S1E52 / Love and Care in a Pandemic / Jon Gunnell & Robert Cialdini

I got on Twitter and just started seeing the images, and I was watching the nurses and the doctors and everyone in the healthcare industry just going through this trauma. I was not, you know, oh, I'm giving myself over to this, I'm going to go up and do this. It was just like people needed help.

Welcome back to Epidemic, the podcast about the science, public health, and social impacts of the coronavirus pandemic. I'm your host, Dr. Celine Gounder. We're coming up on the worst stretch of new coronavirus infections since the pandemic started. And unfortunately, it's happening right as many in the United States would normally be getting ready to travel to spend Thanksgiving with their families. This is a big risk at this stage in the pandemic, but it's a dilemma many are struggling with. Dr. Tony Fauci summed it up well in an interview with Dr. Howard Bauchner of the Journal of the American Medical Association.

You know, Howard, you don't want to be the Grinch that stole the holidays, but I think one family group and individual has to take a look at what the risk is to your particular situation. And the reason I say that and I feel, you know, a concern about not doing that, that serious consideration, is that if you look around the country now, that many of the infections are in small family and friend gatherings, such as dinner parties and small social gatherings.

In this episode of Epidemic, we're going to share some tips for safely celebrating Thanksgiving and the other holidays in the coming weeks. But first, we're going to hear a personal story. Several months ago, I had someone reach out to me on Twitter wanting to share his story. In a dark time like this, I thought it would be nice to take a minute to hear about someone who was driven to do whatever they could to help at a time when New York needed it most. So today on Epidemic, love and care in a pandemic. John Gunnell is a registered nurse from Arkansas. John had been working in hospice care before the pandemic. It had been a difficult few years. He had gone through a divorce and wasn't sure about his career. He says he was depressed. A few months before the pandemic, John took a job as a supervisor at a nursing and rehab facility outside Little Rock. As the coronavirus outbreak was spreading in New York and Seattle, John was thinking about his own patients.

You know, being a house supervisor at a nursing and rehab facility, you have all these geriatric patients that are very susceptible. So we were trying to put guidelines in place at that point. And I was searching out the, you know, the best in the field to do, you know, what we need to be doing because everybody had no idea, you know, what we should be doing in nursing facilities.

The work was hard. So one of the things John would do after his shift to decompress was listen to the radio and podcasts. One of his favorites is the Dan Le Batard Show.

And so I was sitting outside after I got back. I was working two 16-hour shifts on the weekend, and I got in one night around midnight, and I just like, well, I got to catch up on these shows.

And I happened to be a guest on one of the episodes he listened to that night.

Let's see if we get informed here a little bit. Dr. Celine Gounder with us on ESPN Radio. Thank you. He called you the disease detective, and I listened to you, and he asked you where you found hope. Where do you see hope?

You know, I do see hope by, you know, if I look through my Facebook feed this morning, I was looking through and it was full of pictures. Sorry. It was full of pictures of my friends. From school, from residency, who are all— sorry— who are all gowning up and gloving up to the degree that they can, but really underprotected. And I'm just terrified for them. I take hope in the fact that My colleagues are so committed and that we're there for each other.

And it was probably about 12:30. There was a quarter moon over Lake Ouachita, and I just sat there and I listened to you and you broke down in tears and it really touched me. I was like, okay, I kind of need to get up there.

John had been seeing news stories and images on Twitter of what was happening in New York.

I want to be there for those people that are dying alone because as a hospice nurse, that was the, that was the last thing you ever wanted to have was one of your patients die alone. And all the stories of people dying alone and nurses putting their phones in their face and they, you know, they couldn't say goodbye. That struck me to the core.

John thought about it. He knew people in the New York area from his time in the Navy. He could stay with them until he found a job. But not everyone around him was supportive of the idea.

I got a lot of pushback from friends that, you know, they were like, how can you expose yourself to a virus? You have a 16-year-old daughter. How can you leave?

John is close with his daughter, but because of his work with nursing home residents, he had to quarantine away from her.. And he figured if he couldn't see her in person anyway, maybe it was better he did something he felt was more important.

And I don't want to downplay the job I was doing in Arkansas, but like I said, it was kind of a transitional job. And I couldn't have felt good about myself just to stay in Arkansas. We had a long talk about it and she said, Dad, I'm proud of you if you want to do this. So, you know, once I got her green light, I was, I jumped in my car and drove 25 hours and came up here.

Moving to New York City to be a healthcare worker in the middle of a pandemic, it's not something everyone would do.

I don't wanna let fear be in control of my life.

That's a credo that's guided a lot of John's decisions in life. When he wanted to serve in the armed forces, but had claustrophobia. He signed up to work on a submarine. A series of family tragedies built up a fear of death in him. That's what pushed him into hospice care. So when the pandemic happened, John wasn't someone who wanted to hunker down and wait it out. He wanted to get out and try to help.

I kind of like living in a zone where I don't feel safe, where I'm uncomfortable. And that sounds so counterintuitive, But I was suffering from major depression at that time. And the moment I arrived in Manhattan, I have not been depressed once.

John drove 25 hours from where he was living in Arkansas to New York City. He arrived in late March when the worst of the outbreak there was still to come. A few weeks later, he had a job, but he wasn't doing the hospice care he thought he would have. When he started with a travel nursing company, the assignment he had was home health nursing. And the assignment was about as far away as you could imagine from the lake he was sitting on a few weeks before, listening to the Dan Levitard Show. John was working in the Bronx. As somebody from Arkansas coming to the Bronx, what did, like, what did the place look like to you? Like, you know, what stood out to you?

What stood out to me was just the empty streets.

It felt like the city was at a standstill.

You drive by Yankee Stadium and I mean, there's nothing. I just felt alone on the streets. It was like I was the only one, me and the ambulances and a few other essential workers. And I had the streets to myself.

It might be an understatement to say that John looked out of place.

You know, here I am, white with this redneck accent, and there was a UPS driver that came up to me one day and he goes, "Brother, what are you doing here?" He didn't exactly look like a nurse either.

After about a week on the job, he'd stop wearing scrubs in public.

Because wearing scrubs, people would give you the side eye because they thought, you know, you probably might be infected. So I stopped wearing scrubs after like the first week.

Visiting patients at their home showed John how the pandemic was straining health services in the city. His first patient was a survivor of gun violence. John got buzzed into the building where the patient lived.

So yeah, I went up and the Jamaican music was so loud, but the odor, the odor is the one thing that always hits you. And it was just like, oh goodness, you know, I've got a septic patient.

Part of John's job was something called debridement, basically removing dead or infected tissue from a wound.

He needed debridement ointment. And normally I would just be able to, you know, grab my phone and say, hey, can we order this medication? And so we can get some of the slough out of this wound or whatever, but you couldn't. You couldn't. You just had to wait until it got bad enough till you had to send them to the ER. So yes, I remember that first patient like it was yesterday. Just the frustration. It was like they felt like nobody cares. Nobody cares. Just let me lay here and rot.

The healthcare system was overwhelmed.

I don't know any numbers. This is all anecdotal coming from me, but I bet we lost a good bit of those patients because they could not get their wounds debrided and they got septic.

A few weeks later, John started a new job at Metropolitan Hospital in Manhattan. He was going to be on a team running COVID tests. At first, John wasn't too excited about the assignment.

There were 6 other nurses, and I mean, you talk about baby nurses, these are baby nurses. A couple of them were brand new grads, never had a job before. 2 of them were school nurses. You know, and I was like, oh my gosh, this is going to be a bleep show.

John was the most senior nurse on the team. Many of his coworkers were young enough to be his kids, grandkids even. But he says they rose to the occasion.

They jumped in and the testing ramped up and ramped up. We started doing antibody testing. So now all of a sudden, oh wait, none of these people have ever drawn blood before. You know, they just got it. And everybody found what their strengths were, what their weaknesses were, and it's just like a collective unit came together. And I've never seen anything in all my nursing years like that.

Testing people for COVID also requires a lot of emotional work too, John says.

Having to almost reassure every 5 minutes, a new patient comes into your room and they're all just so anxiety-riddled and terrified, and you almost have to be a little bit of a therapist with everyone that comes in your room. You see 30, 40 people a day. I go home and I don't— I can't keep my eyes open. I just fall asleep from emotional exhaustion. And it's just this little group here and we've become a family.

And John may have found something else in New York, love. Shortly before he decided to move to New York and help with the pandemic, John had reconnected with someone from his past.

I mentioned to you about being in the Navy back in the '80s. I fell in love. My first love was in Connecticut.

But it wasn't meant to be. At least not then. There were family issues John had to deal with back home in Arkansas, and she wasn't ready to leave Connecticut. So they broke up. 30 years went by before one day John was sitting outside his place back in Arkansas.

I would, like every afternoon like I do, pull up, listen to the Levertard Show. I was sitting outside watching the bulls and the goats and, you know, The phone rang and, you know, it was her.

John had come up to visit her just before he moved to New York.

It'd been a hard few years after my divorce, even though my ex-wife and I have a wonderful relationship. Just, I needed a change of scenery. And the fact that I knew that she was here and I felt so comfortable meeting her again for the first time in 30 years. That had a lot to do with it. I know that takes some of the shine off of why I came up here, but she's just amazing. And it's one of those little simple twists of fate that happen in your life, and you have to say, okay, I'm gonna do this.

I wouldn't say that takes the shine off it. If anything, some of the most beautiful stories I've heard during this stretch, including actually one of my best friends, have been what this has meant for them getting close to somebody, whether romantically or not. How has this played out with her?

I'm sitting in her kitchen. I have every other weekend off. And so I drive up here every other weekend and it just gets, it gets better every other weekend.

We talk a lot about the negative aspects of the pandemic on this show. And there are plenty. It's been a scary time, and the burdens of COVID are unfairly levied on some more than others. But the pandemic also creates opportunities to help a city in need, reconnect with someone, build a new life. That happens in the middle of a pandemic, too. John and his partner are celebrating Thanksgiving together a week early, just the two of them out in Connecticut. After the break, I'll share some tips on how to celebrate Thanksgiving and other holidays this winter as safely as possible. I'm Dr. Celine Gounder, and today I hope I can count on your support of Just Human Productions. December 1st is Giving Tuesday. —a time to celebrate the generosity of the human spirit. In a time of crisis, we've discovered just how strong our spirit is. All around the world, people have come together to support their neighbors, offering their time, resources, and compassion to keep their communities safe. As a medical doctor, I've seen this spirit prevail time and time again. I've watched people face public health crises and take a stand to take care of each other. I founded Just Human to inform and inspire people, to honor these heroes, and to tell their stories. At Just Human, we believe that every single person has the power to enact change for themselves and their communities. At Just Human, we believe the world can be a healthier place. To keep changing lives, we need to raise awareness of our biggest health challenges and all possible solutions. To continue our mission, we need your help. Please go to justhumanproductions.org/donate to support us today. This is going to be a Thanksgiving like none of us have ever experienced before. COVID cases have exploded in recent weeks. At this recording, the United States was averaging more than 150,000 new cases of COVID every day. It should not be a surprise to hear that the safest thing to do this year is to limit your in-person Thanksgiving to just the people in your household bubble. Like Dr. Fauci said earlier, small group gatherings indoors have become one of the most common ways the coronavirus spreads. But if you have decided to travel or get together with others, please take every precaution to protect yourself and others. If you're going to leave town, quarantine, or at a minimum, refrain from high-risk activities like indoor dining, bars, and private parties. Be diligent about wearing a mask anytime you're around people not in your household bubble. Get tested right before you travel, but understand just because you test negative today doesn't mean you won't test positive tomorrow or the day after or the day after that, out to 14 days later. If you must fly, wear a mask the entire time you're in the cabin of the plane. It's also not a bad idea to wear eye protection. This could be glasses, goggles, or a face shield, along with your mask. And once you get to your destination, make sure you already have ground rules in place, like how you're going to eat. Wearing a face mask while eating isn't really an option, so make sure people are spread at least 6 feet apart. If you can, eat outdoors. Maybe this year Thanksgiving is a family hike and picnic, or you celebrate around a bonfire or fire pit. Or if you can't eat outdoors, prop windows and doors open wide to improve ventilation inside your home.

So this is about probabilities. This is about mitigating the likelihood that there will be an infection.

This is Robert Cialdini. He's a behavior scientist who studies decision-making. Robert and I, along with clinical psychologist Ben Michaelis, wrote an op-ed for CNN.com about how to safely celebrate Thanksgiving. During the pandemic.

If you're going to have a Thanksgiving event where you have a lot of people, you know that you are making yourself susceptible and your guests susceptible to the problem. But what you can do is reduce the probability that there will be an infection as a result using these tips.

That means agreeing beforehand on the expectations around social distancing and wearing a mask. As a behavioral scientist, Robert has a few tips on what to do if someone doesn't follow the rules.

If somebody appears without a mask, you give them one, right? You look like a caring person who wouldn't want to infect your friends and relatives. Here's a mask. So you have a set of those available.

See what Robert did there? He framed wearing a mask as something that a caring person would do. Studies show that linking a request with a positive trait, in this case being a caring person, can increase someone's likelihood of doing what you ask. He also suggested another tip: phrase the request to wear a mask or social distance as an option, not a command.

Of course, it's completely up to you, but we would certainly appreciate it if you did this.

And lastly, like at any Thanksgiving, Try to avoid a fight.

Finally, you never confront them with some kind of argument. You just bring them into the fold.

We're all doing things differently this year. I usually travel to spend this holiday with my nieces, but not this year. I'm celebrating with my husband, just the two of us. Robert is also changing things up.

We usually have a large Thanksgiving, and, you know, with all of the trimmings. We'll probably do it differently. We'll order in Italian food.

And why not order in Italian or Chinese or do something totally different than you normally would for Thanksgiving? If this holiday is going to be different, lean into it. Think about this year as an opportunity to try something new. When you think about what you're thankful for this year, I really hope one of those things is your health. This is going to be a strange holiday, but that doesn't mean it has to be a bad one. Being careful and following some simple steps this year will help ensure that we can all look forward to many more Thanksgivings in the future together. Epidemic is brought to you by Just Human Productions, or funded in part by listeners like you, or powered and distributed by Simplecast. Today's episode was produced by Zack Dyer and me. Our music is by The Blue Dot Sessions. Our interns are Tabitha Gordillo, Annabel Chen, and Brian Chen. If you enjoy the show, please tell a friend about it today. Day. And if you haven't already done so, leave us a review on Apple Podcasts. It helps more people find out about the show. And Just Human Productions is now on Instagram. Check us out at Just Human Productions to learn more about the characters and big ideas we cover on Epidemic and our sister podcast, American Diagnosis. You can learn more about this podcast, how to engage with us on social media, and how to support the podcast at epidemicpodcast.com. Epidemic.fm. That's epidemic.fm. Just Human Productions is a 501(c)(3) nonprofit organization, so your donations to support our podcasts are tax deductible. Go to epidemic.fm to make a donation. We release Epidemic every Friday, but producing a podcast costs money. We've got to pay our staff, so please make a donation to help us keep this going. And check out our sister podcast, American Diagnosis. You can find it wherever you listen to podcasts or at americandiagnosis.fm. On American Diagnosis, we cover some of the biggest public health challenges affecting the nation today. In season 1, we covered youth and mental health. In season 2, the opioid overdose crisis. And in season 3, gun violence in America. I'm Dr. Celine Gounder. Thanks for listening to Epidemic.