An Interview with Nicole Becker Katz
Unmasking Rehab Medicine During COVID - Narratives & Portraits
Nicole is a fourth year medical student at the Lewis Katz School of Medicine at Temple University in Philadelphia. Looking back, she said that dance was a defining part of her path to PM&R. “I grew up dancing and I had a strong love of the musculoskeletal system, and I was always amazed at how things worked together,” said Nicole. “Like most dancers I was often injured and went to doctors and just never felt heard. They were sports medicine trained, but they didn’t understand the dance terminology so I would try to explain what happened and I could tell we weren’t communicating and I didn’t feel satisfied” said Nicole.
After delving into the world of dance science, Nicole developed an interest in sports medicine and spent a lot of time in college shadowing family medicine and orthopedics. However she said, “nothing quite felt right, and then in a serendipitous situation I was introduced to Dr. Ellen Casey (a PM&R physician). She called me and explained to me what she did, and I just remember distinctly her describing the field of PM&R and this lightbulb went off and I was like yes, this makes sense, I want to focus on function, I want to help people live their lives fully.” Nicole also learned how training in PM&R allows you to specialize in sports medicine, traumatic brain injury, spinal cord injury, and amputee care. Nicole realized that with her love of anatomy and biomechanics fostered from dance, PM&R seemed like the perfect fit.
Nicole then worked as a clinical scribe and research assistant for Dr. Casey at Penn, where she gained a much deeper understanding and appreciation for physiatry. Later in medical school, she got involved with AAP (Association of Academic Physiatrists), and this year she is the chair of the AAP Medical Student Council. “The more I get involved with the PM&R community through AAP, our Temple interest group, or any research opportunities, I just fall more in love with it. The people are so special and everyone just wants to help, everything is collaborative, everyone is encouraging, and that just translates into the actual field of medicine from what I’ve seen,” said Nicole. In describing her current work with the AAP, Nicole said how “Once COVID hit we focused our efforts virtually, which has made it more accessible for everyone, in a way we wouldn’t have had otherwise. Our goal is to be the hub for opportunities in physiatry, and our hope is that through our twitter and our newsletter we can try and connect you and support you in some way.”
When the pandemic started, Nicole had one third year rotation left and then all of a sudden clerkships were suspended. Nicole said she started meditating and running during her free time and got to spend more time with her dog, Reese. But she said, “I felt a little weird and guilty about trying to make the most of it, while people were losing their family members to COVID.” At the time, Nicole’s husband was still working in the hospital and so she said that while some things changed, others didn’t. She noted how, “No one is supposed to feel comfortable when you’re worried and scared and not sure of information. I actually spent a lot of time on Twitter trying to learn about COVID, and the more I did the more stressed I got. You’d open up Twitter and it would just be about the death rates or the terrible policies we have in place that weren’t going to protect us. And I wanted to do something about it, but what could I do?”
Around that same time, Nicole befriended another student on Twitter who posted an idea about creating a virtual commencement ceremony that celebrated women and minorities. Because a large proportion of leadership in medicine consists of older white men, many commencement speakers reflected this lack of diversity. “You’re sending out all of these people to do incredible work in this scary time and they’re not even seeing themselves celebrated in roles.” Nicole said how most of her time outside of clinical work was turned toward this project entitled “HealthSTEMencement.” The 1-hour commencement video on YouTube, sponsored by the Time’s Up Foundation and the American Public Health Association, highlights and celebrates the diverse voices and successes of the healthcare professional class of 2020. Projects like this have allowed Nicole to stay busy and give back during the pandemic.
For her OBGYN clerkship, she initially had virtual didactics, and more recently as restrictions eased, students were able to return to their in-person rotations. During her 3-week rotation in OBGYN, Nicole remembered one patient experience that stood out to her: “I was talking to the patient and it was about 6 am, and she didn’t have anyone with her. She was there for a hysterectomy with concern for cancer. And she was telling me how her husband was in the parking lot and he was going to wait in the parking lot the whole time. The cases from what I heard took 4-5 hours. And I was like are you sure? And she said that ‘he can’t be here with me but he needs to be here. So he’s going to sit in the car.’ It’s hard for patients... their support person can’t be there to hold their hand as they’re rolling back to surgery.” Before this encounter she was so focused on the patients and how they were doing, she hadn’t fully pondered the friends and family that would have been with them, and how they were feeling and coping.
In addition, Nicole remembered the mothers who couldn’t have their partner or support person during their outpatient ultrasounds or fetal heart monitoring. “A lot of times I would be cheering them on because they didn’t have someone. I would take their phone and record the ultrasound, whatever it was so they could share it with whomever they wanted to.” Similarly, in labor and delivery, where patients could only have one visitor, Nicole said that, “When the baby was born there would be 3 phones out all of a sudden FaceTiming all of the family and friends who couldn’t be there. And as the med student again I took on the role of trying to help hold a phone and give them that moment they couldn’t have because of COVID.”
Working with patients, Nicole realized the new challenges of being unable to rely on facial expressions and other non-verbal cues, which she said was particularly difficult for patients with hearing problems or those who use lip-reading. “You have your eyes trying to convey empathy and hope that they’ll find some connection with you because to me, the [most] important part of medicine is making sure the patient feels comfortable with you. Especially as a med student where it’s your privilege to be part of their care. You can’t shake their hands, there’s no comfort touch. I would wave to people, which felt childish in a sense. It’s hard.”
Nicole described an info-graphic she saw recently — the first wave was COVID, the second wave was everyone who had health issues during the pandemic but couldn’t get treated, the third wave was everyone who, had they gone to their normal routine care visits, could have prevented some of their current health implications and the fourth wave was the PTSD and mental health aspects from COVID impacting patients and healthcare providers. “I heard an ED attending say ‘the ED is too quiet it makes me nervous,’ which I would’ve thought ‘oh, that’s great! No one is sick, no one is getting hurt.’ But everyone is still getting sick and getting hurt, they’re just not coming.”
With the continued uncertainty and spikes in infection, Nicole is wary about the future, but she is also looking forward to her last year of medical school. She said she’s very excited about her elective rotations, which include adult PM&R, peds PM&R, a neuromuscular rotation, and a sports medicine rotation.
R. Mayeda is a second year MD candidate at the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania.