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President Ruth Watkins: Hello, I'm Ruth Watkins, president of the University of Utah. Over the past nine months, employees at University Hospital have worked heroically to care for Utahns with COVID-19—difficult, heartbreaking work no doubt. Long hours, incredible protocols related to care and, of course, also protective equipment. The emotional toll must be enormous. There are some bright spots and one of them is seeing patients recover. And I'm guessing that that is what keeps our employees going.

I am so deeply grateful to these frontline healthcare workers and I'm sure that many of our listeners would join me in expressing incredible gratitude. We have two nurses with us today, Christy Mulder and David Marple. They both work in the ICU unit at University Hospital. Christy, David, on behalf of all of us at the University of Utah and in our community, thank you so much for what you're doing. I appreciate you taking time with us today.

Well, let me ask you a little bit about your background and maybe we could start with you Christy, and then we'll go to you, David. Tell us a little bit about yourselves, where you came from, where you got your nursing degree and how long you've been at the U. And then what is it that attracts you to ICU? I think many of us wonder that. So, we'll start with you Christy.

Christy Mulder: So, my name is Christy. I've been a nurse at the University of Utah for coming up on five years now and I've been on the MICU the entire time, ICU is all I know. I think the biggest thing that attracted me to the ICU as a student—I went to school at the University of Utah as well and I did my capstone in the ICU—and I was attracted to how attentive to detail nurses get to be in the ICU, how we get to be . . . just looking out for big changes, small changes in our patients. And I really felt like I had a huge role to play in part of getting patients feeling better.

And I liked the team aspect of it. I felt very respected by my colleagues in the ICU, physicians, PAs, NPs. People trusting my opinion and wanting to know what I see because as ICU nurses we're at the bedside 12, 13 hours a day, we spend more time with the patients than anybody. And so, I think having a viewpoint that is valued was important to me as a new graduate.

President Watkins: Really great examples. Being part of a team where your voice is heard and your expertise is respected and also being able to see such a difference in the lives and the impact of your patients and their families. How about you, Dave, tell us your story.

David Marple: Well, I am a long-time transplant to Utah from the Midwest. I've been here over 20 years now. I consider myself a Utahn. Went to Weber State for my nursing degree, and that was almost 20 years ago. I've worked primarily at the U in the medical ICU. I love this unit. I love the patient population that we have, and I love the university. So, I've never had reason to look elsewhere.

President Watkins: Well, it's our good fortune that that's the case so thank you. Thank you for your service with us. Most of us, many of us, I guess, have been fortunate enough to not ever be in the ICU. So, I think for listeners, it would be wonderful to hear a little bit about what is the life of the ICU like, especially now with COVID-19? Protective equipment, tell us about your patients, what length of shift, some of those kinds of things. So, I don't know, maybe this time, Dave, we should have you go first and give us a little glimpse inside the ICU.

David Marple: You know, everybody thinks the ICU is a very high-stress environment and sometimes it can be. With the pandemic, it certainly has become that. We do typically 12-hour shifts and normally we'll do three of those a week. During the pandemic, we've been ramping it up. Some of us are doing four and sometimes five shifts a week. But they're long days. We typically have two patients, and we wear a lot of PPE. So, it changes the whole dynamic of the ICU care that we're doing.

President Watkins: Christy, you want to follow up on that at all?

Christy Mulder: Yeah, I think David's right. A lot of times people see the ICU as a stressful environment, but I really do think that people who are in the ICU, they have to be calm. They have to be able to respond in a way that is thoughtful and collected because so many crazy things can happen that if you get anxious and worked up with it, it's not always helpful.

President Watkins: Yeah. I would imagine your ability to be a poised member of a team is probably pretty vital to this working well in the ICU. Dave, you might tell listeners a little bit about what you have to do to enter the ICU and just to go to work every day.

David Marple: Okay. Yeah, so in our ICU and the MICU, which has become the pulmonary COVID ICU, it's necessary to put on, you see the people with the, we call it a PAPR, it's the kind of the spaceman soft helmet. And we put that on with a belt pack that has an air filtration system on it. And then we'll put a gown, either a cloth or a plastic gown, over that before we go into every room. To get into the rooms, it takes a few minutes to put all that equipment on and get into a room.

When you get in there, the patients see someone that they don't recognize with all this equipment on. Most of these patients are, a lot of them are on some form of sedation, they're disoriented. So, it really has to be an interesting experience for them.

When our ICU filled up, we opened up an overflow and the overflow unit is a complete unit that has negative pressure, and this became really strange. I've been working on that unit quite a bit lately, and you put on the equipment and you leave it on all day or for the hours that you are on that unit. And it's just a very surreal experience to put on your equipment, go in through an ante room, that's kind of a half clean room, and then onto the unit itself. I always think I'm going down into a coal mine or something before that happens. I feel like go into the coal mine and you get on that unit, everything's muffled because everyone's wearing these helmets. You can't hear things. It's a very strange and surreal experience.

President Watkins: It sounds both difficult and also harder to establish human connections, both with your coworkers and with your patients, I'm going to guess.

Christy Mulder: I think we all underestimate how much emotion and communication there is from the eyes down. Because when we're wearing masks all day, there's so much that's lost in communication, the warmth of smiles and seeing people move their mouth as they talk. I didn't realize how important that was. And then especially to go into a patient's room where they're already scared, they're already in a foreign environment. And then to have these strangers come in and these space suits, I mean, it's even more anxiety provoking. So yeah, I think part of our job is learning how to be nurses and care for people in a way that's compassionate and genuine while we feel very out of our element in these space suits.

President Watkins: It's so true. I think being able to reassure people with a smile and with your voice really . . .  it's harder. It's harder in every interaction right now. I think. Well, tell us a little bit, let's talk about COVID specifically and how do you keep family members informed about their beloved person who's in the ICU when they can't be around physically? That must also be an added burden of your work right now.

Christy Mulder: Yeah, I think that's been definitely an aspect of COVID that has been a burden for a lot of us is not being able to have family at the bedside. You know, the family members are the ones that know the patients best. They see who they are when they're not a patient. And so, to have a person that's such a vital role in the medical decision-making not be able to be at the bedside to see the patient condition is hard. Right now, we're using a lot of virtual means to stay connected with family, so FaceTime, Zoom, Google Duo, all the things to really try to keep the family as in the loop as possible.

President Watkins: I'm guessing that is also an extra burden for you to manage while you're managing patient care. But I guess it's a part of patient care. Dave, maybe I could ask you what has been the most challenging part of this pandemic for you? Difficult moments and big challenges.

David Marple: Well, I think the biggest struggle for me has been just to see other people struggling to breathe. You know, I've seen a lot of sick people in the ICU, but never to this extent where people just cannot breathe. I understand how hard our jobs are, but if you imagine the patient, that must be a thousand times harder. So just to see these people, they're not in their element, they are totally blindsided by this. And just to be able to empathize with them has been the hardest thing.

President Watkins: Yes, it is. I mean, it's a horrible thing to think about that thing that we take so for granted, being able to breathe well, being such a vulnerability for so many people right now with COVID-19. Then I can ask you Christy, what's really difficult for you right now in this present environment and what's giving you hope through this time.

Christy Mulder: I think when I think of what's most difficult for me, I think of two things. It's hard to see patients isolated. It's hard to see families not be able to be with their loved ones. It's hard to see people dying alone. That's a very sobering thing when you are going to be the person that somebody dies with. And that's been hard, I think, in this pandemic.

The other thing is just seeing my friends, my coworkers really wrestle with how to take care of themselves while they take care of their patients. And that doesn't look the same for everybody. That's different. And so, watching as my friends figure that out. I think we're all learning new things about ourselves through this and how we cope in such various ways.

President Watkins: It must just be exhausting though. I'm so sorry that you both have to do this right now and I'm so glad you are doing it and grateful to you. What about your own risk? And of course, we're all very heartened as we listened to news about vaccines coming in and health workers, appropriately, getting vaccines first, which is absolutely critical. What has this high-risk environment required of you as you transition from work to home? And maybe Christy, you could answer that one, but I'm guessing you have to take additional precautions and spend a lot of time thinking about how you stay safe and how you support safety and well-being in your family.

Christy Mulder: Yeah, absolutely. I think I'll start off by saying that I feel very protected and safe at work. Thanks to the PPE that we do wear, I don't feel any more risk of exposure at work then than I would at a grocery store. So, I'll just start off by saying that, but definitely my routine of coming to and from work has changed since COVID. Changing scrubs, first of all, caring for patients in hospital-provided scrubs instead of my own personal scrubs. Coming home, instead of just throwing my dirty scrubs into the hamper, like I normally would, I put it right into the washer. I don't touch anything in my house, you know, changing my shoes before I step into my house. Things that I really didn't have to think about before. And Dave and I even joke because I started wearing scrub caps and just like, I don't know if COVID lives in your hair, but I don't want to lay on my pillow at night if I've been in a patient room all day. And so just little things that have definitely changed in the way that I come home after a shift.

President Watkins: I can imagine. And probably a whole new routine has developed as it has for almost all of us as we go about parts of our life. Well, let's take a minute here and get a little advice from you for our listeners. What would you like our listeners to know about COVID-19, about the pandemic, about what you're experiencing every day? And it'd good to hear from both of you on this question. Maybe we could start with you, Dave.

David Marple: Well, you hear this a lot, but COVID real and it's authentic. And I know there are people out there who deny it or do not believe that what's going on in our lives is happening right now. And it's sad to hear that. I know people are getting sick and an inordinate amount of people are dying from this illness. And we would just want everyone to know and understand the gravity of the situation. And it's unfortunate that most people don't grasp that until it happens in their life. We'd like people to know that we're working hard so it doesn't happen in your life. Nurses are particularly stressed out at this moment. It's a stressful job to start with, adding this illness makes it even more so. And it's not just nurses. Nurses get a lot of the spotlight because we are supposed to be superheroes and superhuman. In reality, we're not, we're just human beings, and the community can help us out.

President Watkins: I think though, that's, that's a good point that the community can help you out, help nurses do their job, by taking this seriously and wearing face coverings and staying out of social environments.

Christy Mulder: I think to add to that, it's a team effort. Everything that we are dealing with is a team effort. I think to really support one another, we have to think outside of ourselves, it's not just about you and if you get it, you might be fine, but you don't know how you getting it can affect somebody else in your life or in the community. And so being very sensitive to the fact that this is so much greater than just one individual and like what Dave said, we care about our community. We're working hard to provide the best care and in circumstances that are really hard, but the truth is that we're tired and we are, we're drained. We need endurance to keep caring for patients with empathy and with heart and . . .

President Watkins: You know, I think your message, Dave and Christy, to our community is really clear. And that is that we need everybody to take this seriously. To do the things that we can all do to support each other's health and well-being and to support our health professionals who are working so hard to keep people alive and well through this pandemic.

So, let me close with this, asking you both, what gives you hope? As you look around you, as you've met patients and families, what is helping you hold up through this time?

David Marple: We do have a lot of support and the community and lawmakers are finally getting on board and the vaccine is coming. So, we're hopeful for 2021 and hopefully it'll be a better year.

President Watkins: That's good. I think we all are looking forward with hope to 2021. Christy, anything you want to add?

Christy Mulder: I think I'd like to add that what gives me hope is knowing that pain and suffering is not it, that's not all that life is consisting of even though it feels like that a lot of the time in the ICU. So yeah, just knowing that this pain and suffering that we see patients go through, that we're going through has healthcare workers, it doesn't get the final say and it doesn't have to be all consuming like it may feel.

President Watkins: I'll tell you what gives me hope and it's meeting people like you, Dave and Christy, people that have worked so hard through this pandemic at University of Utah Health, we all owe you an enormous debt of gratitude. Please know that the university—and the community—appreciates you, appreciates what you've given up from your life and your time to help others through this pandemic.

Another thing that gives me hope is science and the fact that science and discovery and innovation is helping us through this pandemic. And we all need to do our part until such time as the vaccine has reached everyone.

Thank you both so much for what you're doing.

Listeners, thank you for joining us today for this edition of the U Rising podcast. And thank you most of all for doing everything you can to support health and safety in our community. So, here's to a better 2021. And I know we're going to get there with people like Christy and Dave helping us along the way.