Unit on the Brink: E5 - Keepers of Hope

Mitch: From University of Utah Health and The Scope Presents, this is Clinical.

I'm Mitch Sears, producer for The Scope Radio, and you're listening to episode five of our series "Unit on the Brink." This is a multi-part story told in order. And if you haven't listened to our previous episodes yet, we highly recommend you go back and start with episode one in your podcast app. Don't worry, we'll be here when you get back. And for everyone else, this is part five of "Unit on the Brink."

As the rest of the state seem to settle into the new normal, for the professionals in the medical intensive care unit, they were realizing that the battle against the novel coronavirus was becoming a war of attrition. The number of COVID-19 positive cases in the state were staying steady through the month of May. The hospital beds were still full of very sick patients with treatments lasting for weeks with some of the more severe cases.

Two months prior, an ambulance had pulled up to the University Hospital carrying a man experiencing severe pains in his chest and a shortness of breath. A 42-year-old veteran who had felt fine just a few days prior, just a little headache and a sore throat. But after being seen by doctors in Tooele, Utah, he crashed, falling into a state of fever, chills, and hypoxia. The man had to be put on a ventilator, and he was not getting any better. The virus had ravaged his lungs and he was unable to breathe.

If the medical professionals at university hospital weren't able to help his body get the oxygen that it so desperately needed, he would suffocate. It was time to call in reinforcements and try some extreme measures to save this man's life. It was time to call in the specialists in the cardiovascular intensive care unit. This episode follows the journey of one Rebecca Brim, the CVICU nurse over this man's care, and the intense emotional and psychological toll that caretakers face as they treat these COVID patients that are facing the gray line between life and death. Presented by Clinical and written and reported by Stephen Dark, this is episode five, "Keepers of Hope."

Stephen: For her 40th birthday, in April 2020, Rebecca Brim and her girlfriends booked a cruise ship to Catalina and Ensenada. Her dreams of lounging on a cruise ship deck, partying into the night and watching the sea glitter beneath the moonlight from her portside window began to crumble shortly after the new year. That was when the 15-year veteran charge nurse at university hospital's cardiovascular intensive care unit CVICU started watching with growing alarm events in Wuhan, China.

Female: The mystery virus started here in the city of Wuhan. Chinese authorities pinpointing its source to this food market. Dozens have been infected, but experts here believe the actual figure is closer to 1,700 cases.

Nurse Brim: It was like, oh damn, China's having a problem. You know, like, ooh, look at China. You know? And I remember talking to a coworker because it's a respiratory and like just the rumblings, you know, the news rumblings. And I remember talking to Kathleen at work like, "Hey, you heard about this mystery illness in China." And she's like, "Oh yeah, we're already talking about it." I was like, "Oh, for VV ECMO?" She's like, "Yep."

Stephen: The CVICU deals with everything between the diaphragm and the neck, Brim likes to say. And as its name implies, the biggest focus on the 20-bed unit tends to be the heart. All nurses who start work at the CVICU are trained on the ECMO, which stands for Extracorporeal Membrane Oxygenation.

It's essentially life support for the heart and lungs and can be a startling sight for the novice. In the ensuing months, Brim knew if the pandemic reached Utah, she and her colleagues will be called upon to help fight the respiratory virus. But as the winter months moves towards early spring, Brim's battles were closer to home with the growing anxiety she saw in her community.

Nurse Brim: And then come March was like, okay, well, what's going to happen? And by, you know, I kind of refused to give into any anxiety or craze or worry about it for quite a while. Like didn't stock up my pantries, wasn't doing that. I was like, "I'm not going nuts at Costco. I am not buying toilet paper. It's fine. We're fine. I don't need all this food."

Stephen: And then things got real. Her husband was told to work remotely from home. Her daughter's school sent her home for the remainder of the semester. Brim's anxiety started to climb as she worried about bringing the virus home to her husband and daughter. She knew the Medical Intensive Care Unit, the MICU was on the frontline caring for COVID-19 positive patients. She also knew that sooner or later she will be part of that same fight.

On March the 18th, a 5.7 earthquake hit Salt Lake City, escalating Brim's anxiety. "Is this the apocalypse?" her husband jokingly asked her. Brim wasn't amused. Then several days later, she got the assignment she had been expecting. She was sent to the MICU to oversee care for the first COVID-19 positive patient her unit would work on, Justin Christiansen, a 42-year-old Iraqi war veteran from Grantsville, Utah.

Justin was on DV ECMO, which was supporting his ailing lungs by pumping out his blood from a large vein in his neck, oxygenating it, and ventilating the CO2, then pumping it back into the same vein. That's what the VV means. Veno-venous, using the same vein. This gives lungs brutalized by both the virus and the medical treatment trying to defeat it a chance to rest. But Justin's oxygenator box needed to be replaced, which meant the life-saving tubes in his neck had to be clamped. With the VV ECMO clamped, oxygenated blood was no longer circulating to his lungs, which were drowning in thick secretions from the virus.

Nurse Brim: So we were up there in a foreign land of MICU corner pocket, negative pressure room, and I wasn't in there, so I was the charge nurse. So I stood at the doorway and like did a lot of looking in and answering questions for the nurse and passing in supplies. And because the second they put in that ECMO, it's us. And the MICU is great and they want to help, but they're like, "This is not what we do. This is what you do." And our team to our doctors take over taking care of them.

Stephen: She stood outside the room with the ICU attending, watching through the window as the nurse stopped the flow of oxygenated blood by literally clamping the tubes.

Nurse Brim: So when you clamp them, so the ventilator is still going and this guy has a beating heart, but you're stopping his lung support. So his oxygen levels start ticking down, and they got down to 20. You and I sitting here, we're probably 98. If you got lung disease, maybe, you know, like maybe you're a little lower, but we want higher than 92. So you and I are for sure higher than 92. This guy got down to 20, and this is not compatible with life. And I'm just sitting there like don't code, don't code don't, don't, don't, don't, don't because your heart can't necessarily beep.

Stephen: She needn't have worried she learned later. This patient was a survivor.

Nurse Brim: As I got to know this guy, realized he's tough as nails, and had I known him better I knew he wouldn't have coded then. So it was just scary.

Stephen: Brim went onto work every shift, treating Justin at the MICU. That his first name was the same as her husband's couldn't help but encourage her to identify with him, perhaps just a little more than she would other patients. She's been a nurse 15 years and knows all too well the dangers of connecting too closely with those she cares for particularly when it comes to a tough environment like the CVICU, where machines like the Mo as brim calls the ECMO, keep patients alive, in some cases long after much of their body has passed the point of revival. And when the decision has been made to turn off the Mo, it's Brim who has to flip the switch. This also involves clamping. And while such an act is a merciful one, it nevertheless haunts her.

Nurse Brim: There are things where, you know, a lot of times when we withdraw life support on an ECMO patient or a patient that has these, because like I said, with the machines in the unit that I work on, your body can stay alive indefinitely. I mean, it's unbelievable how long we can keep a body going on this life support. And when it's time to let them go, the person in there turning the machine off and clamping it is me. That's me. I'm the one ending their life by shutting because the second you shut that machine off, they're gone.

Even though it's the right thing to do and it's what they need and it's what everybody has agreed on, it doesn't make it easier. I just ended their life, and I got to go home from work with that. And then I got this amount of time to drive home from work and let it go. I end their life and then I got 20 minutes to pull it together and come home and be a wife and be a mom and talk to them. And I like, how do you do that? So I get help.

Stephen: Even with therapy and the support of her family, friends, and colleagues, sometimes it's just not enough. She simply has to let her pain out.

Nurse Brim: And my car was my emotional, my box of emotion. My car knows more about what I feel than any other thing in the world. If you had a camera in my car, you would because I've screamed in my car. I have like . . . my car is like my little private box of emotion, where it just explodes out. It's a Subaru. I have little Subaru Legacy. I got it in 2012.

If that car could talk, man, that car, because you know, part of that . . . well, I used to live in Draper. So I used to have 40 minutes to decompress, and I would sob the whole way home and the whole way to work every day. Like that's straight-up unsafe driving how hard I would cry in this car. Because by the time you walk in the door, you got to be like, "Hello. Hi, everyone." Or you get to work and you're like, "Here I am ready to go."

Stephen: Brim is a larger than life figure. One moment she's paragliding high in the Utah sky or standing on a paddleboard late at night on Mirror Lake, the Milky Way reflected in the dark waters around her. The next she's making clay coffee mugs in her home pottery studio. Talk to young CVICU nurses, and they express admiration for her. Brim made an immediate impact on Delaney Williams in 2017 shortly after she had started work at the CVICU.

Delaney: The first time I met Becky and I actually just thought of this, it was my last week of orientation and I had this patient who got flown in from I think it was Idaho, I can't remember, and he was having a heart attack. And so we were working him up, treating him, and then he all of a sudden stroked and then coded, and so we were throwing in bedside ECMO.

And I don't know if Becky, I don't think she was charging that day, but I remember Becky being next to me and my preceptor on the other side of me, and I was pushing meds during this code, which was one of the gnarlier codes I've seen in my career thus far. And I remember Becky just handing me flush after flush. And she's like, "You got this girl. You got this." And I actually think that was the first time I met Becky.

Stephen: Ask Brim to define what a nurse is and there's a lengthy silence. A day later, a two-page answer arrives in your inbox, peeling away the layers of what her vocation means to her. Most of all, she writes, she is an arbiter of hope.

Nurse Brim: I am the keeper of hope even when I know deep down that there is none. I am the keeper of hope when the family and the patient has lost all hope, but I know deep down that there is still hope.

Stephen: Brim was a teenager when she fell in love with nursing, thanks to the most heartfelt testimonial she could imagine from her father.

Nurse Brim: So my dad had two open-heart surgeries when I was young. One when I was in like third grade and then when I was in sixth grade. He had rheumatic fever when he was three or so. Damaged his heart. He had a murmur his whole life, and so he had to aortic valve replacements. And then in high school, when I was about 15, I remember distinctly had broken his leg riding a motorcycle and was sitting in the kitchen. Like the picture is so vivid. I wish I was a really good artist, I would draw it. He's sitting there and he's doing these like foot exercises. And I don't know how we got on it, but he said, "You know, the surgeons may have done my surgery, but the nurses saved my life." Like that quote is like I need to put it on the wall in my house. It just stuck.

Stephen: One of the interviews for this episode was conducted at Brim's rambler in Sandy, Utah. It is quiet one Sunday afternoon as she reminisces about nursing. After a while, you realize there's something missing, the tick-tock of a clock.

Nurse Brim: Yeah. My dad, you know, after his second heart surgery, he was pretty much like he wheeled and dealed in clocks, could fix clocks, was a clock collector. My mom's house is full of ticking clocks, which is funny because he had a mechanical valve so he clicked. So when there was no TV on, he ticked in addition to everything else, which I just love so much, but he literally ticked. He had a St. Jude valve, which is a metal cage and the ball goes up into the ball hits the cage and makes a clicking sound.

Stephen: Yet despite everything cardiovascular nurses and doctors did for her father, she shied away from the heart.

Nurse Brim: It's almost like I am called to be a nurse. I can't really explain it. There's not some I need to take care of my dad because I shied away from heart surgery patients forever. And I was like, "I don't like cardiac. I don't like heart surgeries. Trauma's my jam." Anything but heart surgery, you know, anything but heart surgery. It was kind of weird. I was like not into taking care of people like him. And now where I'm at, I take care of him all day long. So it just kind of fell into place and I love it.

Stephen: She moved to Salt Lake City in 1998 to be a ballet major at the University of Utah. After ballet fell through, she trained to be a nurse instead and in 2005 started working in the 20-bed university hospital surgical ICU. In 2014, the ICU was split into two units, one a surgical ICU and the other, the cardiovascular ICU, which absorbed all the cardiology patients previously treated by the medical ICU.

That left the MICU with critical illnesses that aren't surgical in origin and pulmonary disease, while the CVICU tackled heart failure, heart attacks, and lung and heart surgery. Justin Christiansen's medical needs as a COVID-19 patient not responding well to ventilator treatment brought the two units together. Brim's journey into the virus was threaded through not only overseeing the Mo in Justin's room but also connecting with her patient's wife.

Nurse Brim: Do you know, I got to know his wife more because I spent a lot of time taking care of him in his really critical phase when he was still heavily sedated, not awake, like kept him down because he would be very unstable when we would lighten his sedation, like heart rate, blood pressure, you know, oxygen levels. So he was very, very heavily sedated, and I spent a lot of time on the phone with his wife and a lot of time Skyping with his wife.

Stephen: The similarities between her husband and her patient wove their own spell.

Nurse Brim: It was a lot. I think because my husband's the same age, my husband has the same name, my husband's almost the same build as him. So it generated a lot of fear of COVID for me that I still have because I look at my husband and I go, "Damn, that could be you."

Stephen: And even as she helped care for Justin, the world outside continued to fall apart.

Nurse Brim: My sister and my brother-in-law are losing their job. My kids having panic attacks, like the world's falling apart. And then I'm here in it taking care of it. It's like all of it together, you know, one whole thing. And then here we are with the last-ditch effort, VV ECMO, which is what that is. Like, that's your last oomph like that we've got for people.

Stephen: After Justin had been weaned off the fentanyl and propofol used for sedation, she started to learn more about who he was.

Nurse Brim: He said this is easier than Iraq. And I was like, okay, I'm getting a picture of what kind of dude you are. And like, I was like, okay. So I would like to talk to him in a year and see if that's still like the case and see, yeah.

Stephen: In order to protect a patient's vocal cords while on a ventilator, surgeons will sometimes put an air vent in their throat called a tracheostomy and hook up the ventilator to the trach directly. Brim was one of the first nurses in the state, she says, to assist two surgeons performing the procedure on a COVID-19 positive patient.

Nurse Brim: We do trach people so we move their airway to down here. And so hopefully that helps because then they don't have the garden hose in there in their mouth.

Stephen: On April the 21st at 7:20 a.m., Brim and her colleague were at the nurses station. They could see the patient on a video camera while they were giving their report, and then everything went haywire.

Nurse Brim: I'm staring at the screen while they're talking, and all of a sudden the patient who had been flipping channels on the TV, very calm. I mean, he's trached, he's on the ventilator, he's got his ECMO, all, you know, all these IV pumps behind him, but he's chilling, watching TV, no sedation, starts flailing in the bed. He's coming unglued in the bed. Like something is wrong. Like one minute he's calm, and on the camera, he's coming apart in the bed flailing.

And so two nurses immediately grab PAPRs and I go to the doorway and it's negative pressure. So you can stand the doorway. So I opened the door, and I've just got an ear loop mask on. So I opened the door and I'm like, "Justin, calm down. We are coming in, like stop." And he starts, he like pulls at his trach, and he looks at me for a second and like grabs the rails and then he goes back to like . . . I don't know what's wrong. And he does one flop, and he reaches up to his neck.

Stephen: Unbeknownst to Brim, while rearranging his pillow, Justin accidentally knocked his trach and it blocked his airway. In his desperation at not being able to breathe, he unwittingly tried to yank out the tubes that were pumping his blood out and feeding it oxygenated back into his body. Pulling out the ECMO could have led to a massive hemorrhage. In all likelihood he would be dead in seconds.

Nurse Brim: He reaches up and he comes forward and he's got his ECMO in his hand, he's got both cannulas and he's coming forward. And that like his arm's extending and there was like there was no more standing at the door talking him down. He was pulling his ECMO out. It was coming out. It was going to happen. So I ran in there and just like grabbed his wrist and like eyes to eyes, you are going to kill yourself right now. Like, stop, stop. We're coming in. And so I held his hand because he's like, you know, got this tension on his hand. And I don't know, I stood there for a moment while they finished putting their PAPRs on.

Stephen: Afterwards, she tried to take stock of what had happened.

Nurse Brim: So I like changed my scrubs and got a new mask and washed, you know, my whole arms that were exposed and kind of sani-wiped my neck, but it was really frightening. I mean, I was real emotional about it, and I felt helpless at the doorway, you know, yelling at the guy just to stop. Because normally something like that happens and you just, you go in the room, you go in there, you just go to your patient when they're having a hard time. But instead I like froze at the door, you know, and there's this big push like you're first. You don't jump in front of the bus. You don't put yourself at risk. That's not what you do. But I couldn't stand at the doorway and watch him pull out his ECMO. That was like, and it was almost knee-jerk. To stand there and try and talk him down from the door was hard enough.

Stephen: She called work wellness and was initially told her risk was minimal. She could go home.

Nurse Brim: So that day I call and the guy I talked to was like, "Well, your risk is pretty much zero." I was like, "Okay." Went home. And I have my own protocol for entering the house. I go change my clothes before I leave work. I go straight to the laundry. I strip to naked and wash my scrubs and then I Clorox wipe everything that I've touched on the way to the shower. And so that's how I come home from work now, especially taking care of him for that, you know, all those shifts.

And then I don't come in and say hi to my family anymore. I come in through the garage and go straight to the laundry, and there's a tub of Clorox wipes there and then I backtrack up to the shower. I streak through my house naked to the shower, and then Clorox wipe like every doorknob, the garage door closer.

Stephen: So that's what she did. No need to change her routine, she thought.

Nurse Brim: I did that. I went home and I slept in the bed with my husband. I hugged my daughter, and I'm just so glad to be home from work. And I had this crazy thing, but they said my, you know what, I'm very clear with my husband, very open because I want him to be comfortable too. Because, you know, he worries like, "Well, should you be sleep . . ." Because we had many, many discussions, hours probably like, "Well, do I need to be sleeping in a separate room? Do I need to be social distancing from you guys?" We're all trying to figure it out. And then, so I went home that night and we haven't been . . . I was feeling comfortable with my PAPR and everything and entering my house in that way.

Stephen: The next day, the hospital called with distressing instructions. They wanted her to get tested for COVID-19 and quarantine for two weeks. The news felt like ice water on her family, and learning she would have to be tested, upset her. Like so many in the medical profession, Brim refused to even consider the possibility of being a patient herself.

Nurse Brim: She's like, "Well, we really want you to get tested. How do you feel about that?" And I said, "Well, to be real honest, I don't feel good about it at all. I am downright terrified. I don't want that test. I don't want to do it. But if you want me to do it, if I need to do it for my job, I will do it. I will do what I need to do for my job." I do a lot of things I don't want to do. I do a lot of things that aren't awesome. Here we go. Like if I need to, if that's what I need to do for my health, it's fine. Also fell on my 40th birthday weekend.

Stephen: Her 40th birthday, a time she had so looked forward to before the pandemic, when she would be on a cruise ship sipping margaritas with her gal pals. Instead, she was going to a parking lot in front of a health care center to get tested for COVID-19.

Nurse Brim: So my husband drives me to COVID testing, and I think it's the situation. I think if I was actually sick or I think I might have had a different mindset, but again, it's the whole thing of it. It's the whole, like, it was scary, it was emotional, and then now I'm off work and I'm supposed to be quarantining at home. I'm fine. No symptoms whatsoever. I'm taking my temperature. I got to answer these email things, and the girl comes up to me in a PAPR with the kit in her hand to my window and it's like, "You know what? I'm supposed to be in the one in the PAPR. I should not be in the seat." And so I kind of told her the situation and being a nurse like loving, like I got you girl, like that look like, like they made it like okay, these nurses.

Because I was like, you guys, like I told them what happened. And so, but this nurse in the PAPR with just and her like helper behind her, like just the look on their face was so comforting. And they like, one girl held my hand over here, and my husband held my hand over here. And they just, you know, I wish I could like hug them and tell them how much just their love meant. They're like, "We got you, like, you're one of us. Like we got you, girl. It's okay. You're okay. I promise we'll be gentle." And they were. I mean, I think they were as gentle as possible for a swab.

Stephen: When the result came back negative, she contacted work to ask if she could return.

Nurse Brim: They're like, nope, can't come back to work. And the first week I was off I tried to reframe it like a gift. Like, okay, I'm getting basically a 14-day paid staycation because they told me they would pay me out of their thing. And the first week I was fine, like, you know, hung out with my daughter. She's turned into a latchkey kid. You know, she's home alone a lot. And I can just hang out with my daughter and we did painting and we did homeschooling and I ran. I have a trail behind my house and went running.

And the second week at home, I don't know what happened to me. I just like, like emotionally, like took a dive. I don't know what my problem was. My anxiety was horrible, crying all the time.

Stephen: Her husband struggled to understand since she was negative why was she having such a hard time dealing with the day-to-day? But even her aging, sick dog's need to be put down was too much for her to bear.

Nurse Brim: And I've got this elderly dog at home. This is totally not nursing. This is just life right now. I've got this dog. He's 18 years old. He needs to go to heaven, and I can't do it. I can't do it. And I've messaged the vet a couple of times, and they won't come to the house.

Stephen: Her patient's and her dog's needs oddly merged.

Nurse Brim: He's given me the pleading look sometimes. I'm like, I know that look, dude, stop. I can't like . . . can you please pass on your own, because I can't clamp your ECMO right now, dude. It's like one of those like I can't clamp it. You're going to have to do it on your own.

Stephen: At the end of her leave, she returned to the hospital to find Justin had been discharged, but it was his wife with whom she felt she needed to say goodbye.

Nurse Brim: It's not uncommon for me to go see my patients up on the floor just to say, "Congratulations, look at you. You're getting better." So I messaged her and said, "Hey, I wasn't able to be there, but I just wanted to tell you, like, it was such a pleasure to take care of him. I'm so glad he got better. I think you guys are great. You know, wish you the best of luck. His recovery has been amazing."

Stephen: Despite how desperately sick Justin was, Brim never doubted he would one day make it home.

Nurse Brim: Oh no, not at all. I told her. I said, "There is no reason that he can't come home to you." And so I told her, I said, "There's not . . . I don't see any reason why. There is all the hope in the world."

Stephen: Brim has Buddhas all over her house, in her front garden, on shelves and the dining board in her living room. If she were religious, she says she'd be Buddhist. It's a faith meant for the nurses, it might be argued. After all, the goal of a Buddhist on earth is to ease the suffering of others she wrote in her email.

As a nurse, she not only eases suffering, she bears witness to life and its earthly ending. Sometimes she's the only witness to their death. But whatever her faith or her instincts about the gray line between life and death, she argues, it's all about looking, listening, being there in the moment.

Nurse Brim: Right? And you just kind of have to pay attention. You just have to pay attention. And there's been, I tell you there's been times when I think I'm so consumed with my personal life because, you know, personal life ups and downs, and it's not all . . . and sometimes you can't leave your personal life at home, and I think sometimes you get a little blocked as to what's going on or right in front of you in the room. But other times not, I don't know. There's been weird things that have happened over the years, that I'm not a religious person, but after working in the ICU for 15 years, I'm not nothing like, because what you see you believe and what you feel like you start looking at things differently.

Stephen: Months on from when she was tested, Brim still vividly remembers the compassion in the masked nurse's eyes as she swabbed her. The way the nurse had gripped her hand so lovingly stayed with her too, holding the very hand that had stopped her patient seconds before he pulled the life-saving tubes out of his neck.

It might seem that her career, her calling, her profession is often bittersweet, but she'll take the pain with the joy every time. There's so much beauty in or in the journey of a nurse in intensive care, she wrote in her email. Nurses have to see the pain and suffering to be able to savor the incredible saves that they are a part of. And for charge nurse, Rebecca Brim, the name Justin Christiansen will remain with her forever as one of those remarkable saves.

Mitch: Next time on "Unit on the Brink," for professionals in the medical intensive care unit, summertime is usually a time of rest and recollection with low patient numbers before the flu season starts in fall. But in 2020, the coronavirus pandemic persisted throughout the summer months with Utah numbers of COVID positive patients climbing even higher than we had seen in spring and hospitalization numbers were following suit.

You've listened to the real and raw tales of those healthcare workers holding the frontline, but the interviews you've heard so far, they were conducted in April and May of 2020, the very first months of COVID-19. How were the frontline workers holding up as we enter the seventh month of the global pandemic?

In the last week of August, the Clinical team sat down with frontline workers to check in and see how they were doing four months after we first spoke with them. Join us next week for the conclusion of our first Unit on the Brink series with episode six, "Waiting to Exhale."

Clinical is part of The Scope Presents Network and brought to you by University of Utah Health. If you liked what you heard, please be sure to subscribe and share with your friends. And if you haven't yet, why not give us a rating on Stitcher or Apple podcast? Those ratings really help new podcasts like ours. and it really makes our day to read them.

And to all the nurses, doctors, admins, interpreters, operators, technicians, and all the other hospital employees out there, we know you're listening and we want to hear from you. Do you have a frontline story or a message for us or for the people in our story? Feel free to share at our listener line at 1-601-55SCOPE. Again, that's 1-601-55SCOPE. Or email us at hello@thescoperadio.com.

And finally, be sure to visit our podcast companion site at thescoperadio.com/clinicalpodcast and click on "Voices from the Front Line". There, you can find bios and portraits of the professionals in our story, see what it looks like in the MICU, as well as bonus content we hope enhances your podcast experience. Again, that's thescoperadio.com/clinicalpodcast and click on "Voices from the Frontline".

Clinical is produced by me, Mitch Sears, and Stephen Dark. Music in this episode by ANBR, the Dave Roy Collective, Ian Post, Paper Planes and Ziv Moran. Audio news clips from Sky News.

Special thanks to Charlie Ehlert and Jessica Cagle for their work on the companion site. And of course, our heartfelt thanks to the men and women who have shared their stories with all of us and fight to this very day to keep each and every one of us safe.