Editor’s Note: Trisha Pasricha, M.D., is a research fellow in gastroenterology at the Massachusetts General Hospital. She is a physician-filmmaker and director of the recent documentary “A Perfect Match,” about the American residency match process. The opinions expressed in this commentary belong to the author. View more opinions at CNN.
Like many physicians, I find myself on the front lines of a fight that I did not realize I enlisted in.
Amid a global pandemic, doctors far and wide are being called to the field to embrace roles they may feel completely inept in, oftentimes without adequate protection. When I spoke with my residency classmates this week – all healthy doctors in their 30s – I realized it was likely that many of us would be infected with the novel coronavirus. Given the mortality rates, it is possible one of us might not survive.
When we take the Hippocratic Oath to become doctors, we pledge to care for patients and respect their confidentiality. Never once do we vow to risk our own lives.
But history has shown that doctors do it anyway. Now with limited personal protective equipment, our role in the impending onslaught has been called “unprecedented.”
But it’s not.
My father told me stories of his residency training at D.C. General, a hospital immersed in the ravages of the AIDS epidemic in the late 1980s, before the Libby Zion case introduced limits on the hours residents could work. He was on one 36-hour shift when sleep deprivation caused him to inadvertently stick his finger with a contaminated needle. Without the availability of confirmatory HIV testing, he had no choice but to wait and see if he developed symptoms – and in the meantime, soldier on. It was only years later that he was able to confirm he had escaped transmission. Later as a gastroenterology fellow at Johns Hopkins in the 1990s, when the city’s homicide rate peaked, and victims of gang violence filled the emergency rooms, he recalled being only feet away from gunshots while taking a walk outside the hospital.
I used to wonder why my father kept going to work when it was unsafe.
Now I think I know.
The AIDS epidemic has killed about 32 million people worldwide. For a long time, doctors did their best to treat patients, even when it was unclear how the virus spread. And decades before the first flu vaccine, doctors (and indeed, prematurely drafted medical students) continued their work during the 1918 flu pandemic that infected 500 million people around the world. Physicians facing yellow fever and smallpox before them did the same. Major pandemics may spare generations, but they happen. And when they do, they inflict suffering across all boundaries of nation and race. In the face of the Covid-19 pandemic, I find myself wondering, “Did I study these recurrent judgment days of yore and believe that I would be immune?”
Like my father, I decided to specialize in gastroenterology and dedicate my career to non-fatal motility disorders — bothersome diseases of the gut that almost never lead to death. But he knows an unwritten, hallowed truth about medicine that I never learned in a textbook: that this is the moment that defines a doctor. It was never winning a research grant from the National Institutes of Health, or perfecting a procedural technique. Many of the thousands of doctors mobilizing into harm’s way are scared like me, and they understand this too.
If we deeply empathize with our patients, then we wish to save them just as we would save ourselves from the same illness. Mundane academic goals consume daily life to mask the true terrain doctors spend years climbing. We bury this beneath heaps of prosaic tasks and monsoons of endless didactics. Now is the moment to unbury it.
I remember the first patient who died on my watch when I was an intern. She was a gentle, elderly lady who succumbed to pneumonia at 3 a.m. I cried until noon. For months, I was unable to forgive myself for not preventing a death that was never mine to withhold. Part of me seemed to have died too. Since then, years of grueling medical training and countless sorrows conspired to barricade my fragile heart. But that first experience is precisely what will help me overcome the challenge ahead, as my patients will soon need someone willing to bet on them despite all odds.
In 50 years, medical students may be astonished to discover how doctors faced the coronavirus without knowing the basics of its virology that they may readily have at their fingertips, just as I wondered at how doctors before me combated HIV. But they will not be astonished at our responses.
They may face the same choice with their own patients one day.