At Jefferson, the doctors in training have been reasonably well-provided with personal protective equipment (PPE). There are no nightmare stories about the shortages early in the pandemic, when at many other hospitals, staff were forced to use bandanas as masks or gowns fashioned from plastic garbage bags. “Jefferson has been great with PPE,” Rubin says. “It’s doing the best it can.” Seecof agrees. From the start, she says, “Jefferson did a good job of adapting. I never felt in danger.”

Karaisz casually mentions that he came down with the virus earlier that autumn. “A lot of us have had it,” he says. Fortunately, it was a relatively mild case. “It felt like the flu,” he says. “I didn’t have a high-grade fever, but I was very fatigued. I lost my sense of smell. I had a rash.”

It laid him low for a week and a half, then he went through the recommended quarantine before returning to work. “Like most who are young and healthy, it really wasn’t that bad for me, but what’s scary about the virus is that it’s very unpredictable,” he says. Karaisz cautions that asymptomatic people can carry the virus and spread it to people who face much higher risk.

MASK UP FOR SAFETY

The risk posed by asymptomatic carriers is one of many reasons that wearing a mask is a critically important way to help prevent the virus from spreading. Yet all of the residents have encountered individuals who refuse to mask up. That resistance “is very disheartening,” Karaisz says. “You see patients die in the hospital alone — because of COVID, there are restrictions on visitation — and then you see people who won’t take the simple step of wearing a mask.”

Shortly before the residents’ Zoom interview, a nurse in Alabama went viral with a tweet saying she and her colleagues didn’t want to be celebrated as heroes. They just wanted people to wear masks because of the danger posed by those who refuse to do so. The tweet resonated with Seecof. “I went into this to help other people,” she says. “I don’t want this label ‘hero.’ I’m really just doing my job.”

Rich, the OB-GYN resident, has been tending to pregnant women who are ready to deliver. She’s encountered some resistance to the visitation restrictions required by the pandemic: Only one helper is allowed to accompany the mom-to-be, and the mom needs to have a COVID test.

“The vast majority of patients are understanding and willing to do what is safe for themselves and our staff. It just puts us in a hard spot if the patient refuses COVID testing,” Rich says. While you want to be as supportive as possible during what should be a joyful time, “it puts us at risk if people come in who may be positive for COVID or aren’t wearing masks.”

“Everybody’s seen it all when it comes to mask etiquette,” McLaughlin says. He points out that nurses have even more reason to be upset. “They have the most patient contact. They’re doing the COVID nasal swabs.” Seecof explains, “The sheer number of people dying should alert the population at large — this is a big deal.”

McLaughlin notes that medical staff sometimes overestimate how much the general public understands about something as complex as a novel disease like COVID. Seecof says, “I actually have had patients who’ve tested positive and said they don’t think it has infected them.” She credits Bucknell’s liberal arts education with helping her navigate the conversations that follow — talking to patients about everything in their lives, not just their medical situations. “That allows us to better connect with our patients and better help them through a difficult time,” Seecof says.

COVID’S EMOTIONAL STRESSORS

Treating patients during a deadly pandemic adds psychological strain to what is already a stressful job. Explaining the anxiety she feels, Seecof says, “It’s rooted in the whole uncertainty of everything.” The virus is new, and so much about it is unknown. There is no standard protocol to guide treatment.

The tools in the residents’ arsenal, especially with severe cases, are limited. McLaughlin mentions that when patients go on ventilators, “the odds are still very much against them, even though you’re doing the only thing you can do at that point.” Interviewed after the Zoom session, emergency medicine resident Emily Bollinger ’16 says treating COVID patients “has been a trying experience. You see the worst of it. We don’t have good therapies. It’s so heartbreaking. There’s so much more we have to learn.”

With patients’ families barred from routine hospital visits, doctors strive to keep them informed about their loved ones, but the demands of seeing other patients mean there’s not a lot of time for updates. “Finding that balance has been tough,” Rubin says.

Philadelphia has not, at the time of this writing, seen a tidal wave of COVID cases and deaths like those that overwhelmed hospital staffs in places such as El Paso in November and Los Angeles in January, leaving many medical personnel feeling emotionally devastated. But seeing patients struggling to hold onto life, for any reason, has an impact.

McLaughlin was troubled when he saw a COVID patient desperately gasping for breath while being supplied with 100% oxygen. Lauren Treene Lally ’13, an internal medicine resident who joined the Zoom session in progress, says one of her most tragic cases was an older man whose cancer had returned and who then developed COVID. While he was unconscious and on a ventilator, fighting multiple infections, the man’s son died unexpectedly. Lally was in regular contact with the older man’s wife and shared the pain of her twin catastrophes. “That was one of the hardest,” she says.

Working in certain areas of medicine, especially during this pandemic, sometimes leads doctors to create a protective psychological shell. “COVID or not COVID, we see a lot of hard things,” Lally says. It can be a struggle for the residents to conceal their personal feelings from patients. But whether they’re shown or acknowledged, those feelings are still there. “We bring a lot of it home,” says Karaisz. “It sits somewhere inside of us, and we don’t really acknowledge it. Some days it just all comes out.”

Bollinger and Seecof both say they’ve had to sharpen their skills in talking to patients and families that are confronting end-of-life decisions, such as signing a Do Not Resuscitate order, refusing a ventilator or pursuing comfort care that will ease death instead of continuing all-out treatment. Medical school education touches on this area, Bollinger says, but it doesn’t really train young doctors how to have those conversations.

BUCKNELL BONDS HELP

As the new doctors struggle with the stresses of the job and the extra risks created by the pandemic, having Bucknell connections is a welcome source of support. Some knew each other before landing at Jefferson for residency; others were surprised to find themselves working alongside a fellow Bucknellian.

When Rubin ran into Karaisz in the hallway, he realized they’d been in the same Biology 207 class. Seecof knew Jennifer Rich and her sister, Kim Rich Mosquera ’14, at Bucknell. Lally’s best friend and former roommate at Bucknell, Melissa Malkin Rubin ’13, is Rubin’s wife. Bollinger attended medical school at Jefferson with Rich and later worked with her during a rotation in labor and delivery. Seecof recognized Bollinger as a fellow Bucknellian when their separate work paths brought them together in the emergency room. “It’s funny when you’re on the other end of a call to the ER and you recognize the voice” as that of a Bucknell grad, McLaughlin says.

Jefferson has drawn such a significant cohort from Bucknell because some attended its medical school or another school in the Philadelphia metro area. Others have family roots in the region.

“I’m so happy to see people at Jefferson who are from Bucknell,” says Lally. “I get a pep in my step all day. It makes me feel more at home.” For Seecof, who hasn’t seen her family in a long time because they live across the country, there’s a sense of camaraderie that helps ease the strain of separation. “All the residents in the hospital have really come together,” she says. “Thomas Jefferson as an institution feels a lot like Bucknell — it’s a big place, but it feels very small,” thanks in part to her Bucknell colleagues.

That sense of connection, says Lally, is “a testament to Bucknell.” Even among those who didn’t know each other while in Lewisburg, there’s a common bond, she says. “We’re a community, and it’s nice to carry that feeling here.”

So does this Bison “band of brothers and sisters” at Jefferson have a catchy name? Maybe a secret handshake?

No — or at least not yet. A minute or two of brainstorming among the tired Zoomers produced only two nominees, “JeffNell” and “BuckJeff.” Neither drew much enthusiasm. Maybe with time, possibilities such as “JeffNell Crew” or the “BuckJeff Bunch” will catch on.

As the November Zoom session wrapped up, Rubin offered this advice for fellow Bucknellians as the pandemic dragged into a second year: “Stay positive. Treat yourself to some ice cream at the Freez. And wear your mask.”

By early January, two highly effective coronavirus vaccines were being rolled out in the United States. Front-line doctors and nurses, including those at Jefferson, were among the first to get the shots. We circled back to the Bucknell residents.

SHOTS IN THEIR ARMS

All seven of them were vaccinated within weeks of the initial rollout. “The only side effects I felt were a sore arm and happiness!” Seecof says. Bollinger was hit much harder. The second dose of the two-stage immunization knocked her down for 24 hours. Rich reported a mild headache and some body aches. “Definitely better than the alternative!” she says. Seecof has volunteered to vaccinate others at the hospital, an effort that she says “has been full of joyous moments and camaraderie.”

“There is a palpable sense of excitement in the hospital surrounding the vaccine,” Rubin says. “We still have a ways to go [in controlling the pandemic], but the vaccine is an important step toward normalcy.” McLaughlin agrees that the vaccine is a game changer — but not an immediate game changer. “It will take many months to put enough shots in arms to reach a point where we have some semblance of herd immunity,” he says. Meanwhile, he’s worried that a false sense of relief will set in and lead to backsliding on mask wearing and social distancing.

Dispelling some of the public reluctance to accept the vaccine, Rich says, “This vaccine has been well-tested and is safe. This virus does not discriminate, and I’ve seen people of all ages and backgrounds become seriously ill from it.” She notes that some survivors are left struggling with long-term complications. “I encourage everyone to get vaccinated as soon as you are able.”

Summing up his time in residency during a global health crisis, McLaughlin says, “There are a lot of sad moments, but there are also a lot of moments of personal growth. Working in the first year of the pandemic “has been scary and challenging, but there are always moments of great reward and feeling you’re making a difference,” whether it’s with COVID patients or others. “I’m grateful to be equipped with the newfound resilience that the pandemic has required of so many of us in health care over this past year.”