Year of the Pandemic


Date Published: December 16, 2020

When COVID-19 first hit New York, we turned to Jessica Montanaro, MSN, RN, and Brendan Carr, MD, MS, for an inside look at efforts to fight a terrifying and poorly understood virus. Now, in the midst of a third wave and with vaccines arriving, we asked Jessica and Dr. Carr to reflect on the past nine months. What have they learned? How have they and their colleagues persisted? And what does the future look like to them? Their answers might surprise you.

Podcast Transcript

Part I

Host: 00:00
From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about facing adversity. I'm Jon Earle. It's a historic week. A COVID-19 vaccine has arrived at New York hospitals, including Mount Sinai. It's a week to be grateful. A week to rededicate ourselves to doing our part, whatever that may be, to get this thing over with. Because according to my guests this week, we're not out of the woods yet. This is our end of the year episode. And typically what we do with an end of the year episode is we look back over the past year and we find our favorite moments. And then we share them, talk about them. But it hasn't been a normal year, and it's not going to be a normal end-of-year episode. So what we decided to do instead was bring back our first two guests from our COVID-19 series. These are the people who, personally speaking, shocked me into understanding what this whole pandemic was about, what we were up against. And I wanted to catch up with them, see how they've been, and of course ask the big questions: What have they learned, including about resilience? And where do we go from here? So we're breaking it up into two episodes. The first episode, part one, is with Jessica Montanaro. She's a ICU nurse at Mount Sinai Morningside. And in March when we talked, she told me about what it was like to treat COVID-19 patients and the toll it was taking on her and her colleagues. When we caught up last week, she and her team were ramping up to fight the current wave. Jessica Montanaro, welcome back to Road to Resilience.

Jessica Montanaro: 01:30
Thank you for having me.

Host: 01:32
So we spoke last on March 26th. That was about nine months ago. And at the time there were about 150 COVID-19 positive patients in our ICUs. The number would essentially triple in the weeks after that. And I want to start out by playing a clip from our interview that describes you kind of running around. And I want to hear what your reaction is to that clip.

[Clip] Jessica Montanaro: 01:58
We have a very big unit physically, and I'll be standing at one end. And then I see like 10 people running to a room on the other end and we're running down there and we just get that taken care of. And then you see 10 more people going a different direction to another room, and then we're running over there to see what's going on. So it's been that type of environment.

Host: 02:18
What's it like for you to hear that clip?

Jessica Montanaro: 02:20
In some ways it's a gut punch because as I hear the clip it brings me right back to the unit and remembering exactly what I was seeing. It seems surreal that we lived through that, to be honest with you. It's also something that's really never far from my thoughts. I feel like we go on with life, and obviously we've moved forward nine months, but that experience that I just heard, that I shared really, I think, has stayed with me in some form. I can recall in a minute, but it's kind of unbelievable.

Host: 03:03
I know the numbers right now are not where they were when we recorded, but the numbers are rising. And I was wondering if you could paint a picture for us of what that place is like now?

Jessica Montanaro: 03:14
I think I'd like to start with after all of that intense surge for us in our ICU, which was about, I would say, sustained for like two months, we went into a post-COVID recovery phase. And just trying to get back to some kind of normalization, if you will, in terms of standards and even just how we think as clinicians. Because during that time we were just, our whole thinking had to change about how we were approaching these patients and everything. So getting back to standards, getting back to normalizing things. And we had, obviously, a short period of that. And I think we did quite well during that phase. All the while I think not far from any of our minds that the winter months potentially were again going to be very difficult. So now that we're here, I would say that, you know, it's not that chaotic scene that I described during our last interview. So the current picture is a lot more of a controlled scene, and patients are coming in with COVID into the ICU. It doesn't feel today, and I don't know what the next four weeks will bring, but today it seems more controlled. But it's not un-devastating. It's still extremely devastating. So I can go two aspects with this. I can talk about the environment, but there's a whole personal side that I think is a layer and an element that's happening now with the staff related to those earlier experiences.

Host: 04:56
Tell me about that side.

Jessica Montanaro: 04:57
It's been really hard. I'll be honest with you. The other day, maybe late last week, we had a huddle explaining that we were going into surge mode. Just that we were going to start activating, you know, increasing capacity for beds. And immediately my body reacted, I would say, in a visceral way. And there was, like, an adrenaline that came over me. And all of a sudden you could just feel the energy change in the ICU. We were moving at a little bit faster pace, and yet it wasn't like we were getting an influx of patients. We were just preparing. And then the personal side is as nurses in the unit started to hear that this was the message coming from administration, there were tears, still ongoing, I would say, a lot of anxiety, a lot of expressing the fact that it was scary. I know we can get through this. We know what we're doing. We have better systems in place, but there's a lot of fear and there's a lot of anxiety and there's a lot of flashbacks, if you will, over what we lived through. And the other thing that I think is that, you know, when we went through this at the beginning, there was so much fear involved. We were terrified. I can speak personally. We didn't know if we could touch the countertops. We didn't know if we could touch door handles. We had no idea how we were going to contract this. And if we did, how fast it would overcome us. And so I think because we've been doing this now for nine months, the fear is not as intense or not really there, if you will, the way it was, of this unknown that we were facing back in March. However, it's now almost just kind of exhaustion and despair. It's not fear it's--we're going into it with no reserve.

Host: 06:57
No reserve of?

Jessica Montanaro: 06:59
No reserve. We have no reserve. There's no energy reserve. There's no--we're tired. And I think that, I know for me and I speak to my other colleagues, we're front-line workers and we're health care professionals. And we have been saturated with deaths and sickness. And that's what we do, right? This is a calling for many of us. But on the other side of that, we've all been living through this as people, not front-line workers. We're going into this second wave with going through almost a year of our own personal social distancing and not seeing our families and our own personal things that have gone on for us and the heavy weight that the world is feeling. We have that on top of it. So I think it's just compounded.

Host: 07:52
I know there's been a lot of positive news recently regarding vaccines, and I'm wondering how you see that. Does it feel like the light at the end of the tunnel, or does it feel different?

Jessica Montanaro: 08:04
It's a light at the end of the tunnel for me personally, because I know I will take the vaccine and I have hope that we will have an ending to this. It's not an immediate light at the end of the tunnel. Because I know we have a lot of hard work ahead of us over the next few months. And I'm worried about the fact that there's so much mistrust and fear from people who don't want to take this. I'm worried about our minority communities who have a longstanding mistrust with the health care system, because they are the ones being hit the hardest, and that's my main demographic of patients. And so I don't know how I feel about it. I'm thrilled. I'm glad that we're on a path to hopeful recovery, but I think we have some very difficult times awaiting us, unfortunately, over the next couple of months.

Host: 08:58
So it doesn't sound like it dramatically changes the picture for you of what the next few months might look like?

Jessica Montanaro: 09:03
No, I mean, not what I think we're going to face for working purposes. Because I think we're still going to be faced with death and sickness. And, you know, I was struck when I came back from the Thanksgiving holiday, we had like a mother and daughter with COVID in the ICU. We had a husband in the ICU whose wife had COVID and was in the emergency room. So a lot of families.

Host: 09:28
Is there going to be a piece of mind, though, that comes with once you're vaccinated? You can go to work with more confidence, or does it ease fear at all?

Jessica Montanaro: 09:39
Yeah, I mean, it will, yes, definitely make me more confident or at peace once I'm vaccinated. I don't think, though, until we get a wide distribution and a whole bunch of people ready to take this--that's a separate piece because the physical labor of the work and the emotional stress of the decompensation and the death are separate because that's still going to be there. So while I have, through this entire thing, felt a call to duty and have not shied away. And really just, I felt now that I reflect back on those early times, I had a call to run into the fire. That's how I felt. I felt like the house was burning, and my people were in there, and I did not want to be home. I wanted to be there with my people. And so, I think, yeah, I've always been worried about myself, but I've always kind of just done what I've had to do. So I'll have some peace of mind, hopefully, that I'm more protected. I'm very careful about the precautions I take at work, but again, that's separate from knowing that we still have this potential devastation ahead of us as front-line workers, that we're going to have to care for until probably the summer.

Host: 10:57
Let's go to the next clip.

[Clip] Jessica Montanaro: 10:58
Calm through chaos. And so I kind of tried to make that my mantra. And I'll say that to myself. And I have every single intention of living that when I get into work. But when I get there, it's so chaotic. The level of stress—you just walk in, it hits you in the face. It's hard to not get swept up by that.

Host: 11:17
I'm wondering how that rings to you now. And whether that's something you still tell yourself, or whether that's changed?

Jessica Montanaro: 11:22
I'm so grateful that I had that mantra, and it kind of became the mantra among a lot of us. So yeah, I hear that. And in a weird way, I guess, it brings a smile to my face because that was really so true. It was just focusing on calm through the massive chaos that was around me. Does that ring true today? It doesn't because it does not feel chaotic. The anticipation feels a little scary, but I almost have this confidence that we are so much better than where we were in March in terms of knowledge, in terms of systems having to be in place. We're preparing our equipment the way we learned how to do it over that surge. So for me, I don't know that I have an exact mantra for this, but I am filled with a confidence that I didn't have back in March.

Host: 12:17
And I think it's a great lesson about fear. That information and experience are the two great antidotes to fear.

Jessica Montanaro: 12:24
Yes, absolutely. And it doesn't mean I like this. And it doesn't mean that I'm thrilled we're going through this. And it doesn't mean that people aren't having—my colleagues aren't having anxiety. And it's the type of death that is sad.

Host: 12:41
Do you mean by the "type of death" the isolation?

Jessica Montanaro: 12:45
I think it's isolation. I think it's, you know, COVID ravages the lungs. And if you can't breathe, it's not a pretty thing. It's very sad to watch patients who are on a ventilator. It's frustrating as a clinician to provide someone with an airway and a way to breathe, and then their lungs collapse despite that. And we're doing all of these interventions with chest tubes and all this stuff to help mitigate decompensation. And it just doesn't work sometimes. And we are doing everything we can in our toolbox, and it's very frustrating and it's sad. And I have been extremely reflective in my own personal life as a critical care nurse. I'm so passionate about critical care. And I love my job and I love my profession. This has brought me a lot of time to contemplate on how we integrate palliative care and really peaceful death and quality of life for our critical care patients.

Host: 13:54
What are some of the thoughts you've been having along those lines?

Jessica Montanaro: 13:57
I think that we need to have a conversation early with people about what type of death that they would like. And I don't think that, as a society or our culture, we talk about that enough. I think that we wind up, unfortunately, in Western medicine, in these emergency situations and families are not prepared to let go of their loved one. And so we say, "Do everything. Do everything you can to save this patient," not understanding that that really is going to maybe be painful for them, right? Or it's not going to be really what that patient wanted, but it's because of our own inability to maybe just accept that death is a part of life. And in no way am I saying that we should just let people die, but it has really made me reflect on what measures we allow ourselves to go to as a health care system to save people. And when we do, what kind of quality of life will they have after they've gone through all of these interventions. So a lot of heavy thoughts, I would say, this year.

Host: 15:06
I wonder in terms of the long-term effects of COVID on how we do medicine--I wonder whether bringing palliative care into it sooner and in a more comprehensive way will be one of the long-term effects?

Jessica Montanaro: 15:19
My big wish in health care is that--and as a society or Western medical society--is that we really can integrate that in a much greater way in the critical care world than we are. And it's there. It's definitely there. It's important. We have a wonderful palliative care team and they were so helpful and integral during that surge with connecting families and having those hard discussions. I just wish that we move to a place where we can do that sooner. And a lot of it is that we think we should live forever in this country, and we're afraid of death, and we don't have a sense of being able to let go. And it's not judgment that I say that. I've had my own personal losses and had to contemplate those things. But it's also put me in great touch with my own mortality, watching all of this death. And the types of death that people are going through and having those conversations with my husband.

Host: 16:19
Well, that really brings me to the last thing I wanted to talk to you about, which is how you've changed.

Jessica Montanaro: 16:24
Ah, that's a tough question. How have I changed? Well, I think what first comes to mind is that I have done a lot of reflecting and self-contemplating, and I really just not learned, because I think I always knew this about myself. So I guess I just really cemented the fact that I am a resilient person, and I know that I have that in me. And I'm so grateful for that. I think that it's made me change in the fact that I'm really tired this year. I'm emotionally, physically tired. And to give myself permission to maybe not get that whole to-do list done, right. I live by lists and, you know, I have stress if it's not crossed off and done. And to really give myself permission to not have to get that to-do list done. I think it has made me evaluate what's important in life. And then probably one of the biggest things like I already talked about was my own mortality, really facing that and having those tough conversations with my family. And in my career, I just started my doctorate degree.

Host: 17:38
Oh, congratulations!

Jessica Montanaro: 17:39
Thank you. And—hard. Maybe wasn't sure I really wanted to continue with all this on my plate. But feeling like I can work to still try and make a difference from everything that I've just learned and experienced over this last year. And it has just made me grow in my faith and in my profession and in my skill. I'll just cite this one story for you, which was—we had a COVID patient come up the other day. I get emotional when I talk about this. It's all emotional, but she was, I don't even remember, maybe late seventies, eighties. And she was breathing very, very fast. Maybe fifties or sixties. And so we intubated. And her daughter came up and was devastated. And I told her that I was adhering to the visitor guidelines. And I told her that her whole family could not come up. Just one other person could come up. And she was really pushing me to try and get her whole family up there. And I said to her, "That's really reserved for patients that are eminently dying." I said, "Your mom is not there. She's very sick, et cetera." Went through it with her. And so I needed to find a way to give this woman peace, and that's who you focus on. And that's where I think I've grown as a professional, too, just having those really hard conversations. COVID has taught me--and I think all of us in my unit--so much about how we have to connect these families, even with this restriction in place. We still have to find a way. And I remember she wanted to go in the room. So I said, "I'm going to put a gown on you. I'm going to give you goggles." I got her all in the PPE and she asked me, "Can my mom hear me?" And I said, "I don't know, but I'm pretty sure she can." And I said, "So why don't you go over and tell her that you loved her in her ear, please." And she went in and she did that. And she had that moment with her mom. And her mom died three hours later. And I couldn't see that coming. And it was devastating for me. We tried really hard to save her, but I walked away from that, even though we couldn't save her mother, feeling like I did my part to try and give her daughter peace. And at least she got that moment to go in that room and tell her she loved her. And maybe that was the last thing her mom heard. I don't know.

Host: 20:08
I had planned to play this clip for you, but we've already talked about change. I think you've talked about it very beautifully. So I guess I would just ask if there's anything that you want to share with listeners that you think it's important for them to know right now?

Jessica Montanaro: 20:21
I think that it can't be said enough that this is a serious and deadly virus. And if, you know, I've been on a lot of interviews and I've spoken with a lot of people and this really resonates with me is that please don't say that you support your front-line workers or ask us to be there on the front-line to save you or your family if you're not going to follow the rules because you're only exacerbating the problem. We've all had to make sacrifices. It's a small sacrifice to make for another short period of time until we can get vaccinated and get this under control. And I think that the other thing is that let's respect the fact that you can have all the equipment in the world, but you have to have skills and trained personnel at the bedside. And I want to tell all those who are listening that are front-line workers, we can do this. Thank you for your service. Thank you for not giving up and coming to work every day. And we are in this together.

Host: 21:33
So that was part one of our end-of-year episode. Part two should be out soon. It's an interview with Dr. Brendan Carr. He oversees all the emergency rooms at our eight hospitals. And like Jessica, he doesn't sugarcoat it. So I think you'll enjoy hearing his take on things. Road to Resilience is a production of Mount Sinai Health System in New York City. It's produced by Katie Ullman, Nicci Cheatham, and me Jon Earle. Lucia Lee is our executive producer. From all of us here, thanks for listening. We'll see you soon.

Part II

Host: 00:00
From the Mount Sinai Health System in New York, this is Road to Resilience, a podcast about facing adversity. I'm Jon Earle. This is part two of our end-of-year episode. It features an interview with Dr. Brendan Carr. He's the Chair of Emergency Medicine at Mount Sinai, which means he oversees emergency rooms at our eight hospitals. Dr. Carr was the very first person I interviewed after the pandemic struck in March. And the word I would use to describe that interview is "sobering." And this one is, too. That's because Dr. Carr does not mince words about the weaknesses that COVID-19 has revealed in our health care system or the challenges that remain. But there is hope. There's the vaccine, and there's the incredible resilience that's been revealed all over. So here's Dr. Brendan Carr. Hope you enjoy it. This is the year unlike any other year. So we decided that bringing back our first COVID guest to talk about what the year has been like for you was a fitting way to wrap this year up. One other reason we wanted you back is because, to use Nicci's words, you scared the [bleep] out of us in a very calming way when we spoke in March. [laughs]

Dr. Brendan Carr: 01:09
I see. So really this is all about, like, you want to know if you can sleep tonight or not? [laughs] Listen, the reality is that in a different life we could have met. And you would know that I'm actually a totally lighthearted person. I like to have fun. And I'm confident that is not the guy that you met nine months ago.

Host: 01:29
When we talked, you were literally starting the job. I think you were a few weeks in, not even a month.

Dr. Brendan Carr: 01:34
I started February 1. We diagnosed our first case of COVID in New York City on April 1.

Host: 01:40
March 1.

Dr. Brendan Carr: 01:40
Sorry, March 1. And April 1 we opened the field hospital. Like that's how rapidly it ramped up. And I gotta tell you, the more I think back to those times—before you play me a clip of where my head was then—when I think back to that, I think a lot about the uncertainty. I think about how scared we were. Because we didn't know the—we didn't know the disease at all. And we always know, you know? Even when we don't know, we sorta know. And this, we just, we didn't know what we were dealing with or how to deal with it. But I also think a lot, a lot, a lot about the fact that I had—and I don't know if I talked about this on the podcast—I had absolutely no relationship with the people that I was asking to trust me. And that is terrible. A lot of my management style, a lot of my leadership style, is based on the fact that I will very happily roll up my sleeves right next to you to focus on a problem. And I had none of that sweat equity. I had no credibility with these people.

Host: 02:44
You had to earn their trust.

Dr. Brendan Carr: 02:47
Yeah, I guess. But can you under those circumstances? Can the guy in the suit at the command center making decisions earn the trust of the people in the PPE racing into the fire? Not really. Anyway. Yeah, I mean, thinking back for me, that was a really, really hard part that I'm not sure I had insight into when I was just trying to problem solve. Because I very clearly remember just being in problem-solving mode.

Host: 03:13
If I remember correctly when we spoke there were about 450 inpatients give or take, and I know that number quadrupled in the course of just a couple of weeks.

Dr. Brendan Carr: 03:22
Yeah, that's right. Yeah, there were thousands. And people weren't going home, you know? Do you remember how we used to—we played music when they went home. We celebrated it. We played "Here Comes the Sun," because, you know, if it were a common occurrence, we wouldn't have been celebrating it each and every time. It remains hard in a lot of ways, but the amount that we understand about this disease is just so different

Host: 03:53
We're gonna come back to that in a little while. I do want to start at the beginning with this clip.

[Clip] Dr. Brendan Carr: 03:58
I feel the weight of the importance of getting this right for New York City and getting this right for all the people that trust me enough to put me in this chair while they are on the front lines, taking care of people who are sick and scared. It feels extremely important to me not to disappoint them.

Dr. Brendan Carr: 04:16
I do every day really still feel that weight and think about the importance of that. Except it is a little bit easier. It's a little bit easier because I have personal relationships with people now. It's a little bit easier because I believe that missteps, mistakes will be seen in the context of someone trying really hard to do the right thing, rather than someone that you have no relationship with making the wrong decision.

Host: 04:48
I know another stressor for you was, uh, I think your family was—you either couldn't see your family or they were still, there was some distance there.

Dr. Brendan Carr: 04:56
That remains a stressor, although it really is secondary compared to the—I guess I would say it is the normal stressor of people who work hard and travel now. That is different than, again, thinking about where we were in those moments. It was about the fact that we were all afraid. We were afraid that we were gonna die! Did I talk about it on the podcast that we, I mean the number of people that needed people to notarize their wills and their power of attorney for someone to take care of their kids?

Host: 05:28
No, you didn't mention that.

Dr. Brendan Carr: 05:29
Oh, God. Right. Like, I mean, those are the things that we were figuring out. "Hey, could we get someone to come in on the overnight shift who's a notary?" This was before there was—there's now virtual notaries that you can use. Maybe there were then, too, but I didn't know about them. Before we were fully a "Zoom" world, I used to think of a notary as somebody you had to see in real life.

Host: 05:53
I want to zoom out a little bit. What's been the most surprising thing about how played out, the pandemic.

Dr. Brendan Carr: 05:59
It's a super nerdy answer.

Host: 06:01
Go for it.

Dr. Brendan Carr: 06:03
So in my heart I'm a policy nerd. And I wear that hat as well as the emergency physician hat. And so I have conversations with smart friends who have a hard time wrapping their head around why we are going bankrupt when we have twice the number of patients in our hospitals that we normally have. Doesn't really make sense. How could that make sense? That we are putting ourselves out of business by doing twice the amount of work that we normally do. Find another industry that works like that. Sell twice as many cars or pick a thing, and you have better than expected profits. Meanwhile we can't stay afloat. And so this is the piece that tortures me—the reason we can't stay afloat is because we don't value this type of work financially. The payment structures, the way that health care gets paid for, values some things and doesn't value other things. The only way that we can take this next surge on is to not shut down the normal stuff that we do. We have to keep doing the normal business of health care because there's no reimbursement model for this type of work. We don't have the ability to sort of really understand our capacity in the health care system. We don't have the ability to have visibility of our supply chain. We don't have the ability to have unused capacity that is waiting for "just in case." We have perfectly just-in-timed everything. We're always exactly at 100 percent full because that's how it works. And so, your question was, "What has surprised me?" What has surprised me is the lack of awareness. That the way that we have designed this system, designed the finances of the system, set us up to fail again with whatever the next thing is. And that next time doesn't need to be a pandemic. You see this when people are displaced by weather-related events. You see this when people are displaced by mass shooting, terror events. You see this during flu season, frankly.

Host: 08:21
What you're talking about is a certain type of fragility that comes as a result of the payment structure.

Dr. Brendan Carr: 08:27
Yeah, it's a good word. I don't use the word "fragility," but you're right. It's a balance, and we have it perfectly balanced under normal use cases. It's not so much about finding blame. It's about thinking about the fact that we are by definition fragile unless we decide that we're going to do something differently. Unless we decide to design the system different. Anyway, it's a big lift and I know it's dry and God help you trying to bake it into a podcast that people listen to. But it is the kind of thinking that will make our system more resilient if we engage with it. When our solution is, "Let's hope there's a bailout," it's not a sustainable solution.

Host: 09:21
Yeah. I know you've been thinking a lot about burnout and you've written about burnout and you've talked about burnout since the beginning of the pandemic. My first question for you is—have you felt burned out?

Dr. Brendan Carr: 09:34
We don't ask that question, Jon! Yes, I have. I have felt myself many times be short in circumstances where it's not okay to be short with people, short with patients, and short with my family. I have not ended up, I mean, there, but for the grace of God, right, do I end up not able to function through it. And I have been really, really lucky in that I can find time to recharge. And specifically that just means time with my family. It's so easy these days to be grateful for what you have. Even though we don't go outside and do things like we used to, we have downtime. I get demolished in Monopoly by a terrifying nine year old. Those things are really, really important, and I have had them and I'm grateful for them. But, yeah, of course there are times where it just feels overwhelming.

Host: 10:44
If there's one thing that's really important to do right now for burnout, for frontline workers, what's the most important thing?

Dr. Brendan Carr: 10:52
It's the one thing that's hardest, which is, I mean, I really think it's to unplug. We all recharge differently. But none of us recharge by another 24 hours with a thick mask on, sweating underneath a gown, worrying about whether or not we're getting sick. And yet, you can imagine, if you're wired as someone who knows how to do this and feels drawn to do this, and we're short and, P.S., there's money to be made and it's been a long several months and the holidays are coming. You know, that's the trap. The trap is that if you just pick up an extra couple 24-hour shifts, it can make your finances a little bit better. It seems like a path forward, but you end up in this spiral and that—. I mean I think people just—it is the ability to be supported by someone. We were taught by a guy who is on our faculty who is also an Army reservist about the military's battle-buddy system. And it was implemented by another couple of our faculty members. We just paired people up and ask them to check on each other. It's such a simple intervention. And yet talking about what it's like to watch someone die alone with someone else who lives that life is easier and different than it is to try to talk about it for someone who's not in that universe. You know, even if you have a support system, if that support system is not in health care, it can end up, you know, you pull punches. You don't tell the stories because they're just too dark, and who would want to talk through them? So having somebody who lives in that world and who you can tell those stories to can be cathartic. My goodness, clearly I don't know how to say it in a concise way. But I do think we need to recognize that they need to be allowed to go somewhere safe, mask off, with support and not feel the weight of knowing that if they went back to work, they could probably help some more people. But that's near impossible. When you're not there your friends are. And if you go back there to help carry the weight, their load is lighter, except that, you know, it's just insidious the way it takes a toll.

Host: 13:18
I wonder how you—I don't know quite how to say this, like, get through to somebody who's in that giving mindset, who will give until they burn out.

Dr. Brendan Carr: 13:28
I don't know. I mean, the people that are in it, the people that are wired that way, I don't know how to get through., You know, maybe, and this is off the cuff, but I think a piece of it might be by framing it as increments. You're not walking away, you're not leaving the fight. You really are just taking a little bit of time on the sidelines so that you can catch your breath and hydrate a little bit. And then you will go back in and when you go back in, you'll be more effective at helping them. Because you're able to run at full speed. I know it's a bad analogy. I don't have an answer. And we talk about it a lot, and I don't know that we're going to have an answer. We talked, I mean, I can't remember in what context, but I had a conversation with somebody about how long the adrenaline can last. Because it's not 10 months, and it's certainly not two years. And yet here we are at around 10 months. And there's still a lot of people that are, it's not all adrenaline, you know, but still survival mode. Someone asked me how I was doing the other day and without really thinking too much about it, I said, "I'm just in a holding pattern. Just getting through each day and each week." And I think a lot of people are feeling that way.

Host: 15:02
Does the vaccine feel like a light at the end of the tunnel?

Dr. Brendan Carr: 15:05
Oh, boy does it. But, um, surprising to me that so many of us in healthcare are so relieved and excited that there is light at the end of the tunnel. And that others, their doubts are significant. Their fears around the vaccine are significant. I can't believe that a third of the people that I'm interacting with are expressing uncertainty about taking it. Because it really will drive—that and the production and distribution capacity—really will drive how much longer, how much longer.

Host: 15:47
Can I assume that you're in the "take it" camp?

Dr. Brendan Carr: 15:50
[laughs] I'm in the "take it day one," probably with someone filming it so that we can put it on social media and tell everybody else to take it.

Host: 16:00
One final clip. This one's called "the only way out."

[Clip] Host: 16:03
How do you stay level-headed and just keep making smart, rational decisions under the circumstances?

[Clip] Dr. Brendan Carr: 16:08
Yeah, I mean, "the only way out is through" is I guess what I keep thinking. I don't know what the alternative is.

Dr. Brendan Carr: 16:20
Yeah, you know, I remember saying that. I mostly remember because a friend who listened to the podcast sent me a text and was like, "Oof. Man, that one really sunk in." There's just, there's no side door. There's no escape hatch. We're really just going to weather this storm. You know, here's one last piece that I didn't say a couple moments ago when we were talking about some of the things that have been hard about this and what we learned or didn't learn. It's really hard to watch people make decisions that I know I have to clean up after and my colleagues and friends have to clean up after. It didn't have to get this bad. We could have done more to prevent these numbers from being these numbers. And we didn't,

Host: 17:18
Are you talking about the politics and masking up and all that?

Dr. Brendan Carr: 17:21
I am. I'm talking about decisions to not wear a mask, decisions to congregate, decisions that feel selfish. And I guess I didn't think we were that selfish. I thought there was a little bit more collective ownership of the problem, a little bit more community than we have ended up seeing. How did we go dark again?

Host: 17:48
I think it was that clip. I was introducing it as, like, "This is going to be about your mantra. This is going to be— we're going to be positive." And then I played it and I was like, "Oh, no. That's not what it's about at all. And that's not where our heads are." And that's totally fine.

Dr. Brendan Carr: 18:03
It's so interesting because it was. I mean, listen, I don't know what conversations we're having about, "I wish this. I wish that." There's no wishing right now. We're just sort of, we're getting through. That's what we're doing. But that was—you know what felt different. It felt different because it was in our control. It was in our control. It was us, it was us standing shoulder to shoulder—docs, nurses, techs—all the people that make the health care system go around, taking this on. And we did. We did it really, really well. We saved a lot, a lot of lives. And then, you know, standing next to me, shoulder to shoulder to shoulder, was the scientific community. And, boy did they do it really well. Here we are looking at tons of therapies that exist, including multiple different vaccines, unbelievably rapidly. But now it's out of our control. Now I need to trust other people to accept this. And I guess that is hard. They don't live my reality of knowing that the front line troops are really getting tired.

Host: 19:17
The idea of "moral injury" comes to mind.

Dr. Brendan Carr: 19:19
The idea of "moral injury," is that what you said?

Host: 19:23
It's almost, like, to feel betrayed by the public. Or to feel betrayed by people who should've known better. And that's a really hard one.

Dr. Brendan Carr: 19:32
You know, I think all the time about, "the right to swing my fist ends where the guy's nose begins." I'm sure I'm getting it wrong. It's a famous quote from a Supreme Court justice. And it's about public health, right? I think the original case was actually about forced vaccination. Fascinating. I should probably Google that. Um, you know, but that is what it feels like. Make any decisions you want to make, that's fine. But the second that means that you're putting all the staff in the hospital at risk physically, psychologically, I don't know. But I get it, like, I shouldn't minimize—we shouldn't minimize people's fears. The fears are real and have a strong foundation. The health care system has not been, across the board, fair to people. Especially people who are without resources, especially people of color and people that are otherwise marginalized. It's not resistance for resistance's sake. It's resistance grounded in mistrust. And we have to earn trust. Maybe we are full circle, right? We talked about me entering a job, having no trust of anyone who I was about to ask to do stuff. And here we are, again. The American public has lost trust in health care and health care delivery and in public health. And we need to figure out a way to win back some trust and get through this together.

Host: 21:08
That's all for this episode. 2020 is almost done, but we have one more episode to go. It's a conversation with trauma researcher Dr. Rachel Yehuda about MDMA-assisted psychotherapy for PTSD. It's fascinating. So look for that in a couple of weeks. Road to Resilience is a production of the Mount Sinai Health System in New York City. It's produced by Katie Ullman, Nicci Cheatham, and me, Jon Earle. Lucia Lee is our executive producer. If you enjoyed this episode, as always, please go to Apple Podcasts, give us five stars, write us a nice review. We hugely appreciate it, and it helps other listeners find the show. So thank you, thank you, thank you. In the meantime, thank you for listening and from all of us—happy holidays, and we'll see you soon.