertise, and faith in our duty to look out for the health of our patients are called into question by people doing “their own research.” We have seen our own patients, friends, and family members struggle with loss. We have felt like nothing we were doing mattered. We have held the hands of the dying and wept at the bedside. We are right there with you. Residents, we feel you.
      At the end of the day, colleagues, this pandemic will end. We will get to the other side. Sadly, we will get there forever changed. Over 740,000 souls in our country (and counting) have perished. Millions more have become disabled. Social unrest and upheaval in our society, fueled by unprecedented access to information (much of it inaccurate), has divided us like never before. There is nothing that we can say or do that will take away the pain and suffering we have all witnessed during this crucible. All we can do is put one foot in front of the other and continue to move forward.
      Yet we ask you to hang in there and keep doing the great things you do. Because someday you will be leaders in your community. Someday you will have your own clinical practices. Someday you will have the opportunity to train others. When that day comes, we hope that you reflect on this time as one of intense struggle, but also of incredible growth that made you better. The past 2 decades of experience with Dengue, Zika, H1N1 influenza, Ebola, and now SARS-CoV-2 has shown us that we are in an age of pandemics. The fact that we cannot ignore the global interconnectedness between humans, animals, and the environment will shape the future of healthcare. Having had this experience, we know that you will make sure that our world does better for the next crisis.
      There has been no greater privilege in our careers then to serve alongside you on the front lines. We are humbled to call you colleagues. Thank you for your strength and bravery and all that you will continue to do in the service of humanity.