Notes and Mentions
The Emotional PPE Project provides mental health support to healthcare workers. Physician Support Line 1-888-409-0141 The Mental Health of Healthcare Workers in Covid-19 Data about Healthcare Workers During Covid-19 Out of Office for Real by Shannon Scott-Varnaglia, MD, Mass General
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Serena: Hey Everyone, I’m Serena.
Tina: And I’m Tina and we are the Mental Health Mamas.
Serena: Welcome to No Need to Explain, we are so glad you’re here.
Tina: First, as always, a quick disclaimer.
Serena: We come to you NOT as mental health professionals or experts in the field, but rather as parents with lived experience who are on a mission to normalize the conversation around mental health.
Tina: If you or someone you love is experiencing a mental health crisis, please seek professional support. You’ll find a variety of resources in our show notes and on our website, NoNeedToExplainPodcast.com.
Tina: I want to start today’s episode with some jarring statistics. They’re from a study from Mental Health America ( we’ll put the link in our show notes). It is titled The Mental Health of Healthcare Workers in Covid-19. And while we are all experiencing COVID-19 in one way or another, these medical professionals are totally in it! The study sampled workers in categories like Stressed out and stretched too thin, worry about exposing loved ones, emotional and physical exhaustion, the adequacy of emotional support, and the struggle with parenting. Again, the statistics are jarring.
So in the Stressed out and stretched too thin category, 93% of health care workers were experiencing stress, 86% reported experiencing anxiety, 77% reported frustration, 76% reported exhaustion and burnout, and 75% said they were overwhelmed.
Serena: Yeah, it’s a lot. So we are joined today by Shannon Scott-Vernaglia who works at Massachusetts General Hospital for Children as the Associate Chief for Clinical Faculty Development. And I can imagine that she can speak directly to this very issue. Shannon, welcome to the podcast!
Shannon: Thank you so much Serena and Tina. I am always excited to talk about clinician mental health in any forum, and I’m especially happy to have the chance to talk with both of you because I’ve been really enjoying your podcast! Thanks for inviting me.
Tina: Thanks. Yeah. So I’m gonna just interject here that Shannon also happens to be the first babysitter for our daughter who is now 27. So I really haven’t seen you in person since 1995. So Shannon, tell us a bit of your story.
Shannon: Oh goodness. Thank goodness I’m embracing this whole idea that wisdom comes with aging because that makes me feel pretty old! I guess I’ll start my story back then as I started medical school at Stony Brook the year after taking care of your daughter. I fell in love with pediatrics as I kind of expected I would and I matched to my first choice residency at the MassGeneral Hospital in Boston where I still practice. I have always loved being a pediatrician and being a medical educator. I teach pediatric residents and Harvard medical students and I get great joy from watching them grow. It’s a lot like watching the kids in my practice grow up. Somewhere along the way though, maybe about ten years out of training, I developed a debilitating depression. I cried every day. I felt hopeless. I felt alone. It was really horrible. And it wasn’t just for me, it was horrendous for my family who weren’t really able to help. I was so used to being the doctor and now suddenly I was the patient and I really hated it. The kind of short and happy version is that I found a great psychiatrist who both prescribes medication and does therapy which is kind of a unicorn these days and I got a lot better. But the more gritty and distressing version that I lived is that it took many trials of medications and several years for me to get back to feeling myself again. Now I think of myself as in remission because we know depression is a highly recurrent disease, and I am so grateful for that remission and I am also in a much better place to quickly address any depression if it were to return.
Tina: So Shannon, it definitely is, I think, more common than not that your experience with the trials. Yeah, it takes a while, right?
Shannon: Absolutely. But when you finally get up the courage to go and seek care, you kind of hope it will fix you right away.
Tina: Yes, of course.
Shannon: I’m not sure we’re taught in medicine…you’re sort of taught give amoxicillin for a strep throat and you give fluoxetine for depression. You sort of imagine they both work as quickly and they really don’t.
Tina: Mmhm. Yeah.
Shannon: So in the years since then, part of my healing has been to become an advocate fighting mental health stigma. I didn’t know about this framework at the time, but I have really been on a journey of what’s called, post-traumatic growth. First I had to recognize that for me this disrupted my world view of myself as a healthy person, a healthy person who knew which side of the patient-doctor relationship I was firmly supposed to be on. And while I care for patients with experiences that are certainly much more deeply traumatic, being willing to accept that this was traumatic for me was the first step. And since we know comparative suffering is really not helpful for anyone, I’m not gonna try and compare that as traumatic to someone else’s trauma. And then I had to be able to recognize the negative feelings, but also make room for positives and to look for the positive. I had to be willing to start to share, which was first with my therapist and then over time with others. And I was then able to create my narrative and use it to try and help others which has been really meaning making for me.
Serena: Mmm. Yeah. And thank you for mentioning the idea of comparative suffering. I do think it’s easy to get caught up in that idea. And I just want to share that recently we had a guest on talking about trauma and he said, “If it matters to you it matters.” And that is just something that has really stuck with me. So it sounds like you struggled being a doctor and sort of admitting to yourself and others that you were not ok?
Tina: Yeah and I love on your blog that you said, “How do we make it OK to not be OK?”
Shannon: Oh goodness yes, it was really hard and now I want to be somebody who makes it easier for the next person to say “I’m not OK and I need help”. In fact one of the most meaningful things that’s happened after I published a short essay about this was when a student told me that they had read my essay and after that decided to seek therapy. And that’s what your show is doing too, right? You’re making it okay to not be okay, to acknowledge that maybe you suffer from mental illness, but that you aren’t weak. I like to think of my life as this beautiful tapestry. Some of the threads in it are depression and anxiety. I don’t pretend I would have chosen them but now that they are woven in my tapestry it wouldn’t be the same without them. And if I pulled them out, it wouldn’t look the same because it would dramatically change, kind of, that tapestry of my life. So instead I choose to shine light on them, in the hopes that it might make it easier for others.
Serena: I just love that image, that beautiful tapestry. Yeah. So let’s follow the theme of healthcare workers and how they’re managing during COVID. So the study that Tina mentioned at the beginning, I’m curious if that feels accurate to you?
Shannon: Gosh that resonates so much for me. And I was presenting some similar data recently about healthcare workers in New York in April of 2020. There the nurses, trainees, and faculty had high rates of symptoms of acute stress, depression and anxiety. And what I was saying was how in some ways it was easier back at the start of the pandemic--we were terrified but there was also a great deal of support and a sense of being in it together. People were banging pots and pans for healthcare workers, bringing meals to the hospital. We felt seen even in our fear. None of us had any idea we’d be still doing this two years later and that the miracle we had hoped for, these really highly effective vaccines, would not be embraced by everyone with the excitement that we had expected. So now we’re really worn out. This latest surge just didn’t have the adrenaline of being in a fight together that we might win, it had an overwhelming feeling of resignation, almost a sense of hopelessness for a few weeks there. From outpatient pediatrics where I practice, to the inpatient adult ICU medicine to the true front lines in our emergency rooms, wherever you were…we’re just exhausted mentally and physically.
Tina: Yeah. You know, we’re all living this…what did we say before Serena? We’re all on the water but we’re not all in the same boat.
Tina: I think all of us are in this, we’re not deep down in it like you all are, and we forget how LONG and exhausting this fight has been for all of you on the front lines. So tell us a little bit about what your hospital is doing to make sure that you, your colleagues and your residents are taking good care of their own mental health.
Shannon: Yeah, I’m really hopeful that some of the things that will come out of COVID are really gonna change the culture of medicine around mental health stigma, both locally but really nationally. I think it is getting easier to talk about not being okay, largely because no one is really okay right now. In my department two of my amazing colleagues, Rob Myer and Susan Hada, have led a reflection curriculum for our residents for many years. And they’ve, during COVID, expanded that work to include faculty and fellows. And this gives people an opportunity to talk about what is really hard in medicine and kind of when they’re struggling and create a safe space for that. At the hospital level we’ve trained faculty coaches to coach one another, and I’m super excited to be a part of the new cohort of coaches in training. We are working hard to just check in on one another and luckily it feels like we all have times when we are really feeling badly but maybe that’s the day when someone else is in a brighter spot and they reach down and grab your hand to lift you up a little bit.
I also think nationally the conversation is shifting. There’s some amazing programs like emotionalPPE and the Physician Support Line. These were created early in the pandemic and continue to be great ways for clinicians to find the support they need. I talk a lot about the role of stigma in keeping people from seeking care, especially those in the healthcare field, and the more we make access easier and I think virtual support is a way to do that. Some people just don’t want to be spotted walking into the psychiatry department. So it’s a really important way for someone who might not otherwise seek care to kind of find it.
Tina: Yeah, it’s just so interesting that kind of leveled care, right? We don’t really think about that. But the idea that there are many people, whatever job you hold, that they don’t want to walk in to that office. And I personally think that’s a beautiful thing that’s come out of the pandemic is you know, we as families were told for so long, no we cannot do therapy online. Nope, we can’t do that. We can’t do that. Now all of a sudden they had to shift and the miracle has happened, right? People who can’t get off their couch can now get therapy from their couch, right? Yeah, so we will share some of those resources in our show notes because I think they’re important for people who might have as supportive an environment that you personally have at MassGeneral. Yeah, I just think it’s hopeful, right? We have little bits of hope. So, we have known each other a long time and I have loved watching your family grow mostly from Facebook and Christmas cards, quite honestly. But I have to say, I reconnected with you because of something you posted on Facebook suggesting that systems need to do a better job of supporting kids and families which we have to totally agree with. Can you tell our listeners, you know, without sharing too much, a little more about that? Say more about that situation.
Shannon: Of course. I think this is something I’m really passionate about, and frankly pretty angry that we haven’t figured out a better system for. Our kids were hurting before covid, and since the start of the pandemic, things have just skyrocketed in terms of children and young adults I’m seeing who have depression, anxiety, eating disorders and other mental health problems. We just have to do better. That day when we messaged Tina I was really frustrated because a patient of mine who I had been following really closely as a PCP, like every week or every other week, for her depression was being discharged from a psychiatric stay without anyone from the inpatient team having contacted me to help with discharge planning. Coordinating care between settings and between clinicians and with families is critical to take the best care of kids who are struggling with their mental health. And, better care coordination serves both the care team and the patient because the patient is less likely to end up back in that overcrowded emergency department, or admitted to the overfull psychiatric unit if we support the transition in and out of inpatient care to go more smoothly for families and kids. I manage a ton of depression, anxiety, and eating disorders in my practice and in many cases I have known these patients since they were born! I have a lot to offer in terms of helping families navigate this really uncertain and scary time when they’re coming in and out of the hospital or being diagnosed with a new mental illness. So for your listeners, if you’re worried about one of your kids, definitely reach out to your pediatrician. We’re here to help. And for my mental health colleagues, I’ll be reaching out to you when I’m worried and need help and I just want us to do better doing that back and forth!
Tina: Yeah and I guess we from a family perspective always think that the healthcare folks are communicating and it was just really hard for me to hear that because I know as a family member that I was the one holding all the stuff, contacting all the people but I guess I thought there was some...it really I guess reinforces that whole silo thing, right, for me. And it doesn’t serve anyone. It does not serve anyone.
Shannon: No. It doesn’t.
Tina: Especially our kids. Yeah.
Serena: Yeah. And thanks for the reminder to reach out to your pediatrician. I think it’s not always what we think of when our kids are struggling, you know, with something that’s not physical health. And yet we know that the people we’re already connected to are the best place to start. So I appreciate that. So, having said all of that about the challenges you’ve seen, let’s talk about your miracle world and in this world health care is super supportive and kids and families get just what they need, what does that look like?
Shannon: Oh, what a great question. For those who know me well, know that I almost always use children’s books to illustrate points so I’m gonna bring up Harold and his purple crayon.
Tina: Love it!
Shannon: If I had that purple crayon, I’d design a fully integrated care model from birth. Let’s just picture it: There are mental health experts side-by-side where I’m also seeing patients for their checkups and their vaccines. Maybe I start the day with a new mom who I’m kind of worried might have postpartum depression--so let’s have her come into this consultation room where she can feed your baby for 15 minutes while waiting because my social work colleague is here and she’s gonna come in and talk and help coordinate care with our obstetric group who can help mom. OK, now my next patient, I have a preschooler who has anxiety about going to the bathroom in public, a super common issue. My advice last time was pretty helpful, but things now aren’t…they’re kind of back where they were and aren’t improving. So maybe for this patient well our healthy steps parent coach can give them a call later this week? Now it’s my turn to help another member of the team because a teenager of mine who was referred to our integrated teen stress management group is having a harder time and the group leader reached out. So now I’m seeing that patient and realize she has full on depression at this point and so we talk through medication as an option while also working with our office case manager to help get her connected to individual longer term therapy that in my perfect world won’t take four months to get into. So now it’s the end of the day and we have our built in pre-scheduled multidisciplinary team meeting and the team social worker shares that she’s been in touch with the inpatient team with that patient who was recently admitted. The nurse who has been giving him shots since birth says, gosh, I’ve got some important insight about how that family dynamic works because I’ve known them for all these years, the front desk helps clear a spot on my schedule for a visit the day after discharge, and the social worker makes plans to talk with the school about a reentry plan. Oh and wait, here’s the perfect part, some members of the inpatient team are gonna zoom in for the last few minutes to give us the most recent update and to answer any questions we have about the new medication regimen they’ve started. So that’s all of course with the benefit of my purple crayon but I think we need to aim for that vision. It will take time but if we don’t look for that and believe we can have that future, then we won’t ever get there. So I want to shoot for it and try and draw it.
Tina: So I need a moment. I am literally getting super emotional about your “purple crayon” vision because, you know, we experience what we experience and that’s just so beautiful to me. I think you need to spread that far and wide Shannon. Because I think the system needs to understand how we are all about our kids wellness and whatever that can be and… Yeah, so sorry about that. Yeah, I think in a miracle world I imagine that the medical community would be getting what they need as well because the care goes in a circle, right? What might that look like? What practical advice do you have for your colleagues?
Shannon: Gosh, yeah. No, I think a lot of effort needs to go into good care and we haven’t thought enough I don’t think about how to help the caregivers. I think healthcare workers need diastole. Systole is when the heart squeezes and pumps blood out to the body. It’s essential. But the next phase, diastole is equally important, when the heart relaxes and blood returns. We need diastole and medicine doesn’t allow for a lot of rest and yet we know that part is so important. Culturally hasn’t always been valued to take true time off, and for the last two years in particular, we’ve been fighting a war against a virus and the physical and emotional destruction it has brought to our patients, their families, and to all of us. We need to make time and create space to heal and recover, and that’s gonna include safe spaces to talk about these traumatizing experiences, and to put them into some kind of a framework that helps for post-traumatic growth so that we can create a new normal. Practically speaking I would urge all of my colleagues in medicine to make real time for themselves. No one believes me but it is truly possible (I’ve done it) to not have your work email on your phone for instance. And it is possible to not have your Electronic Medical Record ping your phone when new results show up. And it’s actually possible to go on vacation and NOT check your email once. I like to think I’m a pretty good doctor and I do all of those things. In fact, I think I’m a better doctor because I take care of myself.
Serena: And I totally agree with you. And this is something that is so hard to…it’s a concept I think we know intellectually but actually doing it is harder. We can only take care of others if we’re taking care of ourselves first. So I’m glad you’re modeling that for everyone. It is clear that you are a very caring provider and that you care deeply about your colleagues and their mental health as well as your patients. Let’s talk for a minute about another big piece of your world and that’s being a parent. And the question is two-fold. How do you help your girls take good care of their own mental health? And how do you yourself take good care of yourself while also taking care of your people?
Shannon: Well, I would say if any parent thinks they have it figured out, please call me because I’d like to know! I like to tell parents in my office, we’re all just doing our best and probably messing up all the time at this parenting thing. But for me, that is part of what’s important. We need to share our mess-ups with our kids. We need to talk about the fact that we’re in therapy and what we’re doing to stay well. This was really hard for me when I was really depressed. I didn’t want to talk to anybody else and especially not my kids because I felt like I was failing them as a mom. But now I talk about therapy all the time (they are kind of sick of it actually), and earlier in the pandemic when my anxiety really took hold I talked about going back on medication for that for awhile as well. I think our kids learn most from what we do, not from what we tell them to do. And mostly, I just try my best to be there to listen when they’re ready, and to make it clear I love them exactly as they are because they may not be ready to talk about something that they’re struggling with right away. I’m sure when they listen to this podcast they’ll think that is super sappy but I always hope it lodges somewhere in their brain to pop out when they need it despite the eye rolls I may get when I say something at the time.
And for your second question, you know I take care of a lot of people. And I think part of what was hardest for me was needing somebody to take care of me because that kind of wasn’t my world view. I was gonna take care of everybody else. So now I embrace that. I go to therapy every week, just yesterday. I embrace that I love taking care of others but that to do that I have to take care of myself first. So for example, I just stepped down from a really rewarding but intense position that I loved because I needed more time to care for myself, and my family, and to figure out what other things would bring me joy at work and try some new things out. I took a pottery class with my older daughter. I have been trying to write more. And probably my favorite self care ritual is that each spring in May I take a week off. It isn’t a family vacation (which I have one coming up shortly but phew, those aren’t always so relaxing, right?), and this week in May, it’s just for me. I call it my Garden Week. Everybody who knows me at work actually refers to my Garden Week. In that week I dig, and I mulch, and I plant, and I go for walks, and I spend a little too much money at the local garden store. I also get to have breakfast with my kids, I drive to dance class if I want to to drop my younger daughter off. If I am lucky for a perfect sunny day, I like to make what we call a “spa lunch” and invite my husband on a date on the patio when the kids are out at school. I just enjoy my favorite things for a week, with dirt under my fingernails and callouses on my hands and some like deep connection, I think, to the earth beneath me that kind of grounds me.
Tina: I love it. And again see your life on Facebook and I think it is so sweet when you and your husband sit down in your backyard which is lovely. And yeah. Maybe not a spa lunch but just a moment and I think you’re…I would observe it looks like you’re good at doing that, to take good care of yourself. Shannon, we are so grateful that you took time, you’re a very busy person, to talk with us today. We appreciate your insight and sharing your vision for this healthier future for our young people, for your colleagues, and for your own kids and family and yourself.
Shannon: Oh Tina, it was such a pleasure to talk with both of you. The work that you and Serena do to help families advocate for their kids, to help destigmatize mental illness, and to promote mental health is just incredible. And I am just so honored and appreciative to have had the chance to join you guys today!
Tina: Well, we couldn’t be happier. And my mom, honestly my mom’s gonna be so happy because she knew you, of course, and she knew you saved us at a time we needed saving. And yeah. Anyway. So podcast friends, we are, as always, grateful for all of you listening and supporting us. You can help us out by visiting Apple podcasts, leaving us a review, subscribing and please share with others. You will find lots more content on our website NoNeedtoExplainPodcast.com. You can connect to all of our socials on that. Yeah.
Serena: And this is your gentle reminder to take good care of yourself while you are also taking care of your people.
Tina: Thanks for listening!