As COVID-19 has raged across the U.S., medical residents have found themselves battling more than a deadly virus. In some academic hospitals, the trainees have faced an overwhelming caseload of critically ill patients, working brutally long shifts with inadequate protective gear and little to no help from supervising physicians. In at least one hospital, staff wore trash bags after gowns ran out. In March, some of these stories made their way, via friends, to Amber Gibson, a food and travel writer who lives in Chicago. As friend after friend recounted harrowing working conditions, Gibson decided these stories had to be told.
But she had never tackled a complicated health story, must less an investigative piece. She posted a deliberately vague pitch to an online discussion group for writers and editors, where it grabbed the attention of Lauren Gravitz, a features editor at Medscape. After Gibson followed up with a detailed pitch, Gravitz commissioned the story, but asked if Gibson would be willing to work with a veteran health reporter. Gibson enthusiastically got onboard. Gravitz teamed her up with Cassandra Willyard, a freelance science journalist based in Madison, Wisconsin. Gibson and Willyard’s story, “COVID-19 Crisis Exposes Resident Abuse,” was published at Medscape on April 28, 2020.
While some hospitals are going out of their way to protect trainees, conditions at other hospitals tell a worrisome story. In addition to subjecting residents to working impossibly long hours in dangerous conditions, sometimes unsupervised, Gibson and Willyard found that most hospitals refused to offer hazard pay and even withheld paid sick leave for residents who fell ill to COVID. They searched Twitter, Instagram, LinkedIn, and Reddit looking for residents willing to speak. In the end, Gibson and Willyard interviewed almost 20 residents at academic hospitals. Most of the medical trainees they spoke with, already afraid for their lives, were also too afraid to complain on the record, fearing that doing so would jeopardize their careers. Reporting a story that depended so heavily on confidential sources was a challenge, and fact-checking it, says Willyard, “was a nightmare.”
Here, Willyard and Gibson tell TON co-founder Jeanne Erdmann the story behind their story. (This interview has been edited for length and clarity.)
Amber, your professional focus is normally on food and travel writing. What made you concerned about taking on an investigative healthcare topic?
Amber: Healthcare is something that can be technical and challenging, and it’s not something I thought I would be pitching. I have several friends who are currently residents, or who are fourth-year medical students, who kept telling me these stories. At a certain point, instead of just listening and sympathizing with them, I said, “Do you want me to write about this? I don’t know what normal protocol is for residents, but it seems like this is really not OK.” Interviewing my friends would be unethical. [But] with their help, I started digging on my own for sources.
A source sent me a document [a waiver of liability that medical students at Rush Medical College in Chicago were asked to sign before volunteering to help with COVID care if needed]. With at least one solid document in hand to depict what was going on, I posted on a social media group for writers and editors. I made the post deliberately vague, in case someone was to take the story and run with it.
I knew that I could pitch this. I was lucky that Lauren [Gravitz] saw my post and said, “Email me.” I emailed some details and that’s how everything started. I really didn’t have any clips about healthcare, so Lauren suggested doing a joint byline, because this was a lengthy, more investigative piece. With the sense of urgency surrounding the crisis, we were going to have to do a lot of reporting, and cover a lot of ground quickly. Lauren said she had someone in mind who was great to work with. It was comforting to me to have a seasoned writer I could bounce ideas off of, or talk things through, and to help get better contacts.
How long did you spend reporting and writing this story?
Amber: Three weeks from when we started to when it was published.
How did you divvy up the work?
Cassandra: By the time I got hooked up with this, Amber had already done a bunch of interviews, so she had a leg up. At one point we had a conversation with Lauren, where we talked through the other things we needed to get assigned. And Amber and I had a phone conversation about different leads we were going to chase. As things were progressing, we would send emails back and forth to say, “I will take this,” or “You take that.”
How did you find sources for the story?
Amber: My boyfriend was helpful in that sense, because he already had a Reddit account. Anyone can read the Reddit for Residents posts. However, without an account you cannot message other accounts, or post, or get in touch with anyone. And since these are all anonymous posts, he used his account to help reach out to potential sources and ask them to contact me via email. I was able to find a couple of my really great sources [on Reddit], including those at Framingham Union Hospital.
Cassandra: I had this super-frustrating experience, in that I was going to look for residents to interview too, and I really just struck out over and over again. I’m used to contacting researchers from their lab website, and finding their emails just right there. That doesn’t work if you’re trying to get ahold of medical residents. I was emailing people, or messaging people via Instagram, which just felt super weird. I had what I thought was a genius idea to sign up for a premium LinkedIn account and try to message people, and I just got nothing. I tried tweeting at people who had mentioned stories like this on Twitter, and no one wanted to talk to me. It was really, really hard. So Amber was super invaluable because she had these wonderful connections to her friends who are residents who got her some ins to other people.
I also got a few people going through the Committee of Interns and Residents [a union that represents medical trainees]. There was actually a guy who was on the record, and who I named, who got me someone who wanted to remain anonymous. It was super tricky.
The lede [an anecdote about a resident identified in the story as “Janelle,” who works at a Brooklyn hospital] came as an anonymous tip to Medscape. I don’t even think I knew her name at the point when I got a phone number. And when I tried to call, it was a wrong number. And I thought, Oh, man, that was my one lead and now it’s a wrong number. I emailed back and said [something like], “I tried but this just didn’t work, and here’s my number.” So, of course, she called, and I was like, “Can you hold on, I have to get my child a granola bar? I just have to open it for her and then I can be with you.”
You talked to nearly 20 residents and fourth-year medical students. Why so many, and how did you prioritize which stories to include?
Amber: It was important to talk to a lot of residents to get a picture of what was going on at different hospitals, and [so that we could] talk to multiple people at the same hospital. We wanted to illustrate the most egregious examples and use stories from residents who could paint a rich picture of the situation with pertinent details, which was important to confirm, and to reaffirm that this is a systemic problem.
The unrelenting pressure COVID-19 places on medical personnel must have made scheduling interviews especially challenging. How did you stay in contact with sources to set up times?
Amber: I would have to make myself available anytime they were available. I was pretty much on standby, waiting for people to call. I had one interview that was after midnight. Sources would say, “I should be getting off at 8:00 p.m.,” but then of course they need to go home and shower, and make sure they are taking all of those precautions. I would say, “Just text me when you are ready to talk.” I had to make scheduling these interviews my top priority for a week and a half or so.
How did you balance protecting your unnamed sources and getting the story?
Cassandra: This was really, really difficult because the journalist in me is super skeptical of anonymous sources, and here we have this story with this tension between working with a particularly vulnerable population, who are completely and rightly panicked about their job security, and being a journalist, and wanting as many people as possible to be named. It definitely gave me pause that we used so many anonymous sources, but I don’t think we could have done it without doing it that way.
People were so freaked out. It was shocking, the amount of fear. And it’s always hard to know how much handholding you have to do. People are scared, and people don’t understand journalism, and they don’t necessarily understand the implications of what they are doing. So there’s always this tension, wanting them to say things, and wanting to be able to report those things; [but] you also know that they are vulnerable, and that it could get them in trouble. Even one of the guys who had already agreed to be included, with the understanding that we would not use his name or the name of his hospital. He told me a story that was pretty benign. A day later, he freaked out and messaged me, and said, “I talked to some other residents, and they said this was a bad idea, and I don’t want the story used.”
I understood why he was scared, but I decided to include him because I didn’t see any possible way he would be identifiable.
Amber: I can imagine just how scared they were. They took us at our word that we will protect them. I remember one person gave me an email, and I noticed that it was from her place of work. I was like, “We don’t know who might have access to your email.” I wanted to be careful about that. I had one friend who put me in touch with someone, and then unfriended me on Facebook for a little bit, because someone working for the hospital was his friend, and could potentially link to my name and trace the source through us.
Did the extra caution help your sources open up and talk about their experiences and trust you?
Amber: I think so. I was able to establish a rapport with the folks I was speaking to, and I had so much sympathy and compassion for their situation. I wanted to do the best I could for the story, and I think that came through. Even people who were a little cautious in the beginning, by the end, I was able to reassure them that I wouldn’t compromise their identities. I think they felt comfortable really speaking their heart.
Protecting the identity of an anonymous source can mean omitting some giveaway details that could also make the story more engaging. How did you make those decisions?
Cassandra: For the resident in the lede, the source and I were both very nervous about that. I told her we would do the interview, and I would figure out what I am going to write. I wanted to be very careful, so I said, “I will come back to you and we will run through everything, and we will talk about whether that makes you identifiable, and how we might change a detail or tweak it or take it out.” Also, Lauren was really helpful in thinking about that, too.
I feel like there were details I would have included had I not been worried about protecting this one source in particular.
Amber: One of the residents I spoke with, he didn’t say that I couldn’t use the hospital’s name, but then he texted me the following day and changed his mind because it’s such a small program. Even if he was not personally identified, he was afraid of any ramifications it would have on his co-residents. I respected that because the name of that specific hospital was not needed to tell the story.
For one of my residents, there were some really colorful details, but [those] would have made identifying him especially vulnerable, so I could not include those details.
The story casts some hospitals in a very unfavorable light. What was your process for seeking out responses from the hospitals themselves?
Amber: We tried to reach out to hospitals for comment if the hospital was named, but in most cases our sources did not even want their hospital named, so there was no need to get a response from the hospital. But in these cases, I would try to speak to more than one resident from that hospital to see if their stories matched.
Cassandra: In every case (for me) I couldn’t call the hospital because I wasn’t naming the hospital. If I had called to get a response, I would have risked outing the source. It made me really nervous. Amber was able to contact the hospital in a couple of cases.
How did your sources react to telling stories about the trauma they were experiencing and witnessing?
Amber: A lot of folks would tell me something that had just happened that day, or the last few days. I don’t want to put words in their mouths, but I think for some, it was a little bit therapeutic to talk about it, and for me to confirm that it was not OK. Also, I would be able to then say I’d heard this from other residents, and be able to confirm they were not alone. Folks who did talk to me wanted to be part of changing this situation, so they did realize how powerful their stories were. I was very grateful to them for being willing to talk to me.
You were reporting this story while public health conditions were shifting rapidly. How did you manage the flow of new information as you were reporting?
Amber: This was very tricky. There was a constant stream of new information, [with] new allegations each day, and we had to be constantly reading news, and see if there was something important enough that it would shift our narrative or need to be addressed within our story.
When I spoke to administrators at NYU, I was intending to highlight them as an institution that was doing a better job than others. I only spoke with them once, during our first week of reporting, when I intended to use them as a positive example. However, a week later, things took a turn for the worse there, and negative news started coming out about the deteriorating situation. I still wanted to include the administrators’ original quotes to provide context, but did not have time to re-interview them. And I thought it was valuable to include their responses and their point of view, and let readers decide for themselves who they chose to believe based on these various perspectives that were presented.
Cassandra: Most of my sources came in right at the end, so it wasn’t much of a time lag between interviewing them and us publishing. Also, we were trying to make the case that trainees were being taken advantage of, so it was less important to show that those things were happening in the moment than to show that they had happened. For example, the N95 situation did improve while we were reporting this, and that was great, but it was because of availability, rather than hospitals seeing the error of their ways. Just because residents were getting new N95s didn’t mean that they hadn’t been asked to reuse them again and again in the past.
Once you had to start putting the story together, how did you divide up the writing and editing process?
Cassandra: It seems like the kind of thing that could be really, really challenging, and in our case, it really wasn’t. We worked in a Google document, and we both wrote the sections we had reported. Amber took the first stab at moving things around, but it was not the struggle that I anticipated that it might be. It seemed to work pretty well.
For editing, we had an initial conversation with Lauren to walk through the big picture and figure out what additional reporting the story needed. Like normal, there were a few rounds of edits. We each addressed the pieces that we reported.
With so many anonymous sources, how did you fact-check the stories people told?
Amber: Finding enough sources to corroborate patterns of behavior was key. In many instances, especially if a resident claimed to be left alone with responsibilities above their pay grade, there might not have been anyone else there who could confirm or deny their specific story. We always verified name, contact information, and affiliation to ensure that the people we are speaking with are who they say they are. In a couple of cases, I was able to speak to multiple residents at the same institution. At least that’s showing there are [at least] two different people who are alleging the same things. I felt a little more comfortable about those allegations.
Cassandra: It was a fact-checking nightmare. We’ve got anonymous sources, which in some cases don’t have documentation of the thing they are alleging. And you can’t contact the hospital, because we are not naming the hospital, and if you did contact them, they would probably just deny it anyway.
For the lead source, I basically walked through everything with her because we were trying to figure out where she might be identifiable. The hardest part was not being able to fact-check some pieces of the story because I couldn’t contact the hospitals in some cases. So I did my best just Googling different bits of information. This was not a story where I could 100 percent verify everything that the sources were telling me. But I could verify that those kinds of things were happening. I have so much respect for the people who do investigative stories as their bread-and-butter, because it’s so challenging.
Is there anything that struck you about your experience in reporting this story?
Cassandra: I continue to be surprised by how well it worked out with us being co-reporters not knowing each other, and neither of us ever having done that before, and not really having a plan for how we would do it. It seemed like it naturally went well. I’m not sure if it’s an experience that could be replicated or if it just happened that [with] this story, the process was easy. I was fearful that it could be brutal, but it worked out so nicely and seamlessly.
Amber: I agree. Neither of us had any ego involved. It was really about telling the story as best we can. We were happy to do whatever it took to publish. I was really happy with how the experience was.
What has happened in the aftermath of the story’s publication?
Cassandra: I did get an email from a press person at [the Committee of Interns and Residents], and she was like, It brought me to tears. I was gratified to hear that, and it’s always nice to feel like you are giving people who don’t have a voice, a voice, but have things changed? I have no idea. Probably not.
Amber: I’m really proud of the work that we did and have been reading the 45-plus comments left on our story by physicians and residents. I hope this can be a catalyst for positive change so that medical residents are assured proper protection and humane treatment always.
TON cofounder and editor-at-large Jeanne Erdmann is an award-winning freelance health-and-science writer based in Missouri. Her writing has been published in Nature Medicine, Nature, Women’s Health, Discover, The Washington Post, Slate, Aeon, and elsewhere. She is on the board of the Association of Health Care Journalists. Follow her on Twitter @jeanne_erdmann.