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Julia Wattacheril | Caring for the Caretakers

Julia Wattacheril describes what she and many other health care workers experienced during the peak of the pandemic in New York City

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Julia Wattacheril describes what she and many other health care workers experienced during the peak of the pandemic in New York City

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Description

A podcast that shows the harmony between Christian faith and current scientific discoveries by sharing the stories of interesting people who have found a better way of understanding science and Christian faith.
  • Originally aired on November 19, 2020
  • With 
    Jim Stump

Julia Wattacheril is a hepatologist—a liver doctor—but in April she found herself walking into her first shift working with COVID patients during the peak of the pandemic in New York City. She describes what she and many other health care workers experienced during the peak of the pandemic and what they continue to experience as they care for those hit the hardest by COVID 19.

In this episode, Julia tells the story of a fellow doctor who died by suicide. If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support you can go to suicidepreventionlifeline.org or call 1-800-273-8255.

Music in this episode is by Joseph McDade

Additional Resources


Transcript

Wattacheril:

You know, we dehumanize patients, oftentimes, the way that we document their stories. It’s the best way to make scientific decisions, it’s not the best way to make family decisions. I’m not consulting their loved ones in the middle of the night, I’m doing it as if it’s my loved one, as if it’s my father, it’s my brother, it’s my aunt. And there’s an absolute rending of the heart if you ever think that you don’t have enough, especially in this country, I was very used to that in West Africa. I was very used to that in other places. I wasn’t used to that in the richest city in this country or even conceiving of that.

My name is Julia Wattacheril. I’m an Associate Professor of medicine at the Columbia University Vagelos College of Physicians and Surgeons.

Stump:

Welcome to Language of God. I’m Jim Stump.

Dr. Julia Wattacheril is a transplant hepatologist. For the layperson, that’s a liver doctor. She lives and works in New York City and in April, when the first wave of the pandemic hit there in full force, she was pulled into the hospital to help in the COVID unit. 

Her experiences during the many night shifts that followed as a supervisor in the ICU, were  trying, as they have been for medical workers across the country and around the world. Each night as Julia approached the hospital she was hit by fear of what she might find inside. But instead of shrinking into that fear, she fell back on her Christian faith, reciting Psalm 121: “I lift my eyes up to the mountains, where does my help come from? My help comes from the Lord, the maker of heaven and earth.” And then she would cross the bridge that led to the hospital and begin her work. 

For us non-medical workers, this is a world we have only had glimpses of. As COVID cases continue to rise, Julia’s story is a timely reminder that the effects of this pandemic should not be counted only in terms of the deaths it has caused, but also the toll it takes on the medical workers. In our conversation we hear what it is like on the frontlines, as well as a message of hope for healing and a call for all of us to be healers, in whatever capacity we can. 

Let’s get to the conversation. 

Interview Part One

Stump:  

Well, Julia, thank you for joining us on the podcast.

Wattacheril: 

Thank you for having me.

Stump:

So you are a medical doctor and researcher working in New York City. You’re also a Christian. Let’s begin, if we could, by hearing the backstories for each of those facets of your life. So start with your medical career, if you would. When did you first think you wanted to be a doctor, when you grew up?

Wattacheril:

I think I first entered into the medical line of thinking maybe around the age of 9, 10. Up until then, I had entertained everything from an educator—I’ve come from a pretty robust line of educators—and everything to the finance sector. I remember waking up at five o’clock in the morning and watching the financial returns from the previous day. So I’m looking at Wall Street right now outside of my window. But when I was in the fourth grade, fifth grade, thereabouts—my mother is a registered nurse, she worked at a county hospital—I began to see the implications of some of the science classes that I was learning. And some of what her stories were when she would come home. She worked in pediatrics. And so everything from basic biology classes, and you know, some of the implications for treatments, dosing, the relevant conversations that we would have about the family dynamics in caring for a pediatric patient.

I would say that she didn’t bring too much of that home. You know, internal work politics, maybe, but she didn’t speak too much about the day to day care of patients, except that her value system very much was in the service of taking care of other humans. And I think that’s where the first thought of using my intellect in order to serve other humans along the lines of being a doctor first took root. I would say, it was only college, where I made the initial branch point between becoming a PhD scientist versus an MD. And a lot of that—you know, I’m the daughter of immigrants, so a lot of the way that you think about things is what’s going to pay the bills, or what’s going to put bread on the table, what’s going to lead to the survival of the next generation? And so the practical aspects of a career that would not only be able to take care of me, but able to take care of other generations was also sort of weighing on my head. So in college, I went to a predominantly Jewish, non-sectarian school.

Stump:

Where did you grow up and then go to college?

Wattacheril:

Yeah, I grew up in northeast Texas. And born in Dallas, I grew up in a suburb of Dallas called Carrollton, and went to a large public 5A High School, very sort of Texas suburban upbringing. And then, based on various experiences that I had growing up in Texas, I really wanted to leave. I grew up Southern Baptist and there’s a lot of a sense of not belonging in the Christian church when you don’t look like everyone around you. And there’s this sense of not belonging in your community, when you don’t necessarily look like the people around you. And so, you know, at that time, I didn’t know much about the rest of the United States, but I valued the experience of going to an intellectual hotbed environment, like the Boston area. And so again, that immigrant thinking of what’s most practical, you know, I applied pretty broadly to many schools in the Boston area, and was the recipient of the Justice Brandeis scholarship at Brandeis.

And so at that time, it was called non-sectarian, but still quite Jewish in its focus, but a desire to expand and diversify and have different, both faiths and sociocultural exposures in terms of their student recruitment. And so I lived on the religious quad in an Orthodox Jewish environment. Within a walkable distance to the three chapels. Something that Brandeis is very proud of is that their three chapels represent the three major faiths of the world and that none of the buildings cast shadows on one another. And so that was a very visible reminder of faith. And it was also a place where my clarity about my faith and the difference between old covenant and new covenant, and what it means to be a Christ follower became very, very clear. So it was a bit of escaping from an environment where I experienced quite a bit of racism growing up, and removing myself from a culturally Christian environment and putting myself in a different environment. 

In addition to the faith element, it was very much part of how I discerned you know, not to do a PhD and pursue medicine. I was taking biology classes, organic chemistry, all the traditional pre-med requirements, but I realized very quickly that my motivation for studying, my motivation for doing what I wanted to try to do in the lab was profoundly impacted by a desire to be with humans, and to be around humans, and to help humans. And that might have been a premature truncation of the PhD experience, but I just felt for me, being in a lab, by myself, or with a group of individuals without interacting with humans that would benefit from the work would have been really, really hard for me. And I didn’t have a ton of lab exposure, you know, definitely not before college, but even within the college environment, I just felt like I needed to be proximate to the humans that I was hoping to help. 

Stump:

Well, let’s back up a little bit here again and talk a little bit more about your faith background. You mentioned that you grew up at a Southern Baptist community in Texas, as a person of color. So tell us a little bit more of that experience and then maybe hit some of the high points along the journey that you recounted a little bit in college to where you are today as a Christian.

Wattacheril:

Sure. I would say I grew up very churched. My parents immigrated from India. My dad is of an Anglican tradition, so Church of South India. And my mom is from an Eastern Orthodox type tradition, but generations upon generations of Christians in the family and that sometimes comes up, either in Texas or anywhere when I meet Christians. It is not—you know, St. Thomas around In South Indian AD 74, I believe. So there’s been quite a strong influence of Christians in South India particularly.

So when, when my parents emigrated—I’m second born, I have an older brother—they were outside of their apartment in Dallas, and one of their neighbors happened to invite them to their church. And so we were the only sort of ethnic family in that congregation. It was a church that started in the early 1900’s. It would be called inner city Dallas now, but it was called North Dallas back then. And I grew a lot in terms of the scriptural basis for my faith. And I look back, when the Holy Spirit brings me scripture for songs, many of them, especially now with what’s going on in our current environment, many of them are the old Southern Baptist hymns that we used to sing. They’re deeply comforting. They take me back to what later came to be a stronger influence in my life, the black church, sense of solace, sense of activity and activism, sense of justice. And where that came from was mostly my father in our home.

But, you know, ethnic subdivisions, racial tension, all of that was definitely part of Dallas in the 80s. And I remember maybe as young as four or six years old, talking about it with my pastor and speaking about it with leaders of the church, because it was so, so, so relevant to growing up. And so that was one of the areas that I remember being aggrieved with, in terms of what a body of believers should look like, in the United States especially, and what some of the barriers were to achieving that. And it’s something that I tucked away. But it definitely played a role into how my faith matured and what bothered me. 

That sense, you know, that biblical concept of adoption is the one that really, really has had the hugest impact on how I am ministered to by the Holy Spirit and the work that I do on an individual basis with working with other people. It has everything to do with identity. And when you started off with your questions, you asked me about being a doctor and a researcher, and then as a Christian, and I would say, if I identify most fully with one label, it’s being a Christian. It transcends my work related identity, my skin color, identity, any other form of identity. And the sense of being adopted into the kingdom, being an heir of God and a co-heir with Christ. And that’s quite an accessible status for people who arrived feeling like second class citizens in this country or feeling like they don’t belong. So when you understand the privilege of being an heir to a kingdom, and that you have all right, all power, all authority, because of nothing that you did and something that was done for you, and that really, really sinks in, and you realize that that is available to everybody, it makes you very, very fierce about wanting that level of access for everybody. And it makes you very fierce about wanting to get rid of anything that stands in the way. 

Stump:

I want to return to these topics you’re bringing up right now, about diversity, about justice, about the church’s response to all of this. I want to come to that in just a little bit. Coming out of hearing some of your experiences, we’ve referred several times to the situation and to COVID and what’s going on right now. But you first came to our attention at BioLogos last spring, when New York City was the epicenter of the COVID outbreak, you had had some, I think, interaction with Francis Collins previously and then on the livestream we did with him, we read a brief note from you about your experience of the hospital during those difficult days. And given the polarized nature of society today and what sources of information that people trust. I think it’s helpful for all of us to hear a first hand account of experiences from medical providers. So if you would take us through a bit of what that was like for you then, working in the hospital during the worst of the outbreak. And just tell us your experience, what some of the stories were, the way you processed what was going on?

Wattacheril:

Yes, to the best of my ability to do so. So that prayer that I sent was actually in anticipation of my first shift. At that point, there’s a sense of preparedness that everyone has in emergency situations, but particularly physicians, especially ones with as much subspecialty training as I have, and my colleagues have. We really like being experts in our field and we become progressively more uncomfortable when you take us out of that area and put us in another role that maybe we haven’t done since our training. So in those weeks prior, so let’s see, this was mid-early April, we knew that the cases were approaching their peak, predicted peak, in New York, based on some of the lockdown measures that had been imposed, and just the projections. And so I did what most people would do and what I asked most of my patients to do when I try to expose them to something new is, what prior experiences have you had that could give us a little bit of information about how to process and prepare for what’s coming. So my primary focus up until that point had been staying fit, making sure that I was in good health, making sure that my team had what they needed. I had messaged my leadership privately—I don’t have children, I live alone—so if there was a need for someone to go and work at one of the offsite places, the Javits Center had been turned into an emergency hospital, there were emergency hospital setup and other places. Every little pod is responsible for supplying positions to different areas. So I just sort of privately volunteered to do that, because my concerns about coming home and I don’t have anyone to expose to COVID. And so I didn’t know at that point where I would have been deployed. But all of us were waiting. And once we received our assignments, we were deployed in a capacity as an ICU triage personnel overnight. 

So when a patient enters an emergency room, they’re generally dispositioned to one of two places: either they’re well enough to go home and be monitored at home, or they’re admitted to the hospital. And when they’re admitted to the hospital, they’re either admitted to a floor bed, or to an ICU. And what makes an ICU an ICU is not necessarily with the machines and support, although those are important, it’s the ratio of nurses to patients. And so you can turn anything into an ICU as long as your nursing staff can expand. And so at that stage, and where we were in New York, generally every single square centimeter of the hospital had been turned into an ICU by April. Operating rooms were turned into the ICU, regular floor beds with closed doors, the capacity to isolate patients were turned into ICUs and our volume of nursing stuff had significantly expanded because of other nurses coming from other parts of the country. 

And so in anticipation, the words that I sent you and the plea for prayer that I had, was reflecting some amount of fear, challenged by what I wouldn’t know. There were reports that we had seen coming out of China, from Italy, and from our colleagues that had already done shifts, but it was mostly a sense of there’s an unknown element to this infectious organism. What are the precautions that we take using the sensibilities that we have, using what we know about other infectious organisms and how do we function in that environment given those parameters? And so I couched my preparations based on two prior experiences: disaster management in Houston during hurricane season and then some work that I had done in West Africa, a very resource limited environment, having to reuse gloves, etc. We had meningitis outbreaks and tuberculosis outbreaks. And so given what I knew about infectious organisms—we deal with infectious organisms in transplant, highly resistant organisms, all the time. So it wasn’t too much fear about what I was facing. It was more a sense of it’s been a long time since I’ve done ICU level care, or routing patients to the ICU. Am I going to be enough? Am I going to be competent at this? I value competency a lot. Most clinical people do. And so we don’t like questioning our backgrounds. We don’t mind, we question ourselves all the time. But there was more of a sense of am I fit for the role that I’m put into. And it took about 20 minutes of being deployed on the floor with residents—and I’ll explain what that means—for me to understand that it was actually a very perfectly suited job for those of us that were chosen to do it. 

So as transplant hepatologists, we see patients at all levels of acuity, our patients tend to bleed, they tend to become unstable very quickly and we don’t have machines necessarily apart from ventilators, to put them on, to support them. So we have to think very quickly. And we’re very used to blood and bile and all sorts of below the diaphragm type fluids. We are not phlegm people. We are not our ICU colleagues, our pulmonary colleagues. And so vent management was—ventilator management—was one of the areas that many of us felt uncertain about. And we were doing all these online courses to ramp up our knowledge, which was good. It was more allaying our anxiety than anything else. But the real role that I was put into is decision making. And for better, for worse, we’re really good at that at transplant. We’re really good at hustling, and we’re really good at decision making. 

And so the first 26 minutes, I will never forget. So it was an overnight shift. Every human that works overnight probably experiences this, but you start to become hypothermic right around 2am. So you have your fleece on, you have, you know, we all were wearing generally, scrubs that we put on in our offices, and then walked over to the hospital, did our work, and I would immediately, upon completing a shift, take those clothes off, put them in a sealed bag, and then change into street clothes before I took the subway home. And the whole act, the mechanics of preparation, cleaning off your phone, cleaning off anything, not taking anything to work that might potentially become contaminated, was an opportunity to sort of parse things out and you realize what’s important. You wear the socks that someone sent you from around the country to remind you that they love you. You don’t wear anything important that you care about sullying. A church that my parents are part of sent me a wooden cross. So I put that in my back pocket as well. But as I was crossing that bridge, over into the hospital, for the first shift, I didn’t really know what I was going to face.

I had a group of wonderful residents. We have many levels of trainees given all those years of fellows and residents etc, that we have on our teams. And I met with them in their private quarters, where they’re receiving all of the phone calls about patients that are unstable. And so for this particular role, ICU triage, you’re receiving various forms of communications, some pages overhead, some pages to our electronic system, and some just acute crashing patients where the nurse just calls for help. So your eyes and ears are open to being contacted in multiple ways. 

So within that first 26 minutes, there were three rapid responses, so patients that need sort of immediate assessments, and triage to a different level of care, two arrests—so those are like the Code Blue situations on television shows where you have a patient whose heart stops or they stopped breathing, they lose lose consciousness, and you do your ABCs. You establish an airway, check their breathing, you start establishing circulation. And physicians, especially interns, are phenomenal in these situations. It’s such a trained human response, what to do in that situation, I had to do it on a plane once, you just break out into robotic mode, because it’s so trained. And so breaking out of robotic mode becomes very, very difficult in a situation like the pandemic. So you don’t have 14 people in a room, two putting in IVs, one administering medicines, one checking the pulse, one putting in a breathing tube, anesthesia surgery, everybody shows up in a traditional code situation. In our code situations, we had a sizable team, probably 8 to 10 residents with us, anesthesia would come with their backpack and their masks, high risk exposure for anyone who’s putting in a breathing tube. Surgery would come to put in necessary IVs in order to give medications or get someone’s blood pressure up with products, like fluids. But the amount of humans that were allowed to enter that room were very, very limited. Because every time you compress someone’s chest doing CPR, if there’s not a contained airway, you are exposing all of those humans to an airborne and sometimes aerosolized organism, the virus. And so limiting exposure became a very, very key point of managing this crisis. Partly because at any given time, 10% to 15% of our emergency room staff were out. 10% to 15% to 20% of our residency, our residents were out sick. And so keeping staff healthy became a rate limiting step. So limiting exposures for the people attending the patient to as arresting was a primary area that we had to be mindful of.

There’s always a sense, physicians are constantly battling that sense that what am I missing? What else can we be doing? What else could be going on here that we’re not thinking about? And that’s where having multiple people think about a situation becomes hugely important. So I’m positioned outside the room, I have eight residents, maybe six residents with me. Two of them are in the room, performing CPR. And quickly, I have never heard of that person before, so I quickly need to get their story, establish the top three reasons that their body is trying to leave this planet, and try to stop that from happening through the execution of orders. Obviously, the arresting patient, there’s certain basic things you need, you need a circulatory system, you need a way to breathe, you need a brain that’s awake, and until all those things are, if any of those are missing, you need to supply those through machines, through artificial means. And so making those decisions many of the mechanics are intuitive. What wasn’t intuitive, is what do we do if we don’t have an ICU bed to put them in? How long can we keep doing CPR? What happens when we get called to another one and I don’t have any—I have two people on the last bed four people on this bed, and two more that are attending to someone who we just got called about? I’m going to run out of people. I’m going to run out of me. And I am in a role where I have to support these doctors that are doing the work. I’m here as a supervisor. I’m here to make the tough decisions, which I generally enjoy doing. I generally enjoy complex decisions. None of us like resource limitations. We’re all used to it. But that multiple stacked tension of running out of humans or resources, it was the area that most of us were anticipating, dreading and hoping that we didn’t face in any one particular shift.

Stump:

So then you mean you’re making decisions of very limited resources that in other times would have saved lives, but now some people are going to die because there’s just not enough people or not enough machines or not enough beds or nurses to go around?

Wattacheril:

Correct. That if I need something and it’s not available—clinicians are incredibly practical people, we’re used to making things stretch in extreme circumstances, for limited periods of time—but if there is a scenario where we don’t have enough, and thankfully, I know I never faced that, I believe our hospital never faced the issue of running out of ventilators, per se. But that was something that everyone in those early weeks was wondering, especially those of us that don’t do critical care regularly. Is am I equipped, am I justified, do I have what I need—not scientifically, when you’re told you don’t have, you don’t have—but am I equipped morally, am I equipped ethically to be able to choose and how much information is too much? You know, many of the arresting patients, I never looked in the eye. I was outside their room. I was getting objective data about who they were. And, you know, we dehumanize patients, oftentimes, the way that we document their stories. It’s the best way to make scientific decisions, it’s not the best way to make family decisions. I’m not consulting their loved ones in the middle of the night, I’m doing it as if it’s my loved one, as if it’s my father, it’s my brother, it’s my aunt. And there’s an absolute rending of the heart if you ever think that you don’t have enough, especially in this country, I was very used to that in West Africa. I was very used to that in other places. I wasn’t used to that in the richest city in this country or even conceiving of that.

Of course, I wasn’t processing all of this in that moment. But what I was doing was absolutely crying out to God, saying, “Lord, here’s the reality that I am facing. Look at these exhausted young doctors who are working their butts off, who don’t project exhaustion at all. They project freshness and an indomitable spirit. But I know what they have seen. I have walked these hallways. I know what they have seen, and that no one is speaking about yet. And I need to help them. And I need you to help me. So Lord, in the moment, I need a pulse back. I cannot manufacture that based on the magic potions that I’m pushing into this human or I’m you know commanding someone else to push into this human. Only you can revive this person right now.” 

[musical interlude]

BioLogos:

Hi listeners. We live in an age of COVID 19 and a climate crisis but also an age of amazing new technologies and scientific discoveries. Either way you look at it, science is a major part of our lives and undoubtedly, questions will arise at the intersection of science and Christian faith. BioLogos is hoping to help you explore those questions faithfully. The BioLogos website has articles and other resources to wade through some of the tough questions. And for students and teachers, we’ve recently released integrate, a resource designed for homeschool parents or Christian school teachers to help Christian young people grow in their faith in Christ as they develop a deeper love and stronger understanding of the world God has made. You can find it all at biologos.org   

Interview Part Two

Stump:

So you gave us your first 26 minutes. How long did this go on for you? How long were the circumstances such as you were describing there.

Wattacheril:

So after that spate of arrests and rapid responses, things cooled off enough for us to document, do all the things that you need to do to make sure that people are tucked, the patients are tucked in in the right level of care and getting all that they need, a bit of a breather. But the remainder of the night was all steady consults. And for the most part, the residents knew 95% of what they needed to know. We were treating with hydroxychloroquine at that time. We didn’t know any better. And there were, you know, different interventions that were being studied. There were multiple clinical trials. There were multiple pathways. It was a steady spate of new patients that were becoming unstable and needed our eyes on them. We don’t always move them. Sometimes we elect to watch and see where that where the physiology that patient heads, some people will spontaneously get better, some people will get better. We think due to the interventions that we’ve given them, we don’t know. And some of them will get worse. And so as patients declare where they need to be, our eyes are on them. 

It was roving the hallways, it was making sure that the teams that needed help were getting help. And so, you know, if I observed that something was on short supply, I would immediately message just to make sure that everyone had what they need to carry out their work. I think that’s the job of a leader. A lot of it was praying in hallways. My friends would sometimes call me to check on me while—and you know, these are overnight shifts, so it might be midnight. But I had friends in Alaska, so it wasn’t necessarily New York, midnight time. But there was a sense to which the public really wanted to be part of what was going on in the hospital and us not really being able to share that. I think a real tragedy of what happened especially here in New York, Nick Kristof said it well, is he’s never, as a journalist, been confronted with a war zone and not been able to cover it. And I think a lot of the images that I store in my brain now, that actually sometimes inspire fear, when I start to see them crop up again recently, are things that the public should see and hear and know. And when we deal with misinformation, and getting truth out, there’s a visibility of the innards of the hospital, no matter how silent the hallways were, no matter how enshrouded and depersonalized people were in their PPE, that the public could have benefited from. I think the closest things that I saw were some of the hospitals in Italy, where you saw intensivists sort of rushing between patients and creating new technologies at the bedside in order to sort of just survive day to day. Yeah.

Stump:

And then for how many days, how many nights I guess, did you carry on in that capacity,

Wattacheril:

I chose to do more in a row. Because I always think of everything a new role is sort of muscle memory. And I will maximize my ability to learn by doing three or four nights in a row. And so I had done I think the first go around, I did three nights in a row. Other people just did one night at a time. We’re all of a certain age where being awake all night is not our favorite thing. And, you know, we weren’t relieved of our daytime duties. So I still had telehealth visits with my regular patients to see on the next day, oftentimes. So juggling, it became a very erratic schedule, because you weren’t able to go to clinic or do what your normal job was. But patients were having needs, and it’s New York City, so our catchment is not just the tri-state area, I have patients all over the country and struggling with sort of access, accessing their physicians wherever they work. So it was helter skelter, patchwork sort of those early weeks. A lot of sleepless nights, not because of being in the hospital, but also because of just disruptions to the normal functional days. But we did, I particularly did, you know, three nights one week, and then a couple of weeks would pass and then four nights, you know, three or four nights, the next go around. And we were all told all hands on deck. So be available in a moment’s notice, to do anything that the hospital asks us to do, to go anywhere that we needed to go. And that’s, you know, how you, we all—I didn’t have any question in my mind, that would be who I was and what we did. Because the need was so great. What it would have been nice to have known as you know, and no one can predict this is how long will this continue? When will a break be offered, especially not so much for us, but for the nurses?

Stump:  

So some of what I wanted our audience to hear from you is just the the account of the toll that this has taken on the medical providers, I think too often the the kind of public calculus that’s going on about COVID and the toll that it’s taking is only in terms of the death count, and the morbidity rate, which thankfully has gone down some from the those early days. But the direction things are headed now, And in the Midwest, where I live, it’s starting to look like we’re going to be where you were back in April very soon. And the toll that this takes on the medical providers Is really concerning.

Wattacheril:

I wish I could emphasize that as a critical point of the pandemic. I did an interview with Forbes early on and I think that when things were being unveiled in March, there was an opportunity to sort of engage the public. And instead of dividing healthcare providers from the general public, there was a clear support of healthcare providers along the lines of PPE, something very simple, very basic. You have grandmother’s sewing masks and sending them, you know, to all of us. That kind of human force can be mobilized for a lot of good. So the care of the provider is so intimately tied to the care of the patient. When patients adequately and very understandably complain about the lack of eye contact or empathy or understanding from a provider, I sometimes am grieved because of the feedback that I get from patients that no one has talked to me that long throughout the past 10 years of me seeing doctors. That’s not the way it’s supposed to be. In order to have an empathic person care for you as a human and care for all parts of you, including the quality of life implications, and listen well, that human has to be well taken care of too. And the more that health care has become incentivized towards productivity, or metrics that are not human focused, care focused, but more personal procedure focused, and I benefit from this 100% as well, but our incentives have not necessarily been on prevention, but intervention. That is doing a disservice to the humans who do the work. 

And particularly for people in health care, we’re not necessarily wired towards financial incentives. You know, we don’t, we don’t know how much people are being billed for things. And this is not something that, you know, the average person probably knows. You know, they think of the bills that they get, or their experience with health care is like all feeding necessarily the professionals who they saw. But it’s a complex system, where the humans who are actually delivering the work are very, very, very aligned with the humans who are receiving the care in terms of what our desires are. But a lot of the internal battles that we face in order to get that person the care that they need are never witnessed. They’re medical director calls with insurance companies, they’re battling, you know, systemic sorts of issues on your own time, or, you know, fighting defunct sorts of systems that are not incentivized towards the care of humans.

That all of the effects that we’re seeing from human trauma, namely death related to COVID, will have a natural expression. How one deals with trauma, especially when the workforce is needed. It’s not like anyone can be exempted from the next several weeks or months of what we are prepared to endure. So building resilience and helping people form a narrative around it are critically important. So I worry a lot about whether mental health services will be sustainably offered to all the nurses that have worked and bounced around this country serving in different cities and just seeing this over and over again, whether they will get the help that they need, whether they will stay in their line of work. One of my patients is also a nursing director at a different hospital. And she was recounting, in a safe space, what she also had been infected, intubated, and in her ICU, herself, for about three weeks. And what I hear many people talking about is something like a 911 Commission, something to sort of look at what has happened, how much of it was preventable, and then just adequately resourcing people to get the help they need.

One story from Colombia, and this was something that I don’t talk too much about, because I haven’t processed it yet. As I look out my window, I’m at home, about three blocks away from me, one of my friends and colleagues and fellow believers, Lorna Breen was—she was an ER director, at one of our affiliate hospitals called the Allen hospital—and she died by suicide on April 27th, I believe. And I immediately—so I found out about it through a New York Times article, and I walk by her apartment not infrequently, I prayer walk our neighborhood not infrequently, and as a result of—her story is one that’s worth reading, I’m happy to share a link—as a believer, as someone who’s resourced, as someone who comes from a phenomenal background, from a beautiful family, what she saw and experienced and recounted, and what it did to her, and again, not knowing too many details, not speaking with her in the days prior to losing her. Aside from her being ill and checking on her as a neighbor, I carry guilt that I didn’t check on her enough. Her family has not only created a fund for resources for healthcare professionals, but also, I think Tim Kaine of Virginia has put forth a bill to create legislation where this is just so needed. 

There is a lot of hope that I have, not just at the level of health care professionals, but where people are suffering right now, in their homes, in their churches, etc. is this absent attention to mental health, for both the providers and the patients will gain a lot of traction, simply because it is playing such a role in overall health right now, that we have not done a good job with in health care. And that is something I carry a lot of hope for going forward, is what’s been revealed in terms of the mental health crisis within our country, writ large, but then also within individuals. The church needs to address it for certain. Individuals need to address it. Certainly healthcare providers need to address it. All of those areas, again, I have great hope for as we start to see, very visibly, the coping mechanisms that people are choosing to use to get them through months and months of a crisis and how we can better equip people to choose better coping mechanisms. It’s just like the disordered desires of the heart, in theology, Augustine. You cannot tell someone to stop doing something you have to replace it with something else. You have to reorder their loves. And I think every Christian’s faith is coming to the question of what do we really believe when multiple security blankets have been removed from us, and we get very uncomfortable, and people without a prescribed or subscribed faith, are asking the very same questions. So being open about “the how,” the process of seeking, is where I have great hope for the faith community.

Stump:

There are a number of aspects of this that I’d still like to talk to you about. And perhaps we’ll do that in another time. But maybe you could end here by giving some concrete suggestions for how this community, by which I mean, the people listening to us right now, people who take the science seriously, but also take their faith very seriously, what kind of community like this do to support, I’m thinking primarily of the people like you, the health care providers, where again, the trends of the ways this is all heading do not look good right now. And it looks like we’re in for another round of these very serious kinds of decisions and triage and late nights for providers. What can this community do concretely to better show support for you, for your colleagues?

Wattacheril:

I’ll go based on evidence. So I’ll tell you a bit of a story. I call them my extended family. We’re not blood relation, but one of my very good friends here in New York is originally from Alaska. And her family put together care packages. And they sent me several. And I ended up finding a couple of people, one of whom was a complete stranger to me, and two of whom are mentees. I brought them care packages. And the most valuable aspect of that care package were notes from children. Everyone put them on their fridge. I still have them. I took pictures of them. So number one, get personal. If you know, everyone hopefully knows some healthcare provider, and by that, I mean, very broadly. I talked to many of the janitorial staff and custodial staff when I was on shift at night, because it’s very lonely. I was convicted about how I had ignored, in my mind, I don’t pay as much attention to the night shift employees, because I’m usually roving around during the day, and how lonely and sad it is at night, because you don’t have normal buzz of daytime activity. So I committed to doing things at night. So you know, it’s more, it’s not how much you spend. It’s not the brand of what you choose to send, whether it’s food or socks or anything. It’s that human connection, because health care providers felt so alone. Over and over and over again, when I asked, when I walked the halls and I asked people, how are you doing? How can I better help you? What is bothering you? And they said, “I only can look at happy memes right now because I just did my ninth FaceTime call with a family member right before into terminal intubation, potentially.” And I just, I wasn’t, no one was equipped for that. Being available to health care providers is extremely important. I was asked over and over again, what can I do? What can I do? What do I need? 

And it took me yet again, weeks before I realized, I’m really bad at naming what I need. We’re just not used to thinking about it. And it was sad to come to that realization, like I have needs and I’m just not used to feeling comfortable enough to share them. Or always being in other service mode and selfless mode. And you can’t, You can’t be in service mode and ignore yourself. We know that. But being attentive. I think the other thing that can happen, and I noticed this in church circles a lot, is that people forget, I think this happens to pastors too, that the health care workers need time off. And I hear people like praying for health care workers and all these types of things which are wonderful, and I want the community to continue but also remember they’re not there to answer all the public health questions for you at the end of a church service. They need their time where they’re not a doctor, where they’re just a believer where they’re just a struggling human being. And asking the ones that you’re close to what they might need. And then just knowing if they say nothing, that’s probably not true. They’re just not used to being able to articulate what they need. And something simple like a note of encouragement, an honest note that says, “I see you come home every day looking exhausted, and I don’t know what to do for you. So here’s a pair of socks to remind you that someone cares for you when you’re working.” It’s the tiniest things, you know, the nurses that are there that are turning patients over that are that are doing sort of basic human care, you can think about like Mother Teresa type activity, you know, it’s that type of tenderness that we want to preserve in the people that care for humans. And the way that they can do that is to receive it. So the same thing that you would want for your child, your loved one, that that person is caring for is what would be very, very, very helpful. Notes of support, notes of encouragement, getting personal, being available, backing legislation. 

When we talk about more, bigger things that are carrying weight, backing legislation. Nothing gets done without money and resources. And now in these times of austerity, what is going to get cut is everything that’s considered fluff. And for too long, we’ve considered feelings, fluff. And that has to change. And the only way that we change that is dedicating line item budgets towards studying what’s going on and implementing change. And so it’s, if you have power, if you have resources, using that, to deal with some of what we’ve now seen, not just in healthcare, but in every industry. So reallocating resources to try to address some of these systemic issues. It’s hard, it’s weighty, but it’s also 2020. There’s a ton of brilliant people out there that can work together to accomplish things on the other side of this that we will never have had the opportunity to see with such clarity like we’re seeing now. So depending on your audience and their resources, it can be as simple as a quick message. Don’t ever underestimate the power of words.

Stump:

Okay, language of God listeners, we have some marching orders here. Let’s support the medical providers in our communities, in our own circles of proximity that we have. 

Julia, thanks so much for the work that you’re doing for sharing it with us here, for giving us some signs of hope even amidst the difficult stories that you have gone through and we fear are around the way again. I hope that we might talk again sometime and that we’ll be able to process more fully some of these experiences and glean more wisdom and insight from you. So thank you for talking.

Wattacheril:

I share in that hope with you.

Credits

BioLogos:

Language of God is produced by BioLogos. It has been funded in part by the John Templeton Foundation and more than 300 individuals who donated to our crowdfunding campaign. Language of God is produced and mixed by Colin Hoogerwerf. That’s me. Our theme song is by Breakmaster Cylinder. We are produced out of the remote workspaces and homes of BioLogos staff in Grand Rapids, Michigan.

If you have questions or want to join in a conversation about this episode find a link in the show notes for the BioLogos forum. Find more episodes of Language of God on your favorite podcast app or at our website, biologos.org, where you will also find tons of great articles and resources on faith and science. Thanks for listening. 


Featured guest

Julia Wattacheril

Julia Wattacheril

Julia Wattacheril, MD, MPH is a clinician investigator, transplant hepatologist, and director of the adult nonalcoholic fatty liver disease program at Columbia University Irving Medical Center - NY Presbyterian Hospital. As a Christian, her passion for faith and work integration began in medical school in Houston at the Baylor College of Medicine. After moving to NYC, she completed the Gotham Fellowship at the Center for Faith and Work and continues to develop innovative ways to implement spiritual tools to help healthcare providers and the patients they serve. She has a particular heart for connecting with people at the fringes of any sphere but particularly in academic medicine.

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