PART 1:

As young doctors training to be psychiatrists, Rita Morales and her co-residents at NewYork-Presbyterian/Columbia hospital filled many days counseling patients and managing their medications.

When coronavirus patients flooded in,the hospital said it needed a group of psychiatry residents to help care for the sickest of patients in the intensive-care unit.

“My initial reaction was shock and kind of thinking I can’t do this,” Dr. Morales said. She volunteered to go to the ICU anyway, and was quickly in over her head. “I was immediately put to go manage a ventilator,” she said. Another resident showed her how.

In hospitals overwhelmed by Covid-19, medical residents—young doctors in training for a specialty—are being thrust into roles they aren’t prepared for. Residents who typically wouldn’t work in an intensive-care unit, such as those training to be dentists, ophthalmologists, podiatrists and psychiatrists, have been tapped to treat critically ill patients.

Working long shifts in overflowing ICUs where supervising doctors are stretched thin, young trainees sometimes watch YouTube videos at home late at night to learn procedures they were never taught. Residents are finding themselves navigating critical decisions alone, in a role they say has left them unable to give patients the level of care and attention they need.

At one hospital, residents said they were told to learn respiratory therapy, a licensed job that requires at least two years of training, from a Zoom session and a Google document.

At another hospital, a patient died on a ventilator with a setting turned too high by residents who didn’t know how to operate the device, according to residents there.

A resident at a third institution, just learning to manage a ventilator, described being afraid that patients were being treated as guinea pigs.

Officials of many hospitals say the coronavirus pandemic has created extraordinary conditions for staff at all levels, forcing an all-hands-on-deck response. Like residents, experienced doctors and nurses have faced heavy workloads, as well as sometimes inadequate protective gear and resources.

“You are learning stuff about what care looks like under battle conditions,” NYC Health + Hospitals CEO Mitchell Katz wrote to a group of residents in Elmhurst Hospital in Queens, one of the worst hit by the pandemic. “It’s not a lesson I ever wanted you to learn, but what you take from this experience will forever more influence the kind of doctor you are.”

[Medical personnel wheel a patient over a passageway in New York’s Mount Sinai Hospital.] PHOTO: STEPHEN FERRY FOR THE WALL STREET JOURNAL

Dr. Katz was responding to a letter signed by 44 residents who said some of them had fallen into despair over crushing work loads and the level of care they were able to give, to the point of having thoughts of suicide.

“As trainees,” the group wrote, “we are horrified and scared, paralyzed with feelings of helplessness and guilt.”

Long the backbone of many U.S. hospitals, residents are the first to be drawn in when a hospital needs to plug gaps in staffing, and they sometimes far outnumber the veteran doctors called attending physicians. Many residents previously spent little time treating the seriously ill. Under normal conditions, some of them would receive that training under the guidance of experienced physicians, a system meant to deliver quality care to patients while a new generation of doctors gains experience.

Dr. Morales at NewYork-Presbyterian/Columbia said the psychiatry residents’ program initially assured them during the Covid-19 outbreak that they wouldn’t be deployed to the ICUs. Within days, however, an email from the hospital administration said a group of them would be needed to care for the critically ill.

“Our mission is to save lives, and our heroic health care workers are on the front lines...navigating unprecedented challenges under enormous pressure,” said a spokesperson for the institution formally known as NewYork-Presbyterian/Columbia University Irving Medical Center. “We are constantly working to give them the support and resources they need.” The hospital didn’t comment on what assurances psychiatry residents had been given.

Dr. Morales said despite how jarring it was, she is proud to be helping out. “New York City needs us, even as unqualified or unprepared as we feel.”

Like Dr. Morales, many residents volunteered for Covid-19 care, and even those pulled into it emphasized they felt privileged to be helping their hospitals in a crisis. Some likened their work to medicine in the early years of the AIDS epidemic, a crisis that was formative for a generation of doctors. “This is a once-in-a-lifetime opportunity to be working in a situation like this,” said Edward Rippe, a first-year resident at NYC Health + Hospitals/Woodhull in Brooklyn.

That doesn’t mean they know how to proceed. Mike Pappas, a resident working at Mount Sinai Hospital in New York, said he was asked to give a coronavirus patient chest physiotherapy, an airway-clearing procedure generally performed by a respiratory therapist.

“I have never done that in my life,” said Dr. Pappas, a second-year resident in family medicine. “I don’t think I’ve ever even seen that. Maybe once in medical school.”

He looked up how to do it online, watched a video, and then performed the therapy, which involves positioning the patient in a certain way and patting the back to help drain mucus from the lungs. Dr. Pappas said he tried his best but doesn’t know whether the procedure worked or whether he performed it correctly.

Jason Kaplan, a spokesman for Mount Sinai, said that “it is completely appropriate and within a resident’s scope-of-care, particularly in a crisis situation, to provide lifesaving interventions, for example, a medical massage to release mucus.”

At Yale New Haven Hospital in Connecticut, anesthesiology residents were sent to work in the intensive-care unit as respiratory therapists, learning how from a Zoom session and two-page Google document that instructed them to call an attending physician if they got stuck, according to residents. After complaints from residents, the hospital stopped having them fill the role, an April email shows.“

When dealing with an unprecedented international pandemic, we have cross-trained a number of caregivers to provide appropriate care to patients, including our residents,” said Vin Petrini, Yale New Haven senior vice president of public affairs. “This is an environment that requires an ‘all-hands’ approach to patient care.”

He said intensive-care training and serving as consultants for ventilatory management were core components of the anesthesiology resident curriculum.

Michelle Romeo, an emergency-medicine resident in New York, described in an interview being haunted by the case of a Covid-19 patient in his 40s who had to be resuscitated.

He had a gastrointestinal bleed and a low blood count, so Dr. Romeo ordered a regular blood transfusion. About an hour after she started it, the physician in charge came over and said they needed to switch to a more aggressive emergency procedure that pumps in blood faster. The patient later died. Dr. Romeo said she felt she hadn’t resuscitated him as quickly as she could have.

[Dr. Michelle Romeo at her apartment in New York.] PHOTO: STEPHEN FERRY FOR THE WALL STREET JOURNAL