Growing Pains

“Each morning, I make my way to joy, joy that God has given me the breath of life for another day. The process is never instantaneous though. My alarm is usually blaring for five to ten minutes continuously before I can get up but sometimes I’m able to jump out within a minute. I purposely place my alarm a physical distance away from me so that I’m forced to get out of bed to turn off the pesky annoyance. And when it’s off, I make my bed and sit at the edge and I pray that I consciously choose joy over the circumstances of my day.” – February 19, 2020 journal entry, surgery rotation, pre-quarantine 

At the start of 2020, my biggest concern was beginning clinical rotations. As a medical student, I could finally start contributing to patient care, which was both exciting and terrifying. Surgery was my first rotation, arguably the most time consuming and emotionally exhausting. But it was the schedule that allowed me to attend my best friend’s wedding in July. I was a groomsman and I wouldn’t miss it for the world. By the middle of my second rotation, medical schools across the nation pulled their students out of clinic. Two weeks later, the county judge issued a “stay home – work safe” order on the city of Houston and we received an email that we would not return to the hospital for another 2 months. Never did I expect a global pandemic to put life on pause. 

***

The intercom blasts overhead. “Shoppers we kindly ask you to practice social distancing. Wear a mask and maintain at least six feet distance between each other. We know these are difficult times, but together, we can stop the spread of coronavirus.” The line is already bleeding out of the grocery store. It turns the corner and continues as far as it can before looping back on itself. X’s are marked 6 feet apart. Anytime shoppers left through the exit, an equal number would be permitted inside. It feels like a perfectly balanced scale where any disruption could tip it into chaos. Most people don various types of face coverings from home-made cloth to certified surgical masks. I readjust my glasses. They had started to fog up so I tighten the seal of my mask. It’s my turn to enter the store. I squeeze some hand sanitizer before putting on my gloves. Technically it shouldn’t matter whether my hands are clean, but at that point, it’s become a force of habit. For all intents and purposes, the gloves are not sterile. They could touch produce, packages of meat, and any other item in the store. But they could not touch my face. If my nose has an itch, I wouldn’t dare touch it. I make an exception for my glasses only if I pinch the rim. I have a system. The left hand would only touch store items and push the cart. And my right hand would reach in my pocket and navigate the grocery list on my phone. It starts off well. I remember the first few items off of my list. Left hand grabs a container of celery and puts it in the cart. It proceeds to grab the pre-diced carrots and bell peppers. What’s next on my list? Right hand reaches inside pocket and grabs the phone. The face ID doesn’t recognize me with my mask so I have to type in the password each time. Oh, that’s right avocados. Right hand puts away phone. Left hand fidgets open a plastic bag and instinctively the right hand goes to grab an avocado. Shoot. I messed up.As long as I don’t touch anything else besides the avocados, I should be fine. I put the bag of avocados in the cart. Up next is the meat section. I begin to push the cart with both hands. I don’t even stop. I’ve already messed up. My system sucks. I’ll just wipe my phone down when I get home. Whatever I do, I can’t touch my face.

I forget what day is today. They’ve all blurred together in my mind. The weekends were once a much-anticipated reprieve from a busy week of clinic. Now they’re no different than a weekday. What makes a weekend so special when the entire week is otherwise unremarkable? My alarm continues to go off. I stumble out of bed to turn it off. My routine had started out with great intentions, but like all habits, motivation started to dwindle after a few weeks. Though I had no clinical responsibilities in my quarantine, I wanted structure in my life. After all, I was still a medical student. I listed out tasks I needed to complete every day: Read my Bible. Work out. Zero out review Anki cards. Do 10 U-World questions. Complete any new Anki cards. By 6 pm, all work had to stop. My routine then devolved into completing the tasks whenever I could (even if it meant staying up late) and soon even attempting to do the work was the only qualification of a job well done. The desire to be productive butted heads with the need to rest. But rest imprisoned in one’s home inevitably brought on a feeling of apathy and lethargy that could only be mitigated by productive work. This was the vicious cycle that lay before me each morning. 

There’s a picnic table across the street from an open field that hasn’t been mowed in months. The area lays underneath wooden roofing with a lattice beam structure. It’s the perfect place to hang my gymnastic rings. I’ve never seen anyone else use the area. I found this place after a month and a half of working out in my house when the only daylight I saw was taking out the trash and my 45 minute walks with my roommates. Now, I’ve carved out this little haven for myself to work out in. It’s my one time of the day I’m outside and even in the blistering Houston humidity, I’m still grateful for it. When I’m out here, I forget for an hour that a virus is ravaging our world both mentally and physically. I forget that the largest medical center in the world is barely keeping pace with the rising cases of COVID-19. I forget that our society’s future looks different than what we ever predicted: a generation of students shifted to an online platform, businesses barely surviving with employees working from home, and families wondering whether surviving the pandemic is worth suffering through the recession. In that hour, I forget all of that. And I remember what it’s like to soak in the warmth of the sun. I remember I have healthy lungs to breathe in the fresh outdoor air. I remember that even though it feels like life is on pause, nature’s beautiful symphony still plays on. And the best part is I’m still alive to hear it all.

“Mom. Dad. Are you sure you don’t want me to come see you? I’m going back to the hospital soon.” I haven’t seen my parents for months. The last time was on my birthday two weeks before quarantine. They live twenty minutes away from me, but I can’t afford the risk of exposing them and neither can they. Out of an abundance of caution, our interactions have been limited to video chats and phone calls. Besides my two roommates, I haven’t seen anyone else. It’s been a while since I’ve shaken someone’s hand or given them a hug. The wave to my neighbor or the simple nod as I walk past others at the park is more exciting than I care to admit. Sometimes I think I forget what it’s like to talk to another human being. Zoom has become the new hangout spot. The friends I’m used to seeing in person every other day, I’m grateful to see even once a week on my screen. And the friends I talk to a few times a year, I’ve now been able to see once a month. But soon, the conversations start to lose steam. There’s something about the physical presence of another human being that a digital medium cannot fully capture. You run out of creative ways to answer “How have you been?” because the truth is nothing has happened and nothing has been happening for a while. You start to crawl back into your hole. All the time in the world is somehow not enough time to call your mom or text your friend. But it’s more than enough time to face your inner thoughts whether you want to or not. You used to always have one commitment after another, unable to spare time for anyone else. It turns out the issue was never other responsibilities. It was other priorities. But there’s no point in dwelling in the past. Grace is a wonderful thing. Maybe this quarantine was a blessing in disguise, the rest we never knew we needed in order to make the change we subconsciously always wanted to make. 

Lately, I’ve been craving pizza. For a few weeks, it was chicken and then it was burgers. But now it’s pizza. I live with two of my best friends—one of them is the friend getting married. Work just ended and they make their way to the living room. “I could go for some pizza but we got pizza five days ago.” A thirty minute discussion to diversify our dinner plans with healthier options or new experiences only serves to justify what we were all thinking the entire time. Pizza. We call in the pick-up order and jump into my car. My Spotify daily mix starts shuffling. I take the highway and we catch the sunset on our right. There’s no rush-hour traffic. I roll down the windows a bit and pop open my sunroof. The wind starts rushing into my car. Folk-pop is playing in the background and we’re singing along, at first seriously and then obnoxiously. Nothing seems to exist outside of this moment of pure joy. We arrive at the restaurant. The front door has a sign. All customers are required to wear a mask. We walk in. Masks accentuate everyone’s eyes and it feels like they’re staring at us. Some say eyes are the windows to the soul but sometimes they just look like mirrors that reflect our biggest insecurities. “Hi, pick-up for Kevin.” I insert my credit card holding on to the tip of it to avoid touching the machine, and I quickly sign with my pinky. As soon as we get back to my car, I immediately put on some hand sanitizer. The music starts playing again. We get home and set up our pizzas on the coffee table. We inevitably decide to watch our go-to show, Psych. A few episodes later, a food coma starts to set in, and we sit comfortably in silence. Then one of us makes a comment. Someone else laughs. And the conversation is reignited staying strong until well past midnight. We haven’t stayed up this late since college. After six years of friendship, we still manage to laugh at the same jokes as if we heard them for the very first time. Life feels great. What did I do to deserve friends like these?

***

I’m back in the hospital. It’s been two-and-a-half months. They screen every person that enters the building now.In the past 14 days, have you travelled internationally or been in contact with anyone who’s travelled internationally? No. Within the last 24 hours, have you experienced any coughing, shortness of breath, fever, chills, diarrhea, constipation, or muscle aches? No. Blue or white mask? The blue mask is fine. Medical students aren’t allowed to see COVID-19 positive patients or PUI’s (patients under investigation). That means any patient with fever, cough, or clinical history suspicious for COVID-19 is off limits. It feels like I’ve forgotten all of my clinical knowledge, but we’re considered essential workers. I look at the intern who’s already admitted a patient and doing the full work-up. She asks me to go in and take the history. This is a heart failure exacerbation patient. Did you remember to ask about any recent infections? No, I forgot. That’s fine. Remember that it’s important to understand the underlying etiology of heart failure exacerbation to prevent future recurrence. Were you able to hear the crackles on auscultation? Not really. What’s your assessment? They seem fine. What’s the plan? I think they’re stable enough to be discharged. I felt so lost keeping track of all these moving parts for this one patient. These interns are only three years above me in training yet they can be in charge of 5-6 patients at a time. I can’t even imagine myself in their position three years from now. On the last day before summer break, I get my feedback. It’s surprisingly positive. Somehow in all the fumbling around and self-perceived failures, I’ve grown. The EMR is easier to navigate. A differential diagnosis seems less daunting. The clinical flow and reasoning make more sense. I don’t get as nervous picking up a new patient, realizing my role as a learner does not take away from my role as a provider. I walk out of the hospital. It’s a sunny day. Another year of medical school has officially passed. 

The cardboard exterior makes the couch particularly hard to grip as we heave it from the garage to the second floor living room. My friend and his fiancée are setting up their new house in anticipation of the big day. He gives me a tour. The house’s aesthetic seems fitting for a young married couple. Most of the rooms aren’t furnished yet. There’s a dining table here, a different couch in the study and a bed frame in the master’s. I picture them starting their lives in this new home. I picture the memories they’ll make along the way. I picture them figuring out how to grow together, learning each other’s quirks and loving each other through it all. Their children will know that in the midst of a global pandemic, mommy and daddy got married and faced it together. We order burgers for dinner, the first of many in this house. They are a convenient distance from all the good restaurants. It looks like I’ll be coming over more often. 

***

Assessment: 3rd-year med student with PMH of 2 months of clinical experience s/p quarantine presenting with mild anxiety in the setting of a global pandemic. Labs are unremarkable. Physical exam findings likely 2/2 growing pains.

Plan: Reassurance and supportive therapy. 

Versions of this story have been published on other platforms:

  1. Progress Notes, the Baylor College of Medicine student journal, (https://blogs.bcm.edu/2020/08/18/growing-pains-clinical-training-during-covid-19/?fbclid=IwAR1IvRjDVRgNwQaOvpT1ZQ-AjM-NTMuIXfHgEdHcskidY3MAGD4OM8NW7Fo)
  2. KevinMD (https://www.kevinmd.com/blog/2020/08/growing-pains-clinical-training-during-covid-19.html)

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