I must admit that I envisioned a slightly different final year of residency, one spent basking in clinical settings in which I had previously thrived or dreamed of thriving, but alas…COVID. So here we all are, learning to adapt and be flexible in a world of Zoom and phone calls, not only with our families and friends, but with patients new and old.
My third year of residency culminated in four months on the Consult Liaison (CL) service, which commenced in March 2020. After a few short weeks spent learning the exhaustive differential for altered mental status and acute management of Haldol and Zyprexa-refractory agitation, we confronted a new illness, one causing anosmia and agitation, cough and confusion. While we aimed to learn about the neuropsychiatric manifestations of this novel virus, the residency was tasked with navigating previously uncharted territory: how to socially distance residents in workspaces so that we could continue with our responsibilities of caring for patients safely. No easy feat given relatively limited space despite the seeming vastness of the buildings that make up Massachusetts General Hospital.
My personal circumstances were such that I was very concerned about exposure (pregnant!) and the rotation and residency leadership acted swiftly to guarantee that my baby and I were safe and unscathed by the potential of hospital exposures and I was not only allowed but encouraged to spend the remainder of the rotation working from home, with adaptations to the rotation that made such a thing possible. CL is considered by many in the residency to be the capstone of our training, one in which the learning curve is steep and the material obligatory; the reward being that one feels at the end as though they could actually envision entering the world as a psychiatrist with the cursory amount of information necessary to take care of patients. So, while thankful to have accommodations made to work at home, I was nervous that I might miss out on the famed breadth and depth of the rotation. After nearly four months doing telemedicine consultations on a range of patients under the tutelage of many of the wonderful CL attendings, it became clear that such concerns were unfounded. I consulted on several patients a day and participated in inter-disciplinary team conversations as though I were present in the hospital, all thanks to a bit of patience and technology. I cherished conversations I had with patients and though, never having met them in person, cultivated close clinical relationships with many of them. While it was a vastly different experience than was expected, I could not have asked or wished for a better one, one in which I learned, treated, educated, counseled all the while keeping myself and my burgeoning family safe. I am forever thankful to the residency for taking such measures and can’t wait to introduce everyone (even if only by Zoom) to the baby who is soon to join this world!
Now a few months into my fourth year of residency, I am spending much time reflecting on from whence I have come and where I plan to go. Still working primarily from home, I am doing mostly outpatient work with my panel of patients with whom I have been working for the last few years. While my patients and I have had to adapt to a new world of communicating, I have found that for the most part, not much is lost in translation and we are able to keep calm and carry on with the benefit of being able to see each other’s faces and facial expressions, which is obviously important in our field. In addition to caring for my patient panel, I am participating in the Mentalization Based Therapy elective and have taken on two additional patients with whom I am doing this type of dedicated therapy with the guidance of a multi-membered team at McLean Hospital, many of whom are experts in this treatment for personality disorders. I am simultaneously working as McLean Outpatient Chief, a role which is equal parts administrative and supportive, which I find deeply rewarding, particularly when it comes to helping residents cope with the many challenges and stresses of residency training. I am also the Psychotherapy Chief and, in this role, I spend time co-leading the PGY2 psychotherapy seminar with Dr. Robert Waldinger, which is a great privilege as he is a beacon of expertise in the world of psychiatry and psychotherapy. When planning my 4th year of residency, I prioritized extracting every last ounce of wisdom from my training, as I plan to move home to my home state of New Mexico to practice upon completion of residency. With just nine months left of training, I am eager to learn as much as I can and bask in the knowledge that training in our institutions impart. Even though I must do so while physically away from my colleagues and patients, our ease in doing so is testament to human capacity for adaptation, which feels quite apt in our world of psychiatry.