In this episode, we interview Dr. Budhrani, who has been practicing clinically for over 20 years as an emergency room (ER) physician, is the CEO of Innovation Health, whose goal is to unify the health care system to making the patient experience easier and more affordable, and is a professor at George Washington (GW) School of Medicine. We are grateful that he was able to make the time to speak with us about the impact COVID-19 is having on the medical system as a whole, the mental and physical health of front line health workers and their families, and what resources are available to them.
Dr. Budhrani believes it is critical for health care providers to have a seat at the table when discussing what the ‘new’ world will look like and how to get people back to work, back to school, etc. He also explains how coordination of care is key. That healthcare industries need to share data and manage populations in a coordinated fashion to prevent the virus from spreading, and to inform the public health response for future pandemics, or a second wave. He says thinking of COVID-19 as ‘going away’ is a dangerous assumption, but rather thinking about how to manage and prevent it's spread are going to be the keys to our success going forward. Not simply rolling the dice and hoping it will go away.
When we sat down with Dr. Budhrani, we were in the midst of the country realizing that although front line staff are ‘heroes’, they are still humans who need support. Right before our interview, news came out that a New York doctor had taken her own life, a doctor in Washington DC announced on social media how difficult it is to bury his emotions, and Governor Cuomo, Governor of New York, committed additional funding to support mental health services for front line staff. We caught him at a time when our country and our listeners needed to hear how to help front line workers and how front line workers can get the support they need.
In response to this, Dr. Budhrani describes the stress he feels each time he thinks about entering the ER, with new guidelines and policies being enacted every day. How he leaves home with two layers of clothing knowing the top layer will be exposed and how much he needs to think about things he rarely considered before such as being well-groomed and having adequate personal protection equipment (PPE). Stating that in reality, he is now going in “physically armed” to work.
Hearing that, we asked him why he would go back into the ER right now having an already full plate with Innovation Health and teaching. “If you are blessed with the opportunity to have the knowledge to help someone, then I think we feel as though we have a moral obligation to impart that knowledge, especially right now. In our lifetime there has not been a clinical tragedy at this scale that has affected so many lives across the world, and I feel a moral obligation to serve. That’s what drives me to go into the ER.”
He explains further that despite feeling hot and claustrophobic in layers of PPE for 10 hours at a time, and how that can make a person “mildly delusional,” in this climate there is something really satisfying about being able to help someone. "I think that is a significant driver of all of us who do this.”
“We’re seeing some of the greatest impact on mental health and physical health on these front line folks, and they need to be addressed now so it doesn’t erupt like a volcano later.”
We sat down with Sherry Bensimon, a New York and New Jersey state licensed funeral director, to hear her story of how COVID-19 is impacting her work and home life. We found Sherry after she was interviewed for a New York Times article about how funeral directors are risking their lives to do their jobs.
Sherry has given her life to taking care of the dead in all possible ways. From the time she was a teenager, she was a member of the chevra kadisha, a Jewish holy burial group made up of volunteers from the congregation who wash and shroud the deceased to prepare them for burial.
She explains that taking care of the dead is very important in her society, “New York is one of the most stringent in terms of taking care of it’s dead. We’re still human beings [upon death]. New York requires special schooling to become advocates for the dead. They can’t speak for themselves, we have to, and that’s why I got into this profession.”
A funeral director is responsible for a great mitzvah, a good deed, “I’m the one who is responsible for taking care of the dead. In Judaism, taking care of the dead is one of the highest acts, it’s probably just below saving a life. Had this person not been alive, a small community would not have existed. To do my job is a beautiful, life-affirming thing.”
Sherry describes how difficult it has been for her to do her job during this pandemic, “These people died alone and now they are being buried alone. A lot of cemeteries are limiting mourners to 3-8 people at a time. At least I’m there, but the people that should have been there are not. They’re [the deceased] not being given the love and respect they deserve. That is emotionally the hardest for me. How do you tell a family sorry but your cemetery will only allow three people?”
“To us, we hold dear so much to our rituals. Here is something that is so important to us, you know, gatherings and funerals are very sacred for a lot of cultures. And that comfort, you just can’t get.”
As a physician assistant working in oncology at a multiple myeloma center in New York City, Alex Kaiser gives us a glimpse of what it's like to be a healthcare provider who is not treating COVID-19 patients during this pandemic. She explains how she’s supporting her patients through and how she’s finding ways to support herself.
In the first few weeks of the pandemic, Alex and her colleagues had to make quick decisions around which patients absolutely needed to come into the hospital for chemotherapy, despite the risk of COVID-19, and who could wait. This meant conducting a risk/benefit analysis, pausing or drastically shifting some patient's care, and managing patients’ anxiety around these decision. Alex explained how oncology allows providers to establish strong, long lasting relationships with their patients and how because of that she often absorbs her patients’ fears and concerns, making these rearrangements in treatment exhausting.
So she quickly came up with a COVID-19 cancer care package (pictured above) to better support her patients. She sent around emails to gather donations (hand sanitizer, thermometers, etc.) and FedEx-ed or hand delivered the packages to her patients. Additionally, after friends shipped her loads of face masks, she started handing them out at grocery stores or gas stations. “Since I wasn’t on the ‘front lines’ of COVID-19,” said Alex, “I thought about what else I could do in my community. You receive when you give.”
Despite her hard work and dedication to her patients and her community, Alex explains how many health care workers not on the ‘front lines’ (ie. emergency room, COVID-19 units) are currently feeling a sense of survivors’ guilt, “Because we don’t have N95 (surgical mask) bruises on our faces or we’re not holding patients' hands as they die, it’s easy to feel like I’m not doing enough.” However, Alex discovered that this comparative guilt does not serve her, and decided to take a new approach.
Alex explains that self care was not high on her priority list the first few weeks of the pandemic, and her usual coping skills, such as festivals and music shows, were taken away from her due to the shutdowns. She lives alone, her non-medical friends left the city, she couldn’t go outside to run, and she felt a sense of anxiety. She asked herself the question: what serves me and what doesn’t serve me? In answering that question she decided to take a hard look at her social media life. It had become really difficult to look at people spending their "social-distancing" time at the beach or at a lake, so she un-followed some of those friends. Instead, she reached out to social media to find support. As a Phish fan, she posted in a Facebook group called ‘Phish Chicks’ asking if anyone would be willing to send her mail since she was feeling lonely. She immediately began receiving packages or letters every day, and plans to reciprocate the gesture when things settle down. She went on to share that she began really paying attention to the little things as a way to find relief. She tried adding color to her apartment, she began collaging, she also figured out that getting to the grocery story and preparing food was something that was causing anxiety. With her parents 45 minutes away in Long Island, she was able to out source this task to them. Her parents would ask for a menu each week, cook a fridge worth of food, and drive in to drop it off and visit with masks on from six feet away.
“I’m hopeful that this could be a reboot for mankind, and good things could come out of it, not just bad things. That we could somehow all unite together.”
Rouben Madikians is a flight attendant, yoga teacher, photographer, and COVID-19 survivor. His story inspires us to look for connection even in the isolation, and that being vulnerable takes strength and courage.
After a few days of feeling foggy and disoriented, Rouben eventually developed a fever and tested positive for COVID-19 while on a layover. Due to that he was forced to self-isolate in a hotel for two weeks. Despite being scared, alone, and feeling terrible, what Rouben shares from this experience is how held he felt by the hotel, his family, and his co-workers. Highlighting his commitment to looking for connection even in separation.
Rouben reflects on those two weeks in quarantine, as well as his experience working as a flight attendant during the pandemic, “I miss touching someone on the shoulder, hugs from my friends, shaking my passengers’ hands, or taking a child to the flight deck.”
He descirbes a story of infant twins who were hospitalized while ill. Once their nurse put them in the same incubator, one child put their hand on the other, and their vital signs changed almost immediately. This story, he says, shows that we are "social beings." That physical touch physiologically makes him feel better. Rouben’s experience has been that admitting this is vulnerable, and that sometimes people equate vulnerability with weakness. To that he says, “So be it, fuck it.”
The feeling of loneliness is so real for so many right now, and even if we’re with other people, we may still feel alone. Rouben explains, “Either we don't have bandwidth [to engage deeply], or there are just so many layers in between us and that person, forcing us to shut down. If I’m shutting myself down to the negative feelings, I’m shutting myself down to the positive...it’s the same neural pathways.”
Rouben expressed extreme gratitude for the generosity of family, friends, flight attendants, his company, and the hotel staff. However, his biggest fear is that he could have spread the virus to others before it was detected. Frontline employees don't get tested until they show symptoms. Rouben didn’t have symptoms until about six days into his illness, and even after he had a fever, he had to obtain a prescription in order to be tested. “We need to be tested, no questions asked,” said Rouben, “I hope the rules change around that.”
"Maybe I needed to get covid to go deeper into this. So, in a way, I'm grateful."
In Season 1 of Finding the Helpers, we are bringing personal stories of front line staff and families impacted by COVID-19. Our diverse guests will be invited to share their story of being on the front line, and in combination to their story, two expressive art therapists will provide art and creative activities that will support the challenges the individual and their family is facing. These could include ideas for short relaxation techniques to be done on the front line, creative ways to explain in kid friendly terms what is happening, ways to stay connected to family and children during long periods of isolation, etc. Throughout the podcast, conversation will include mental health insight related to the pandemic, anxiety and stress, grief and loss, resiliency, coping skills, and understanding the pandemic. Presented by the nonprofit Playing to Live's, whose history began in 2014 as a grassroots program focused on bringing play and creativity in the midst of the Ebola deadly viruses. Following our work in Ebola, we have continued our work as advocates and creators for play and expression across the globe in refugee settings, post war countries, and in the United States of America.
Lindsay Bingaman is the Regional Program Manager for Playing to Live, based in Nairobi, Kenya.