With COVID-19 vaccines providing light at the end of the tunnel, we catch up with ICU nurse Jessica Montanaro, MSN, RN, nine months after our first interview to find out how she's doing, what she's learned this year, and how she and her team are fighting the pandemic's third wave. Ms. Montanaro is Assistant Nursing Care Coordinator, Medical Surgical Trauma ICU at Mount Sinai Morningside.
Get the latest on COVID-19 vaccines
https://www.mountsinai.org/about/covid19/vaccine-information
COVID-19 Facts and Resources
https://www.mountsinai.org/about/covid19
Mount Sinai Morningside:
https://www.mountsinai.org/locations/morningside
If you're enjoying Road to Resilience, please review us on Apple Podcasts. It helps new listeners discover the show. Thanks!
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Learn more about the podcast on our homepage.
Feedback and guest suggestions welcome! Email us at podcasts@mountsinai.org
Road to Resilience is a proud production of the Mount Sinai Health System.
Check out more episodes of Road to Resilience —as well as guest pictures, transcripts, and more— on the Mount Sinai website.
Road to Resilience brings you stories and insights to help you thrive in a challenging world. From fighting burnout and trauma to building resilient families, we explore what’s possible when science meets the human spirit.
With COVID-19 vaccines providing light at the end of the tunnel, we catch up with ICU nurse Jessica Montanaro, MSN, RN, nine months after our first interview to find out how she's doing, what she's learned this year, and how she and her team are fighting the pandemic's third wave. Ms. Montanaro is Assistant Nursing Care Coordinator, Medical Surgical Trauma ICU at Mount Sinai Morningside.
Get the latest on COVID-19 vaccines
https://www.mountsinai.org/about/covid19/vaccine-information
COVID-19 Facts and Resources
https://www.mountsinai.org/about/covid19
Mount Sinai Morningside:
https://www.mountsinai.org/locations/morningside
If you're enjoying Road to Resilience, please review us on Apple Podcasts. It helps new listeners discover the show. Thanks!
Sign up for our monthly newsletter.
Learn more about the podcast on our homepage.
Feedback and guest suggestions welcome! Email us at podcasts@mountsinai.org
Road to Resilience is a proud production of the Mount Sinai Health System.
Check out more episodes of Road to Resilience —as well as guest pictures, transcripts, and more— on the Mount Sinai website.
Road to Resilience brings you stories and insights to help you thrive in a challenging world. From fighting burnout and trauma to building resilient families, we explore what’s possible when science meets the human spirit.
From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about facing adversity. I'm Jon Earle. It's a historic week. A COVID-19 vaccine has arrived at New York hospitals, including Mount Sinai. It's a week to be grateful. A week to rededicate ourselves to doing our part, whatever that may be, to get this thing over with. Because according to my guests this week, we're not out of the woods yet. This is our end of the year episode. And typically what we do with an end of the year episode is we look back over the past year and we find our favorite moments. And then we share them, talk about them. But it hasn't been a normal year, and it's not going to be a normal end-of-year episode. So what we decided to do instead was bring back our first two guests from our COVID-19 series. These are the people who, personally speaking, shocked me into understanding what this whole pandemic was about, what we were up against. And I wanted to catch up with them, see how they've been, and of course ask the big questions: What have they learned, including about resilience? And where do we go from here? So we're breaking it up into two episodes. The first episode, part one, is with Jessica Montanaro. She's a ICU nurse at Mount Sinai Morningside. And in March when we talked, she told me about what it was like to treat COVID-19 patients and the toll it was taking on her and her colleagues. When we caught up last week, she and her team were ramping up to fight the current wave. Jessica Montanaro, welcome back to Road to Resilience.
JESSICA MONTANARO:Thank you for having me.
HOST:So we spoke last on March 26th. That was about nine months ago. And at the time there were about 150 COVID-19 positive patients in our ICUs. The number would essentially triple in the weeks after that. And I want to start out by playing a clip from our interview that describes you kind of running around. And I want to hear what your reaction is to that clip.
[CLIP] JESSICA:We have a very big unit physically, and I'll be standing at one end. And then I see like 10 people running to a room on the other end and we're running down there and we just get that taken care of. And then you see 10 more people going a different direction to another room, and then we're running over there to see what's going on. So it's been that type of environment.
HOST:What's it like for you to hear that clip?
JESSICA MONTANARO:In some ways it's a gut punch because as I hear the clip it brings me right back to the unit and remembering exactly what I was seeing. It seems surreal that we lived through that, to be honest with you. It's also something that's really never far from my thoughts. I feel like we go on with life, and obviously we've moved forward nine months, but that experience that I just heard, that I shared really, I think, has stayed with me in some form. I can recall in a minute, but it's kind of unbelievable.
HOST:I know the numbers right now are not where they were when we recorded, but the numbers are rising. And I was wondering if you could paint a picture for us of what that place is like now?
JESSICA MONTANARO:I think I'd like to start with after all of that intense surge for us in our ICU, which was about, I would say, sustained for like two months, we went into a post-COVID recovery phase. And just trying to get back to some kind of normalization, if you will, in terms of standards and even just how we think as clinicians. Because during that time we were just, our whole thinking had to change about how we were approaching these patients and everything. So getting back to standards, getting back to normalizing things. And we had, obviously, a short period of that. And I think we did quite well during that phase. All the while I think not far from any of our minds that the winter months potentially were again going to be very difficult. So now that we're here, I would say that, you know, it's not that chaotic scene that I described during our last interview. So the current picture is a lot more of a controlled scene, and patients are coming in with COVID into the ICU. It doesn't feel today, and I don't know what the next four weeks will bring, but today it seems more controlled. But it's not un-devastating. It's still extremely devastating. So I can go two aspects with this. I can talk about the environment, but there's a whole personal side that I think is a layer and an element that's happening now with the staff related to those earlier experiences.
HOST:Tell me about that side.
JESSICA MONTANARO:It's been really hard. I'll be honest with you. The other day, maybe late last week, we had a huddle explaining that we were going into surge mode. Just that we were going to start activating, you know, increasing capacity for beds. And immediately my body reacted, I would say, in a visceral way. And there was, like, an adrenaline that came over me. And all of a sudden you could just feel the energy change in the ICU. We were moving at a little bit faster pace, and yet it wasn't like we were getting an influx of patients. We were just preparing. And then the personal side is as nurses in the unit started to hear that this was the message coming from administration, there were tears, still ongoing, I would say, a lot of anxiety, a lot of expressing the fact that it was scary. I know we can get through this. We know what we're doing. We have better systems in place, but there's a lot of fear and there's a lot of anxiety and there's a lot of flashbacks, if you will, over what we lived through. And the other thing that I think is that, you know, when we went through this at the beginning, there was so much fear involved. We were terrified. I can speak personally. We didn't know if we could touch the countertops. We didn't know if we could touch door handles. We had no idea how we were going to contract this. And if we did, how fast it would overcome us. And so I think because we've been doing this now for nine months, the fear is not as intense or not really there, if you will, the way it was, of this unknown that we were facing back in March. However, it's now almost just kind of exhaustion and despair. It's not fear it's--we're going into it with no reserve.
HOST:No reserve of?
JESSICA MONTANARO:No reserve. We have no reserve. There's no energy reserve. There's no--we're tired. And I think that, I know for me and I speak to my other colleagues, we're front-line workers and we're health care professionals. And we have been saturated with deaths and sickness. And that's what we do, right? This is a calling for many of us. But on the other side of that, we've all been living through this as people, not front-line workers. We're going into this second wave with going through almost a year of our own personal social distancing and not seeing our families and our own personal things that have gone on for us and the heavy weight that the world is feeling. We have that on top of it. So I think it's just compounded.
HOST:I know there's been a lot of positive news recently regarding vaccines, and I'm wondering how you see that. Does it feel like the light at the end of the tunnel, or does it feel different?
JESSICA MONTANARO:It's a light at the end of the tunnel for me personally, because I know I will take the vaccine and I have hope that we will have an ending to this. It's not an immediate light at the end of the tunnel. Because I know we have a lot of hard work ahead of us over the next few months. And I'm worried about the fact that there's so much mistrust and fear from people who don't want to take this. I'm worried about our minority communities who have a longstanding mistrust with the health care system, because they are the ones being hit the hardest, and that's my main demographic of patients. And so I don't know how I feel about it. I'm thrilled. I'm glad that we're on a path to hopeful recovery, but I think we have some very difficult times awaiting us, unfortunately, over the next couple of months.
HOST:So it doesn't sound like it dramatically changes the picture for you of what the next few months might look like?
JESSICA MONTANARO:No, I mean, not what I think we're going to face for working purposes. Because I think we're still going to be faced with death and sickness. And, you know, I was struck when I came back from the Thanksgiving holiday, we had like a mother and daughter with COVID in the ICU. We had a husband in the ICU whose wife had COVID and was in the emergency room. So a lot of families.
HOST:Is there going to be a piece of mind, though, that comes with once you're vaccinated? You can go to work with more confidence, or does it ease fear at all?
JESSICA MONTANARO:Yeah, I mean, it will, yes, definitely make me more confident or at peace once I'm vaccinated. I don't think, though, until we get wide distribution and a whole bunch of people ready to take this--that's a separate piece because the physical labor of the work and the emotional stress of the decompensation and the death are separate because that's still going to be there. So while I have, through this entire thing, felt a call to duty and have not shied away. And really just, I felt now that I reflect back on those early times, I had a call to run into the fire. That's how I felt. I felt like the house was burning, and my people were in there, and I did not want to be home. I wanted to be there with my people. And so, I think, yeah, I've always been worried about myself, but I've always kind of just done what I've had to do. So I'll have some peace of mind, hopefully, that I'm more protected. I'm very careful about the precautions I take at work, but again, that's separate from knowing that we still have this potential devastation ahead of us as front-line workers, that we're going to have to care for until probably the summer.
HOST:Let's go to the next clip.
[CLIP] JESSICA:Calm through chaos. And so I kind of tried to make that my mantra. And I'll say that to myself. And I have every single intention of living that when I get into work. But when I get there, it's so chaotic. The level of stress—you just walk in, it hits you in the face. It's hard to not get swept up by that.
HOST:I'm wondering how that rings to you now. And whether that's something you still tell yourself, or whether that's changed?
JESSICA MONTANARO:I'm so grateful that I had that mantra, and it kind of became the mantra among a lot of us. So yeah, I hear that. And in a weird way, I guess, it brings a smile to my face because that was really so true. It was just focusing on calm through the massive chaos that was around me. Does that ring true today? It doesn't because it does not feel chaotic. The anticipation feels a little scary, but I almost have this confidence that we are so much better than where we were in March in terms of knowledge, in terms of systems having to be in place. We're preparing our equipment the way we learned how to do it over that surge. So for me, I don't know that I have an exact mantra for this, but I am filled with a confidence that I didn't have back in March.
HOST:And I think it's a great lesson about fear. That information and experience are the two great antidotes to fear.
JESSICA MONTANARO:Yes, absolutely. And it doesn't mean I like this. And it doesn't mean that I'm thrilled we're going through this. And it doesn't mean that people aren't having—my colleagues aren't having anxiety. And it's the type of death that is sad.
HOST:Do you mean by the"type of death" the isolation?
JESSICA MONTANARO:I think it's isolation. I think it's, you know, COVID ravages the lungs. And if you can't breathe, it's not a pretty thing. It's very sad to watch patients who are on a ventilator. It's frustrating as a clinician to provide someone with an airway and a way to breathe, and then their lungs collapse despite that. And we're doing all of these interventions with chest tubes and all this stuff to help mitigate decompensation. And it just doesn't work sometimes. And we are doing everything we can in our toolbox, and it's very frustrating and it's sad. And I have been extremely reflective in my own personal life as a critical care nurse. I'm so passionate about critical care. And I love my job and I love my profession. This has brought me a lot of time to contemplate on how we integrate palliative care and really peaceful death and quality of life for our critical care patients.
HOST:What are some of the thoughts you've been having along those lines?
JESSICA MONTANARO:I think that we need to have a conversation early with people about what type of death that they would like. And I don't think that, as a society or our culture, we talk about that enough. I think that we wind up, unfortunately, in Western medicine, in these emergency situations and families are not prepared to let go of their loved one. And so we say,"Do everything. Do everything you can to save this patient," not understanding that that really is going to maybe be painful for them, right? Or it's not going to be really what that patient wanted, but it's because of our own inability to maybe just accept that death is a part of life. And in no way am I saying that we should just let people die, but it has really made me reflect on what measures we allow ourselves to go to as a health care system to save people. And when we do, what kind of quality of life will they have after they've gone through all of these interventions. So a lot of heavy thoughts, I would say, this year.
HOST:I wonder in terms of the long-term effects of COVID on how we do medicine--I wonder whether bringing palliative care into it sooner and in a more comprehensive way will be one of the long-term effects?
JESSICA MONTANARO:My big wish in health care is that--and as a society or Western medical society--is that we really can integrate that in a much greater way in the critical care world than we are. And it's there. It's definitely there. It's important. We have a wonderful palliative care team and they were so helpful and integral during that surge with connecting families and having those hard discussions. I just wish that we move to a place where we can do that sooner. And a lot of it is that we think we should live forever in this country, and we're afraid of death, and we don't have a sense of being able to let go. And it's not judgment that I say that. I've had my own personal losses and had to contemplate those things. But it's also put me in great touch with my own mortality, watching all of this death. And the types of death that people are going through and having those conversations with my husband.
HOST:Well, that really brings me to the last thing I wanted to talk to you about, which is how you've changed.
JESSICA MONTANARO:Ah, that's a tough question. How have I changed? Well, I think what first comes to mind is that I have done a lot of reflecting and self-contemplating, and I really just not learned, because I think I always knew this about myself. So I guess I just really cemented the fact that I am a resilient person, and I know that I have that in me. And I'm so grateful for that. I think that it's made me change in the fact that I'm really tired this year. I'm emotionally, physically tired. And to give myself permission to maybe not get that whole to-do list done, right. I live by lists and, you know, I have stress if it's not crossed off and done. And to really give myself permission to not have to get that to-do list done. I think it has made me evaluate what's important in life. And then probably one of the biggest things like I already talked about was my own mortality, really facing that and having those tough conversations with my family. And in my career, I just started my doctorate degree.
HOST:Oh, congratulations!
JESSICA MONTANARO:Thank you. And—hard. Maybe wasn't sure I really wanted to continue with all this on my plate. But feeling like I can work to still try and make a difference from everything that I've just learned and experienced over this last year. And it has just made me grow in my faith and in my profession and in my skill. I'll just cite this one story for you, which was—we had a COVID patient come up the other day. I get emotional when I talk about this. It's all emotional, but she was, I don't even remember, maybe late seventies, eighties. And she was breathing very, very fast. Maybe fifties or sixties. And so we intubated. And her daughter came up and was devastated. And I told her that I was adhering to the visitor guidelines. And I told her that her whole family could not come up. Just one other person could come up. And she was really pushing me to try and get her whole family up there. And I said to her,"That's really reserved for patients that are eminently dying." I said,"Your mom is not there. She's very sick, et cetera." Went through it with her. And so I needed to find a way to give this woman peace, and that's who you focus on. And that's where I think I've grown as a professional, too, just having those really hard conversations. C OVID has taught me--and I think all of us in my unit--so much about how we have to connect these families, even with this restriction in place. We still have to find a way. And I remember she wanted to go in the room. So I said,"I'm going to put a g own on you. I'm going to give you goggles." I got her all i n the PPE and she asked me,"Can my mom hear me?" And I said,"I don't know, b ut I'm pretty sure she can." And I said,"So why don't you go over and tell her that you loved her in her ear, please." And she went in and she did that. And she had that moment with her mom. And her mom died three hours later. And I couldn't see that coming. And it was devastating for me. We tried really hard to save her, but I walked away from that, even though we couldn't save her mother, feeling like I did my part to try and give her daughter peace. And at least she got that moment to go in that room and tell her she l oved her. And maybe that was the last thing her mom heard. I don't know.
HOST:I had planned to play this clip for you, but we've already talked about change. I think you've talked about it very beautifully. So I guess I would just ask if there's anything that you want to share with listeners that you think it's important for them to know right now?
JESSICA MONTANARO:I think that it can't be said enough that this is a serious and deadly virus. And if, you know, I've been on a lot of interviews and I've spoken with a lot of people and this really resonates with me is that please don't say that you support your front-line workers or ask us to be there on the front-line to save you or your family if you're not going to follow the rules because you're only exacerbating the problem. We've all had to make sacrifices. It's a small sacrifice to make for another short period of time until we can get vaccinated and get this under control. And I think that the other thing is that let's respect the fact that you can have all the equipment in the world, but you have to have skills and trained personnel at the bedside. And I want to tell all those who are listening that are front-line workers, we can do this. Thank you for your service. Thank you for not giving up and coming to work every day. And we are in this together.
HOST:So that was part one of our end-of-year episode. Part two should be out soon. It's an interview with Dr. Brendan Carr. He oversees all the emergency rooms at our eight hospitals. And like Jessica, he doesn't sugarcoat it. So I think you'll enjoy hearing his take on things. Road to Resilience is a production of Mount Sinai Health System in New York City. It's produced by Katie Ullman, Nicci Cheatham, and me Jon Earle. Lucia Lee is our executive producer. From all of us here, thanks for listening. We'll see you soon.