Reflections from the DCU Center
Elke Schipani
After being pulled from our final third year rotations and somewhat precipitously being placed into a two-week pandemic curriculum in its stead, I thought about what my next move would be. The uncertainty of the year ahead in the wake of the COVID from that point in March was as salient as it is now. As we finished our third year and began to plan for our fourth, I thought about what lay between myself and the students who had just been graduated to help with COVID surge staffing. Yes—I still had to complete my capstone, a subinternship, some other clinical rotations, but I had a lot of the knowledge I would leave medical school with. And yet the difference between my position and theirs was: “stay home” vs. “we need you.” I often thought back to the decision to take one year between graduating college and starting medical school. What if I hadn’t done that?
As questions and uncertainty swirled around me, the opportunity to complete a required fourth year rotation in emergency medicine at the field hospital erected to accommodate surge patients arose. Before the official offer was made, I already felt a compulsion to sign up. Maybe part of this was certainty—knocking down a requirement and making progress towards graduation, but I’d like to think that at least some of it was a desire to make my knowledge useful and contribute to the fight against COVID.
Working shifts at the DCU as a medical student was challenging in many different ways. Physically, donning protective equipment including a gown, gloves, mask, and face shield made the task of taking breaks for the bathroom or a sip of water an entire process of doffing. More than the respirators themselves, the face shields prevented the flow of oxygen so I often felt short of breath myself when wearing them. For a week, the supply of gowns were clear plastic material that created condensation as you overheated within them. They were so stiff you could barely hear over the sound of everyone crinkling their gowns.
As I got to know the DCU center’s role in healthcare provision, along with the other surge sites created by the hospital, I learned that many of the patients at the field hospital were what I’ve heard some physicians called “rocks.” The less than ideal name is given to individuals whom the team knows will be staying for a while, often due to barriers to discharge. While some patients at the DCU were triaged from the ED with a question of whether they will require more intensive hospitalization (and indeed, many did), just as many remained at the DCU center because of a mismatch between their needs and that of their homes. Some examples:
Asymptomatic individuals unable to return to their assisted living until they had two consecutive negative tests
Elderly patients living alone with no one to aide them in quarantining once returning home
Patients who entered the hospital with non-COVID complaints who acquired COVID during their hospitalization
Patients with mental health conditions, hospitalized for COVID and weaned to the field hospital, but now having acute mental health decompensations, possibly due to the environment, now needing inpatient psychiatry accepting COVID+ patients
As I carried out medical student duties at the field hospital, which mostly involved monitoring vitals and checking in on patients, I couldn’t help but read through their charts, listen to their stories of their illness, and feel for them. So many of these patients found themselves in really unfortunate situations. It just sucked, for lack of a better word. I was disappointed with the systems and disappointed that we hadn’t done better by them. And that was hard to swallow.
As I reflect now nearly 2 weeks since my last shift at the DCU, and I prepare to have myself swabbed for COVID RNA today, I wonder where all of the patients who stayed at the DCU are. Have they recovered? Are they in stable living situations? Do they now have some semblance of immunologic protection? While I claim to say I experienced the DCU field hospital, nothing compares to what they saw. While they stared around at their empty room and concrete floor, I got to walk the halls. As the lights dimmed to minimal fluorescence for night time, I got to go home. While I felt short of breath behind a face shield in their room, they felt that all the time. As I smiled as much as I could towards them with my eyes, the only visible part of my face, they stared back in fear, knowing they had to trust us.
Elke Schipani is a fourth year medical student who completed her emergency medicine rotation at the DCU field hospital during the COVID-19 surge. She is applying into neurology with an interest in critical care.
