An International Medical Graduate’s Journey in the COVID-19 Pandemic

An International Medical Graduate’s Journey in the COVID-19 Pandemic

International Perspectives

Apr 01, 2020

By Mona Hassan, MD

I arrived in the United States from Lebanon on March 7. This was supposed to be my dream trip. I had prepared for it for months; the excitement and the anticipation all built up until the day I arrived in Cleveland, Ohio. Almost immediately, things started to go downhill due to an unexpected visitor called coronavirus.

Being a PGY-2 internal medicine resident, I started to have a clear idea of what I want to peruse later as a fellowship: hematology. I was so excited to come to the United States, do my observership in hematology and bone marrow transplantation at an institute which is considered to be one of the best in the field, and do my Step 2 Clinical Skills Exam (CS). As an activist in my daily life, I was going to attend the Harvard Arab Conference to do fundraising and raise awareness about the importance of education among refugees—I myself am a refugee who benefited from a scholarship to study medicine. I had planned a perfect trip to three cities, Boston, Cleveland, and Philadelphia, to attend three events which are very important to me and to any international medical graduate (IMG).

When I traveled to the U.S., there were news reports about the COVID-19 virus outbreak, but it had not yet been declared a pandemic by the World Health Organization. People in the airport were wearing masks, but the planes were full and the movement in the airport was more or less normal. Little did I know that this was beginning of something that would change the plans of millions of people around the world.

On the first day of my elective, the hospital was going into emergency mode. All of the planned face-to-face meetings were shifted to web conferences. The next day, those of us who had recently come from overseas were asked to stay outside the patients’ rooms and wear masks, and I think it was quite understandable considering we had just arrived from the airport. The attending physician on floor service did his best to explain principles and teach us, despite the fact that we were not directly involved in patient care or face-to-face interactions.

Then the most feared thing happened. Three cases of COVID-19 were reported in the state I was in, and the whole world went upside down. Talks about suspending all observers, electivers, and medical students started to circulate, and talk became action. All observers were suspended from seeing inpatients and most were asked to go home, just days after arriving in the United States. An email was sent to everyone who had observership in the coming months that it was cancelled.

My attending fought so hard to keep me and another observer in the hospital. He spoke directly with the hospital president and reached an agreement—we could continue our observership as long as we mainly saw outpatients. No one can imagine how much grateful I was for the stand that my attending took. He saved my long-awaited observership. In the meantime, a lot of the observers and electivers I knew were in my rented apartment, trying to see if they could find a flight back home. IMGs lost a lot of money on plane tickets and lodging.

At that point, I was going to stay. I still had my observership in the outpatient clinic and I got the chance to see CAR T cells being prepared and infused—seriously, how cool is this? I still had my Step 2 CS and the conference.

The next day, I was in the lymphoma clinic when the bad news arrived. All Step 2 CS exams were cancelled until mid-April and they would reschedule when the centers reopened. The Harvard Arab Conference was also cancelled. I felt like crying while I was seeing a patient with DLBCL, but I continued the clinic as if nothing happened. After we finished, I went for a walk, just trying to figure things out: Okay. This happened. I need to talk to the Educational Commission for Foreign Medical Graduates (ECFMG). I need to talk to my airline. I need to talk to my hospital to see if I can change my schedule so I can stay in the U.S. until the centers reopen and I can take my exam, because it will be very difficult financially to go back to Lebanon and then return to the U.S. later this spring.

I cannot describe my feeling at that point. It was a mixture of fear, disappointment, anger, and sadness all combined to one. How can your whole plan—the plan that you worked so hard for, and saved money for months for—change in less than a week?! It was only one week, but trust me, it felt like a decade. It was literally the longest week of my life.

I felt I had I hit rock bottom and that things could not get any worse—and then my country, Lebanon, declared a state of emergency due to COVID-19 and announced that airports would close for a preliminary 2 weeks, which could be extended.

At that point I had to make one of the toughest decisions in my life. I could risk staying in the U.S. and at least continuing my observership even with limited outpatient exposure, because I really was learning a lot in a field which I love, without knowing when I would be able to go home. I could risk going back to Lebanon, passing through the airport and staying in quarantine for 14 days at home, where I would be staying with a sick mother. The idea of contracting COVID-19 and infecting my mother was terrifying to me, but so was the idea of being stranded in an unfamiliar country for an indefinite period of time. After many hours pacing around my room, I made the decision to go back to Lebanon. In the space of less than 4 hours, I booked a plane ticket, packed my bag, went to the hospital, said my thank-yous and goodbyes, and headed to the airport.

On the trip home I saw more than 10 residents and 15 medical students in the same situation as me. Some of them spent the entire trip back to Lebanon crying.

And here I am in Lebanon, in home quarantine, talking to my friends who just matched, talking about how they feel afraid of the uncertainty of their future. Afraid that they will not be able to travel or get a visa because of the travel ban due to the virus. Afraid that the hospitals will not be able to wait for them and they will lose the positions for which they had waited so long.

 Despite all the frustration that has caused, I think that the coronavirus pandemic makes us appreciate all the things that we usually take for granted, like freedom, safety, having coffee with your loved one, setting plans, and simply being able to see patients with no fear on either side. All of our trouble seems to be trivial when compared to the many people who are being affected.

Hope deferred makes the heart sick. We need to keep the voice of hope higher than all other voices, because it is the only ingredient that will make a difference. Hopefully, this too shall pass.

Dr. Hassan is a postgraduate year 2 resident in the Department of Internal Medicine at the American University of Beirut Medical Center, Lebanon. She is interested in pursuing a fellowship in hematology/oncology. She is a strong advocate for refugee rights and education with an interest in public health, and she serves as chair of the humanism fund at her hospital. Follow her on Twitter @mona_hssn.

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