In the best of times, internal medicine residents form the backbone of most academic medical centers. In this age of COVID-19, the role of UNLV School of Medicine internal medicine residents has become even more important.

At UMC, the medical school’s chief training hospital, the residents manage patients in areas critical care, infectious disease, pulmonology, gastroenterology, cardiology, neurology, endocrinology, and nephrology. UNLV Medicine outpatient clinics? Yes, they still see patients there, too. When it comes to COVID-19 patients, they take care of patients who aren’t on ventilators as well as those in the ICU who need the support of medical machinery to breathe.

Dr. Aditi Singh, the internal medicine program director, notes that residents have never forgotten that the loved ones of patients cannot visit during the pandemic.

“Our residents call the families of patients each day to let them know how their loved ones are doing,” she said. “They understand just how important it is for families. You can imagine just how emotional families get, how thankful they are for news about someone they love.”

Singh stressed that residents seeing patients for issues other than coronavirus must strategize patient rounds. “They want to ensure they are not exposing other patients, and minimize having to change back and forth out of their personal protection equipment (PPE),” she said. “It brings a different element to patient care that residents have become very thoughtful about.”

Some of the more than 50 residents who have cared for patients with COVID-19 recently spoke about their experiences.

Dr. Yen Cao

In the ICU, she cares for some of the most critical COVID-19 patients in ICU. At home, she nurses her 10-month-old daughter and continues to pump breast milk for her little one. “Previous studies (on coronaviruses) did not demonstrate significant viral load in breast milk but we still don’t know whether COVID-19 is transmitted in breast milk,” Cao said. “I choose to continue pumping for Audrey as there is an abundance of benefits from breast milk, including antibodies. I just take precautionary measures to ensure that it’s done under clean conditions — washing my hands, and sanitizing the pump equipment.”

Last year, the medical school created the Above and Beyond Award after Cao saved the life of a driver who had been in an accident. After witnessing the accident, she ran to the scene and began the CPR, saving the woman’s life.

Dr. Amaan Shafi

The son of a Las Vegas gastroenterologist, Shafi said he is blessed to be in a position to help people with the coronavirus. He said it’s extremely important to remain calm in phone calls to families worried about their loved ones. “It is so easy to get emotionally involved and then people won’t get the important information they need,” he said. “Sometimes I’m on the phone with an interpreter because the patient is Spanish-speaking, and I always worry that the essence of what I’m saying could get lost.”

Dr. Annie Hong

Pregnant, she is due at the end of May. Because she is so close to giving birth, she is no longer seeing critically ill patients. “I definitely wish I was on the front lines,” she said. “But I understand “

Now Hong is reviewing the work of the infectious disease team, trying to ensure that testing for the coronavirus is as accurate as possible. “It’s like an extra check,” she said.” Sometimes there are false negatives. We’ve developed a system in order to determine which patients must be retested. It’s so important to have a correct diagnosis. We don’t want to expose people to the virus.”  

Dr. Pallavi Satuluri

On the ICU rotation with a young child at home, she was, according to Dr. Singh, among the physicians who realized there would be a great need for interpreters for the loved ones of Spanish-speaking patients with COVID-19. “I can understand the fear of families,” Satuluri said. “We call every day and those who can’t understand English need to know what’s going on. There’s so much fear and we need to do all we can to calm them.”

It’s difficult for Satuluri's tiny daughter to stay calm when mom gets home. “No matter how much she cries when I get home, I make sure not to touch her, to disinfect before I hold her.”

Dr. Zachary Hanson

He can’t forget his first COVID-19 patient. “He pretty much came in without any respiratory symptoms. In 12 hours, he not only developed symptoms but he had to go on mechanical ventilation. Thankfully, he recovered quickly. He was off the ventilator in five days.”

Hanson says he has wanted to be a physician since he was 10 years old. “There were medical issues in my family and I wanted to be able to stop that kind of suffering. That’s what I still want to do — stop people’s suffering today.”

Dr. Tyler Heeren

He said he was “freaked out” when he saw young guys his age (in their early 30s) on ventilators. “It was scary. They had no medical history and the virus was laying people out flat in the hospital.” Heeren said he was struck by how a man in his late 70s was barely showing symptoms of the coronavirus while another young guy “with a complex medical history” died shortly after he entered the hospital. “We did everything we could,” he said. Talking with the loved ones of patients is both necessary and challenging, he said. “Giving false hope is worse than being honest.”

Dr. Wilson Chan

He noted that many of the most critically ill COVID-19 patients he’s dealt with have numerous organ complications, including renal failure requiring dialysis, liver failure requiring transfusions, and infections requiring antibiotics. He remembers one patient that he had admitted to the hospital directly from the emergency department. “I was there when the decision was made to intubate the patient (put on a ventilator) as the patient’s respiratory status had declined to the point that the patient could no longer protect her airway. I was really sad when the patient said before being intubated that she did not want to die and that she had trusted everyone involved in her care in helping her get better.”

Dr. Gabriel Washington

A Stanford Medical School graduate, Washington said that after working with COVID-19 patients in the ICU, the only thing he has time for when he comes home is “to eat and go to sleep.” He said he’s found it particularly difficult to speak with the families of loved ones with COVID-19 “where there are few signs of progress. They’re waiting eagerly for some positive news and you can’t give it to them. I know how difficult it has to be for them, and when I can’t give them good news, it’s very hard.”

Dr. Hui “Annie” Feng

As she’s worked on the front line of the coronavirus pandemic, Feng has missed the socializing she’s done with other residents. “We’re a very social program, but with the social distancing we can’t get together like we used to, like go to lunch together.”

With that in mind, she organized an initiative to give every resident “a care bag.” It includes a stress ball to squeeze, an aromatherapy candle, a coloring book, popcorn, chocolate, lip balm, water bottle, and hand lotion. “She wanted to do something positive to boost morale during this difficult time,” Singh said.