Return to the Spring 2020 Newsletter

Spring 2020 Newsletter: A Residents’ Perspective on COVID-19 Pandemic — Brigham and Women’s Hospital/Harvard School of Medicine

Rossella Intini & Shaiba Sandhu -PGY2

Dear colleagues,

The world around us changed in a blink on March 10 when the state of emergency was declared in Massachusetts (MA) and stay at home orders were announced. Would you have believed if you were told 6 months ago that a global pandemic was looming and waiting to establish its roots uprooting your daily, boring yet essential activities? Would you have thought that the gym membership you were so motivated and excited to get would suddenly be lost to a 0.12 microns sized virus? Would you have imagined your day that used to run at the speed of lightning would come to a halt and you would end up binge-watching Netflix day in and out with a long-winded roomie, without the possibility of an escape? Would you assume that our plans to participate in the AAOM 75th celebration enjoying a good mojito and passing our boards would have been crashed? Could you believe that you would have missed the 67th birthday of your mother-in-law? - Ok, this is probably not too bad.

Welcome to a new world where smiles are hidden by masks, hugs are replaced by distant waves and socializing has been given a new name of virtual happy hour. Let us introduce ourselves and share our experience from the aspect of patient care, academics, and the way our personal and professional lives have been impacted by the COVID-19 pandemic. We are two rising third-year Oral Medicine residents at Brigham’s and Women’s Hospital and Dana Farber Cancer Institute in Boston (MA) who have been trying to tackle the pandemic with altruism, friendship, and a bit of irony.

As the pandemic started, the private dental practices closed, directing an increased number of patients to the hospital for urgent dental care. If on one hand, this flattered the division of Oral Medicine providing us the opportunity to play our part in these testing times; on the other hand, it translated into the conspicuous extra workload that was gracefully managed by our team including clinic assistants, residents and our attendings. Our hospital promptly responded providing us operational guidelines and personal protective equipment for taking care of urgent procedures. As you know, dentists are among the health professionals that are at the greatest risk of exposure primarily due to the generation of aerosols in dental procedures making us feel like marching generals with a sense of duty and commitment. Our proud moments not only include being accessible for our patients but also available for our medical colleagues who are the front-line heroes in ER. 

While the dental procedures increased, we had to change our non-urgent in-person oral medicine visits to either telephone or video conference to ensure the continuity of care. However, this has not happened without difficulties given the need for coordination among the front desk, providers’ zoom accounts, and patients’ technological skills. However, at the end of the day, together with the efforts of our patients, including their dedication to click an optimal picture of their oral lesions for assessment, we are able to diagnose and provide a treatment plan successfully in the majority of our patients, excluding those who need a biopsy for a definitive diagnosis (Figure 1).

We have been seeing urgent patients who likely needed a biopsy for a possible (pre)cancerous lesion. This happened without a light heart. Operating room availability for H&N surgeries has been drastically reduced, not allowing patients to access the urgent care they might have needed (Figure 2). Still, our patients continue to be a source of inspiration to us, showing how gracefully they can deal with an uncertain prognosis in an uncertain time.

Our academics have also shifted to the virtual mode where the classroom seats have been replaced by our couches. Although video conferencing has made it feasible for all of us to continue our education, there are times when we miss the learning atmosphere a physical conference room/ classroom provides. But on a brighter note, this has opened avenues for connecting and learning virtually from any educator in the world. 

Not all days have been glorious though. We have felt lonely and lost, most of all because a lot of us are not from Boston. Not knowing when you will be able to hug your mum in Italy or your sister in Canada or daughters in China because of the travel ban has hurt us immensely. We like to believe that is part of our commitment when we decide to enter the medical field as a resident, i.e, being able to put aside our troubles to help others find answers to their conditions and a possible cure.

The pandemic has brought along with it a sense of self-awareness for all of us. It has given a pause to our lives making us contemplate who we are, where are we going, what steps we have made until now, what decisions should be made, what kind of human beings we want to be. The challenge will be keeping those promises we have made during this time.

For a lot of us, the hospital, with its monotonous white light, empty aisles, and long working hours, has been our home and shelter. Despite all odds, we still feel fortunate about being able to come to our hospital to relish the daily free food giveaways. But, more importantly to  see the members of our team, connect and laugh together, in a way that has bonded us more than ever, and all of this while following our hospital’s motto of “hygiene and heart, six feet apart” (Figure 3). Yet, we know that some colleagues and people out there are struggling with isolation. They were either already feeling lonely or they have found themselves hopeless in this historical moment. If you want to reach out, please contact us through email to [email protected] or [email protected]. We are part of something bigger than our own hospital world.

Figure 1. One of the many attempts to get this patient to turn her camera to obtain an intraoral photo.

Figure 2. After climbing up the ladder through first telephonic, then video and finally clinical appointment, a panoramic radiograph confirmed osteoradionecrosis with pathological fracture and the patient was scheduled to see the ENT surgeon who designated the patient as “Priority Level 1” for the OR schedule.

Figure 3. The authors enjoying a respite from the hospital in the sunshine