How a group text helped this Philly doctor survive the ‘battlefield’ of COVID cases | Expert Opinion

Young residents call it the Sunday scaries — that feeling you get late in the afternoon, when the warm glow of a free weekend fades into cold apprehension about the week ahead. It’s a potent mix of nerves and nausea, brought on by the “Ghost of Call Nights Past.” In urology, this specter comes as the difficult Foley catheter, the bloody urine that won’t clear, or the 2 a.m. emergency surgery for testicular torsion. Once you’ve had one hard night, it’s easy to worry that the next week could bring another. Thankfully, when the “scaries” haunt me, my co-residents are ghostbusters ready to chase them off.

We have a group text chat to support each other’s medical and non-medical needs. When we face unfamiliar and uncomfortable situations — what a senior resident dubbed “battlefield medicine” — we turn to each other. Our collective knowledge helps us navigate new hospitals, strange consults, and attending preferences. More importantly, the group text is a judgment-free zone. Topics vary widely, from complex patients and difficult surgeries to debates about a notorious tiger-loving Netflix star. No matter the subject, I am guaranteed a sympathetic ear.

As residency progresses, we lean on each other more. We have embraced the battlefield metaphor and jokingly draw parallels between our lives and that of soldiers; gowning up for surgery is akin to arming ourselves for battle and morbidity and mortality conferences sometimes feel like facing a firing squad. One particularly difficult call weekend taught me how deep our bond truly ran.

During my second year of residency, having just started urology full-time, I had a patient with a history of pelvic radiation and bladder neck contracture. This is a challenging problem; a closed-off bladder neck makes urination difficult. This leads to urinary retention, and the bladder stretches out like a water balloon. The bladder lining is weakened by radiation and can bleed spontaneously. The blood collects in clots, which further block off the bladder, leading to more retention and then more bleeding in a vicious circle. The patient had been unable to urinate for days prior and the urology team had used a wire to place a small catheter through the narrow bladder opening and relieve the obstruction. Unfortunately, the bleeding had resumed, the catheter had clotted off, and the patient was writhing in discomfort with a full bladder again.

Flushing clots out of a small catheter is not an easy job. It’s like trying to sip coffee through a stirring straw – it’s possible, but it takes a long time and effort. If this had occurred earlier in the day, the team would have removed the catheter and replaced it with a large size. However, it was late at night on a weekend, so the normal urology support staff had gone home. I was tired and, with my inexperience, terrified of being unable to replace the patient’s catheter. Instead, I took the safer option and painstakingly flushed three liters of saline through the tiny catheter until it cleared. It was a temporary fix, but the patient felt better. I admitted him to the hospital and left to fight another day.

The next morning, I texted my team about my challenging night. My co-resident had finished rounding at a nearby hospital and was free to go home. Instead, she came to my hospital, and over the next hour, we widened the bladder outlet and placed a large catheter together. We watched the patient slowly exhale the universal sigh of relief that comes from emptying a full bladder. My seemingly insurmountable problem from the night before was fixed. When it felt like me against the world, she helped me be brave.

During the peak of the COVID-19 pandemic, the Sunday scaries became a daily occurrence. Both patients and providers were dying, and the battlefield metaphor became all too real. To minimize exposure to the virus, our division limited the number of residents present in the hospital at the same time so I did not see my co-residents for months. I felt alone. In recent weeks, the hospital has slowly returned to full capacity, but things are far from normal. Temperature scans are now required for entry, and everyone wears a mask and stands six feet apart. Philadelphia has reopened from yellow to green, but inside I am still on red alert. We have regular seminars on resident wellness and I have access to meditation apps. They are appreciated, but I can’t roll out the yoga mat while on call. My resilience comes from my co-residents — every chime from a new text is a reminder that even at a distance, my squad always has my back.

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Kiran Sury received his journalism degree from Macaulay Honors at Brooklyn College, and his MD from SUNY Downstate College of Medicine. He is a third year Urology resident in the Perelman School of Medicine at the University of Pennsylvania. The opinions expressed in this article do not represent those of the University of Pennsylvania Health System or the Perelman School of Medicine.