Clinical Conversations

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We talk with Colleen Farrell who’s doing her third year of an internal medicine residency in New York City.

Fortunately, we caught her during a one-week vacation (she was supposed to be taking two), and she chatted with us about how she and her colleagues are coping.

We asked her what she thought COVID-19’s larger lessons would be, and she gave an interesting, impassioned answer.

Running time: 12 minutes

Other interviews in this series on COVID-19:

1. Dr. Anthony Fauci
2. Dr. Susan Sadoughi
3. Dr. Matthew Young
4. Dr. Julian Flores
5. Dr. Kristi Koenig

Joe Elia:

You’re listening to Clinical Conversations. I’m your host Joe Elia.

We’ve come to New York City this time, at least electronically, to talk with Colleen Farrell.

Dr. Farrell is a third-year resident in internal medicine at NYU in Bellevue Hospital. This July, she starts a pulmonary and critical care fellowship at New York Presbyterian-Cornell. I became aware of Dr. Farrell when a classmate of hers sent along a posting she’d made on social media. It read, in part, “I feel grateful that I am able to put my training to public service. I don’t do well being cooped up at home. I became a doctor to do this work, but I would be lying if I said I wasn’t scared. I am calm and committed but also deeply, deeply terrified.”

Welcome to Clinical Conversations, Dr. Farrell.

Dr. Farrell:

Thank you. Thank you for having me, Joe.

Joe Elia:

So there you are in New York City. How are you and your colleagues doing? Are you getting enough time away from the clinic to get sleep and get food?

Dr. Farrell:

Yeah. So I would say that the experience varies widely from week to week. So in this situation right now in the midst of the COVID pandemic it seems — like for everyone — you’re either fully on or totally off at home. So you’re catching me in one of those off periods. About two weeks ago, I started taking care of coronavirus patients at Bellevue. When you’re doing that work, the shifts are long and really tiring. Our whole residency schedule has been kind of recreated to meet the staffing needs of this crisis but built into that is some time off.

So right now, I was still due for a two-week vacation towards the end of this year, and so right now I’m getting one week of that. So I’m in this weird place of getting rest right now and knowing that I’m jumping back into it in just a few days.

Joe Elia:

Well you mentioned in that posting that I quoted from, you mentioned a patient. I wonder how that patient fared. Do you know?

Dr. Farrell:

Last I checked he was still in the ICU. He was intubated and requiring dialysis. Yeah. So this is actually the first coronavirus patient I met, and when I met him I was really worried about him. He was still breathing on his own but requiring a lot of oxygen. So it was the middle of the night. I called one of our ICU doctors and he was moved to the ICU where he still is. We’re seeing that with a lot of our patients, that when they get to the ICU it looks like it’s a pretty long course for a lot of them. It’s not needing to be intubated for a few days and quickly extubated, but it’s a long course with a lot of uncertainty. So I keep kind of checking in, hoping that he’ll get better, but it’s going to take time, I think, to see.

Joe Elia:

Yes. Let’s hope that he does get better. How are you keeping up with policy? Have you joined any of the private chat groups like the one described by Dr. Julian Flores during his interview here?

Dr. Farrell:

Yes. Right now, we’re dealing with so much information. So I’m getting information from several places. First of all, I think — especially in my role as a resident physician — decisions I make are about the patients I’m directly caring for, or managing my own team, and so it’s hyperlocal. So first I have to pay attention to the policies from my institution. We get multiple emails a day and like a lot of residents I’m not employed by just one. Well, I’m employed by an academic medical center, but I rotate at NYU Langone, Bellevue Hospital, and the VA. So those are three completely different hospital systems. They’re three different hospitals, for one, but they’re also a private hospital, a public hospital, and a federal hospital.

So just to do your job you have to keep track of those policies. So we have a lot of internal communication with documents: “This is the latest of the PPE standard. This is how long you have to be out of work if you have symptoms. This is when a patient is allowed to move to this place or that place.” Those are the policies I pay the closest attention to. Then I would say while I’ve been home this week on my “vacation” I’ve been tuning into New York Governor Cuomo’s updates and those actually help me understand kind of even what I’m seeing sometimes at the hospital.

He’s been talking about [transferring] patients from some hospitals in New York City to others to even-out the load, and that helps me understand [that] when I’m at work I might be getting transfers from other hospitals and understanding why that is. Then in terms of more informal mechanisms, I’m pretty active on Twitter. I get a lot of updates there from people on the frontlines and then I’ve also been reconnecting with colleagues from medical school that I haven’t been in touch with for years. My Harvard Medical School class Facebook group — I don’t think anyone touched it for three or four years but all of a sudden people are connecting on there, talking about what’s going on in their hospitals and just sending support to each other. We’re all thinking of each other and kind of reading what’s going on in different parts of the country.

Joe Elia:

Tell us a bit about your social media posts. Are you looking at maybe a career as a writer?

Dr. Farrell:

Yeah. I’ve loved writing at least since college and have been writing about social and ethical aspects of medicine since I was an undergrad 10 years ago and I was writing about the early years of the AIDS epidemic in the US. At that time, I was reading Atul Gawande and found his books captivating as so many do. I kind of even realized at that time that I wanted to do the kind of writing in medicine that spoke to audiences beyond the doctors and scientists in a hospital.

So then in medical school I was really closely mentored by Dr. Suzanne Covin, who’s the writer-in-residence at Mass. General Hospital, and she’s been a tremendous role model to me. I use writing as a way of both processing my own experiences and kind of sharing with a broader medical community — and more society at large — some of the social and cultural aspects of medicine. So sometimes that’s through essays that I publish but I actually really like using Twitter and sometimes Facebook as a way to send off little missives. I like that they’re informal. They feel real and authentic. They’re not filtered through an editor or someone else. It can be a really cool way to connect with people and it’s writing. Any time you’re using words you’re learning how to write.

Joe Elia:

Yes. I know those editors do get in the way…

Dr. Farrell:

I’m grateful for editors but sometimes it’s paralyzing knowing that you’re going to be scrutinized.

Joe Elia:

Sometimes they help… So you’re on vacation this week. Are you reading or binge-watching?

Dr. Farrell:

I mean it’s a very weird vacation. I’m just staying inside my apartment. My husband is home. He is a third-year NYU law student and is doing law school remotely this week. We’re watching movies. We take turns who picks the movie each night. So we watched Alien. We watched How to Survive a Plague, a really great documentary about the early years of AIDS and then we watched Indiana Jones. So we’ll see what we pick tonight.

Joe Elia:

Those are all consonant with your current experience…

Dr. Farrell:

And writing. That’s the other thing. Right now, it’s nice to have some time. I’m doing some writing about my experience in the ICU last week and also doing some writing reflecting on…I mentioned I wrote my senior thesis in college on the early years of the AIDS epidemic. I’ve been thinking about what I learned doing that historical research then and what lessons I might be able to take from it now. So it’s nice to have some time to think and marinate a little bit before I jump back in.

Joe Elia:

I want you to project yourself forward in time a bit. When this pandemic ends and you’re training other young clinicians, say 20 years from now, what will you tell them was COVID-19’s most important lesson?

Dr. Farrell:

Well, I think it’s a lesson about health inequities and existing injustices in healthcare. I think that we are seeing right now that the health of one person affects the health of the entire society and that health cannot be treated as a commodity only available to those who can afford it. It needs to be treated as a human right. Right now we’re hearing politicians say no one should be denied a COVID test or COVID treatment because of their ability to pay, well I agree with that, but why shouldn’t that be the case for cancer or diabetes or anything else? I think we’re going to see more that this pandemic doesn’t affect all communities — even within the US — equally. It is ravaging Rikers Island right now, where we have mass incarceration.

When I call families and update them on their sick family member it’s totally different if they have a big apartment where they can separate within the apartment from those who have symptoms and those who don’t. But when you talk to a big family in crowded city housing they don’t have those possibilities. When government support doesn’t include undocumented immigrants you have a huge health justice issue on your hands. So I think that one of the biggest lessons from this time is to say that the social safety net and healthcare for all is not optional. It’s not a luxury. It’s a foundation of a functional society that has any degree of concern for the people within it. I think that we have been existing in a healthcare structure that is grossly unequal and oftentimes prioritizes profits over people, and I think that this pandemic is going to lay that bare for our whole society to see.

I hope that in 20 years I will be able to say maybe this is the last straw that helped our society change and provide healthcare to everyone. I hope that’s the story rather than we continue on or we return to the status quo after this ends.

Joe Elia:

Well, Dr. Farrell, I want to thank you for speaking with me today and I hope you’ll come back in 20 years and we’ll review that together.

Dr. Farrell:

That would be lovely. Thank you so much.

Joe Elia:

That was our 262nd episode. All the others live at Podcasts.JWatch.org. We come to you from Physician’s First Watch and NEJM Journal Watch — members of the NEJM Group. The executive producer here is Kristin Kelley, and I’m Joe Elia. Thank you for listening — and wear your masks and wash your hands.