COVID and Med Ed: Resident and Student Describe 'New Normal'

Cherie A. Fathy, MD, MPH; Ramie A. Fathy

Disclosures

April 10, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Cherie Fathy is an ophthalmology resident (PGY-3) at the Wills Eye Hospital at Thomas Jefferson University. Her brother, Ramie, is a third-year medical student at the University of Pennsylvania. Amid the chaos that COVID-19 has caused in medical education, the siblings talked to each other about how their lives and training have been affected.

Cherie: Hey, Ramie. How are things on your side of Philadelphia?

Ramie: Hey, sis! Ramzie [our brother] and I miss you over here. It's been a little over 2 weeks since we decided that we probably shouldn't see each other in person.

Cherie: I'm thankful that we have FaceTime to stay connected, especially when it comes to checking in on Baba [our father]. I haven't seen Baba since January. It's just not worth the risk of possibly exposing him. It's definitely ironic just how much the tables have turned, as we're now "scolding" him for going out.

Ramie: I definitely feel that about Dad. I keep thinking it's a little extreme, but I also know I would never forgive myself if I got him sick.

What about your residency training, Cherie? How has COVID changed things? What is your "new normal"?

I guess my new normal is anxiety.

Cherie: I'm part of a skeleton crew of residents who alternate working days. That way, if one group is exposed to the virus, we still have another set of residents who are ready to see patients. Our eye emergency room serves as a haven for those who can't seek care elsewhere. Wills has one of only three emergency rooms in the country dedicated to eye pathology. It is well recognized in the area as a place where primary doctors, eye care providers, and local emergency rooms can send patients they feel uncomfortable managing. We have also had patients find us and choose to come to an eye emergency room instead of going to an urgent care or local emergency room for their ocular pathology.

Now that several clinics have closed in the area, I'm seeing patients who have waited too long to seek care and now have fulminant ocular infections or advanced macular degeneration from having missed their injections. I think those latter patients have been worried to leave their homes. Many are already older and may be immunocompromised. We are also seeing patients who accidentally injured their eye with new workout equipment or suffered a chemical injury while dyeing their hair because the salons are closed.

Some patients have read about conjunctivitis as a sign of COVID and come in and ask for COVID swabs, which we do not regularly use in the eye emergency room. Per the American Academy of Ophthalmology (AAO), the virus can cause a "mild follicular conjunctivitis that is virtually indistinguishable from other viral causes or conjunctival congestion." Of course, that part is often left out of the news stories.

I now hoard my surgical mask and am trying my best to not lose or soil it. I will be filled with guilt if I have to use another one. Ophthalmology examinations require us to be in close contact with our patients. After every patient interaction, I wonder if that person may have been an asymptomatic spreader or if the virus was transmitted despite my mask, the breath shield, and my copious handwashing and disinfecting.

Honestly, it's not that I'm that worried about myself. I'm worried that I could transmit this virus to my patients, or to you, Ramzie, or Dad. I guess my new normal is anxiety.

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