Jun 23, 2021

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 9 of our series "Unit on the Brink." This is a multi-part story that is told in order. And if you haven't listened to our previous episodes yet, we highly recommend you go back and start with Episode 1 in your podcast app.

"Unit on the Brink" is a story that intimately explores the firsthand experience of medical frontline workers during the coronavirus pandemic. The stories that are shared are raw and occasionally deal with personal trauma. Listener discretion is advised.

For the frontline workers in our story, as the number of COVID patients continued to grow throughout the winter, there were moments where the end of the pandemic seems so very far away. If our visit to the unit on December 10th was any indication, the presence of SARS-CoV-2 had settled into the unit, establishing a new normal that tested the resilience of everyone in the unit.

The extensive safety protocols that had seemed so novel months prior had become second nature. That daily repetition of safety briefings with the rote recitation of COVID diagnosis after COVID diagnosis, the whoosh of PAPR is becoming the background noise of every patient interaction. The threat of infection becoming a gnawing thought in the back of the mind, but much quieter than it had been back in March. Day in, day out. COVID.

Hope it seemed was becoming hard to come by, but on the morning of December 15th, in a large exam room at the university hospital, things began to change. At 11:32 a.m., Utah's very first dose of Pfizer's COVID-19 vaccine was given to MICU charge nurse Christy Mulder. For those in the room, they describe an electric moment of excitement that seemed to jump from person to person as the needle pierced her arm, and a small round of applause broke out among the few people gathered there.

From the footage and photos of the event, you can see smiles break out on the face of everyone there, even if those smiles were covered by masks. Finally, a glimmer of hope, of protection, of an end to all of this. On this episode, we tell the story of one Christy Mulder, the woman who was the recipient of the very first dose of vaccine in the state of Utah. Her story is a reminder of the need for resources and a support system that every nurse, provider, and family member so needed to draw on in the face of the onslaught of cases.

And how faith, no matter what forms it takes, whether religious or simply the comfort to be found in Utah's landscapes, can provide a source of guidance even in the darkest of times. Hosted by Clinical, and written and reported by Stephen Dark, this is Episode 9 of "Unit On The Brink," "Keeping The Faith."

Stephen: When Christy Mulder graduated from nursing college, she knew she wanted to work in an ICU, having fallen in love with the fast-paced frontline work while a critical care intern at the Huntsman Cancer Institute. She applied to work at the Medical ICU in University Hospital, only need to be asked a question in her initial interview that would come back to haunt her.

Christy: And I remember in my interview, MICU, I remember being asked the question, "How do you cope with pain and suffering? Because you are going to see a lot of death and it's not going to be an easy place to work. So how are you going to cope with that?" And I was 21 when I graduated nursing school, I had no idea. I mean, I didn't even know anything about life, let alone death and pain and suffering.

Stephen: The MICU hired Mulder, and after a break to clear her head hiking with her father and then doing some global health work in Nepal, she started at the fourth floor Medical ICU. Like all newbies, Mulder found her first year on the unit a daunting daily visit, the fire hose that left her beyond exhausted.

Christy: You're running around just trying to keep people alive. And then I think after the first year, it kind of settles in and you're able to process a little bit more.

Stephen: A sense of where she was working became ever clearer that second year.

Christy: Just because, once everything settles in, you can actually open your eyes and process the death and suffering that surrounds you.

Stephen: And with the advent of the COVID 19 pandemic, that pointed, direct question from her interview would gain ever greater urgency and poignancy. It would force her, as it has done all who work there, to draw on resources, on personal strengths she might otherwise never have planned. And in Mulder case, it led her to draw on her spirituality.

To understand Mulder's journey, both as an ICU charge nurse and a person of faith, you have to go back to the roots of where she grew up. Mulder's parents came over from Vietnam. They were refugees, but not in the common sense of urgency you might associate with the boat people. They came years after. First her father, later her mother.

Christy: I mean, in one sense, yes, they came as refugees. My uncle came as a refugee right after the Vietnam War in the '70s, but my parents didn't come until '90s.

Stephen: Not that it wasn't for the want of trying.

Christy: My mom would tell me these amazing stories of when she was a young girl and trying to escape and get out of there. She would sneak out with her friends in the middle of the night and buy her way onto a boat to like leave. And she was unsuccessful. But no, I guess they didn't officially come as refugees, but in a sense, yes, because Vietnam was a terrible place to live when they were there.

Stephen: She grew up in Salt Lake Valley.

Christy: So I was raised in Vietnamese home, Vietnamese culture, which means, my parents were not really . . . they were kind of nominal Buddhists. So my dad grew up Catholic. My mom grew up Buddhist. And I guess a nominal Buddhist would look like a lot of ancestor worship, but just around a certain time of year.

Stephen: According to Mulder, her experience with Vietnamese culture isn't necessarily one that prioritizes warmth and human touch.

Christy: You don't touch each other. You don't . . . My mom tells me she loves me once a year on my birthday. Do I doubt that she loves me? Absolutely not, but that's just like we just don't. Vietnamese people don't share their emotions in any capacity. And it's very much like you just deal with it, you move on.

Stephen: Growing up in Utah, she struggled with the demands of the local culture and her place in it.

Christy: And I'm so ashamed and embarrassed to say this, but I think growing up here, I always wanted to be white. Like all my friends are white. Everybody I know is white. Why am I not white? I don't get it. Why is my family different? Why do I speak a different language? I mean, I didn't learn English until I went to school.

Stephen: At preschool, she confronted the unyieldingly pervasive nature of English beyond the walls of her home.

Christy: I have these like very short vivid memories of speaking Vietnamese to my teachers and had no idea what I was saying obviously. And I remember being so discouraged by that and just feeling like, wow, I feel really out of place here.

Stephen: As she grew older, so she started to carve out a sense of herself in the English language.

Christy: But then, you know, you adapt as most young kids do. I learned English very quickly. I learned cultural social skills very quickly, and then it became less of a problem. And now, I mean, I love that I grew up in a home that is very culturally Vietnamese. And then in a place in a city where it's also very culturally Utah, I don't know, American culture and Vietnamese culture mixed together and I love that. I love that I get to have both of that.

Stephen: As much as she came to know, through her social circles, a sense of Utah's unique religious culture, she nevertheless found far more questions than answers.

Christy: But of course, like growing up in Utah, I was very much exposed to the LDS culture. And so a lot of my friends were Mormon, and I grew up going to all the youth activities with them and hanging out with them. And I really wanted to be Mormon, because I wanted to fit in with that. But I think as I entered into young adult college, I started to question a lot of things and felt like I'm not quite sure I understand this. I just had lots of questions. I was pretty open to all sorts of worldviews and interested in different worldviews.

Stephen: In college, she met a friend who was Christian.

Christy: The biggest thing that stood out to me about her was she had a deep friendship with God that seemed very genuine and very personable. And that was very foreign to me because I was like, whoa. I think in my head, God was always like somebody who was far off, like watching you and telling you to do these things. And then you do these things and then you like earn your way. But this friend, she just, she was very clear that, you know, this is my relationship with God. I don't have to earn my way before him. He loves me just as I am.

Stephen: That friendship was also composed of many conversations about the possibilities of faith.

Christy: I think ultimately I really came to believe that I have nothing to offer God and yet He still loves me and cares for me and desires to know me. And I think that's been freeing, you know, not to have like this expectation to be a certain way or live a certain way or whatever. And He doesn't see us as these people who need to be perfect. It's like if you are broken and if you are needy, like even more so does He want to draw closer to you.

Stephen: It was that understanding, that coming to terms with the messy complexities of life that, in some sense, helped her confront the challenges of caring for COVID-19 ravaged patients. And for her then colleague charge nurse Cat Coe, Mulder's strength in the face of the virus' onslaught, helped her face those same difficulties.

Cat: She definitely turns to her faith consistently to help sort of make sense of and cope with everything that we see. And she . . . I would not consider myself religious, but I do find that talking to her about these things, whether she brings religion into it or not is very helpful.

Stephen: Something in the strength that helps anchor Mulder through the pandemic also helps deepen the bond between the two friends.

Christy: One thing that Cat and I have really grown in our friendship together is to be able to look at the situation we're in and realize like this is hard stuff that we're seeing. We're seeing people die, we're seeing people suffer, and we don't have to put this perfect bubble wrap over it and say that everything is fine because it's not. And that's okay to just take that as it is.

Stephen: Friendship is what nursing is all about, says the MICU's nursing manager, Naydean Reed.

Naydean: That's one of the things that I've noticed, like especially with critical care, but in all nursing, I think. You go through these extremely traumatic events and, you know, the traumas happening to other people, but you you're there witnessing it. You're living through it. You're trying to save their lives. And I think when you go through something like that with somebody, there's an intimacy that forms between you and your coworkers that I can't . . . I mean, I can't even explain it other than to say it's an intimacy and a bond.

Stephen: Nursing creates bonds of strength, of love the last decades, even a lifetime says, Reed.

Naydean: And I have people that I worked with, I don't know, close to 30 years ago that they call me up randomly and say, "Hey, I need this." And you would drop everything and go do it for them, because there's just like this bond that you can't even, I don't know. I can't even explain it, but it is. It's an intimacy that you have with your coworkers when you're trying to save someone's life.

And like these nurses that have been through this for this last year, I definitely see that with them. And I would see it when they would come to my office and just like almost in tears because they're so worried about their coworkers and, you know, "Hey, I talked to this person last night. I don't know if they're going to be okay. Will you please check on them?" And you would see that before, but they just care so deeply for each other now. It's they've been through so much trauma together.

Stephen: Each person reacts to patients suffering in their own way.

Christy: I think a lot of nurses it's easier for them to just not feel that pain. Like we all cope differently. We all respond so differently to these situations. And for some, it's just numbing themselves. They go to work, they do their thing, they leave, they cut it off. And however you cope, that that's how you're going to cope. And I think, over time, I've seen nurses, healthcare workers who are just jaded. And I think if you're jaded, you shouldn't be in the ICU. And that might be a way of coping, but I don't think it's a healthy one.

Stephen: By her second year at the MICU, Mulder's uneasy relationship with the pain and suffering around her was one she managed to push largely to one side.

Christy: I think for a long time I didn't know how to process it. And it was easier to not. It was easier to just not think about it, to just go home from work and just move on with your life.

Stephen: But towards the end of her second year, a really bad flu season hit.

Man: Coughing, sneezing, body aches, and fever are impacting a lot of people in Utah right now.

Man 2: In this country, the flu has reached epidemic proportions. The CDC reported today that the virus is now widespread across the entire continental United States. Twenty children have died. Just over 100 died last flu season.

Man 3: The Utah Department of Health is now saying influenza is on the rise. More than 400 Utahans had been hospitalized because of the flu. Most of them older than 65.

Stephen: A confrontation with death proved unavoidable.

Christy: It felt like every shift I worked there was somebody who died. And that's when it really hit me hard, and I remember like just feeling so low and not really like being able to like process through it very well.

Stephen: At her Salt Lake City church, one Sunday in February 2018, during this deeply troubling time, it seemed as if her pastor was in some way speaking directly to her from a passage from the Book of John.

Christy: It was a sermon on death and suffering essentially, which was everything I was going through in the MICU. And the sermon helped me process through a lot.

Stephen: Mulder found in just two words an answer to her struggles.

Christy: I just remember it so distinctly, a sermon about how Lazarus dies and Jesus feels that weight and that suffering and that pain. And I think, and then he cries. It's like Jesus wept. I think that's the shortest verse in the Bible or something. I don't know. But Jesus wept, and I think that to me, it was like, oh, wow, okay. Yeah. This was not like . . . this is meant to be painful. This is meant to be heavy. We are supposed to cry. We're supposed to be broken over death because it's a painful thing.

Stephen: Two years later, in the early spring of 2020, as COVID-19 hit hard and held onto the lives of MICU staff with ever-growing tenacity, that lesson came back to her.

Christy: And so I think that has played in my head through COVID a lot because I had a feeling, when COVID hit, that I would feel that same kind of heaviness that I felt two years ago. It's different, but I think a similar idea of needing to hold on to this hope.

Stephen: Many of Mulder's colleagues reached out to therapy or embraced nature for support, says Reed.

Naydean: They got really tired. And I think some of them looked to each other a lot, I think. They organized different exercise groups outside of work. They would go on hikes. One of our nurses, Jared, was fantastic with trying to get people together. He'd have them out in his backyard and they'd have cookouts. And he did a really good job. I think they looked to each other.

Stephen: Reed relied on audiobooks to escape into her own little world. But as summer came with it rising rates of infections, she too struggled.

Naydean: But you, my son, Ruben, who you met in the beginning when I'd come home and I'd like to take my shoes off, my husband would bring me a glass of wine. I'd go out on the back porch. I wash down all my stuff, and I would just sit out there and I would just like cry.

And when my son came home from Costa Rica, I overheard Ruben talking to him and he's like, you know, "Mom's different, right?" He's like, "Well, what do you mean?" He's like, "Well, she just comes home from work, and she sits on the patio. And she drinks a glass of wine, and she cries for a little while, and then she comes in and has dinner."

Stephen: And then the virus hit home to her in a way she never would have expected.

Naydean: I had a really close friend take his life in February. And he was at an ER physician, and COVID was just too much for him and he just couldn't do it anymore. And then when that happened, that kind of put me over the edge.

Stephen: One thing was COVID-19's devastating impact on her unit's patients. Another learning that the horrors of the pandemic had cost the life of someone she loved.

Naydean: Yeah, it was just so personal and so close and somebody that I loved and admired so much. And I mean, I think it just brings home that, you know, even though so many people are dying of COVID, there are also have been so many suicides over this last year.

And, you know, I know of the two that affected me personally, but I just think there's a lot. So much mental health, and, you know, it's just, I don't know, just all the isolation and everything. It's been hard to watch.

Stephen: In an article on the website, Kevin MD, a palliative care doctor described the deeply erosive feeling of powerlessness that came from watching his patients die from the virus. The provider wrote, "We are morally injured and unable to reconcile what we have experienced with who we are as healers." Through the suicide of her friend and all that her nurses and she have gone through, Reed understands these words all too well.

Naydean: It's just hard to watch that time and time and time again. And I think that that helplessness of not being able to stop this disease, not being able to do anything for these patients, and just watching so many of them just die in front of you. And I liked how he articulated in the article that like these are good people.

Stephen: That phrase, "moral injury," sounded the depths of the despair that the virus has driven so many to.

Naydean: It makes you question, why you're . . . why am I doing this? Why do I keep coming day after day when I . . . am I even making a difference?

Stephen: Mulder saw her colleagues struggling with those same questions.

Christy: Truthfully, it's just, that has been, I think, more than the death and the pain and the loneliness. The hardest thing for me about all of this is seeing people that I love, like Cat, just go through a really hard time. And it's sweet because we get to go through this hard time together, but that's been a bigger weight for me.

And so I think to see friends feel very depressed and very at their wit's end, that's been the hardest and the best part about all of this, because it's provided for a deep opportunity to grow our friendship and care for each other and love each other well during a hard season.

Stephen: She is more than aware that faith isn't for everyone and that others have different ways in the face of the pandemic of coping, of fortifying themselves, or blocking out what they've been through.

Christy: Some people are going home and numbing themselves with alcohol or TV or video games or whatever they're numbing themselves with. Other people are numbing themselves with, you know, staying busy, whatever that looks like for them outdoors. I think, you know, obviously, the outdoors are amazing. They're beautiful, especially here in Utah.

Stephen: It was in the outdoors that Reed found a measure of comfort after losing her friend.

Naydean: I think there are a lot that rely on nature and getting outdoors. A lot of the staff on their days off, they're down in the desert, they're out in the mountains, and that is their spirituality. That is their escape. I was finally able to get out to the desert about two or three weeks ago. I just went overnight by myself, sat in the dirt, and went for hikes and it's just like so healing.

I mean, I think if I had anything, that would be the closest thing to my religion. And I know, Eli, one of our nurses, he goes every single day off he's down there in the desert. Sam, same thing. He's out doing things. Kirk and Jared and a lot of the nurses climb.

So I think, you know, Christy has her spirituality and I think that for a lot of these nurses, that is their spirituality. However you say it. That's where they go to find their refuge and where they refill their buckets and make it so that they can come back and do it again.

Stephen: Reed drove the two and a half hours to the wedge overlook in Emery County, Utah. She pitched her tent along the ridge of what's called the Little Grand Canyon, a timeless red rock canyon formed by millions of years of erosion by the San Rafael River.

Naydean: Yeah. I just went and went for a hike and built a campfire and listened to my book and drank some whiskey and went to bed and got up the next morning and went for a nice long hike. It was really, really nice. It was very peaceful just to get out there by myself and think.

Stephen: By the end of 2020, as the attrition rate in staff departures at the unit continued to climb, even Mulder started to think about leaving.

Christy: I'm part-time. So instead of working three days a week, I work two days a week. And I think that makes a huge difference. I'm just not there as much.

Yeah. I think when I have friends that a lot of my dear friends have left. Cat resigned recently and she put in her two weeks. So when people you love and respect and care for are starting to be done, naturally you're going to question the same thing.

Stephen: On the days when she felt too exhausted to keep going, her Wisconsin-born husband supported her through prayer.

Christy: He prays for me every morning before I go to work. Sometimes I don't even have the energy or desire to pray. Just like, I'm just like, okay, here we go.

I'm so wrapped up in this like mountain I have to climb up the workday. It's good to have somebody like my husband, who is just like, hey, before you walk out the door, like God help Christy to be a good nurse today. That's all he says. And that's like enough to just remind me that, you know, I desire to be a nurse that's honoring before God with integrity and do what I do with intentionality instead of just this thing that I do.

Stephen: Mid-December, 2020, Reed asked Mulder if she was interested in being the first person in the MICU to receive a dose of the Pfizer vaccine.

Heidi: Light at the end of what has been a very dark tunnel. That's how Utah frontline workers are describing the rollout of the Pfizer vaccine today. Ginna Roe kicks off our team coverage this evening. Ginna.

Ginna: Yeah, Heidi in the last half hour, I actually heard from U of U Health, and they tell me they have vaccinated 80 healthcare workers so far today, and they are still vaccinating right now. Now, that some of these healthcare workers held back tears today. They said they're emotional. They're proud to be getting this vaccine out and to be getting this message out to Utah public.

Christy: It feels like a weight lifted off.

Ginna: Christy Mulder, the first Utahans receive the Pfizer vaccine says she's overwhelmed by what this means.

Christy: As healthcare workers, on one hand, it's, it's an honor to be able to care for our community during this time.

Ginna: For the frontline workers who have been at the heart of this battle today is the beginning to an end.

Stephen: After nine months of the pandemic, the dramatic arrival of the vaccine proved a game-changer for the MICU staff.

Christy: I think the vaccine coming has been a huge morale booster for our unit, a huge ray of hope, and a next step for all of us. Just a pretty clear vision of, okay, this going to end at some point. We're making huge progress towards that, so I think it's been really encouraging for everyone on the unit to have the vaccine.

Stephen: It brought her a measure of fleeting fame. Interviews with media, local and national, and also a curious Utahan honor being drawn by The Salt Lake Tribune's legendary cartoonist, Pat Bagley.

Christy: Honestly, I didn't even know who Pat Bagley was. And then Hatton was like he is very famous. I was like, oh, cool. Like, that's awesome. That's really exciting, but I didn't know who he was before.

Stephen: She didn't feel anything with the first shot, something she attributes to the excitement.

Christy: Lots of cameras. I just like, I think there were more cameras on my second dose. Lots of people like constant photos, several news stations, videos, like it was a pretty big deal. Lots of cameras at the first one too.

As far as getting the vaccine itself, no pain. Like I didn't even feel the needle. I think it was all the adrenaline. I didn't feel the needle at all. Now that we're 25 hours out, like I have a headache. I feel very tired and just achy.

Stephen: That Mulder was first in line didn't come as a surprise to her friend, Cat Coe.

Cat: Christy is universally well-liked on the unit. She is a charge nurse. She's been there for, I don't know, maybe four and a half years, and she has been a huge reason why I have stayed in that job. She's wonderful.

Stephen: Despite the glimmer of hope the vaccine represented, Mulder didn't want to simply rush away from what's happened.

Christy: I think it's still going to be a long road and a lot of recovery from, you know, even if we are on the downhill. I do think that is still important to keep processing. Not like be in a hurry, to blow past everything, you know, but actually take time to process.

That's what I've been really like talking to Cat a lot about was like, hey, you're not at MICU anymore. Like I need like take time to process because you're coming down from heavy, heavy stuff. So don't just blow past it and move on to your next job. Like actually take time to think and reflect on the last year of life and really just your time on MICU as a whole.

Stephen: On May 6th, Mulder completed her last day at the MICU. The following day, she graduated as a family nurse practitioner before heading to Alaska with her husband to go backpacking, along with taking time to simply rest and reflect.

Cat Coe was never far from her thoughts. In part, because she was a reminder of how important processing the past year they spent together really was.

Christy: And I've appreciated my friendship with Cat and a few others in that way of just like being able to confront it and face it. And it's not easy, but I think that's better than, you know, looking forward to something else constantly that you're never really processing what you're going through right now. Or hiding it so deep down and covering it up with so many whatever various coping mechanisms, jokes, laugh, being jadedness. It's just like, I don't think that's as helpful long-term for the PTSD that we may be feeling.

Stephen: Mulder and Cat Coe are bound together by more than simply nursing during a pandemic.

Christy: I mean, Cat has said that to me several times, like, man, I feel like I have this wartime camaraderie with you. And I guess I didn't think about it that way until she said it, but I was like, yeah, that's true.

Stephen: Even though many have left, it's the experience of providing care during the coronavirus pandemic that binds these men and women to each other in a way that few say veterans of wartime conflict can truly understand.

Christy: We have gone through things. I mean, as nurses, we experience things together that normal people don't experience together with their coworkers and colleagues. So there's this pretty . . . just COVID aside, I think there's a pretty profound relationship that nurses can have through their job together. And I love being a nurse and I'm so thankful that I get to be a nurse during COVID, even if it has been really hard. I think it's an honor.

Mitch: 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'd like to see images from our visit to the MICU from the extremely talented photographer, Bryan Jones, take a look in the show notes for a link to the "Keep Breathing" multimedia story written by Stephen Dark and designed by Stace Hasegawa.

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, message for us or someone in our story? Feel free to share it at our listener line at 1-601-55SCOPE. Again, that's 1-601-55SCOPE. Or email us at hello@thescoperadio.com.

Clinical is produced by me, Mitch Sears, and Stephen Dark. Music in this episode by Annie Zhao, "Beneath The Mountain," The Church of Jesus Christ of Latter-day Saints, Ian Post, ANBR, and Yehezkel Raz. News clips provided by FOX13 and KUTV.

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.

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