Face Mask to Face Medicine

By Madeline Ruszala, UIWSOM, OMS-IV

Knock, knock. The door swings open and I’m nervously thrust into the exam room. Out of habit, I reach out to shake the patient’s hand as I introduce myself, “Good morning, I’m Student Doctor Ruszala. It’s nice to meet you.” The patient raises his eyebrows in a look of confusion as I pull my hand back unshaken. I realize in that moment that I’m not learning to practice medicine in the same world I was in just a few months ago. I smile and wonder if he can see the smile in my eyes because the rest of my face is hidden behind my mask and under my shield. This mask may be only one millimeter thick, but it feels like a concrete wall between the patient and me in that moment. Ten weeks prior, cases of COVID-19 began to surge in the United States and medical students across the country were pulled out of hospitals and clinics as a protective measure to reduce exposure and conserve the personal protective equipment supply. We were told that it would be a two-week pause in clinical rotations as we attempted to “flatten the curve” across the country. Fourteen days quickly turned into six weeks and then ten weeks. I had spent the past two months at home, avoiding the grocery store, completing coursework on Zoom, trying to explain to my one-year-old daughter why the park was closed, and worrying about what the future would hold. How would this affect my medical education? Would I have the opportunity to learn everything I needed to know to become a physician? Would I be able to graduate on time? Questions such as these raced through my mind day and night.

Being taken off my rotation due to a global pandemic was a paradox. I had chosen to pursue medicine because I wanted to help people when they were unwell. I understood that being around patients with communicable diseases would be a risk to myself and my family. I knew that I would likely get sick more frequently than others. However, I never considered I would live to see a pandemic like this. I surely never expected to be told that when the healthcare needs of the country were at their peak, I should stay home. The level of internal conflict this brought was painful. I wanted to be there to help. I wanted to put my training to good use. I knew that I was not quite ready to treat patients on my own, but there had to be some way I could be helpful when the hospitals and doctors were overtaxed. And yet, what I was being asked to do was “stay home and stay safe.”

My part in helping to control the spread of this illness was not in the clinics; it was in my own home. My role was staying out of public places and encouraging my loved ones to do the same, especially in the

midst of constantly changing public information. It was learning about They went from learning on campus in large and small group sessions, the disease from cutting-edge case reports and online didactic sessions as well as hands-on learning in the anatomy and clinical skills labs, to rather than seeing it firsthand. For my classmates and me, being side- learning online via Zoom overnight. Many students reported that the lined was difficult, but the order encouraged us to be creative and find transition was difficult as they had to learn to use new technology and other ways to help. Students from UIWSOM helped in the COVID- to focus in their home environment which can be very distracting. 19 pandemic by donating PPE to local drives, delivering PPE to local Our third-year students were preparing to take their board exams physician’s offices, making and donating face shields, helping with con- when the “Stay at Home” order was put into place in March. Many tact tracing, providing childcare for physicians whose daycare had had their exams canceled or postponed for indefinite amounts of time. closed, and much more! Some still have not had the opportunity to complete these important

In addition, when we could not be on our scheduled rotations, we assessments. They were forced to be resilient and to adjust to changes were able to complete a Telemedicine elective rotation. I learned about at a moment’s notice as no one could predict where this pandemic was many important facets of telehealth, including billing and HIPAA going to take us. practices, and even practiced doing patient visits via Zoom. I foresee The members of the Class of 2024 began their medical education telehealth being an important part of the future of medicine and I will in July and have not yet been able to travel to campus for full-time be more prepared to help my patients in this way. All the time I have learning. This has been an incredible feat for these students who have spent learning to use Zoom will surely prove useful as we enter into been forced to adjust to the rigor and pace of medical school in this the first ever virtual residency application season. Stu- unprecedented time. The faculty and staff have redents in the Class of 2021 are prepared to do “meet and sponded by trying to bring the learning to the students greets” with residents, interview, and rank programs in I foresee telehealth in the best way possible given the circumstances. Stuhospitals and cities that we have never visited. Through being an important dents are currently experiencing all the typical courseit all, we came together to help each other and our com- part of the future of work, but in a virtual format and they have only been munity endure one of the most difficult times that we have faced and I’m confident we will continue this. When we finally received the news that we would be medicine and I will be more prepared to help my patients in this way. able to meet their classmates and professors via Zoom. This is hard for me to comprehend because I know how difficult the acclimation process is, but they have able to return to clinical rotations, I was excited to con- demonstrated an extreme amount of flexibility, which tinue my education and, at the same time, apprehensive will be incredibly valuable in their future careers. to return to the “real world” knowing how much had changed. My de- In the end, no one can predict exactly what the future months will sire to serve had not faltered and my interest in learning to be an effec- hold regarding the COVID-19 pandemic, but I know for sure that I tive physician was still there, but there was also the fear of being will continue smiling behind my mask and consider this time in my edexposed and becoming ill. We’ve seen that most cases in previously ucation abundantly valuable. One of my preceptors told me that she behealthy individuals are mild to moderate. However, that does not dis- lieves we have lost sight of humanity amidst this pandemic and I think count those who experienced severe symptoms and are now living with that in many ways that is true. We need to remember that the human potentially lifelong consequences of the disease. Either way, I suited race has faced many difficult periods. The way we will make it through up and headed back out to finish my rotation in Internal Medicine. I this is to unite ourselves and work together to keep everyone healthy. was surprised to realize that with the new guidelines in place, I saw As future physicians, we play an important role in this pandemic. very few sick patients in the outpatient clinic. Our role involves learning how to handle difficult situations and how

Most patients I saw were coming in for annual wellness exams or to to adjust. Communicable diseases surround us every day, but controlfollow up on chronic conditions. No one who had a fever or cough ling and slowing the spread of a pandemic is not new. We need not rewas allowed in the clinic. Again, I saw the paradox unfolding before member this time for all the things that were taken from us in our me. Sick patients were not allowed to see their physician—the one education, but for all the new opportunities that were presented. 2020 person they are supposed to turn to when they are ill. We’re still learn- has been a year filled with proverbial lemons for medical students ing how to respond to the challenges set forth by this pandemic and across the country, but we will continue making lemonade. We’ll just attempting to keep those who are well away from those who are sick have to sip it through our masks. should be prioritized to control the spread of disease. Still, we need to find a way for patients to access their physicians and the care they need. Madeline Ruszala is a fourth-year medical student at the

In talking to students who are still in their pre-clinical years, they have University of the Incarnate Word School of Osteopathic Medishared the impact the COVID-19 pandemic has had on their education. cine and is a member of the Bexar County Medical Society.