Episode 1: The Space Between
Synopsis
The Nocturnists is back with the second installment of “Stories from a Pandemic”. How have healthcare workers been holding up over the past year? In this episode we hear stories from healthcare workers around the country about what it’s been like after the dust has settled. We explore how the “healthcare hero” trope has helped or hurt us in the preceding months. One doctor explores his dreams, a speech language pathologist talks about the need to be of use, and a geriatrician imagines herself as a Force-wielding member of the Star Wars Millennium Falcon crew.
LISTEN
Contributors
This episode features the voices of Lori-Ann Edwards, MD; Lauren Klingman, MD; Laura Perry, MD; Lakshmana Swamy, MD; and other healthcare workers wishing to remain anonymous.
CREDITS
Host: Emily Silverman, MD
Podcast Producer: Adelaide Papazoglou
Associate Producers: Isabel Ostrer, Molly Rose-Williams
“Pandemic Theme” composed by Yosef Munro; “Star Wars Theme” composed by John Williams, performed by Mike McInnis, MD.
Series illustrations by Nazila Jamalifard
Audio Engineer: Jon Oliver
Production Assistants: Hannah Yemane, Ricky Paez, Siyou Song
Support for The Nocturnists comes from the California Medical Association, the Patrick J. McGovern Foundation, the California Health Care Foundation, and people like you who have contributed through our website and Patreon page.
TRANSCRIPT
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The Nocturnists: Stories from a Pandemic Part II
Episode 1: "The Space Between"
Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
You're listening to The Nocturnists: Stories from a Pandemic. I'm Emily Silverman. Heroes. They help, protect, save, motivate, guide. They instill hope. They remind people of good and they do what no one else will. They're often portrayed as more than human. Though they may die their deaths have meaning. Doctors, nurses and other essential workers have been showered with praise from the beginning of the pandemic. But the hero trope can be weaponized, too. It can sweep the missteps of leaders under the rug, it can hurt, it can exploit, and it can paper over the pain. How are healthcare workers holding up during this time? The Nocturnists is back with our second installment of Stories from a Pandemic. Today's episode is called The Space Between.
Laura Perry
I'm better, I guess, is probably the first thing I'd say. I quit my job and I started a new job. I'm now working at the VA as one of the nursing home docs, which is a big change from doing home based primary care, which is what I was doing before. I can't remember exactly when in July, I left the last clip, but the last year has been awful. Absolutely awful. Residency was bad. For all the reasons that residency is always bad. But at least I felt like in that setting, I had some sense of camaraderie. The last year I felt so professionally alone. And now being a nursing home doc is very different. There's much more of a team setting and I'm never alone. But there's so much recovering that I have to do just to, you know, be able to live my day to day. I feel like there was a tidal wave. And I'm on a raft, but nothing else has changed. You know, it's still overwhelming and just trying to keep my head above water. During the first six months of the pandemic, I lost two of my three living grandparents. My grandfather, who was someone I was incredibly close to died at the end of February last year, I think from COVID. But at the time, you know, they weren't running PCRs. It was something that was just starting to kind of bubble up in the news then, even though we had this really sad and kind of bizarre, acute illness. He didn't get tested and it wasn't really on anyone's radar. And then my grandmother on the other side of the country died in May, shortly after her caregiver got sick with COVID. And she died not of COVID but of just sort of increasing frailty. The dwindles. You know things have kind of settled in the way that they do after loss and death. After a time. It doesn't feel as frantic as it did before. It just sort of feels melancholy. Tense about this time last year, I felt like on this adrenaline kick, I talked about it with my brother who's a second year resident, he'll like finish his shift and be practically vibrating just from the intensity of the stress. And I said, Yeah, I remember, you know, those night float shifts when I used to feel that the most. And I feel like I have been sort of carrying that emotion this entire time. Just so amped up by everything that's going on, that it's hard to just turn off. And it's getting slowly better from what I sometimes joke is the geriatricians' favorite therapeutic intervention, which is the passage of time. But I still feel dizzy and disoriented and maybe a little altered at times.
Anonymous
How am I doing? I guess the the simple answer to that would be, it's complicated. I, like many people, have never been through a pandemic and I also have never had such a prolonged period of disruption. I was actually speaking with one of my friends the other day about how, and I don't know if it's a uniquely American thing, or if it's a, a people everywhere thing, but how we're moving through the pandemic, is probably one of the more disturbing things to me, from a human standpoint. 1000s of people are literally dying every day, and we're all just sort of moving on about our lives, like nothing is happening. Maybe it's because the stimulus has been on so long and so chronic, doesn't hurt as much as not as shocking to a lot of people. But I find that for me, it is. And it can sometimes feel like you're isolated in being shocked or upset by something, because we're not acknowledging it out loud. Not everybody's saying how scared they are. So you feel like maybe you're the only one who's afraid. And everyone else is just like writing their grants and papers like normal. And so there must be something wrong with me for not being able to persevere in the same way. I remember, back in spring of last year, our hospital sent out a email for us to nominate someone to be recognized for showing the most grace, during this period of redeployment and COVID death. I felt pretty angry. You know, it was one of those, one of those feelings of anger, like where I could feel the heat sort of rising in my body and sort of taking over my face. I remember sitting with that email open for a little bit of time, and just thinking how what I needed wasn't an award, or even a pat on the back or an accolade. I needed someone to acknowledge the hurt that I was feeling. Even on the news, you know, there was always "These are our heroes", or people singing songs and clapping for them, or, you know, this company delivered food to the workers at the hospital who are redeployed or putting in overtime and that sort of thing. And it was never asking healthcare workers how they're doing. Most of us didn't sign up to do what is essentially wartime health care, working shifts that we wouldn't normally work, in services that we wouldn't normally be occupying. And what I wanted, at the time, from the hospital, from my program, from the people around me, was just to acknowledge that it was a mess. That acknowledgement was coming from nowhere. And so then to get this email that's like, you know, let's put on a pedestal, the person who's shown the most grace or who has persevered the most, or who's gone through the pandemic without showing any of the negative emotions that make us feel uncomfortable. It just sort of reifies this idea that what we value is not really the whole spectrum of human emotion. If I show up feeling the fullness of my emotions, the wholeness of myself, then it makes you have to acknowledge that I'm feeling that and then maybe also have to acknowledge that you're feeling it too.
Lori-Ann Edwards
It was a very dark time. It challenged my optimism. Just seeing that much death and dying, knowing that it could be me. It could be my mom, it could be my dad, it could be my best friend. I didn't realize how much a part of me optimism was. I didn't realize how much I relied on it and depended on my optimism. It just, it wasn't there. The hardest thing about the pandemic is the amount of death and dying. In the area that I work in the patients are extremely vulnerable to not only getting COVID, but not surviving it. I've had patients come in at 9am. And by 12pm, they're intubated. By the next day, they're dead. I can remember the first COVID positive intubation that I did. I was terrified. I am in a room shielded off from everyone else. And I am literally face to face with the source going right for the lungs. And there's a possibility that all these things that I have on may not protect me from this virus. I see a lot of intubated patients as an anesthesiologist. And I always wonder what it's like to have a tube in your lungs and be awake and be aware that it's there and have that struggle to breathe. What are they thinking? What is it like? In the beginning, some of my dreams were very abstract, I would be like drowning, or there would just be an instance where I cannot breathe. I remember in dream where I was, in my body, intubated, and I remember the sound, I remember hearing the monitor just beeping with my heart rate. So I could hear that pulse ox like just beeping. And I could see the physician or nurse just moving around my room and like doing things to me. And I remember wanting to say out loud, "Hi, I'm here, I'm here, I'm awake!" I felt locked in and trapped. Nobody could see me or hear me. I've never felt so helpless.
Lakshmana Swamy
When the pandemic hit, I was spending a lot of time in the COVID ICU and my brain was really kind of nonstop COVID. That translated directly into my dreams. There was one dream where I was about to be put on a ventilator, what I was doing to so many people, and it was really rough. But there are other dreams, which would just be somewhat normal, but always still about COVID. I had this reoccurring dream of being a superhero, where I was trying to, like save people and do superhero things. But my superhero powers just kept not working. And it was like this profound sense of powerlessness and of being confused, why I couldn't fly, why I couldn't use like my Jedi powers or whatever. And I just remember having those dreams and waking up and thinking this is a really, really thinly veiled metaphor for what's going on and at the bedside in the ICU. The night that I got the second vaccine, I have such a strong memory of this. I had just finished this sci fi book called Red Rising. In it, it was just this like really sort of emotional action packed climax where there was a lot of like righteous anger, I think is what I remember. And I had these terrible fever dreams that night when I got that the second vaccine. I started to have chills and I should have taken more Tylenol than I did. And I remember being curled up under all these blankets and shivering and sweating and going in and out of these fever dreams about being in this sci fi novel, and just being filled with with rage. I remember I would wake up and be like, why do I you know, feeling the hangover of emotion. And it really felt like emotion that wasn't mine. You know, I was trying to escape the fevers and the chills and sleep. And instead I was in this like, intense world of just really powerful emotion that felt like it was being put on me.
Stephanie
What has changed for me is everything and not much. I mean, it's both all at the same time. In the very beginning of all of this I didn't know my role. I don't think most rehab physical therapists occupational therapists knew what our role was going to be. To be honest, sometimes I still wonder what my role is. My patients that I see, I feel like a sense of, of dread. And it's not because of them. It's not anything to do with them. It's that I know that I'm the only person going out to see them, and talking to them, and next to them and and touching them. And I know I'm going to leave. And I know that I can't fix what has happened. I can't open the board and care and I, I can't get the neuro psych consult to come out, I can't do these things that I wouldn't even have to think about if the pandemic was under control. A 1 2 3 4 5, and then relax. A lot of the assisted livings and board and cares haven't had visitors since the pandemic started. People are very, very lonely. It feels like there's nothing I can do about it. And yet I'm in their home. And I'm asking them all these questions. And as, as a speech therapist, a lot of what we do is talking and even if we're working on swallowing, I can't help but have conversations with people. Over the last eight, nine months, I've had many, many people beg us not to discharge them. "Who is going to come you're the only people that I talk to." And if it does something to you to not be able to fix that.
Kelly M.
As an ICU, we became full at the very beginning. And because of the course of how COVID has run, patients are staying for two weeks to two months and not leaving. So the only turnover within our ICU are when someone dies. So that means that you're taking care of a patient for for weeks, if not months, you know them before they're intubated. And when they're talking. And then you're their major caregiver and you're the person that's with them every day, when they're sedated and unable to speak for themselves, and you get to know them through their families. We've all been living in a state of you turn the corner and you don't know who's going to die. I'm so tired. So today was my first day off work. I was in bed until one o'clock. Because I can't physically get out of bed. I love going to work. I love being a nurse, I love helping people. I love learning how to be the best that I can be for my patients. And like I've never I've never had the experience of coming to work and just dreading because you know there's going to be a code, you know someone's going to die, you know that you're going to have to do post mortem care. I don't sleep before I go to work. I probably sleep for like four hours before my first shift. I stay up to like one and then I have to be at work at 6:30. I don't eat or drink because you're wearing your N95 and all of your gear all day. So I, I like I don't even fill up my water bottle until probably about one o'clock. Because there's one emergency after the next, after the next, after the next, and so you never know like what you're going to show up to. But you know it's going to be a disaster. I always try to fix things. This is something that hasn't been able to be fixed.
Lauren Klingman
I'm an emergency medicine resident. I am burned out, I want to leave residency. I want to tell them that every day I draft an email telling them I'm about to leave, and then I don't send an email because of course, I can't leave. What else would I do? But, you know, the 60 hour to 90 hour work weeks, six days a week, are slowly killing me. I'm so tired all the time. I go home after my shift and I cry and I play Emily Scott Robinson's "The Time for Flowers" on repeat, and I just cry in my car and I drive home. And that's no way to live. I should be studying when I go home, I should be learning things. I keep getting that feedback of study more from my senior residents, from the faculty, you know, you need to go read studies, you need to go study more, you should be working on research. And you're right, I should be working on the research that I signed up for. And I can't I cannot bring myself to do it. The only things I do when I go home is I watch the Great British baking show and make an obscene amount of bakery items, that then I forced my spouse to eat. I also have a travel website that I built. And I put itineraries on there of all the places that I've been and all the places I want to go and I spent an obscene amount of time researching different places in the world, that I could be, and imagining myself there. Most days when I'm sitting there, working in the COVID hospital feeling like every single patient that I'm seeing has COVID or is sick, or is there for reasons that are absolutely ridiculous in the time of COVID, and they shut down everything again, the world just feels like it's falling apart, because the world does feel like it's falling apart. Just imagine all the places that I could be, or would want to go. And if I had my dream, I would just run this travel site. I would form trips for people. I would take them to these beautiful, wonderful places. I'd feel like a human again, when all this is said and done, that's what we're gonna want, we're going to want human connection, we're gonna to want culture, we're gonna want beauty, we're gonna want art, all the things that we were deprived of during the era of COVID. The only thing that kind of keeps me going is imagining these beautiful places and taking people on these trips. I don't know that that's the best way to spend my time, I should probably be learning things. I'm a little afraid I'm going to leave residency without actually knowing anything except for how to care for COVID patients. And a really good idea of a 10 day itinerary to Italy.
Anonymous
I've actually thought about this a lot. And I've thought about like how I have also been complicit in such a system, that our medical training and we praise the person who stays up the longest or who you know, violates duty hours and all of these different things. And we sort of tell our stories about the time where we ignored our own humanity in order to care for other people. And there's like a valor and praise that comes with those stories. And the example for me is I was diagnosed with my autoimmune disease in 2017. That day, I woke up in the morning and I felt like I was getting kind of sick, I didn't feel well. I was a junior resident, and I was the junior in the ICU and I really wanted to do a good job. And so I go to work and I was exhausted. I remember in the afternoon when we were doing rounds, I was basically leaning over the patient tray table in order to hold myself up and I felt short of breath. I actually had a fever. And I didn't stop I didn't say like "Excuse me, I feel like I'm dying". I kept going I went throughout the rest of the day. I worked a 12 hour day to 7pm. And when the person came to relieve me I was huddled in a blanket with rigors like my teeth were chattering kind of thing. I walked home and ended up going to urgent care because I thought I must have the flu or something terrible. I get to the urgent care and I had a heart rate of 170. My temperature was 103. And they were like you need to go back to the hospital from whence you came. Like something's seriously wrong with you... I ended up having a clot in my IVC and I had bilateral pulmonary emboli. And the thought that I had when they told me like all of the different things that were going on was like, holy crap, I could have actually dropped dead in the hospital. And knew that there was something wrong with me, I woke up in the morning feeling like something was wrong with me. And I didn't listen to that at all, you know, you find that there are a lot of doctors who work through a fever, or who will work through the flu or RSV, or cold, and they're still coming to work kind of thing. And that's praised. It's part of the job, you work long hours, you're a better person, because you're working so much. But that moment was so transformative for me, because I realized how little I was valuing myself. And like, how, if something terrible had happened, if I had dropped dead in the middle of the ICU, for example, or like, on my way home, or like, not woken up, because I didn't make that stop at urgent care, it would have just been so much more devastating for the people around me than having to disrupt someone's afternoon by having them come in to cover me because I was sick. And so like relating this to how we're sort of moving around COVID, the idea of like me being blissfully redeployed to an ICU setting is alive. And you you heard very little of that story. But you heard a lot of the like, I'm rising to the occasion story, or, you know, this is our calling. And that was the dominant story that you heard. So those of us who are feeling like, this is not what I signed up. For those of us who are really feeling that loss, we're like, okay, so where are the rest of us, because we're getting all of this like, Hero story. But no one really wants to hear my side that this sacrifice, it feels like it's killing me. That emotion that you must feel in that moment. And the emotion that you feel when someone's like you're doing a great job, you're a hero. Without the acknowledgement of how messy the rest of it is the space between I just think we could do a better job of talking about the space in between being a hero and falling apart.
Laura Perry
There have been so many points this year, where I thought that it was all too much and that it would destroy me. I think everyone I know who's in medicine has just done that same thing. We all pour ourselves into this. We give and we give and you know some of us are more eloquent about than others. And some of us are more emotionally capable of handling that than others. But, you know, there have certainly been times where I've just couldn't take it. I certainly downgraded my ambitions a lot. I think that's the only way I've been able to handle it is that for me, it's good enough just to be a really good doctor. Not trying anymore to like, publish the best papers or appear on TV as like the famous doctor giving advisor. Any of the things that I used to imagine I just want to do the best job for my patients that I can and get through the day and still be alive at the end of it. I think I can toggle by having hope just within the individual encounter. What I do go see a patient you know, and I feel like I've done something good. And I've helped them I can sometimes hold on to that a little bit longer and despite the vaccines and how exciting that is, I don't think this is going away for a long time. Couple more years at least. And we are so hurt so I play a lot of video games. I watched a lot of Star Wars.
Carrie Fisher (as Princess Leia)
"This is our most desperate hour. Help me Obi Wan Kenobi. You're my only hope."
Laura Perry
Why Star Wars? Oh gosh, um, I think my favorite part is the Force. I think honestly, it's, this is gonna sound silly, but it probably is like the closest thing that I have to a spiritual belief that we all are connected by a force. I don't necessarily believe that we can manipulate it you know into lightning that we can shoot it our enemies but the mythology that came out of that, and the different ways in which it can act is just so beautiful. I love Alec Guinness. I mean that the role of Obi Wan Kenobi is to this day my favorite, or one of my favorites. Now I have many favorites. But I love how close it seemed, even though it was a long time ago in a galaxy far, far away. But you know, yeah, if we were to suddenly start interstellar space travel, this is exactly what it would be like. And that we'd still have the same petty squabbles, you know, maintenance issues. Like the Millennium Falcon is you know, constantly having to be repaired, you know, somebody that has like a Great Muppet Caper type of feeling to it. You know, I think I speak for every woman of our generation when I say I love Princess Leia, Princess Leia was amazing. And now I really love Ahsoka Tano after watching Rebels in the Clone Wars. I love how small it makes each individual planet seem when there's bigger things at work. That maybe some of this stuff feels a little bit less overwhelming when you sort of have a sense of a bigger perspective that we are just one set of beings in one small place in time.