By Kathy McGrath
In early 2020 when Maxine Kish was finishing medical school at Queen’s University, she looked forward to starting her residency in Toronto, where most of her family and friends lived. Little did she know she would be working in a global pandemic hotspot that would prevent her from seeing most of her loved ones for many months.
“I love Toronto and this is where everybody is, but the city has been more locked down than any other in Canada,” said Dr. Kish, who grew up in Centennial. While she lives with her boyfriend and has only seen her parents a few times in the past year – usually outside and wearing masks.
When the pandemic first hit, Dr. Kish was starting her last week of a pediatric rotation at a clinic in Kingston when Queen’s officials pulled her out. “I don’t think any of the staff knew any more than we did,” she explains. “Everybody was in the same boat, listening to the news and making decisions on the fly.” She stayed in Kingston for a week with a few roommates while preparing for her final exams. Her graduation was cancelled (and later held virtually) but, at that point, the graduates were still hopeful they could see each other in the fall. “We thought we could have a big get-together in November, but obviously that didn’t happen.”
The 28-year-old, who attended Mowat Collegiate, is now doing a two-year residency in family medicine at Toronto Western Hospital. Dr. Kish cares for several hundred patients as part of a family medical health team, and also does monthly rotations around the city in various specialties like obstetrics, internal medicine and emergency medicine.
Fortunately, by the time she started working last July, Ontario had accumulated enough personal protective equipment (PPE) to keep her safe. She found, however, there were inconsistencies with usage. “When I was doing my obstetrics rounds, we wore face shields only when delivering babies, whereas I was always expected to wear a face shield when talking to patients at the family health clinic.”
Dr. Kish felt fairly sheltered from the pandemic until she started her rotation in emergency medicine last December. “On my first shift there were four COVID patients – some we knew were positive and others who tested positive later. At that point, it gets a little scary because you’re walking into the room of a patient you know is positive. You just hope you’ve put your PPE on correctly and that you are careful taking it off,” she said.
Removing PPE carries a high risk of contamination and doctors are taught how to remove it safely. “There could be droplets on the edge of your face shield, for example,” Dr. Kish said. She asked other staff to watch her remove her PPE the first time she worked in the emergency department.
While COVID patients at Toronto Western are usually treated by dedicated COVID teams, Dr. Kish occasionally learned that someone she saw in her family practice was later diagnosed. “You start thinking back to when you dealt with that patient and try to remember if you were wearing a gown and how well you washed your hands.”
Apart from physical threats, residents often work gruelling schedules that are psychologically challenging. Dr. Kish thinks the pandemic is hindering them from developing a camaraderie that helps them cope. “Most residents become very close friends, but now, with having to wear masks and stay apart, the opportunity to talk and vent about what you’re going through is limited.”
Another issue is a lack of hands-on learning. “It’s something we talk about all the time,” she said. “People are not coming in as much for things like mole removals. I do think that will affect us, especially family doctors who might want to incorporate that into their practice but may not feel they have the training to do so. They may have to go get training outside their residency now.”
On the flip side, this generation of young doctors has integrated virtual medicine into their practices from day one. Working at a teaching hospital, Dr. Kish said about 30 percent of her patient visits are virtual. “Assuming some patients like them, we’ll be able to keep having virtual visits in the future,” she said. “And we are learning how to triage things – what needs to be seen in-person, like rashes, versus what can be seen virtually.”
When she completes her residency next summer, Dr. Kish will either find work as a family practitioner or she may do extra training for in-patient hospital work.
Despite the challenges she faces, she feels she made the right choice going into medicine. “It’s a very rewarding job. I’m helping people, I get to do what I love and also make an impact.”