Interviewer(s): Henry
Interviewee(s): Sarah

Henry: Great. And just to be clear, your real name will not be used. You'll be pseudonymized. And any references to your organizations will be just alluded to.

Sarah: OK.

Henry: So do you have any questions for me before we get started?

Sarah: No, I don't think so. OK, good So.

Henry: How old are you?

Sarah: 30.

Henry: And what's your job?

Sarah: I am a nurse practitioner.

Henry: What kind of unit?

Sarah: So during COVID, I was working in outpatient radiation oncology.

Henry: And now.

Sarah: I'm just home with my baby. Now.

Henry: Was that your only job?

Sarah: During the pandemic? Yes. Yes.

Henry: Do you have a lot of immunocompromised patients then?

Sarah: Yes.

Henry: OK, so can you tell me about when you first heard about COVID?

Sarah: Yes. I think I first heard about it like listening to my daily podcast that I listened to on the day to work, like on my way to work. And then there were like rumblings about it at work. But it was probably like a day or two before we started getting like official communication from the hospital. Like, yes, we know this is going on.

No, we don't know, like what's going to happen. But like, we're monitoring the situation kind of thing. And it started with if you have a patient who was like in I can't remember if it was like in the Hubei province or if it was had been in China, like contact infection control and like they know what you're supposed to do and supposed to ask.

That's like how it started was it was just like very specific patient populations. And then it just like event- I mean, it's hard to remember, right, because like things changed constantly and so fast. And then like very suddenly the institution adopted this policy where it was like nobody could come from like across state lines. If you did, you had to like quarantine for 14 days before you were allowed on campus.

It was like just sort of shocking. Like we understood why they were doing it, but like all of our patients. Oh, so I guess I should mention. So I was working at [Hospital] which is a really it's just a cancer hospital. So people do come internationally and from all across the country to get treated there, which put us in like kind of a unique setting, probably similar to like [hospitals], those kinds of places where people are coming from really far away.

So they had like all of these things put into place kind of all at once. And then we were like Oh, OK. Like, I guess this is going to be like really serious. And I guess before it started, like jumping all over the place before that point, they announced they were like closing the employee gym. And there were no more like in-person meetings, like everything was getting moved to zoom Yeah.

And I remember at that point, people were kind of like, oh, you know, like, this seems kind of like overkill or whatever.

Henry: That would have been in March that they started shutting things down, then, right?

Sarah: Yes. Yeah. So and I want to say I feel like we were shutting things down earlier than other or maybe it was like smoking. So the medical center in [city] is like it's the biggest medical center in the country. So there's like a bunch of hospitals like all in the same place. I think that they were all sort of adopting similar policies at the same time.

But it felt a little bit early. Like my friends who are nurses in other states, it seemed like we were kind of like adopting some of those measures on the earlier side. But honestly, it was probably just like days, right, because things were changing so fast. But I do think it was a little earlier.

Henry: He’s cute. He?

Sarah: It's a boy. Yeah.

Henry: Hey, little man. Hello.

Sarah: He might just stare at the screen. Yeah.

Henry: You know, maybe he can find himself on the screen.

Sarah: Right? Yeah.

Henry: Hey little man. He’s adorable. Those eyes! But you would have heard. I mean, you heard about it from podcasts. I mean, that would’ve been in late January, right?

Sarah: like, I'm trying to think like it would have been whenever it was sort of like breaking. Like, there's this virus in China. It seems to be really severe. So maybe it was February, you know, like, it's it's kind of hard for me to remember exactly when that was.

Henry: The month the lockdown in China was on the 22nd.

Sarah: Yeah. Okay. So then maybe it was then. Yeah, I have like I feel like, you know, the last couple of years have felt like decades. So it's hard for me to, but I was like, I would, I was paying attention, I would say. So I think whenever it was, if they were in lockdown, that would have been like when I was first aware of it.

Henry: Yeah. I mean, it doesn't need to be that exact.

Sarah: Okay. Yeah. Okay. Well.

Henry: So can you tell me about your your initial thoughts?

Sarah: Yeah. So I think initially I was like, China is so far away and they've had virus outbreaks before, and we will we will be fine. Like, that's, that's so far that was my initial reaction. Like, I was not concerned at all when I first heard about it.

When the hospitals started making measures, though I think I started to get a lot more concerned when they were like, no more meetings and shutting down the employee gym and stuff because that was before like kind of the whole country shut down you know? But that's sort of I started to get concerned then.

Henry: Was there any any change between those two points.

Sarah: Plus with like hospital protocols or?

Henry: With like how concerned you were, or scared, or curious.

Sarah: Yeah, I mean, I think so. I also I worked in head and neck radiation oncology, which means that every patient I was looking in their mouth, we would do like the flexible nasal laryngoscopy used to like we were like in in people's head and neck area. So we were also like identified as a high risk area. So I think that once people started getting more concerned, less, you I it was definitely scarier because you have to weigh like doing what's best for your patient, which is like assessing their pharynx but also like we didn't really understand like how lethal it was going to be so that was Yeah, that was that was kind of scary.

Henry: I think What kind of conversations did you have about this?

Sarah: The time like with my coworkers?

Henry: Yeah, sure.

Sarah: I think we were all so I think that there's a lot of like faith in our institution. I think I felt and my coworkers kind of felt like we could trust the hospital leadership, like they were going to do what they needed to do. And it was just kind of like this sit tight and like let them figure it out kind of thing.

Like, I think I mentioned, like, when they first made some measures, like no meetings, closing the gym, I think, or at least I was kind of like, I don't know, like that seems kind of kind of like a lot. But then just a couple of days passed, right? And the the cases were just like exploding like all across Europe and stuff.

And so I think then my attitude kind of changed about it. But yeah, kind of just waiting to see what the hospital was going to have us do. Um, and I have to say, like, I do feel like they acted appropriately, kind of like every step of the way. Like I, I do feel like my health was prioritized.

It was hard. It was really hard. Like I mentioned, all of these things that got put into place, like restricting patient movement and stuff. But I do think that they were making the right calls Okay.

Henry: So in the months between when you heard of it for the first time and then once the hospital started being more strict and making it more real for you.

Sarah: Yeah. Um.

Henry: Could you just talk about how you felt in that time period?

Sarah: Um, yeah. So I think you know, like day to day in the hospital, I don't think I was thinking about it that much, to be honest. Just because it's so fast paced and you have like so many patients, it's kind of like I didn't necessarily felt like, feel like I had time to, like, stop and reflect about whether or not I felt safe at work knowing that this was, like, unfolding before but then when I was home and, like, reading about it and stuff, I do think that, um, like, I was anxious about it.

Kind of like, increasingly so, like I said at first. So in January, I think I was like not worried about it at all. I was like, oh, it's going to be like, like SARS or something. Not that that wasn't serious, but that it was like, contained. I wasn't necessarily concerned about it, like spreading across the globe. Um, but then, like, it just kind of kept getting reported on, kept getting reported and kept getting reported on.

And so I guess like yeah, probably just feeling like slowly more anxious about it over time, but not at work. I think just because I didn't I didn't really have a minute to like stop and, and be concerned about it.

Henry: So did your perception change before the wave hit.

Sarah: Before the wave hit, like when the lockdowns started. Yeah. Before that, yeah. Yeah, for sure. I yes, I remember like the weekend. So the meetings had had stopped and the employee gym had been closed, like they made those announcements and then the weekend before everything is shut down, I went to New Orleans for a bachelorette party and I remember being there and the streets were kind of empty, but I remember like being in bars and stuff and I was like, Is this safe?

Which is never something that would have crossed my mind before, right? Like, ever, ever. Like, you're at a bar. You're not like people are carrying viruses all the time, but you don't think about that when you're going out but I remember like being a little bit concerned about that, and that was like the weekend before. All of the lockdowns were not just oh my goodness, I'm just going to stand up.

I can keep talking, but gets bored easily.

Henry: You could also turn the camera off if you want. It's not an issue.

Sarah: Okay. I don't think if anything, I think she likes looking at the camera lens to feel like an adult.

Henry: Hey little man. You got an opinion about COVID?

Sarah: He’s a COVID baby, obviously. Well, yup.

Henry: Well, actually. So some of my friends had a COVID baby, and you know how Corona is crown in Spanish? So I tried to get them to name their baby Keter, which is crown in Hebrew. But they didn’t bite.

Sarah: khkhkh.

Henry: The initials would have been KGB, too.

Sarah: Oh, baby.

Henry: If it was, it would have been OK. It was like a year or two ago.

Sarah: Yeah.

Henry: They weren’t biting. Um, OK, so you may have just answered this, but did you have a eureka moment when you realized how bad it would be?

Sarah: Um, and I think I had a eureka moment with, like, this is really going to change how we work because I actually had a patient who was from Wuhan and I remember like going to open his chart and I don't know, like, I never looked for international patients. I never like super pay attention to, like, the city that they're from, right?

Like, I recognize what language they speak because I need to know, like what kind of interpreter to get. But I saw it and I was like Wuhan, like, oh, man. And the hoops I had to jump through to make sure that we were, like, allowed to see him that day was kind of crazy. And it was like, nobody really knew it ended up being fine because he had arrived like before.

He'd had already been in the States for like 14 days or something. So it was like, no big deal. But it was kind of like, you know, that was weird. You never, like, treat a patient differently because of where they're from. But he was like, it wasn't just like from China. It was like, I was like, Wuhan, oh, OK, I recognize that.

So I think that was my moment where it was like, work is really going to change. I think my moment for like how that meaning like how many people died or because I think like when everything closed down, it was like, wow, this is I mean, we joke that like unprecedented is the word that everybody uses. Right? But I mean, that was like the best word to describe it.

Like this is crazy. But then at the same time, like you're reading about like how in New York, like, they had nowhere to put bodies. I mean, that was like, you know, because I mean, we had COVID in [city] for sure. But because like the [city] wave was not like as tall of a spike as the very first like New York way, just because New York is obviously like more of an international city.

I think that was just like, oh, my God. You know, like I remember like going into work that first time after like all non-essential personnel were told this, like stay home and work remotely and like walking into work. And it was like so empty, like empty. [Name] is a very big hospital and it's usually like really bustling with people.

And it was like it was very strange how empty it was. And that was probably the first time that I was like a little bit scared actually at work because like, I said I had not really I didn't really have time to think about it, but I was walking into work that day. It was like pretty empty. And I was thinking like, you know, I like the whole country is being told to stay home, but like I am reporting to work and like and I have to do this obviously and yeah, just not knowing, like I'm lucky I'm healthy.

But at that point, we still didn't really understand, like who was getting sick and I was like, you know, yeah, like, what if something really horrible happened and my, my husband is a doctor and he obviously was working during COVID as well. So for both of us, it was just kind of like this bizarre experience. And then you're worrying about all the people in your lives who are immunocompromised, which isn’t necessarily something that you would maybe otherwise worry about on a regular basis.

But my husband had cancer. He's fine now, but it was like, does that put him at higher risk? Like, should he be going to work or should he be exemt? you know, just like we had no idea. Like his the fact that he had six months of chemotherapy, like does that mean that he is at higher risk and should he get permission to like not come into work for a little while?

So those are some of like the kind of like family specific things that were running through my mind like that day that hadn't necessarily like been something I was worried about.

Henry: Before but these were things that these these came into your head really when the hospital started changing the system.

Sarah: It was like it was that first day that I went to work when it was essential personnel only that I was like, oh, man, I'm like like or do I work with people who shouldn't be here? You know, like if, you know, like people who had like Crohn's disease or ulcerative colitis and are on like immunosuppressive drugs, like should they all stay home?

Like those are relatively common chronic diseases. Should they not be at work? so that was just kind of like a weird and actually just it wasn't like hospital policy, but just like on my, in my clinic we were sort of preferentially like shielding certain employees. So like you had to come in to work because you're a nurse. But like I know that maybe this nurse has really bad asthma.

And we were like, you know what? Why don't you just, like, answer phones? Like you're not going to see patients like that. We kind of just like did that on our own because it was like it was just yeah, it was really scary. Like, we had no idea what to expect.

Henry: Did you have the same N95 shortages that a lot of other places did?

Sarah: No. We were so lucky I think just like really good like leadership planning. Apparently, I learned after the fact that I'm in you know, I don't know if I'm going to get this story right or not.

But I guess, like [hospital] had been playing paying close attention and they actually were were buying like emergency supplies like way ahead of time. Like they kind of had that foresight, I guess, to be doing that. So we had to like if you needed an N95, you only could wear one if you were in like certain patient care areas and you had to like go to a secure location and like sign it out but we were never told to reuse them.

Like, we all got like one a day. You didn't have to put it in a brown bag and like bring it back the next day and oh yeah.

Henry: It's so go ahead.

Sarah: No, I was I was just talking to him.

Henry: Do you think the- you said the hospital saw this coming kind of and prepared?

Sarah: That was kind of like that's what I heard like they were seeing what was going on in Wuhan and they were like and we're I think we benefit that we're large enough that it's like if we buy thousands of N95, even if it's overkill, we will probably use most of them or like we're a large enough institution that like we had the capital that they could do that because obviously it's really expensive.

But yeah, the sort of like rumor, I guess because I didn't hear from like the mouths of the administration, but the rumor I heard was that they were sort of paying close attention and like made a decision on an administrative level to like buy tons of masks and face shields and all that kind of stuff. And like we never experienced any shortages, which is kind of incredible.

I feel like it doesn't stop. I mean, especially my friends who are working in [...]. It sounded like it was horrible, like, you know, just a disaster with PPE. Um, so we felt really fortunate for that.

Henry: I think you had I mean, not that it matters for PPE shortage, but if you did have an extra few weeks before the wave hit you.

Sarah: Yes, we did. Right, right. Yeah. So we were just sort of like watching what was happening in, like, New York mostly. Just like, oh, god. Yeah. So I think by the time it hit [...], as a whole, people were taking it more seriously because we had already seen what was happening in New York, but we were not like phase one in New York or in the US, you know?

So you didn't really have to like convince people at that point, I think, to take it seriously.

Henry: And what about your patients.

Sarah: I you know, it's funny because I was in [city], like you wonder sort of like what the reaction was were of the people there. I would say the large majority of the patients were like completely on board with definitely wearing masks and stuff. But I think that's because they all have cancer. And so even if their politics is different, their own like self-preservation, I think was like for myself, I need to do this. rtpar

I think people's biggest complaints was not being able to have a support person there with them. That was really hard for people you could only have one in special circumstances, like patients who had like cognitive or like memory issues or children obviously so we got pushback with that. You and some pushback with like the quarantine stuff, like, oh, you're coming here from Arkansas, like, yes, you have to quarantine for 14 days before you can come here.

That was really hard for people to understandably right? Like they get it. But it was it was hard. I think overall people handled it really well considering everybody trying to come here like is seriously ill. Yeah.

Henry: Was that was this hospital policy or was this just your clinic?

Sarah: Yes. Hospital policy

Henry: so they they prepared they got, they procured these N95s as far as information sharing goes. Were there any they said you said they nixed meetings, but were there any like discussions or email blasts or especially in like February, like telling you what was going to happen.

Sarah: So February? I want to say we were getting periodic communication. Um, from upper leadership in the form of emails being like, yes, we're aware this is going on and we're paying attention like stay tuned for changes. And so there was that. And then there were also things that were information. It was disseminated from your direct supervisor. So like, you know, the unit's nurse manager would like have things to tell the nurses or like the APP supervisor would like had things to tell like me and other APPS.

But I think so yes, there was communication. I don't remember how frequently it was though. I think it just it slowly got like more and more frequent kind of like. Yes, we’re monitoring this. Once they started making changes though, because at some point it must have maybe it didn't happen till that first day of lockdown. There was daily communication where like all the hospital leadership meets, they looked at like the total numbers of COVID positive patients, the amount of ICU beds we had, like the vents we had like all of that.

And they would like send it out every day as well as like changes, links to PowerPoint slides for like charting things that, you know, like all that kind of stuff. But but before, yes, there was communication. It was not daily though. definitely not.

Henry: And and when when they changed this policy, when they said, OK, no more, now you have to quarantine 14 days now or now no more visitors.

Sarah: Yeah.

Henry: What was what was your what was your reaction to that?

Sarah: So my initial reaction was like oh my God, this is going to be a disaster. Just like managing the emotions of the patients like that, honestly, was my first reaction. Like, people planned their trips to us with their time off, with their ability to have child care, like how their disability lines up. I was like, this is going to be a disaster.

And it was you're on the phone with patients and they're crying, you know, because like they had everything all lined up and now it's going to be messed up. And like, how are they going to pay for those 14 extra days, you know, like in a hotel room or something? That to me, honestly, I think the emotional like I don't want to call it burden, but kind of the emotional burden of like what aching patients through those changes would mean a change like that.

Like, they made the announcement and it was like effective midnight tonight. It was like that and like having to call all these people who were supposed to be coming in from out of state and explaining the rules. It was brutal because we're just the messenger and nobody was like blaming me specifically. But it's hard when like all day long, you are just yeah, you're managing people's emotions with with that change.

Henry: But did you feel that change was necessary or that it was, you know, finally or were you like this is stupid?

Sarah: So I think my reaction was these people have cancer. Like, come on. I think it was hard for me because I was thinking like from a patient perspective, I mean, I didn't want people getting on planes. Right. I guess I was thinking more like lots of people drive in [...]. It's like they have cancer, like they need to be treated.

And delays actually could lead to a worse prognosis. Right? It's not like this is a like screening colonoscopy that's being delayed or something. So I was actually frustrated like I understood it, but I was like, can't we can't there be some sort of middle ground, you know, to get these patients treated like the regular schedule was supposed to be?

So I was frustrated. I don't know that I had a solution, but I really felt for people because time is so important when it comes to cancer. And like, you're just telling people that they have to delay it. And, you know, you call the people and it's like, you know, a seventy year old like retired man and he's like, I haven't left my house,

I swear, you know, people who were like really trying to do the right thing. And I still being like it doesn't matter. Like, it doesn't matter what you've been doing. Like, you can't come here.

Henry: Yeah, OK. So speaking of time, we have a baby there. So if we can wrap up with certain questions looking back, what do you wish your hospital had done differently?

Sarah: I wish that they had found a way to make having a support person safe. We had enough masks giving people bad news, bad cancer news, and then they're crying by themselves in their room is like horrible I don't think anybody should have to go through that. So so I wish that there like I said, I don't even know that I had the solution right, because any extra body was extra risk.

But I mean, we, I had those visits where somebody is just bawling and they're alone. And I just and that was that was really hard.

Henry: Yeah. So anything you would have done differently personally as an individual?

Sarah: Oh.

Henry: Not as in not as like a nurse as an individual.

Sarah: No. I think I think we my husband and I handled everything very like we handled it really seriously, you know, like we didn't meet with people. We kind of like we're always following the most up to date guidance. We cancelled our wedding or no, we got married, but just with six people there. But yes and no, I think I mean, knock on wood, to this day, neither one of us has gotten covid.

So, no, I don't think we would have done anything different. So, yeah.

Henry: What else would you like to tell me about the way you felt in early 2020.

Sarah: Oh, I guess uh… I think initially when everybody was really on the same page early on during the lockdowns I think there was like a lot of camaraderie with, like on the units. And I think we felt like important you know, like the public like supported us.

And I think that was kind of like a brief window of time before things really started to like devolve the rhetoric got really nasty, but there was a small window of time where that was really nice. It was like, OK, we all have to be here and we don't know what's going on, but like we're in this together kind of thing.

And so that was, that was nice. And when things got harder that got harder. Yeah. Just feeling like you were having to fight against like so much misinformation. More so in my personal life, I guess. Like, it was almost like offensive, you know, like when people weren't taking it seriously and it's like, you know, for, like, my patients who are immunocompromised, you know, like, that's offensive to them that you would like not take something like this seriously.

Henry: Two more. What do you think I should have asked that I didn't.

Sarah: About the early pandemic. I can't think of anything.

Henry: And what else would you like to tell me? Yeah he's hungry, so I’ll let you go.

Sarah: I don't think anything. Yeah, he was just like it was a crazy time to be in health care. Like, I will say, just like an interesting thing from my family was like we had this family like Zoom calls, right where it's like aunts, uncles, cousins, like, everybody and everybody. My husband's name is [name]. Everybody wanted to hear from [husband] about, like, [his] experience working during the pandemic.

And I wanted to be like, you realize the doctor spent the least amount of time in the way of everybody, right? Like, it's like the nurses aides, the nurses, the respiratory therapist. But it was just interesting that, like, everybody wanted to hear from him and like, he was not doing that much patient care, like in-person patient care. I just think that perception is kind of interesting.

And like, people don't realize always who like who does the like really dangerous work in a hospital. Not the doctors don't, but like, you know, it's like the 66 nurses aides. Yeah, exactly. And like, I don't think that people understand that you are so grouchy OK.

Henry: Ok thank you so much. Does he need attention? So I think we can end this interview.

Sarah: Yeah. Yeah.