S1E1: COVID Goody Bag

Cal and Cathy welcome Lee Harper-Chen and Alexis Paules, ICU nurses who work at the bedside with COVID patients. In this episode we hear what it's really like for front line health care workers, why just showing up is impressive, and how taking care of ourselves (by wearing masks and washing hands) is the best way to support nurses and other front line providers.

About Our Guests:

Lee Harper-Chen is an ICU nurse at a level one trauma center in the Washington, DC area. She started caring for COVID patients during the spring surge and suffered with COVID herself for three weeks over the summer, which she caught in an outbreak among nurses. In her free time she loves playing sports and cuddling with her two young boys and their dog.

Alexis Paules accepted a job in the Neuro/trauma/Surgical ICU after college graduation, and has been working for about a year and a half now. Their ICU became a COVID ICU during the pandemic. During her first year of nursing she got married to her high school sweetheart and they just became homeowners in Maryland! Alexis loves to sing, cook, and spread the love to those around her.

About Interdisciplinary:

In this podcast, massage therapy educators, practitioners and positive deviants Cathy Ryan, RMT and Cal Cates, LMT will use research, science, experience and humor to explore the broad landscape of health care through a truly interdisciplinary lens. We will be joined by compassionate, self-aware humans who are actively participating or are interested in participating in interdisciplinary care to have honest, uncomfortable conversations about topics like access, racism, death, ageism, ableism, and equity that address the intersection of being a human being and providing quality care, so that we can expand our impact, confidently navigate new challenges, and together create lasting, sustainable changes in health care. You’ll always learn something. You’ll always laugh and you’ll come away better informed and with real things you can do in your own community and practice to create a more compassionate and collaborative system of care for all humans.

Transcript

Cal Cates: Welcome to Interdisciplinary, the healthcare podcast from Healwell. Massage therapy educators, practitioners, and positive deviants Cathy Ryan and me, Cal Cates, will use research, science, experience, and humor to explore the broad landscape of healthcare through an interdisciplinary lens. You'll always learn something. You'll always laugh. And you'll come away not only better informed but also with some real action steps for your own community, practice, and life. Thanks for being with us. Hey Cathy, how's it going?

Cathy Ryan: Hey! Happy 2021. Fingers crossed it's a kinder, gentler year. But as you mentioned earlier, it's a low bar, so...

Cal Cates: Yes, it is a low bar. It seems it could only be better. But, last year kept surprising us, so we'll find out. So for those of you who are new to Healwell podcasts, Cathy and I are doing this from the opposite coasts. So, I'm Cal Cates. I'm over here in the Washington, DC area. And Cathy, where are you coming to us from?

Cathy Ryan: I'm here in the northern wilds of British Columbia, Canada.

Cal Cates: I keep telling Cathy we need to switch places, but she's not interested. What're you going to do. So today for our inaugural episode, we're so excited to introduce to you and actually to have them introduce themselves to you: two of our good friends from the healthcare world, a couple of nurses who work in a level one trauma center in a major urban area that serves a very diverse population. They have certainly been on the "front lines" as we've come to know them over this last year. And we're going to open up the floor really to them. So friends, tell us a little bit about yourselves. What should we know as we get into this conversation?

Lee: I'll start. My name's Lee, and I've been an ICU nurse for about nine of my 11 years being a nurse, and I wouldn't ever do anything else. I'm in the bedside forever club. Some nurses come and go. They pass through on their way to being a nurse anesthetist or being a nurse practitioner. And nope, I am--people say "What are your goals for your career?" I say you're looking at them. (Yeah, I'm living it.) Yeah, living the dream every day. And yeah, so I love my job, and I had the great pleasure of training Alexis when she joined our unit. Molded this young one out of clay, and now she's a super nurse in her own right.

Alexis: Oh, man. Yeah, I graduated from nursing school in 2019 and went right into working at the ICU. So, I've been there for about a year and a half now. And, most of that has been COVID nursing, COVID ICU. Who knew? So yeah, I'm a baby ICU nurse, still learning. But, I think the last year has certainly made me grow at an exponentially faster rate in my confidence and skill than I probably would have otherwise. So. I feel like an older ICU nurse than I am.

Cal Cates: I bet. Yeah, and one of those experiences that maybe you wouldn't sign up for but you're like, oh, now that that's happened, I'm glad that I have that experience. (Alexis: Yeah, yeah, definitely has been interesting.) Yeah. So, I think a lot of our listeners fall on the side of--I can't even believe we have to say this, but--believing in COVID. But, there are a lot of people who don't still or who sort of think it's overblown. I feel like I want to ask you both: what is it like when you go to work where it is very real? And then you go out in the world where people are not wearing masks or who are hanging out in bars or doing the things that you know will lead to you taking care of them quite probably.

Lee: I used to get so worked up. I used to get so fired up, and every time I saw someone, I felt like a personal slap in my face. And, I took it so, so personally. But, I've had to sort of mellow out over the past year and just realize that we can only do what we can do. I've channeled some of my frustration and rage and personal anxiety into trying to be a peer educator on the platform of Facebook, which is a thankless task, but I feel a secular calling to it, if you will, to make my own posts, educational or humorous or sad. But then also, there's a Facebook group for my small city about neighbors helping each other through COVID. And, I felt this calling to start posting facts and statistics and little-did-you-knows and engage with my community that way and take questions. I opened myself up for... As I mentioned, it's to channel my own anxiety about COVID and comfort myself and others by presenting facts.

Alexis: I was just going to say I feel very similarly to Lee. It's interesting, because obviously, COVID is something new to everyone. So, the education aspect, it's almost to a point where you wouldn't know unless you were there, you know? So, especially in the beginning, I think everyone kind of thought of it as something that only affects immunocompromised people, only affects older people, only affects X, Y, and Z. And therefore, even my friends, even some of my family had the mindset of "Well, it's not going to affect me. And even if I get it, I'm going to be okay." And only through working in the ICU and seeing what we see am I able to kind of correct that and say, "You know, it can affect everyone." So.

Lee: And you don't know. You don't know. You're rolling the roulette wheel--spinning the roulette wheel if you decide to go out there and act like a damn fool. And you think that "Oh, I'll only get a mild case." You just don't know. I've watched forty year olds bleed to death from it. I've watched fifty year olds have catastrophic strokes and lose limbs. You just can't predict. Yes, there are certain higher risk groups that aren't necessarily what you think of. It seems to predominantly affect those who are overweight and those who have poorly controlled diabetes. And of course, it overwhelmingly affects populations of color, folks who maybe for socioeconomic reasons can't avoid being out and about and taking public transport and working and living in large households, because that's how they manage and perhaps culturally that's preferred. And so, there was a time when the roster of our ICU patients, it looked like a phonebook from South America. I believe we had 11 beds filled with 11 Latino patients. (Alexis: COVID positive, yeah?) Right, COVID positive. We looked at each other and said, "This is not a coincidence." This is what's happening. So, that's been... And then of course, communities of color have less health information geared toward them perhaps and also maybe less able to kind of understand some of the information. Not always, of course. I'm making a huge generalization. And then there may be some very real resistance to public health information because of terrible history that our country has, doing awful things to people of color. At our hospital, we take all comers. We don't ask any questions. We get a guy from the dumpster out behind Safeway. We get... (Alexis: Everything in between). All in between. We get dignitaries and everything in between. I can't say our hospital doesn't... Many parts of healthcare have a ways to go before they treat everyone with equality. But I will just say, in our ICU I have not seen any difference. Everyone gets excellent care. But also, everyone suffers the same.

Cal Cates: I think about the additional challenge of not having visitors or having very limited visitors and people who maybe have limited English proficiency or no English proficiency. How do you guys handle? I imagine you've been having incredibly intense, intimate conversations. That's not completely strange for the ICU, but kind of non stop-ish. And how are you guys... How do you deal with that?

Alexis: Yeah. I think the visitation thing has been an issue in and of itself, because a lot of these patients are at a point of their life that's very stressful. It's a time of the unknown. And they can't have their support systems there. Often, it's even complicated by the fact that they're COVID positive, and they're living in a household, and therefore other family members of theirs are also COVID positive. So even if they were in one of our few, tiny categories of exceptions where they could have a visitor, they can't have theirs, because their closest family member is COVID positive as well.

So and that's been I think since March really, March of 2020, that we haven't been able to have visitors. (Lee: Yeah, March or April we stopped. We did a brief moment of having visitors come back in, I think in, maybe September, October. And that was a bit of a headache, because people would just straight up lie and just show up at our front desk.) It was impossible to control. (Lee: You can't come in here! Yeah, so we certainly have been doing a lot of FaceTiming. We have these little tablets on wheels that you can wheel up to the patient's bed. And because our patients are so sick, they're often intubated, sedated, on tons of drips. And so, there isn't a lot of two-way conversation. What we will hear from outside the room is just sobbing coming from the tablet, just the sound of despair. And we use interpreter phones a lot. We put them on interpretor phones. And we have some in-person interpreters for certain languages. We can come up... But then the issue is then they have to gown up to go into a room. At one point--do you remember this, Alexis? There was a chaplain who came up, and she was very, very upset that she was not told in advance that the patient was COVID positive, and family members were hugging her. Realize she was providing the support that she is called to provide and kind of felt a little bit surprised, like we sprung this on her. COVID loves crying. It loves tears and saliva and snot.)

Cal Cates: Yeah. Right.

Lee: That's an interdisciplinary thing that's been interesting for us. Other services like the interpreters and the chaplain. (Alexis: Yeah, spiritual care.) Yeah. I know that the linens people won't go in the rooms to pull out the linens of the COVID... (Alexis: Or the trash.)

Alexis: We have containers full of sharps. Needles and things. And the sharps people are... Oh, my goodness. And some of them do. I won't say all of them don't. But there was one night shift where someone came to change the sharps in my COVID room. And I had just spent probably three hours in there putting in certain venous access into the patient so we could give him more potent medications. And, you're spending three hours in there. You can hardly see. You can hardly breathe. You're sweating. I get my gown off, and he asked me to go in for him to get him the sharps. And I said, "Sir, why can you not go in?" And he said to me, "I'm scared."

Cal Cates: Oh... What'd you say?

Alexis: This was peak COVID. That's a very valid feeling. I remember at the start of COVID being completely terrified, like putting on my PPE, making sure I didn't have a square inch of skin showing. I didn't even know. Just hoping it was enough to protect me. Going into the room holding my breath through my mask, trying to be as quick as possible. Like, terrified. So, I get that. And I don't know where he was coming from. But in the moment, I just pretty much laughed.

And I was like, "I'm sorry, sir. You're terrified? And that's preventing you from going in?" Come on.

Cal Cates: For 15 seconds.

Alexis: Yea for three seconds to grab a box. I just went in there for three hours. Please. Come on.

Lee: I had a little mini tantrum the other night when the trash person asked me to go in and pull my trashcan out. And again, I had just come out, and I was like, "Yeah, no. Sorry. I do too many other people's jobs for them. You're going to have to do yours. I'm terribly, terribly sorry."

Cal Cates: Well, I wonder... Go ahead, Alexis.

Alexis: I was just going to say it can become a frustrating trend somehow. Wait we might be biased, but I feel like it has been a trend that the amount of exposures, like going into and out of rooms, has fallen heavily on nursing in ways that... Like, maybe my respiratory therapist is busy in another room, and so she tells me on the walkie talkie to go and alter the ventilator settings for her. That's me going in again. Or taking out the trash. Or grabbing the bin. Even in the beginning of COVID, there was this unspoken rule amongst nurse practitioners or APCs, are doctors, even attendings, that they wouldn't go into the room to assess the patient. Or maybe they would once a shift. They were able to limit their exposure and base the day's care off of our assessments.

Cal Cates: Right.

Alexis: And that was something else to me. Now, that did improve over time. I think enough of us stood up for ourselves and said, "You've got to go in your room and assess your patient." But, that was frustrating and crazy to me.

Lee: But those were the good old days when we got one mask per entry to the room. I can remember throwing that mask away and being like "Whoop, bye bye!"

Alexis: it was freeing. We used to get a new mask every time, a new face shield every time. We were provided with head coverings. And shoe coverings. I don't even know how long that lasted, but it wasn't long.

Lee: Yeah. Now we preserve and conserve our PPE. We get one mask per week or one face shield per week or your own goggles. We get these Bill Nye the Science Guy goggles that we're supposed to wear over... The issue is you can catch COVID through your eyeballs. So, you don't want any splashing or any breathing into the eyeball area. Someone threw away my goggles! At the end of the week, you throw away your PPE bag. You get like a goodie bag, and you write your name on it. Like it's a party and you have your kids' bag and whatever. (Alexis: Everyone decorates them.)

(Cal Cates: Worst party ever.) 

Cathy Ryan: That's just wrong. A COVID goodie bag.

Lee: Your goggles, your mask, and your thing. And then at the end of the week, people start getting frustrated. They're stacked everywhere. It's just like, the COVID germs are everywhere. And people throw them away. And oh well, out went the goggles. But the good news is--and how is this good news, but it is--I had COVID myself over the summer. And not only did I keep the antibodies well into the fall, but then we both got our first round of vaccines. We are super excited. So, I actually have less personal anxiety, because been there done that. Been there done that and have the antibodies as a souvenir.

Cal Cates: I want to hear more about the vaccine and antibodies, but I want to make sure we don't skip over the--I feel like the thing you were talking about with people not going in and sort of using your own progress notes to do their assessment. Different people who could really be valuable in the room sort of opting out. And, one of the huge conversations we had in the massage world, of course, was massage was deemed not essential. And, all kinds of massage therapists were like "We're essential! Rar rar rar." And we're like, okay, but it's not about "is what you do valuable." That's not the question here. But at the same time, I think about what you said about the chaplain, and I think that at Healwell we do a lot of work in the ICU, and we work with chaplains and social workers. And, we work with the respiratory therapists and all these people who sort of... I guess the respiratory therapist, not so optional. I don't think a social worker is optional either really. How does that play out, and even when you're thinking about a... What are the conversations at your hospital around the facilities people are getting paid minimum wage to put their lives at risk? And, I hear what you're saying. Rubber needs to meet the road somewhere, right? And so, somebody gets paid more or acknowledged for the risk. How was that all playing out over the course of the year? Or was it? Everybody was just going about their business just trying to take care of people, and...

Alexis: Yeah. I would say it obviously varies from person to person. As I said, it's not every environmental services, the trash, and the cleaning people that will refuse to go into the room. Even some of them would call ahead of time and say, "Hey, we're going to come to the unit in a half an hour. Next time you go in your room, if you can put your trash outside, that would be great." So, there is some collaboration. I won't say that it's completely one-sided. (Categorical.) Yes, categorical. But it's tough, because in a lot of cases, it is us... In like the case of the translator or the chaplain, that's us seeing a need for our patient and then calling upon an outside resource to come in and help. So, those people are doing us a huge favor and a huge service by putting themselves at risk. Like, a big service to the patient but also to all of us as providers, especially the translators. We could not do what we do if you can't communicate. And it's not even just nursing. It's the doctors. You utilize that service as well. So, yeah. I even think just throughout the year it's become better. Even in the beginning, the X-ray, the people that would come to take X-rays of our patient and all of them, we were teaching them. (Cal Cates: At the bedside.) Yeah, the bedside. They'd have to come into the COVID room. And, I remember--Lee, do you remember, in the beginning, they were asking the X-ray people to stay outside and guide us how to move their equipment, and they would click the button and take the images from the outside of the room? That ended up changing. Thank God. But that was the initial thought process of how they were going to... So anyway, that ended up changing. But I remember us teaching them how to apply their PPE.

Lee: I'm not sure if they were trained or didn't get to practice, but they would come and just... They have a huge machine they have to maneuver. I don't envy them... after each interaction with a patient, a COVID patient in particular. But I remember, they'll just leave the door open. It's a negative pressure room, so you need to keep that door closed. We don't want the COVID germs blowing around. And then, they'll walk out of the room with their gown on because they forgot something. And you're like, "No, no, please." (Alexis: Or stopping them because you see them in the room without goggles. And you're like, "Hey, hey, can I grab you a face shield?" All that has improved, because everyone knows now. There's better education. I think even within the departments, they're educating their staff better. But, yeah. All these disciplines coming in. It's their job to do their job. They have to come be a translator. They have to come be a chaplain. They have to come take an X-ray. It's in their job description, but...) COVID changed all of that. (Alexis: COVID changed everything. Everyone's normal.) Everyone's normal changed. I remember one of the patient care techs who's like a nurse's aide who goes and helps with bathing or something like that. And one of them asked me, "So, what about us? Do we go in COVID rooms?" I said "Yes, honey. Your job did not change, only your outfit."

Alexis: Yeah, we've all got to adapt. And then as to the DES environmental services not getting... They're getting minimum wage and having to go in and do that. It just is how it is.

Cal Cates: Yeah.

Lee: They're heroes. Even without COVID, we couldn't run our hospital without them. (Alexis: We could not, yeah.) They are amazing and do a very important work for patients and for us. And, I don't think they got paid enough before COVID, and now risk their life for what? (Alexis: They're still essential.)

Cal Cates: Now, did you guys notice any--oh, go ahead Cathy.

Cathy Ryan: Yeah, just one of the questions that I have is a couple parts to it here. You're both ICU nurses. So, highly educated. Probably some of the best trained nurses out there for sure. Was there anything in your education and training that prepared you for pandemic? [laughter] And then the second part of that question is as a result of all this, is there something for you that you see--this has got to change going forward? We cannot continue in this way, just with or without COVID. Going forward, we've got to change this in healthcare.

Lee: Great questions. Wow, Cathy. What did we learn in our training about pandemic? This thing in 1918, this flu. We kind of touched on that. And, we practiced putting on gloves. (Alexis: Yeah, gloves. Glove application has been such an applicable skill.) Gloves and a gown, right? I think I put on an N95 one time during nursing school. I was like, "Oh, that's cute. I'll never have a TB patient. Haha."

Alexis: And every year they fit you for them. And you're like, "Meh. Maybe I taste that thing they're asking me if I can taste through my mask, but it'll never matter."

Lee: It doesn't matter. I'm not going to get TB. And now yeah, guess what? That's my best friend. I put that sucker on. What's got to change? Nurses have to be valued and paid appropriately. Staffing has to be safe and equitable. I remember one of my fears at the beginning of the pandemic was that many nurses were going to fall ill, and it was just going to collapse. Luckily that did not happen, because guess what? PPE works. So that's actually been great. There's been only a few, a handful of us, that we know of in the hospital who have gotten COVID. So, that's great. That means that the procedures actually work. But, nurses do need to be valued. We have trouble keeping nurses, because they vote with their feet. And now with the pandemic, the travel contracts that certain hospitals in the... (Alexis: Tempting!) A thousand dollars a week? (Alexis: How could you say no?) We're an inner city facility, and some of our equipment is missing or broken. That's part of the challenge that I like is you're a little bit of a MacGyver every day. But, people are saying, "Oh, well, I can go to this wonderful hospital. Make a ton of money. Get in, get out. Nobody gets hurt." So, that's been challenging. We can't keep up with the pay scale that nurses can demand now. So, that's been tough.

Cal Cates: Have you guys--oh, go ahead Alexis.

Alexis: I was going to say, I just think it's funny, the part about totally being unprepared for COVID, because they don't teach you anything about that in nursing school. And then, I was with Lee on orientation for a few months. I came off in November. So, I was my own independent nurse from November to March, kind of pre-COVID. And then it was like poom! Two super sick patients every single shift. Dealing with the highest risk medications, the sickest of the sick, right off of orientation. I was like "I surrender!" I was like I don't even know how to be a normal nurse, and now I'm having to... Like, I wasn't at all prepared. I don't know. Lee is like a champion nurse for ever. Like, not prepared specifically for COVID but pretty kick butt ICU nurse. I was like, "I am not qualified. I am a faker. I'm a warm body. And that's all that matters."

Lee: No way, because we just presented you with this incredible mountain to climb, and you just hopped right up it. Watching you grow as a nurse has just been one of my true happinesses. Everyone gets excited when they see you on the schedule. You're a nurse leader even at your young age, so...

Cathy Ryan: I would imagine it's like individuals in the military who are plopped down into the middle of a warzone, nursing with limited supplies. And it's like a crash course in how to be at the top of your game with having to be MacGyver with the smallest amount of tools to be able to do jobs. So, on one hand, Alexis, I can see how the value of that for you going forward as a nurse, you've just gotten decade's worth of experience in a very concentrated amount of time. On the other hand, as a person myself, I think about if I had been plopped down in that. I may have started running. I gotta think of a career change here. There's part of me that's like, man, I don't know if I would have had what it takes to, you know, feet right to the fire like that.

Alexis: Yeah. I remember. This goes along with what Lee was talking about earlier with what needs to change. As more and more people were getting sick, the census of our hospital, the amount of people coming in, was increasing and increasing. And as she said, the amount of staff was decreasing and decreasing. So, in order to incentivize the nurses that we had to pick up more shifts, they did pandemic pay is what they called it, which was like an added bonus amount of money if you picked up a certain amount of shifts. So, in the peak COVID times, I think I picked up 10 straight weeks of overtime, working four or five 12-hour shifts a week, many, many weeks. Sometimes both my patients died on my shift days back to back. Like, taxing emotionally, physically, mentally, everything taxing. And I made it through six weeks keeping my "sanity". And then I remember on the seventh week, I was laying on the couch and my husband was laying on the other couch. And we were watching TV. It was my one day off before going back for another four shifts in a row. All he said was, "Do you want me to make you hot chocolate?" And I bawled my eyes out. Then I started having a full blown panic attack. And he was like, "What's happening?" I couldn't breathe. I was hyperventilating. He had to walk me out on the balcony so I could catch my breath. I was dizzy. I was about to fall over. And then it was like a introspective moment of just the whole past six straight weeks of overtime all hit me at one moment of "I have to go back and do it again." Just realizing that--every day off trying to get enough rest and get enough joy in and get enough to boost yourself up to go in again. And do it again for X amount of days straight.

Lee: Nurse burnout is no joke. And this does fall predominantly on young people without children, I think, or who have excellent childcare. My husband's also essential, so he has to go into the office. So, I couldn't pick up that much overtime, because guess what? The kids don't have any place to go. And then I had this sort of guilt that I wasn't there. I was only doing my two shifts per week, but with the understanding that I had to also... Our school system abandoned us in the spring. Schools shut down and there really wasn't anything done in our particular county, so I just then suddenly had to educate these little people. So I switched to working weekends. So, I was Monday through Friday teacher. My husband was a champion also. Our children go to language and culture school on the weekends. So, he would do that with them and teach them at night, coach them for their lessons. And then, I would go in Saturday, Sunday to the ICU. So, that was tiring in its own right. But yeah, I had this sort of guilt that I wasn't with my fellow soldiers. I wasn't fighting alongside them as hard. But, I don't know. Somehow we made it through the worst of it. We are having a little mini surge now. We have half the total number of COVID patients that we did in the spring currently. So, our big total in the spring was 190. And currently we have 90 to 100, but of course in the spring we also canceled all non-elective, all non-emergent surgeries and procedures. And now, because our hospital system lost so much money, we're like "Actually, we have to keep going." Now, we have to serve our population as well. People still need brain surgery and heart surgery. So, we have not slowed down any of our core services now with this winter surge. So.

Cal Cates: Wow. (Lee: We're still very busy.) So, as you guys, thinking about the way... I mean, it sounds like nurses... I've always sort of, I have like an existential crush on nurses in a very broad sense. I just love nurses. But I feel like this pandemic has really been a place where you guys really have like... You look around and everybody's scattered. And, I wonder, I think it's really easy to sort of take regular for granted. And, coming back to kind of the interdisciplinary thread, when you think about how having reliable arrival of the respiratory therapist and knowing you can call the social worker and the chaplain and all the different disciplines who support you so that you can "just nurse"? And how much different it's been kind of being all of those things. And, does it increase your appreciation for the interdisciplinary nature of care? Does it point to you about how much better it even needs to be? Because it wasn't ideal in the before times. There's definitely we could do a lot more. One of our things at Healwell is we really feel like part of the way to move healthcare forward is to have disciplines training together. And when you have, for instance, nurses and physicians or nurse practitioners and respiratory therapists learning together, when they find themselves "in the field," they understand each other's jobs differently. It seems that there will be less of an opportunity for that kind of being overlooked or misunderstood or kind of more opportunities for collaboration and better care. Where do you see what you've learned through this and kind of losing that interdisciplinary aspect? Do you see that as something you want to work on in the future? How does it all play into your understanding of how you get to be a nurse?

Lee: Man, all I can think of is that we used to do these things called interdisciplinary rounds, where you'd get everyone in the room. It'd be the RT and the doc and the nutritionist and the pharmacist and everyone. We're not allowed that many people in a room all together, so that fell by the wayside. So, we've got to pick that--that was our best opportunity for collaboration, truly, was every morning or most days, right? We do those. And really have everyone touch base from all sides. And I hope, I wish that we would collaborate more with massage therapists and other practitioners like Reiki. They used to offer that, I think both for the staff and the patients. It's been such a stressful time, that would be great. Pull in some caring for the caregiver. (Alexis: Yea. Care for the caregiver.) And massages in the break room from 3 to 4 PM. Something like that just to help us out.

Alexis: They did give us a therapist. (Lee: Oh, Thursdays from 5 to 7?) Yeah. I'm never there when she's there, but she is there for us. That is new. They didn't have that.

Cal Cates: It's interesting. We, Healwell, we can never... Before COVID, we could never get hospitals to spend money to have us come in to work with the staff. And, we've definitely gotten some contracts during COVID where hospitals were like "Oh my gosh, we have to take care of our nurses, basically." And, the first of those programs that we did, those nurses also had a therapist that they could see if they wanted. And so, they got massages. And, I believe it was three separate nurses later that day went into the therapist and said, "Oh my god, I had no idea how much I was holding, how sad I was." We were like the cup of hot chocolate, where it was a moment where someone was nice to you, and you're like, "No, no, don't be nice to me. I'm just going to crumble."

Lee: You can't handle. (Alexis: You don't see it coming.)

Cal Cates: Yeah.

Alexis: Oh my gosh. Yeah. But in terms of an eye-opening experience, like very, very eye-opening in terms of increasing my appreciation for all of those different services and departments. But, yeah. Like in the beginning, we were really, really feeling the weight of not having them be able to do what they normally do in the way that they normally did it. And even one department that I forgot was Nutrition, who delivers the food trays and everything, and how they've changed throughout COVID, and having to coordinate with them. Like, I'm going to go in this room, can you please bring breakfast like now? And now they deliver it on a disposable tray for your COVID patient and all of that so you don't have to increase exposure by bringing the tray outside of the room to get back to them after. All of that. I'm working with them way more than I did prior to. I didn't even think. It was just in the back--the food just showed up, and I brought it into my patient. I didn't even think that there was a person making that and pushing the cart and putting it on a tray. So yeah, for sure, like eye opening experience of all the people that are involved in caring for each patient and the impact that they have on that patient's hospital course. And you don't even think about it, you know? Very, very crazy to think about.

Cal Cates: Yeah. (Alexis: Humbling.) Yeah, everybody feels essential suddenly.

Cathy Ryan: Well, we can only hope that part of the experience that we're all having as a result of COVID is one that elevates our humanity and our consideration for one another, whether it be at the grocery store or working the various services within the hospital. Not only direct patient care, but all of those supportive services. There's human beings with stories. And I think that's part of what I think is really important about this podcast is we're hearing some of your personal stories about what this journey has been like for you. We kind of joked at the beginning about COVID being a real thing, but certainly, I've had people in my practice, "What's everybody in a... about all of this?" And I'm like, it's a real thing. And I think for me, because I had someone close to me, someone that's a family member not living close to me, that got COVID in the early days of this-- fortunately all went well, they recovered at home--but it made it very real very fast for me. And I'm glad that it did. I'm a science nerd, so I think I would have been on board with the realness of it anyway. And Cal would have gotten me there really quick if I hadn't been. But I think it's really important that we are hearing these stories. I think this is what's going to resonate for people. Lee talking about, "Hey, I had COVID. This is what has happened for me." And then Alexis, for you to talk about the hot chocolate, the realness of we go, go, go, go, go. And then when there's a moment to exhale, boom, that's when it hits us. And like Cal, I'll say it online. I love nurses deeply. Literally, my mom was in nursing. Two of her sisters were in nursing. So, of course with that bias, a very personal relationship with nursing. So, deep, profound respect for nurses and all that you do and what you face in a day. And, you're human beings that have stories.

Cal Cates: So many more questions that we could ask you guys. But, thank you so much for what you've shared with us today. Is there anything you want to make sure that our listeners know about? About anything. About your experience, whether it be with COVID or just what consumers of healthcare should know, what our interdisciplinary colleagues should know. Anything you want to leave us with?

Lee: Take care of yourself so that we can take care of you better? We're not out of the woods yet. But, the end is potentially in sight with COVID, because the vaccine. When I went to get my vaccine, the mood in that room was one of... It was a party. There was optimism and joy. And that was the first time in many months that I had felt a room so filled with joy, and people were not suspicious of each other. Like, "you're sitting too close to me." It was like, no, we're all here because this is awesome. So, for the moment, continue doing what you're doing. Mask up, distance, wash them hands. Get in line for the vaccine. Get whichever one is offered to you first, as long as there's no contraindication, but check with your doctor or healthcare provider. But get it, because the more of us who get it, the quicker we can get back to normal or hopefully the new normal.

Alexis: (Cal Cates: Or something better.) Something better than this.

Lee: This will, as you mentioned, cause us to appreciate our humanity and treat each other more nicely and unweave the human condition, because we did learn something, I hope. I hope people have learned something from this. I think that actually not having visitation in the hospital was a bit of a difficulty for people in understanding just how sick these patients are. A lot of times you'll see people say to COVID deniers, "Well, you should go spend 10 minutes in a hospital." And I'm like, "Yeah, you should go spend 10 minutes in a hospital."

Cal Cates: Yeah.

Lee: COVID patients are the sickest group of patients that I've ever seen in my 11 years of nursing. I can't tell you. I've taken care of cardiac surgery patients, polytrauma patients, burn patients, everything. I've never seen patients that require more medication support and device support. I mean, their kidneys fail, their lungs fails. (Alexis: And decompensate so quickly.) You can't even turn their head to prevent pressure ulcers, because they'll die. They will die if you turn their head. (Alexis: Delicate. Delicate.) Fragile. Brittle. So, it is that roulette wheel where yea, someone in the neighborhood just lost their taste and smell. No big deal. But, someone two streets over has died from it. We just all have to... As individuals, I believe in a society, it comes with responsibilities as well to those around us. #LoveOneAnother

Alexis: Yeah. That's what I was going to say. That's the big thing that I think would be great if we could all do is if you... For us, I'm thinking like at my work, something that I need to do is tell people that I appreciate them. Voice that to every discipline, because everyone's going through this really tough time, and even though I'm having a hard day, so is he and so is she and so are they, and we're all showing up to work, and showing up right now is impressive enough. That's hard enough to just show up after all of this to work, despite the emotional exhaustion and everything that we're facing. So, I would say to suggest that for all the disciplines, everyone that's working with people from different disciplines to express gratitude and show it and mean it that you do recognize everyone's hard work and appreciate that. And, you could say the same for people out and about in the world, not working in maybe a hospital setting or healthcare setting, but just treating everyone with grace right now. Because it can be hard, I think, when you see a select few kind of going against maybe what you think they should be doing. As Lee said, I used to take that personally. Like, take it as kind of a slap in the face. So. Yeah.

Cathy Ryan: Alexis, I have to ask, are you Canadian? Because that was just so kind and gracious.

Cal Cates: Aw. See, Cathy thinks only Canadians can be kind. (Alexis: I'm not Canadian, but I came from a family that was really nice, so I've been trained to kind of censor myself.) (Lee: We know what we're doing here today.)

Alexis: Yeah. So, I don't know. I take people wearing masks as a great show of kindness and gratitude towards healthcare providers everywhere.

Cathy Ryan: Be kind, wear a mask. (Lee: That's the name of the game.) And wash your hands.

Lee: There is a light at the end of the tunnel. I really do see it. I really do have high hopes for Fall 2021 where we might be able to meet for the Holidays. We might have schools in full session. It is very possible that it could be that.

Alexis: Cling to it, baby. Cling to the hope.

Lee: I have enjoyed turning that corner in my mind, whether or not we can actually get there. It gives me something, a goal to aim for and focus. (Alexis: I have enjoyed clinging to that hope as well.) I'm going to keep on keeping on with my Facebook educating in my echo chamber. No really, but no. There are some more suspicious folks on there, and I've had some run-ins with some and some very productive dialogue with some others. So. I think that a little education goes a long way, and people are very interested to hear from healthcare providers. Anyone can be a Google expert or "Oh, I read a bunch of articles," but I think it helps to hear from people on the frontlines who have actually lived it. And I'm like, "Yeah, it's not fake, dude."

Cal Cates: Yeah, this is legit.

Lee: If there's anyone to believe, it's me. Please. I'm not exaggerating. What would I gain by pretending my life is horrible? People are dying all around me. You think I find that entertaining? No, I don't.

Cal Cates: Yeah. Well, thank you. Thank you both. We pay you handsomely. And that is to say that, because I forgot our early pun in our episode, I'm going to share with you a nurse pun now that maybe you already have heard. But, what did the nurse say when she found a rectal thermometer in her pocket? (Lee: Where the heck's my pen?) Dammit, some asshole has my pen. [laughter]

So on that note, we wrap our first episode of our new venture Interdisciplinary, the healthcare podcast from Healwell. Thank you both for being with us. And thank you all for joining us. Go Like us on the social media and all the places, the Facebook and the Twitter and the Spreaker and the places that you get your podcasts. Cathy Ryan, as always, thank you for being my co-pilot.

Cathy Ryan: Thank you, my friend. And thank you, Lee and Alexis, for taking care of people's loved ones. We appreciate what you do. And just, I'm making a bold statement: massage therapists love nurses. We're there for you. (Lee: Well thank you, and we're here for you too, and let's collaborate more and more in the future.) (Alexis: Yes, please.) (Lee: And thank you for having us on the show.) (Alexis: Yeah, it's been a pleasure.)

Cal Cates: Thank you guys. Happy New Year. (Lee: Happy New Year.) (Alexis: Happy New Year.)

Rebecca Sturgeon: Interdisciplinary is produced by Healwell. Our theme music is by Harry Pickens. You can send us feedback at info@healwell.org. That's info@healwell.org. New episodes will be posted weekly via Apple Podcasts, Spotify, and our Facebook page. Thank you.