I wait for what is to come.

Nasir Malim MD

Montefiore Medical Center, Internal Medicine PGY1


March 25, 2020

Brief Covid thoughts from the front lines as a first year Medicine Resident.

All thoughts are representative of myself and not a larger institution.

January 14th, 2020: Finishing my medical ICU block. Witnessed 2 patients pass away from the flu in my 2 weeks.

January 24th, 2020: Working in the ER filling in for a resident doctor with the flu. Head doctor huddles every morning to discuss the novel coronavirus and screening precautions we are taking.

February 20th, 2020: First grand rounds on Covid-19. discussed the 2 English language peer-reviewed publications. Discussed threat of pandemic, however at that moment influenza was still the greater threat domestically.

March 1, 2020: First confirmed case COVID-19 in NYC. In the days following many additional reports of localized and widespread cases.

March 6th, 2020: My first COVID-19 rule-out patient with hypoxia, shortness of breath, and ground glass opacities on CT chest. The day prior to suspecting COVID-19 and taking appropriate precautions the entire medical team and all staff went into this patients room unprotected.

March 7th, 2020: With patience and lots of determination I was able to retrieve appropriate personal protective equipment and see my rule-out patient.

March 8th, 2020: My rule out patient tests negative, the medical team and staff breath a sigh of relief. News from areas around the world, including the dire situation in Italy, continues to poor in.

March 16th, 2020: I transition to my clinic block. We initially transition to telemedicine, and within a few days all clinics at my institution are essentially shut down to accommodate resident return to the hospital to prepare for the expected influx of COVID patients.

March 18th, 2020: First Internal Medicine town hall on the current situation in the department and hospital with COVID patients coming in.

March 19th, 2020: Though this was not a new thought, the reality sets in that tough medical-ethical decisions will need to be made in the coming weeks. Decisions around who gets a ventilator and who doesn't, who is given a chance to live and who doesn't. Many people will not survive this, including people I know and love.

March 20th, 2020: I cancelled all the plans I had been looking forward to for months and years. The wedding in Houston, my first ever trip to Houston where I could enjoy my first try of Texas BBQ, I had to cancel. My honeymoon, the re-try of a honeymoon initially planned 3 years prior that was cancelled by Hurricane Maria, I had to cancel. Graduations, family trips, once in a life celebrations: cancelled or soon to be cancelled.

March 21st, 2020: I wish this was only the first time I cried after feeling emotionally overwhelmed from the medical, social, lifestyle, implications of living in the era of this pandemic. The emotions I'm feeling are truly a roller-coaster.

March 23rd , 2020: One thought I now cannot escape keeps recurring. My internal medicine program is ~150 residents across the 3 years, with a 1% death rate and realization that younger populations are not as safe as once believed, there is a fair chance that myself or someone among my colleagues will probably not survive the next few months.

March 24th, 2020: I am starting on sick call for our new schedule aimed to accommodate the rise in patient numbers. So far I haven't been called in and had a couple extra days to rest at home, though the overwhelming thoughts remain. The number of hospitalized COVID patients at my hospital climbs above 200.

March 25th, 2020: Due to lack of access to alternatives to N95 respirators, I'm going to have to shave my beard for the first time in over 12 years which I have kept for religious reasons. This is difficult but given the circumstances is the necessary move. I wait for what is to come in the coming days, and my next ICU block in the coming week.


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