On the Front Lines of COVID-19: One Resident's Experience

Completing a medical residency can be trying in the best of times, but when you’re a resident during the worst pandemic in 100 years, it’s equal parts scary, overwhelming, intense and clarifying.

Dr. Brandon Temte, an R3 at Providence Portland Medical Center in Oregon, was teaching at a medical school in Uganda when the pandemic became an international crisis. He caught the last flight home and showed up for work a few days later, to a completely changed hospital.

Here, Dr. Temte, who plans to specialize in Pulmonology, shares his journey, and what he’s learned from being a resident in the time of COVID-19.

Provider Solutions & Development: Where were you when you realized coronavirus had turned into a pandemic?

Dr. Temte: I was in Uganda with one of my best friends. It was March 2020, and we were three weeks into a program teaching at a medical school there. The Center for Disease Control declared coronavirus a pandemic when we had about one week left. My buddy and I got calls from our parents at almost the same time, around 4 a.m. They said we needed to get back, that the U.S. was closing its airports. The airlines weren’t even answering the phone, so we drove seven hours to the nearest airport, where we bought tickets and caught one of the last international flights out.

What was it like when you returned to your hospital?

We had no schedule, so we just showed up and said, ‘How can we help?’ We were planning for the worst. They shifted the resident schedules to keep us safe but still use our services. Like a lot of people in our program, we volunteered. I signed up for a lot of extra ICU shifts. From March to May, a lot of our elective rotations were shut down so I was constantly in the ICU or doing a home rotation, where I did online learning from home.

What was your ICU like as you dealt with the first wave of COVID?

It was pretty full, so we opened our NICU, and that was our designated COVID ICU for a while. We had a reasonable number of patients on ventilators. I was working from 6:15 a.m. to 8:30 at night. Our days would start with a lot of pre-rounding and chatting about folks. In the afternoon, we’d do procedures and call patients’ families. We had 36 beds in the ICUs, and most of those beds were filled. We were dealing with a lot of ARDS – Acute Respiratory Distress Syndrome – that’s the thing that makes everyone so sick from COVID. ARDS is a form of severe lung injury and can occur as a result of an overwhelming inflammatory response to the virus. I got to do a lot of procedures – central line placement, which is the large IV in the neck. I’d tap into the lungs, put in dialysis catheters and perform ultrasound-guided procedures.

Why did you volunteer to be on the COVID team?

I really wanted the experience of learning how to manage COVID patients and getting comfortable in every circumstance. It was a time when people needed us, and that’s why I got into medicine.

How were you affected during that time?

There was fear and anxiety. I think everyone had that. It’s a normal response. I didn’t have some of the stressors other residents had. Some residents had kids and other people in their home. I was living on my own, so I isolated myself. The risk of bringing COVID home to the ones you love was the biggest stressor for most people.

What was the hardest part for you?

It’s everyone’s worst day when you go to the ICU, and it’s incredibly hard not to have your family there to support you. I had so many difficult conversations with patients’ family members over the phone from March to May. We relied on technology — tablets, Facetime and phones. That was the most difficult part for me mentally, going from the intensity of that to just going home and being stuck in my one-bedroom apartment, alone with my thoughts.

What did you do to cope?

When I was on home rotations, I spent time really reaching out to friends and family. I realized that during my training and residency, I hadn’t done a good job keeping up with them. I called my cousins, my grandparents, my brother and my parents, and I took advantage of that time to reconnect with everyone in my life. I also went on a lot of runs throughout the city.

Did you second-guess your decision to become a Pulmonologist?

I have not questioned my path. I saw this as an opportunity to make difference. I’ve put a lot of time into managing respiratory failure, and I got to be there for my patients’ worst hour. That’s what got me through.

What was life like after the first wave of COVID subsided?

We got used to functioning in the pandemic, and our elective rotations opened back up, along with our clinic. We went back into clinic rotations. Life started to feel a little more normal, just with a lot more PPE. We had some opportunities, within our social bubbles, to have some socially distant hangouts at the park, things like that. So some of those coping mechanisms started to come back, and that was beneficial.

How did the way you treated your COVID patients change over time?

Initially, we had so many questions. There were different trials showing different things, and the rules seemed like they’d change every day. We were working in a land of physiology with incomplete data and doing the best we could. But by mid-summer, we had a structure in place. We worked with our Infectious Disease department and created protocols. Now we have medications that we know work, and we know when they work.

What’s next for you?

I’ve been notified that I will be Chief Resident next year, so I’m pretty excited about that. I’ve got a list of fellowships I’m applying for. My whole family is back in Wisconsin, so I’ll probably head back to the Midwest. I’m looking forward to a future in Pulmonology. Every day I walk out of my Pulm rotations, and it confirms that this is exactly what I want to do.

If you could give advice to someone starting their residency, what would you say?

No matter where you go, you’ll have a lot of opportunity for personal and professional growth, and I would say take advantage of every one of those opportunities. Take part in research or a quality improvement project. Be the driver of your own professional growth. You won’t always get it right, but that’s ok. There’s something to learn from that. Just go for it, and make sure you get the support you need. Take the time to remind yourself what an immense privilege it is to be a doctor.

What has been your biggest lesson from COVID?

It reinforced the importance of communication for our critically ill patients. I’ve had to explain things to patients and families when they’re afraid and angry. I’ve found it really rewarding to be able to tell people clearly and honestly what is happening to them or to their loved one, and to do it in a way that is compassionate and understanding. That’s something you can’t learn from a book or from a lecture. You learn that by doing it, and people appreciate it more than words can say.