Kinesiology senior Alexander Phillips began working as an EMT in December 2019, just months before the COVID-19 pandemic swept the United States and altered our lives forever. As part of the typical testing protocol for new EMTs, he was fitted with personal protective equipment, including a respirator. At the time, it was business as usual.
“I was tested with (the respirator) to make sure it functions and everything,” Alexander said. “I’m thinking like, okay, I’m probably not gonna use that very often.”
But within a few months, that PPE switched from a mandatory guideline to a scarce, crucial resource, as the U.S. and Michigan experienced a rising number of COVID-19 cases. Alexander, who is studying Athletic Training, recalled these turbulent first few months of work in a Zoom call with The Michigan Daily.
“(The pandemic) was just constantly changing at that point, it was like you’d wake up every day and the news will be saying something different,” Alexander recalled. “And it was pretty much the same thing at work. It was pretty chaotic … it just felt like there was so much information happening so quickly.”
Alexander wasn’t the only student who took their medical studies to the workforce during the pandemic, but some had more trouble finding ways to help. LSA junior Stephen Moss, who is studying Molecular, Cellular and Developmental Biology, received his EMT license at the end of February 2020, around the time the pandemic began to encroach on life in Ann Arbor.
“As soon as I tried to find a job, I was just thrown right off the deep end into the pandemic,” Stephen said as we spoke over Zoom. “I had just got my license and then everything shut down, and the place I wanted to go work at put in a hiring freeze because they couldn’t afford to hire more people.”
After spending months applying for jobs and volunteer positions at ERs and field hospitals in Michigan to no avail, Stephen returned to his home state of Rhode Island, where he finally found some luck volunteering for the Medical Reserve Corps. By then, it was already May, and Stephen was eager to get to work.
“One thing that was just really weird to me was how hard it was to find a way to help,” Stephen said. “I mean, I was looking for a job, I like getting paid for my work, but I was also just looking for a way to help, and it was astonishingly difficult to do that.”
Stephen described getting trained by the National Guard and being placed at a testing site in the parking lot of a senior center. At the time, the U.S. was experiencing PPE shortages, and he recalled trying not to waste his equipment while working for hours in the summer heat.
“Every day we were out there in like, 80-degree heat, in these enormous hazmat suits, head to toe,” Stephen said. “Everyone had one face shield that you cleaned … We had to wear six pairs of gloves. You had three base layers, and then you had your suit on top, and then you had three more. And it was very hard to manage all of that.”
If you are someone like me, who is not studying medicine or involved in health care work, it can be difficult to imagine standing face-to-face with COVID-19 patients, responding to 911 calls that report shortness of breath or administering one nasal swab test after another. It’s scary to picture being in such close proximity to danger, suffering and even death. It’s part of the reason we tend to characterize health care workers as superheroes; we view them as unafraid, charging into turmoil and emerging unscathed.
Dr. Janice Firn, a clinical assistant professor in the Department of Learning Health Sciences and a clinical ethicist at the Center for Bioethics & Social Sciences in Medicine at the University of Michigan, said the heroizing of health care workers can sometimes become problematic.
“A system can take advantage of people if we praise them for their self-sacrificing, but then we start penalizing people who won’t play the game or ‘sacrifice to that level’ when actually maybe they’re just being healthy,” Dr. Firn said.
Indeed, data has shown that during the pandemic, health care workers have experienced elevated rates of PTSD, anxiety, depression and other mental health conditions. Some have even quit their jobs due to high stress and burnout.
“With the people that don’t really understand or know about health care, it feels like there’s a reduction of health care to a quantitative, checking boxes kind of thing, where it’s like, ‘We have the ventilators, we have the ICU beds, we’re good,’” Alexander said. “And it’s frustrating seeing the more human side of that, and going into hospitals and talking to the nurses and working with co-workers who are just so exhausted and burnt out from literally a year of doing this, because that’s the qualitative side of it that is hard to describe.”
The way we portray health care providers, and our subsequent expectations of them, originates from a historical and social narrative, as doctors and nurses have been viewed as healers for thousands of years. Hippocrates, an ancient Greek physician and one of the leading figures in the history of medicine, urged that doctors have two main tasks in treating patients: “to do good or to do no harm.” But what does “good” mean, and what does it mean to be a good provider? Is it casting aside one’s own needs for that of the patient? Is it stepping away when the burden becomes too heavy for effective work? These dilemmas loom even larger in the context of a rapidly changing, high-stress situation like a global pandemic.
I wondered, then, how these pressures fall onto students like Stephen and Alexander, whose first experiences providing health care — before they even start their formal careers — are during the COVID-19 pandemic. How do these accelerated lessons in witnessing pain and loss impact their psyches? How do they grapple with seeing suffering at work while their neighbors on campus throw parties? How do they understand the virus medically while making sense of the pandemic socially?
I spoke with five students who work on the frontlines — EMTs, nursing assistants, medical technicians, those who administer COVID-19 testing — to explore these questions. And while each interview was humbling, giving hints of that all-familiar heroism, I felt a sense of heaviness behind their words.
“Even with the medical field, I think it’s going to be a long process to recover from it,” Nursing senior Rebecca Petrella said. “Not even just cost wise, but mental health wise, for everyone who went through it. And it’s hard to think that I’m just about to start off my medical career because I already, in a sense, feel burnt out from having to go through all of this.”
Rebecca started working as a patient care technician (also known as a nurse’s assistant) at the beginning of March 2020. Within a week of the new job, she was told their floor, an adult pulmonary and general medicine unit, would be filled solely with COVID-19 patients.
“I had about a week of orientation, which was normal,” Rebecca said. “And then I came back the next week and they were like, ‘Yeah we’re all COVID now. Is that fine with you?’ And I was like, ‘I guess.’”
Petrella described the energy in the hospital for those first few months of the pandemic as nervous and uncertain. And while she didn’t worry too much about getting sick herself, Petrella told me the fear of infecting others kept her isolated for most of the summer.
“All my friends went home, and I didn’t have family here, and I was really worried about passing it to other people,” Rebecca said. “So I basically went to work and my apartment the whole time, and it was really hard mental health wise.”
That isolation was compounded by what she saw at work — patients struggling with or dying from COVID-19, some being moved to the ICU, others asking her if they would die.
“Just hearing patients’ stories about everything was really hard and really sad,” Rebecca said. “I was very much in my own headspace and internalizing a lot of things … As a nurse, you’re told to leave work at work, and that’s sometimes really hard to do.”
While incoming health care workers are trained to deal with the pain, grief or death of their patients, being thrust onto a COVID-19 floor as an undergraduate is a new phenomenon, to say the least. And yet, one of the most celebrated traits of health care professionals — one especially heightened during the pandemic — is adaptability.
“At this point, what I’ve gotten way better at doing is separating myself from patients,” Rebecca explained. “And I can still feel that empathy with them while I’m with them, but after that I need to just leave it behind me and think about the general picture of everything that’s going on.”
Nursing senior Reagan Cloutier expressed a similar sentiment when we spoke over Zoom. Reagan, who is the president of the Student Nurses’ Association, works as a nursing assistant at the C.S. Mott Children’s Hospital. Throughout the pandemic, the floor she works on has admitted both COVID-19 and non-COVID-19 pediatric patients.
While children experience milder COVID-19 reactions than adults, many of Reagan’s patients are chronically ill, and are thus at greater risk for complications if afflicted with the virus. Reagan described how one of her greatest fears during the pandemic is that she will unintentionally infect one of these patients with COVID-19. But despite this anxiety and the tense energy in the hospital, she spoke confidently about her work as a nursing assistant.
“Being resilient health care providers is really important because … you’re not going to see a patient die every day of your career, but you certainly are going to deal with heavy stuff almost every day of your career, and it’s good to know and have the skill set to be able to deal with that,” Reagan said.
Nurses often spend the most face-to-face time with patients, especially during the pandemic, when the hospital limits the number of people such as visitors allowed in COVID-19 rooms. For that reason, nurses are not only providing medical attention and information, but also emotional and social support. Of course, this means that they bear witness to — and help mitigate — tough situations.
“It’s important as a nurse to internalize those things your patients are telling you, but it’s also important to protect yourself, so that you know that’s not coming home and affecting your day-to-day life,” Reagan said. “And that you’re able to come home and enjoy your life and not necessarily live in your patient’s grief or live in your patient’s concerns or worries.”
It’s a mentality that takes time to build, according to Dr. Firn, who spoke about the training of young health care professionals in dealing with patient loss and pain.
“I don’t think we necessarily go into these sort of service positions thinking we’re going to help people die,” Dr. Firn said. “That’s a lot of what health care is, but I don’t think we do a good job of training folks in an area where we can talk about it.”
Dr. Firn mentioned that pre-clinical exposure to topics in grief and loss can help health care professionals better react and empathize with patients. She noted a course like this that she took during her own education in medicine and social work, which she said had significant impacts on her clinical work.
“It did help me, sitting with those uncomfortable feelings,” Dr. Firn said. “And sort of playing out those scenarios meant that I had done some of the pre-work, so I could be more present to patients and families in the moment.”
But Dr. Firn noted that it’s difficult to mimic this gradual, classroom introduction to grief during the pandemic; and while Reagan and Rebecca both indicated that the pandemic had strengthened their emotional durability, I wondered if it was enough, considering how new they are to the workforce.
“In thinking about students, how are we preparing them even before they get into the clinical experience for that?” Dr. Firn concurred. “And then when we’re in it — do we have the ability to get good supervision? Because this impacts us, but where do we talk about it in a way that is not going to penalize us, or have people think ‘Oh you can’t do this job,’ just because (grief and loss are) impacting us.”
Reagan and Rebecca both indicated that the Nursing School and Michigan Medicine do a good job of publicizing the mental health resources available to students, whether in normal or pandemic times. However, both largely prefered a different method of consolation: talking with family and friends.
Rebecca described the feeling of camaraderie during night shifts, when less activity on the floor meant more time to connect with the other nurses.
“It was nice to talk with people and hear that they were struggling too with everything going on, and it felt really validating for my feelings about how everything was playing out,” Rebecca said.
University alum Marissa Robeson, who graduated this December with a degree in Biopsychology, Cognition and Neuroscience and works as an EMT, leans on her family for support, as the majority of them work in emergency medical services.
“Having my mom as a nurse, it is nice, because even though I don’t want to reflect too much on what happened at work, she’s been a nurse for 30 years, so she has no problem asking me questions like, ‘Oh, why do you think this happened?’” Marissa said. “And she uses every moment as a teaching moment for me, which has been really nice, because she’s taught me a lot of how to deal with things, especially unexpected things.”
Leaning on fellow health care professionals in a time of distress is beneficial because of shared understanding, Dr. Firn said.
“I think that getting the perspective of people who’ve been in for a while and the skills that they’ve built and the coping techniques that they use can be extremely helpful,” Dr. Firn said. “And talking about it with somebody who knows what you’re talking about, so you don’t have to explain the backstory. Supportive colleagues are one of the best mitigators of burnout and things like that.”
The irony behind doing your part during the pandemic, especially as a student who doesn’t work in health care, is that in order to have the most impact, you must do the least. But it can feel disheartening to watch our nation experience chaos from a socially-distant position on the couch. For this reason and more, it was inspiring to speak with these students, hearing about their experiences and the substantial weight they are carrying on their shoulders. While the term “health care heroes” is controversial, there is merit — and a great need — to celebrate the work of all those thrust into a situation none of us thought would ever occur.
As students, a lot of our work is in the classroom; the same holds true for those who are pursuing medical careers. But for these students, this past year might have been their most significant and influential lesson.
“It was almost like we were tested before we ever studied,” Marissa said. “But now that we’ve learned what works and what doesn’t work, we’ve been able to make a study guide to get us to where we are now.”
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