Medical students in the Carver College of Medicine have a unique perspective on the current pandemic. Participants in the Sub-Internship in Internal Medicine course last month were given the opportunity to reflect on their thoughts and feelings about COVID-19 and express them in whatever form they chose.
2024 Inpatient Clerkship
Anonymous - Painting and reflection
“Better on This Side”
Inspired by the physician’s journey. It is easy to look forward to the next step and think the grass is greener (or sky more colorful) on the other side. “Residency will be better”, “when I’m an attending I’ll finally be able to...”. However, I have found great comfort in taking a step back to enjoy the journey itself, as learning is part of the fun of medicine. I accentuated the detail on the trees to bring your attention to the trees right in front of you rather than trying to look for the colorful sky that awaits at the end of your journey.
Suchet Anand - Drawing and reflection
While at the VA, many of the patients I helped take care of were suffering from heart failure. And for each of these patients, we spent much of our time working with cardiology to start and stop different parts of goal-directed medical therapy, titrate doses, and hand out Lasix like candy. At times it felt like the diagnosis of heart failure defined my patients. It seemed like we focused so much on their treatment, that we didn’t think about other important aspects of our patients – their emotions, feelings, and thoughts. I made this drawing to capture my perspective on how sometimes the medications we prescribe create chains that trap the heart and the feelings it holds.
Erin Capper - Watercolor and reflection
This drawing is about a patient I cared for during my sub-I who had a history of alcoholic cirrhosis. She presented to the emergency room for acute blood loss anemia and decompensated liver failure. We treated her pain and continued to replace her red blood cells, but it was soon clear that she was not getting better. Despite our best efforts, the team was only providing temporary relief for her problem and what she truly needed was a liver transplant.
As the days progressed, the team advocated for the patient, trying to arrange inpatient liver transplant workup. But it seemed that no one we talked to would start the process. And as each day passed, she continued to worsen.
I saw first-hand how she struggled with grief. How she blamed herself because she chose to drink. And, how sad she was that this choice also affected the people she loves. Despite her worsening cirrhosis, she continued to fight for her second chance. And as a team, we continued to advocate for her and her right for a transplant evaluation.
Dibu Kumar - Illustration and reflection
Reflection: Many times the patients we help care for on inpatient services have periods of altered mental status caused by a wide variety of etiologies (e.g. stroke, delirium, intoxication). It can be scary as a patient, family member, and healthcare worker to see somebody not able to act like their normal selves. In times like these, it is very important to tap into the human aspect of medicine. I made this collage to reflect my perception of what it could feel like to be dealing with altered mentation.
Zachary Shepard - composition
Reflection: I composed this piece as a depiction of a patient’s treatment course, which culminated in a goals of care conversation and eventual discharge to hospice. It is titled “IV."
2023 Inpatient Clerkship
Evan Economos - illustration and reflection
The breadth of the human experience is well illustrated in the patient population at UIHC; and this was never more clear to me than when I compared two patient interactions from the cardiology teaching service. One patient was a board certified cardiologist who had more publications that I have birthdays, and the other had only the most basic understanding of human anatomy. Obviously the level of detail that went into our discussions was vastly different, but each person deserved the comfort that comes with understanding. This was a perfect example of how different hospital experiences can be for people even while having similar problems. This is true for any number of variables besides medical literacy. I think that we have a duty first to recognize these differences, and then to do whatever is necessary to ensure the most effective and productive healthcare experience for our patients.
Samuel Choice - Photo and reflection.
Reflection: I’ve had a few of my patient’s pass while on service at the VA. I feel like for some of these patient’s, they’ve had wonderful interactions with their family at the end of life, with appropriate palliative care. However, I have seen lots of patients who pass alone, or with aggressive care that might not be the best for that patient who is too sick to speak for themselves. I found an abandoned house in a field and took a picture while in Iowa and made some edits that in my mind represent the bleakness of inappropriate, aggressive care, with a comfortable, pain-free exit option centered in the middle of frame.
Anonymous - drawing and reflection
Reflection: So often, I find myself with my head down, walking to work to complete another shift. Rounding on patient after patient, consulting consult after consult, writing note after note, I avoid making eye contact with the world around me. We do this, I believe, from an instinct of self-preservation. An instinct to shelter ourselves from the height of emotion we find ourselves surrounded by – the pain, suffering, fear, and frustration. An instinct to shelter ourselves from the expectations and responsibilities we place on ourselves and experience and perceive from those around us. We are afraid, perhaps, that if we face the world we find ourselves in, it may be too much to bear.
And yet, those moments in which we pause – pause for a conversation, a hand on a shoulder, an encouraging and empathetic word – those are the moments in which our work is done. Those are the moments in which humanity is found. Let us not be afraid to raise our gaze to engage in the world of humanity. We may find it lighter than we imagined, or ourselves stronger than we would have guessed.
Ella Gehrke - Poem and reflection.
She stands in front of us.
A team of strangers, myself included, staring back.
Her grief flows out onto the floor, separating us.
We cannot pick it up and take it, the grief is fluid and liquid, slippery, immeasurable.
He said DNR. She, a dutiful wife, supported him in life and death.
“If we walk into the room and your heart has stopped, would you like us to perform chest compressions to keep you alive?”
I have seared this question into my mind, memorized the appropriate pauses and inflection of words. It is direct, it is simple and clear.
Now, as the moment approaches closer and his condition appears tenuous, she clings to her grief and demands for full code, desperate.
Reflection: This poem is about a patient my team experienced during a long call shift on a weekend. We were taking on the cross-coverage role when we received a page that a patient’s wife was becoming combatant with nursing staff and there was a request to speak to the team as soon as possible. Prior to our arrival at the patient’s room, we learned that the patient had advanced ALS and was ventilator requiring. Yesterday, the palliative care team and the primary team had a goals of care discussion with the patient and his family. At that time, the patient had expressed his medical goal to be DNR in the setting of an advanced fatal disease. This decision was documented. The next day, when we met with the patient’s wife, she explained that the family had decided to change the code status of the patient.
Nicole Hehr - Drawing and reflection.
Reflection: This piece comes from reflecting on my experiences on the wards with complex cases. In particular, there has been several moments where I was struck by how the primary team (my team), the patient, and the patient’s family could all be in the same room having a shared experience, and yet see and understand the situation so differently. This piece is a reflection of that disconnect and how very different our experiences can be.
2022 Inpatient Clerkship
Pooja Patel - Illustration and reflection.
Reflection: In our new world with COVID-19, masks, and a global pandemic, I chose to use watercolors to portray a situation which I am sure many providers in healthcare have faced. As healthcare providers, we must take the time to educate our patients about different healthcare decisions so that they can make an informed choice. One of the patients discharging did not have the COVID-19 vaccine. In this case, the patient did not want to get the COVID-19 vaccination because of the side effects that he wanted to avoid. He did not want to feel unwell (fevers, chills, drowsiness, headaches) as he has to go to work. He also already had osteoarthritis of his knees and did not want his joint pains to get worse. Finally, he had heart failure, and he was scared that the vaccine may cause inflammation of his heart, which he heard about on the news. As his medical team, we took the time to explain to him that the symptoms of the vaccine are mild, if any, and severe symptoms such as myocarditis are extremely rare and have only been seen in a small portion of younger males. Therefore, the patient should rest assured that the possibility of an adverse reaction was minimal. Ultimately, he chose to not get the vaccine. However, we were able to give him all the information so that he can make an informed decision that is best for him. As healthcare providers, we should not only give patients all the information but also respect the decisions that they make regarding their own care.
2021 Inpatient Clerkship
Brooke Jennings - illustration.
Reflection: I drew this picture to highlight the new challenges we face with patient connection during the COVID-19 pandemic. While I can’t overemphasize enough how important it is to keep safe and wear our PPE, it has also changed our interactions with our patients. One of my favorite aspects of healthcare is providing compassionate care and connecting with my patients. While I know that these PPE measures are necessary to protect everyone, at times they feel like barriers between me and my patients. Sometimes I find myself wondering, can my patient tell that I care? Do my words feel genuine? I continue to work every day to adapt my nonverbal communication skills with different techniques and more verbal communication. At the same time, I also wonder when I see a patient or their family member with a mask on, are they really okay? Are they understanding what’s going on? I miss being able to see their faces, gauge their reactions. I dream of a day where it will be safe to be face to face with my patients and their families and appreciate a moment of silence together. Sometimes a moment of silence and a look of compassion means more than you can put into words.
Dhruv Kothari wrote a poem describing his work with patients and his team, along with a written reflection.
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Lens Patients |
Reflection: This poem is a reflection on my experiences of both working with the team and interacting with my patients. As a medical student, so much of pre-rounding and getting my presentation ready for rounds felt like a rush. Writing down all the vitals, labs, imaging results and thinking of an assessment and plan for each patient I was responsible for felt more an exercise to show my team that I am capable than a real patient connection.
Mahek Shahid - poem.
We come shuffling in,
The assembly line forms,
“Stay the course, working with hepatology”
Your eyes dart back to the tv screen
“Have a good day patient 18.”
As the assembly lines marches out,
One by one,
I see the pictures you hung up
Of your son
I notice the drawings in the other corner,
The only colorful thing in the room.
We come shuffling in,
The assembly line forms,
“Stay the course, walk with PT”
Your eyes gaze off toward the window,
Have a good day patient 18.
I sense the words at the tip of your tongue
Yet they do not escape,
I watch your eyes fill with despair
Maybe you’ll wait another day.
We come shuffling in,
The assembly line forms,
“Stay the course, continue to eat”
The assembly starts to fold in, ready for departure
“That’s it? This is torture!
I can’t just sit here all day,
Everything changes and only I remain
What did the transplant committee say?”
The assembly looks left and right,
Unable to comment as they haven’t a clue
“They haven’t gotten back to us yet,
But you’re the first person we’ll tell when they do.”
We come shuffling in,
The assembly line forms,
“Stay the course, we are working with the transplant team.”
Your eyes regress back to the tv screen,
“Have a good day patient 18.”
Anonymous
Reflection: In terms of COVID experiences, I think mine is unique. We have many shared experiences of COVID as medical students, but I experienced COVID in different ways over the past year and thus would like to share my story from different viewpoints, besides that of a medical student.
Employee: I remember hearing of vague whispers of a new virus, one with a high mortality rate, one that was not controlled, one that China was denying. I was a pathology extern on Transfusion Medicine at the time, spending day-to-day with patients and afternoons with my resident, an intern; writing notes, making plans, and discussing life, we lived blissfully unaware of what was to come. We laughed about the ridiculousness of the virus, and he made plans to visit his family in the middle east in the coming months.
Sawyer Kieffer wrote a haiku inspired by a patient.
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I don’t want to die Before a nice root beer float Not here, not like this |
Reflection: This Haiku was inspired by one of my patients - a 74 year old veteran who was admitted for failure to thrive in the setting of newly diagnosed stage IV small cell lung cancer. I’ve spent the last 10 days with this man and have gotten to know him well. He’s my favorite patient (are we allowed to have favorites?). He’s funny, quirky, insightful and a tremendously positive person. This poem was inspired by a conversation I had with him one morning before rounds. Despite having been impressively stoical about his circumstances he admitted to me that he had felt really afraid for the first time last night. He told me this: he said,”I realized I was afraid, and I said to myself, ‘Why are you afraid of dying, Frank? You know none of us are supposed to be here forever’. And I realized - I’m not afraid of dying. I’m afraid of dying here, like this, without ever again tasting a nice root beer float”.
I thought this was brilliant and powerful. In just a few sentences he showed me so much about who he is and what his goals are. Sometimes life is about the simple things and enjoying what we have while we have it. I was able to get root beer float supplies and we enjoyed one together before he started chemotherapy a few days later. I’ve learned that, although not all problems are fixable, victory comes in many forms. Curing cancer may be difficult but making a rootbeer float is easy.
Jennifer Poncelet reflects on working with veterans.
Reflection: My medicine sub-I experience was at the VA medical center. The flag represents working at the VA with veterans, and the silhouette is of a patient that could be any veteran. I drew the silhouette in the background to represent how veterans’ experiences serving have influenced their health and life experiences. The silhouette is a shadow behind the American flag for this reason. Some of my patients shared stories with me from their lives and some about their time serving. I could hear in their voices the passion and emotions they had decades ago that are still within them. I incorporated EKG rhythm strips within the flag to represent healthcare and the intertwining of veteran’s health with their passion and service in the armed forces. Although many of my patients shared some of the same diagnoses, some had unique mental and/or physical health challenges associated with their time in the armed forces, and each veteran was affected uniquely by these challenges.
Gabriel Conley - poem.
Another life ending, another family tragedy
Six days in a row can test your sanity
From being taught to heal, to being sought to feel
The pain of all these families
They need to know it’s okay
That palliation is the way
When body and mind and health all give way
To endless time, and a peaceful lay.
We’re great at aiding the young and the recently well,
charging disease like the Americans at Normandy
But are we so great at recognizing,
when continued life brings only suffering?
2020 Return to Inpatient Clerkship
Weiren Liu took to Twitter to describe his creative reflection projects.
One assignment for my @IntMedatIowa SubI is a personal reflection on the med student experience in #MedEd during COVID. Dr. Gebska encouraged creativity. So this is my assignment in a twitter thread format: Upcycling, Troubleshooting and Other Random Quarantine Projects.
Virtual clerkships have limitations. But trying to accomplish small crafty projects in quarantine with limited resources and trying to make things work with only materials I had at home helped me better appreciate the ingenuity and the work clerkship directors put in to create virtual curriculums for medical students during COVID. Thank you to Dr. Gebska, Dr. Suneja, Kathleen and many others @IntMedatIowa for creating and providing @IowaMed students with the best IM clinical experience possible here @uihealthcare!
Ben Wilkinson plays a piano piece based on the song "Quarantine."
Reflection: For my reflection I chose to play a piece based on the song “Quarantine”. The original song was not about the current pandemic but captures the feelings of isolation we all feel. My version incorporates a building tension, reflecting the uneasiness we feel as we try to go about “business as usual”. Everyday tasks such as grocery shopping now carry a sense of danger, a constant anxiety. The tension in the song is slowly building in the same way, just beneath the surface.
As we care for our patients, we must remember the anxiety and tension that has been building in them as well. They bring a sense of isolation with them, which is intensified as visitors are limited and caregivers hide their faces with masks. Making a connection with our patients it now more important, and difficult, than ever before. Even though we may be in the same room with our patients, we are still quarantined away from them. We must continue to search for new ways to reach out, connect, communicate, and break the growing tension.
Nick Evans wrote up a progress note about himself.
Progress Note: 7/25/20
Subjective
Patient is a 28-year-old man who presents today for follow-up. He was previously seen in clinic 3/19 and 5/1. Briefly, on 3/19 he described experiencing concern and general uncertainty as to the developing COVID pandemic. His medical school rotations were essentially canceled for the time being and learning became “virtual”. At that time there was a lot of confusion as to what would happen in terms of medical education and how/when students would be allowed to return to the hospital. On 5/1, he returned to clinic (via video visit) with symptoms of Zoom meeting burnout and social distancing fatigue. Despite these concerns, he was notably more optimistic regarding how the pandemic is affecting others. He noted that he had been making efforts to keep in touch with friends and family.
Brandon Johnson's poem describes his return to the hospital after months online.
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A Better Tomorrow I walk towards the hospital I wait my turn for screening I meet my fellow medical team I go to round with anxious nerves I leave the hospital so very late |
Reflection: This poem provides an overview of my first day back in the hospital after months of doing online coursework. Seeing how much had changed in the hospital and world in a relatively short period of time was anxiety provoking. Little things I took for granted now became much more apparent such as walking into the hospital, introducing myself to the rest of the team, and limiting visitors for our patients. While seemingly little, I think these can all add up to take a toll on a person’s morale. However, through all of this, I have hope that things will get better. Eventually, we will be back to the world we all know.
Nathaniel Johnson wrote a poem about an experience on a VA ward.
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Inpatient Isolation The world is changing around me, this is what I know “I want to see my family”, they say as they lie in bed He’s getting sicker and sicker, he maybe has days to live The world is changing around me, this is what I know |
Reflection: This poem was written about an experience I had while back on the wards with the internal medicine team at the VA hospital. Currently, there is a strict no visit policy for most patients. An exception to this rule is for terminally ill patients, where the hospital staff has been very accommodating to allow for visitors. However, only approved and a limited number of people can visit the patient at a single time. This makes it tough for patients who have large families to see all the loved ones they wish to see. Although it is tough to see patients struggle to see family members in their final days, I understand that visitor limitations are a necessity to keep everyone involved safe. Patients currently hospitalized during this period face more challenges than patients have ever before. Not only are they battling their own health conditions, but they are also fighting with social isolation and loneliness while hospitalized. As healthcare providers, I feel it is important we recognize this and make sure we are treating the
entire patient, and not just the disease that brought them there. Although the days can be busy as the list of things to do gets longer and longer, taking that extra time to check in and converse with patients about their life and interests can go a long way. Sometimes all we need is a friend.
Marcus Munoz's reflection makes the case for wearing a mask.
Please, Wear a Mask
We were nearing the end of our shift on the hematology oncology in patient unit and got the notification that we were receiving a transfer. The patient was a 60-year-old woman who had recently been diagnosed with Ewing sarcoma and they were found to have widely metastatic disease as well as bilateral pulmonary emboli. Although hemodynamically stable, the senior resident calling to transfer the patient seemed a bit rattled. He knew this person was sick and emphasized that our team should have a low threshold to transfer them to the MICU.
When she got to our floor she was accompanied by her husband. Something I greatly appreciated about my time on the hematology oncology floor before COVID times was getting to know the patient and their family. I learned getting to know a person deeply is crucial when trying to make complex medical decisions in the context of a cancer diagnosis. My senior resident and I introduced ourselves to the patient. Despite requiring eight liters of oxygen per minute, the patient was smiling and had a calming presence.
Irtaza Khalid created an educationa video about flattening the curve.
Daniel Metasic wrote about ‘The Road Less Traveled’ in the COVID-19 Pandemic.
Every day I walk across this bridge that brings me to the University of Iowa Hospital and Clinics and medical school campus. I have trekked over this concrete over a thousand times in all sorts of conditions, day and night during my training. These pictures captured on my iPhone a year prior to the pandemic resonated with the feelings of 2020. The left side illustrates a bustling city street – people are in their cars coming and going. In stark contrast, the right picture shows an empty frozen street without a car to be seen. The early months of quarantine were desolate as society quarantined to ‘flatten the curve’ and slow the rising cases of COVID-19. During the early months of the pandemic, it seemed that life just came to a stop – nobody had anywhere to be – except healthcare workers. As I make the journey to the hospital every day, I take a look from this viewpoint and think about how times have changed. It was inspiring and humbling to see the role of physicians, scientists, and public health officials navigate the uncertainty of the situation but also take appropriate measures to ensure a healthy society. This pandemic has provided me with more motivation to continue to learn and strive to be the best physician that I can be so that one day I am prepared to help when called upon. This pandemic only strengthened my role in this world to serve others. - U.S. Route 6 in Iowa City, Iowa. (August 21, 2020).