Date Published: November 6, 2020
Over the past few months, physician assistants (PAs) at Mount Sinai have been engaged in a vibrant discussion about resilience. Their goal—To process their COVID-19 experience together and share strategies for managing feelings of stress, grief, and even guilt. In this episode, two PAs and a clinical social worker talk about why they joined the 11-week resilience workshop and what they’ve learned. Whether or not you’re a healthcare worker, there’s plenty of food for thought here.
From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about facing adversity. I'm Jon Earle.
Cilin Philip: 00:09
We saw a lot of terrifying things. And we lived through a lot of traumatic experiences. That has to be addressed. Because it's not that this, oh, let's just say, hypothetically, if this pandemic ended today, "Hey, tomorrow, we're all better. We're all ready to go back to our normal jobs and all the mental illness is just gone and we're all okay." I don't think it works that way.
Back in April during the height of the pandemic in New York, more than half of health care workers were experiencing acute stress. Almost half showed symptoms of depression. And about a third had anxiety. That's according to a study published in June. I don't think anybody's going to be surprised by that. Health care workers across the country are under a lot of stress. And for months now, the key question has been, what can we, as health care organizations, and as a society do about it? How can we take care of those who take care of us? Google "How to boost resilience" and you'll find tons and tons of articles and videos. It's overwhelming. Both too much and not enough. Recently, Mount Sinai Center for Stress, Resilience and Personal Growth—itself a product of the pandemic— developed a more systematic approach. They created an 11-week workshop that covers science-backed resilience strategies and gives participants a place to talk about what they went through. In this episode, you'll hear from two physician assistants and a clinical social worker who participated in the workshops. Together, we map out some of the complex feelings that front-line workers are wrestling with. And we talk about what it means to process them. Regardless of whether you're a health care worker, there's a lot of good stuff in here. I hope you enjoy it.
Shauna Linn: 01:44
My name is Shauna Linn. I'm a physician assistant at Mount Sinai's main campus. I work in the Recanati/Miller Institute of Transplant Medicine. So I take care of patients who have undergone liver, kidney, small bowel or pancreas transplants.
When the pandemic surged in New York, Shauna was redeployed essentially to an ICU. Among her other tasks, she found herself calling patients' families on Zoom, trying to bring them closer to their loved ones in the hospital. Was there one call in particular that stands out in your memory?
Shauna Linn: 02:13
Yeah. There was one woman I was in communication with, the daughter of a patient. She was extremely eloquent, had a British accent I distinctly remember. And her demeanor just changed so dramatically when she saw her mom. She went from so composed and so savvy to just a child, essentially. Broke down crying, you know, "Mom, I love you." And for the first time it really registered for her how much her mom was suffering. And she went from pushing for every intervention imaginable to saying, "Yeah, this is not what she would have wanted."
What was that like for you to be mediating a conversation, an experience like that?
Shauna Linn: 02:53
It was very terrifying emotionally, but also extremely meaningful and powerful because you felt like you were the only connection this person has to their loved one. I wasn't really mediating it per se. I just felt like I was kind of a vehicle through which she could see her mom, and I tried not to editorialize it or intervene too much, but I just tried to give her mom some, you know, hold her mom's hand, give her mom some tactile connection that she wasn't able to do.
Shauna's deployment was stressful, but it also gave her purpose and an incredible sense of solidarity with her colleagues.
Shauna Linn: 03:31
Honestly, it was before I deployed--before I really felt like I had a purpose or a role at all--I was kind of in limbo. And actually getting involved with the deployment helped ground me in such a way, because I felt like it was such a social connection and a support system with people who are working on this concrete thing that we could be involved with. And it just feels like we both battled some things together. So we have a mutual respect. And when I call them, I feel like they take my concerns seriously because we worked alongside each other. So that's kind of what I take away from it—like a sense of almost, we were in a war together. It's not like that intense, but it was in some ways like that.
When we talk about processing the experience, what is it that you're processing?
Shauna Linn: 04:22
I think I'm processing the timeline and what actually transpired. Because in the moment I feel like we were just running on this adrenaline and time was so compressed. I felt like I built relationships with my coworkers that I haven't experienced after working a year on transplant. So I'm trying to process like, how did I become so enmeshed in some things in such a short timeframe? And how can I have that again? Because I miss that. I miss that connection. At the same time I feel like, I don't know really. I feel like I'm still in the middle of it because I can't fully assume that it's over. But I don't know, just the enormity of the life that has been lost. I can't even imagine.
Cilin Philip, an orthopedic surgery PA, was redeployed five times.
Cilin Philip: 05:13
The thing that took the hardest toll on me is not knowing when this was going to end. Because if you had told me, "Cilin, I want you to do this really unpleasant job, but it's only going to last two weeks. And after two weeks it'll be over, and then you can go back to your regular thing." I'd be like, "Fine. I'll suck it up. I'll do it for two weeks. And when it's over, it will all go back to normal." Not knowing if and when it would end and just continuously being redeployed over and over and over again to me was very draining.
How did that play out in your life to be so drained?
Cilin Philip: 05:47
I would not classify my mental well-being in that state to be good. I don't know how to word it other than just saying I was mentally, physically and emotionally drained. I was isolated. I was alone. I wasn't depressed, but I could feel the weight of it like slowly building. And had this kept going on indefinitely, like, let's just say it went on another additional six months longer than it did or whatever the case may be, I don't know what my mental state would have been at the end of that.
For Cilin the most vivid memories are moments of human connection.
Cilin Philip: 06:21
The most prominent memories of working through COVID, other than the interactions with fellow co-workers and friends, were my interactions with patients. But not from a provider standpoint, just from being-a-human standpoint. I remember I was in the ED and there was a patient kind of tucked away in one of the rooms in the corner. She was elderly. She was suffering from COVID. She wasn't going to make it, she was DNR, DNI. It was just a matter of time. And so I just sat with her and I just thought in my head like, "If her family was here, what would they be doing? Maybe saying a prayer? Maybe just making sure she's comfortable?" I didn't save her. And this is not somebody that I had direct involvement in her medical care, but just to be able to sit there with her and just let her know, "Hey, you're not alone." I don't know. To me, that was probably the most significant thing that I was able to do in that entire pandemic.
Cilin saw has colleagues struggling with stress.
Cilin Philip: 07:21
One of the hardest parts for me was seeing my coworkers come into work, afraid, nervous, scared for their lives, in tears, you know, coming into work with a heavy heart, probably mentally not ready to be there, but knowing they had to be there.
Did you relate to those feelings? Did you share them?
Cilin Philip: 07:41
I did, but my personal feelings and my personal thoughts on it didn't affect me as much as seeing my friends and loved ones or colleagues go through it. And that was actually one of the biggest reasons why I decided to take on the resiliency workshop, because I knew there was a need and I thought this was something that we could do to address that need. And this is a part that I could play to just help out in that cause.
Describe the need for me.
Cilin Philip: 08:20
We saw a lot of terrifying things. And we lived through a lot of traumatic experiences. That has to be addressed. Because it's not that this, oh, let's just say, hypothetically, if this pandemic ended today, "Hey, tomorrow, we're all better. We're all ready to go back to our normal jobs and all the mental illness is just gone and we're all okay." I don't think it works that way. I think this is something that has to be addressed. I think it's something that has to be worked through. I think you have to really heal from that.
Driven by their experiences, Shauna and Cilin joined the 11-week resilience workshops. The workshops were organized for physician assistants by the Center for Stress, Resilience and Personal Growth. Each workshop revolved around a resilience factor, like optimism or facing fears. Those are topics we explore a lot on the podcast. And the groups became places to share and process together. Gabrielle Finley co-facilitated one of the groups. She's a clinical social worker at Mount Sinai's World Trade Center Mental Health Program. She does individual and group therapy there. Talking to her helped me understand the theory and practice behind the resilience workshops. What are the emotions that you've encountered in the PA workshops?
Gabrielle Finley: 09:35
Guilt, anger, sadness, worry. A lot of sadness. I think a lot of sadness and a lot of uncertainty.
How does that come out? What sorts of things do people say?
Gabrielle Finley: 09:49
I think that people are reflecting back on some of the decisions that they had to make and to get support from other people to say, you know, "I was in a similar situation. I also had to make a really tough decision and there were no perfect decisions to be made. And I made the best decision that I could in the moment.' And there was tragedy. There was tragedy all around. And to know that they couldn't have done more, they couldn't have saved more lives.
When we talk about processing and experience like this, what are we talking about? Like, what does it mean to process your experience through COVID?
Gabrielle Finley: 10:33
The way I think about processing is just like helping people to let their emotions come out in an adaptive way. Which is usually about talking about it in a setting with a therapist or with friends. Giving people the space to feel their emotions, just to sit with their emotions, to be there next to them, to support them while they're experiencing things that they were probably frightened to experience or have been pushing away or just have brushed under the carpet in order to function. I think it's also about giving people the words to share their experience. It's kind of—it's like putting a narrative to an experience that you had. Giving it a story. And that's a way that people can store those things in their memory bank, by having—attaching an emotional experience with words and emotion names.
Tell me more about sitting with emotions. What's that all about?
Gabrielle Finley: 11:44
Yeah, it is, you know, a lot of times after trauma people become somewhat phobic of their emotions. And a lot of people who work in trauma therapy think about PTSD is kind of like an emotional phobia. And in many ways, that's how I think about the treatment. I can be there with them. I can hold someone's hand. I can be in that space. I can try to help them feel safe, but ultimately people need to experience their emotions without intervening in those emotions. Letting those emotions play their course out. Because if you don't, if you jam up those emotions, they have consequences to you in other ways.
You've compared it to a wave crashing.
Gabrielle Finley: 12:36
Yeah. I think about emotions as being something that has a beginning, middle and end. And they start out slowly and then they have this crest, and if you let them pass and roll out, you'll get through the emotion. Emotions don't last forever. But what we tend to do is intervene. We don't let them run their full course. And when we do that, they just keep crashing on us and keep crashing on us. So there's no way to get past the emotion unless you swim through it.
When is the time to—how do you think about the time to compartmentalize versus the time to confront and explore?
Gabrielle Finley: 13:23
I mean, I think when you are responding to an emergency, whether it's a medical emergency or whether it was responding to Ground Zero after the 9/11 attacks, I mean that's a moment to compartmentalize and that's the moment—we're hard-wired to respond to crises in that way. When we go into that fight-or-flight reaction, we are compartmentalizing. You're not thinking about anything else except protection—protecting yourself, protecting others. So those aren't the moments to think about the consequences to yourself or the meaning of life. Those are moments when you're just going and focusing and doing what's necessary in that moment.
I had the chance to sit in on one of the workshops yesterday. And there are many interesting things that I heard, but a couple of them were these sort of interesting reframes, ways of looking at a challenging experience. Somebody said, "If I hadn't been through X, I wouldn't know Y."
Gabrielle Finley: 14:25
Y as in the letter Y. And the other one that was related was looking at what you learned about yourself, and particularly in a positive way. How you can be resourceful perhaps in ways that you didn't realize.
Gabrielle Finley: 14:39
Yeah, absolutely. Yes. I mean, understanding your strengths and knowing that you can call upon those strengths day-to-day or when you're faced with challenges and knowing what your strengths are really helps improve a sense of competency, a sense of confidence. And I think that is one of the gifts—if we can call it a gift—that trauma can give to people. That idea of post-traumatic growth is knowing who you are and what you can handle and what your strengths are.
Another thing I noticed was that, of course the workshops have themes and there were slides—although you didn't use them that much, it was like a couple of slides, food for thought. It's not like you were chugging through a slide show.
Gabrielle Finley: 15:30
But at a certain point, it struck me that it was almost as though what mattered the most was the fact that you were there, that everybody was there in the same room. And that the specifics of what was said or what tools were shared almost came second.
Gabrielle Finley: 15:49
Yes, absolutely. I think, you know that that's the humanity of it to just know that you are not alone in your suffering. Maybe that sounds like an expression you've heard many times before, but it is so profound and it's so meaningful.
There's just something deeply reassuring about being with other people who get what you've been going through that's hard to articulate exactly why and through what mechanism, but it just is.
Gabrielle Finley: 16:22
Right, right. It's like you can feel the comfort. It's like when you hear someone who speaks something that you can relate to and that resonates with you, it's like your whole body is wrapped in a warm blanket, right? You can feel your heart rate slow down. I can feel the tension go out of my neck. It's just that connection that you have gives you courage and gives you strength and reminds you that your relationships are what it's all about. Most healing happens in the context of other people. When you have real pain and you have real sadness and you've had real sorrow and tragedy, you can't take those things away. Life always is going to have sadness and grief in it. But what you can do is come together with other people and you can share that pain. So healing to me is a lot about sharing your burden so that you don't have to carry it alone.
What does healing feel like?
Gabrielle Finley: 17:23
When I think about healing specifically for people who have had traumas, trauma can certainly put so many restrictions on your life. After you have a trauma, you can often become really scared about re-experiencing something that will remind you of your trauma. So people's lives can be very, very restricted. And when I see people recovering, I see them having a more full life, doing the things that are really consistent with their values. Whether that is spending more time with their family, getting involved in community events, reading more, they spend their time doing things that are important to them as opposed to living in a bubble.
I asked Cilin, who actually co-facilitated one of the groups, and Shauna how they were feeling as the workshops were wrapping up. Has being a part of these sessions changed the way that you cope?
Cilin Philip: 18:23
I think I underestimated the value of speaking about things out loud. Even if it's not to just like—because I might not necessarily be saying something because I need somebody to say something back to me. But just expressing things, letting things out, speaking openly, just saying out loud things that I was holding in. And just the act of doing that in itself can be healing and therapeutic.
Shauna Linn: 18:51
You're not going to solve your whole life issue in an hour once a week, but it gives you strategies, tools. It provides a safe space for open communication. It invites you to be with people who you might not cross paths with otherwise, but who have a similar motivation and desire to hash out these questions. So, yeah, it's been a very lovely experience.
Here's Gabrielle again for some final thoughts. I'm imagining a general audience listener hearing this conversation, And I'm wondering if there's any kind of specific thoughts that you would want to leave them with.
Gabrielle Finley: 19:32
I guess, you know, I'm trying to put this in an elegant way. There's always opportunity. Whether it's like, if you're thinking about joining the resilience group, or if you're thinking of just getting to know the colleague next to you that you've never spoken to before but maybe you will think about it now. There's always opportunity around us to grow and to learn and to foster relationships. I guess it's just like the topic of these groups and the topic of your podcast, Road to Resilience. There's so many opportunities all around us to continue developing that. We're never too old to learn. We're never too rigid to change. There's all these opportunities. So never think that it's not possible for you.
Thank you again to Shauna, Cilin, Gabrielle and all the PAs we talked to for this episode. If you work at Mount Sinai and want to learn more about the resilience workshops, please visit the Center for Stress, Resilience, and Personal Growth. We'll put a link in the show notes. If you liked this episode, please rate and review Road to Resilience on Apple podcasts. It helps other people find the show. Thanks. The podcast is a production of the Mount Sinai Health System in New York City. It's produced by Katie Ullman, Nicci Hudson, and me, Jon Earle. From all of us here, thanks for listening. We'll see you next time.