Fred Milgrim: A NY doctor’s warning
Health-care systems in America do not support physicians and do not support the most vulnerable patients. Physicians are seen as upwardly mobile and willing to pay the price of unacceptably low residency pay and backbreaking work in order to do what they love. Patients without access to care are seen as unambitious—they lack insurance because they do not work. Hopefully this crisis opens the eyes of Americans to the plight of both groups.
The White House, the Centers for Disease Control and Prevention, the Department of Health and Human Services, the National Institutes of Health—they all failed to deliver on sufficient testing, on guidelines, on coherent messaging. Hospitals across New York City failed to report health-care-worker fatality rates or to produce ventilation-eligibility criteria, leaving me to guess at my own risk and to decide who lives and dies. There has been an abdication of leadership at the highest levels of this crisis that has trickled down to me, a physician in an ER with inadequate personal protections telling oxygen-starved patients to come back when they cannot speak a full sentence or are coughing up more than one tablespoon of blood. These institutions, just like my attendings, are teaching me a lesson through absence: how to manage a pandemic alone. And I am ready because I have been left alone before.
“Sink or swim” seems to be the mantra of medical training. The second year of my residency was physically taxing, with eight or nine 12-hour overnight shifts in a row. I frequently had to flip my sleep schedule to wake up at 6 a.m. or 5 p.m., depending on the day. The physical rigor of residency left me moody, weary, stretched thin. And yet that was only the beginning of the process. On top of the physical exhaustion, residency pushes new physicians to extreme autonomy.
My attendings could have easily lightened my patient load, but they did not, so that I could learn self-sufficiency. They could have acknowledged the particular challenges I faced later as a black physician at NYU Medical Center, treating upper-class white patients who sometimes doubted that I was even a doctor. But they did not, so I could learn resilience. They could have counseled me on how to process the immense human suffering of Bellevue. Instead they mostly did not, leaving me to internalize my agony, and see the next patient. Their effective absence—only there as a malpractice safety net—taught me how to work efficiently, to manage an entire team of caregivers in the emergency department, and eventually to manage the ugliest parts of myself and others.
This approach was not without its costs. The isolation at work was made worse by isolation at home. A resident work schedule spares no nights or weekends; I craved moments of release or nourishment with friends and family and found them few and far between. The social isolation compounded by intense personal tragedies—the loss of my mother while I was in medical school and my father during my residency—had me at wits’ end, and eventually forced me into therapy and a two-week elective period that I used as a wellness leave. But residency had made me competent in my field and able to practice in a vacuum. Costs be damned.