To help mark Resident and Fellow Appreciation Week and acknowledge the innumerable challenges physicians-in-training faced during a year marked by COVID, we asked resident and fellow leaders to reflect on the past year and share their perspective on a few questions.
Below are some insights from Katie Dunleavy, MD, a PGY3 Internal Medicine Resident at Mount Sinai Hospital and President of the Mount Sinai Hospital House Staff Council and Veronica Peschansky, MD, PHD, a PGY4 Neurology Resident at Mount Sinai Hospital and Vice President of the Mount Sinai Hospital House Staff Council.
As we come to the close of the 2020-21 Academic Year and you think back on the past year, can you describe a moment in your work as a physician that you found particularly meaningful?
Dunleavy: I strive to find meaning in my work every day, whether it be a shared joke with a patient, a laugh with a colleague or a meaningful connection with a patient and their family. COVID has made this more difficult and more crucial to my daily work. I remember a NYC snowstorm this year, the streets were lined with snow and as I made my way into the hospital for a night shift, I wondered how the night would unfold. I was amazed by the nostalgic effect the weather had on my patient interactions that evening. As the snow fell over the lights of NYC, patients shared stories of snowstorms, happy childhood memories and harrowing road trip adventures. These memories brought me back to my own happy snow-filled memories of college in Middlebury, VT. This evening reminded me that every shift has the potential for magic, every patient the potential for connection and joy.
Peschansky: It happens all the time. Being the physician that can explain a diagnosis or plan to patients or families in such a way that they understand and buy in, is one of the most rewarding moments for me. It can be something simple (how dehydration and lack of sleep can worsen a migraine) or complex (the effect of the immune system on myelinated nerve fibers), but I cherish the ability to find the right words for the situation and see them 'click.'
During a week in which we show appreciation for Residents and Fellows, can you share a moment when a resident or fellow in your own program (or another program) inspired you?
Dunleavy: I am constantly amazed by the work of my fellow house staff at Mount Sinai Hospital. The innovation of colleagues to find solutions instead of divides, and passion instead of commiseration is quite remarkable. The advent of "House Staff Appreciation Week" and "Resident/Fellow of the Month" came from a thoughtful effort through GME and House Staff Council to shine a light on these efforts. As an Internal Medicine resident during COVID, we have seen our job description change on a daily basis. The fast pace of change was both invigorating and tiresome, a balance we all struggled to keep. When I think back to the moments and people that inspired me, it has been the Internal Medicine residents at Mount Sinai Hospital who keep pushing forward to create a moment of excellence. Thank you for caring for each other as much as you care for our patients.
Peschansky: I am lucky to work with co-residents who go the extra mile. My colleagues continually set the example that one more family conversation, just a few more minutes of reading or that extra phone call to a consultant can make a difference in patient care even on the busiest of days. When we see each other doing that extra bit, we are always willing to step in and ask 'how can I help you get this done,' even if it's not strictly our responsibility.
“Hope Springs at Sinai” (Katie Dunleavy, MD) This year is like a garden recovering from a season of frost. Beautiful things can grow from broken soil. The promise of new beginnings, the delight of fresh blossoms and the fragrant aroma of hope.
If we were to bury a box in Central Park for other physicians in training to dig up in 50 years, what are three things you would tell them about the unique challenges of training as a resident or fellow during a pandemic?
Dunleavy: My first instinct would be to bury a N95 for safekeeping (just kidding!). I’d include a copy of Ruthven’s “Essential Examination” and ask them to keep the art of physical exam alive, one I learned dearly and wholeheartedly as a medical student at The Royal College of Surgeons in Ireland. I’d include a guide to telemedicine, so they could ponder our earnest attempts at what would surely be a dated technology by then. I would include the NY Times front page article, “U.S. Deaths Near 100,000, An Incalculable Loss” from May 24, 2020 as a reminder of the insurmountable loss from the COVID-19 pandemic and an acknowledgement of the effect of the pandemic on our residency training, our mental health and the future of medicine. I’d also include the New Yorker magazine cover from November 16, 2020, Pascal Campion’s “Hope Again” highlighting a poignant change in US history following the election of Joe Biden and Kamala Harris to office and the promise of hope amidst a crisis of conscious.
Peschansky: Physicians are always bumping up against the edge of the unknown - even after thousands of years and improvement rapidly, every specialty deals with mystery cases. Then imagine a new and infectious disease, spreading rapidly, and trainees at the forefront of its treatment daily! There was no expert attending to turn to. We trusted in our observations and our colleagues and adapted minute to minute. As a resident, you have a special relationship with your colleagues. In the best of years, it is a trying, but shared experience, both in terms of clinical experiences and in how it shapes your personal growth. Now imagine being cut off from that group - barely seeing your friends' faces when you need that smile most, unable to share a bonding session due to distancing. We made do with Zoom and texting, but missed the hugs and moments outside of work together. Our learning was affected too. When one condition colors every differential diagnosis for the better part of a year, when conferences are all remote, when treatment is delayed or restricted - we see medicine in a different light than generations before us. We tried to remember this is not the norm.
Can you describe what training at Mount Sinai has meant to you in your development as a physician? Any words of wisdom for those new trainees that will be joining us in the coming weeks?
Dunleavy: Mount Sinai Hospital has made me the physician I am today. I never imagined the trials and tribulations I would face as a resident during a global pandemic, but the lessons I’ve learned will stay with me throughout my career. As I move forward to fellowship in Gastroenterology, I know I am capable of embracing uncertainty to foster a learning environment that allows me to thrive. Strong female leaders like Barbara Murphy, MD and Emily Gallagher, MD have shown me the strength of being a woman in medicine. I've learned to always do the right thing, even if it’s the harder or less liked thing. Quality patient care depends on your self-respect and it's important to take care of your people.
As you begin your next step into residency at Mount Sinai, I urge you to value connection and find flow in your work. Know you can always ask for more support. Cherish a world outside of medicine and find a place to escape. Take on new challenges, but learn your boundaries. When in doubt – see the patient, speak to the family member, call the attending and always ask for help when you need it. And please, always introduce yourself when you walk into a room :)
Peschansky: Mount Sinai is a treasure trove of experts and knowledge. Being surrounded by deeply committed, intelligent and hardworking colleagues pushed me to be better. The different practice sites - East Harlem/Upper East Side, Elmhurst, the Bronx - provided opportunities for service and to play an important role in the community through one of the most trying times in recent New York City history. The tenacity and creativity of Mount Sinai house staff is irreplaceable, and I hope to continue in that spirit.