Speaker 1: Welcome to Healthy Conversations. I'm Dr. Daniel Kraft, and I feel lucky to be in Healthy Conversation today to discuss an amazing documentary called, "The First Wave." It captures the terrifying first four months of the COVID Pandemic in early 2020, inside New York City's Long Island Jewish Medical Center. The director is Matthew Heineman, who's with us, as well as one of the lead clinicians in the documentary, [inaudible 00:00:25] and hospitalist, Dr. Nathalie Douge. Really thrilled to have you both with us. Matthew Heineman: Thanks for having us. Dr. Nathalie Douge: Thanks. Speaker 1: The First Wave is really an incredible film. This documentary just rolled out in theaters and is now streaming on Hulu, so congratulations. But let's now zoom back in time to what seems like a lifetime ago, March of 2020 in New York City, just as the pandemic was starting to hit. Matthew, can you give us a taste of how this documentary project even got started? How were you able to embed your team inside of a hospital setting as the pandemic was rolling in? Matthew Heineman: I woke up, like everyone did, terrified by this potential tsunami that was going to sweep across our country. And like all the films that I made, felt this huge obligation to take this issue that was relegated to stats and to headlines and to misinformation and should try to put a human face to it. And so, I reached out to hospital systems all across the country and eventually got access to film at Long Island Jewish Medical Center in Queens in my backyard. Speaker 1: And Matthew, you've had experience from the medical side. I watched your incredible documentary from 10 years ago, "Escape Fire, the Fight to Rescue the American Health Care System." What were some of the lessons from filming other documentaries in challenging situations that you brought to this one? Matthew Heineman: In some ways, and this sounds pretty cheesy, but in some ways, I felt like my whole career led up to this moment, from being in extremely dangerous situations in war zones, to making a film on health care previously and dealing with emergency rooms and HIPAA issues and consent issues and moral issues. But at its heart, I love making character-driven verite films about individual people, just a few of them, and hopefully learning a lot more about the grander story. Speaker 1: You said it's character focused, and we're lucky to be joined today by Dr. Natalie Douge, one of the key characters in the film. Natalie, you were thrown into the pandemic, like all of us, in the early stages, but right at the heart of it in a hospital. Can you give us, zoom back to what your thoughts were as it was just starting, and how did that shift over time? Dr. Nathalie Douge: So when we first were told about it, there were little meetings about, oh, when and if we would get COVID patients. We literally had to go piece by piece, looking up literature from Wuhan, figuring out if there were any similarities in the patients we started seeing. And the whole PPE, that is something that, yes, we're taught to do, but it wasn't something we were doing every single day. So I remember in the beginning, we were washing our hands to the point where most of it was bleeding, it was cracked, because we were just so terrified. Quickly, we had to come together to figure out, "Okay, so this is what we have at our disposal in terms of resources." We were reusing PPE, in terms of masks, for two weeks at a time. It was chaotic, yet a lot of us, in terms of the clinicians, we became so transparent and dependent on each other to get through our day-to-day. Speaker 1: And the film really captures, not only the esprit de corps, but also how you were all just figuring things out on the fly. I've spent plenty of time as a clinician in intensive care units, running codes, but here the tragedy was unfolding so rapidly, and there's a scene where everyone gets to only have only a minute to reflect on a patient who passed away after a code. How did you find yourself adapting to that pace of acuity and tragedy? Dr. Nathalie Douge: So looking back, I realize I primarily was on autopilot seeing such traumatic experiences, because we would have patients that we literally thought would be okay, and the next thing you know, their condition deteriorated when it seemed like a blink of an eye. I was having, at one point, 16 patients a day, up to 25 patients a day. You don't have that, it seems like luxury of time, to really process the feelings of despair. You still have to do what you need to do for subsequent patients. So you give yourself five minutes, I'll have a quick crying session, and I would literally tell myself, "Get it together. You have another patient to see who's counting on you, whose families are counting on you to try to help see them through." Speaker 1: Matthew, what are your thoughts on how the health care system should change? Matthew Heineman: I don't know. There's so many lessons to be learned. I'm just a dumb filmmaker who attempted to tell this story. I hope that the film provides a mechanism through which we can all reflect on what we've been through. I think every single person on this earth has been affected by this, we've all been changed forever. It's ironic to me as an outsider to see an industry that is theoretically focused on health and the practice and the art of medicine, where mental health is still stigmatized. That's one of many things that I hope can change and come out of this, is understanding the trauma and the burnout. Speaker 1: We've actually lost about half a million health care workers in the US since February of 2020, and 18% have quit since the pandemic started. We don't really have the resources to continue that trend. Dr. Douge, you've been through this trauma yourself. What has it been like for you and your colleagues over the last 18 months? Dr. Nathalie Douge: So honestly, the struggle is real. After the "Second Wave" that we endured during the holiday season of 2020, I literally had a mental breakdown at work. Walking down the halls, I was flooded with, as if I was transported back to the earlier months of the pandemic. I remember telling the chief of my division, "I cannot work on the COVID unit for Christmas. I refuse to give another death certificate as a present." So given those moments, I too have resigned as a full-time physician. At this point in time, I decided to work independently as a locums physician. I now have to look inward and truly process all that I have gone through so that I don't project some of the trauma I have experienced onto my patients and their family members. And it's so crazy, I tried to escape some of the COVID I was seeing in New York City, and I ended up going to Montana at the height of their surge. And it was just so disheartening to see, because this was a small rural town, they're not getting that publicity of how much the staff is struggling, but they need the help just as much as some of the other major cities. So in regards to the mental health of the health care workers, a lot of the onus has been on the individual like, "Okay, we have these "Resources" for you, it's available," but what time are you giving us health care workers to get there? My schedule is not any less for me to now have time to go through a therapy session. Why isn't there mental time embedded in work schedules? Why aren't personal days and vacations mandatory? Why is it something that we have to constantly search and strive to get, where it should just be something that's automatic in order to force us to take that break? Because we will keep going, because we're trained to push through it, push through it, but we're starting to crumble. Speaker 1: Yeah. And in places like North Carolina and others around the country, sometimes the health care workers are not the heroes. There's not the clapping or the cheers, they're sometimes denigrated. Have you dealt with that personally, folks who are denying the pandemic and not honoring, let alone supporting, health care workers? Dr. Nathalie Douge: Absolutely. Because that was my first time in Montana. So I get off the airport, I'm like, "Oh, this is great. There's open air, there's nothing going on. We're great." And then, you literally go inside the hospital and it's packed, there's no beds available, and you have patients and family members discrediting what's actually happening. We're constantly telling them, "This is real. You need to tell your family members who are not in this hospital what you're going through, because they're not seeing what you're suffering in person." I just thank Matt and his team for truly humanizing and showing the complexity of the human emotions that come into play during a crisis, particularly now that we know there are preventive measures to avoid this unnecessary suffering. Speaker 1: Yeah. And I encourage folks who are listening to get their communities to see this important film. So much of the pandemic has been fractured by different tribes, and I'm just wondering if you have any thoughts, Matthew, about how to better communicate the challenges of public health and this pandemic? Matthew Heineman: COVID sweeping across our country, our world, I think one of the greatest tragedies of COVID is the fact that we, as an American public, were shielded from the realities of what was happening inside hospitals. If you look at war throughout history, it's often a way for fractured societies to come together around a common cause. Instead, this further divided us, it became politicized. There's a reason journalism exists, and war zones journalists go there and we see, hear, read stories, and that informs public discourse. That wasn't really happening in the early weeks and months of COVID. Do I think that this film is going to bring our country together? No. Do I wish it would? Yes. But realistically, we all live in echo chambers. There's no Fauci in the film, there's no Trump in the film. I made very, very distinct choices to try to take politics out of it, and I do hope that, at least in some places, this film invites both sides of the aisle to be able to converse and reflect and debate and argue. Speaker 1: It does, and it doesn't even have a voice track. But in some ways that you certainly couldn't have planned, the documentary overlaps with the Black Lives Matter movement that developed during the pandemic. Dr. Douge, I'm sure you have seen social disparities highlighted by the pandemic in terms of mortality and morbidity in many populations, which also overlaps with social justice, and I'm also sure that's something that really matters deeply to you. Dr. Nathalie Douge: It's crazy how things worked out because, as a black female physician, no one knows what I do for a living once I am out the hospital doors. So the social unrest actually was something that I've been living through my entire life. The fact that the COVID-19 pandemic just put a magnifying lens so the rest of the world can see me as a whole person. Because so many times, I feel like people separate me as Nathalie Douge, the physician who was this hero that's saving lives on a day-to-day, but I'm also Nathalie Douge, this black female who some people might be scared of. I can't separate those two, all of that makes me who I am. So the same way I decided to pursue a career in medicine as a physician to advocate for the quality of life in a health perspective, I would be doing a disservice not to do the same of preserving quality of life for individuals of all walks of life, but especially black people and people of color. So I felt like it was my duty to be able to be a voice or, to some sense, a megaphone for the disparities that have been going on for generations. I think the film shows that through vulnerability and through when people are open and transparent. You're able to see yourself within individuals when you break down all of these walls, and once you find yourself relatable to someone, your actions tend to change. You don't want to cause harm to someone who you see yourself in. That's how we are able to evoke change that we want to see. And I think The First Wave is that catalyst, or just something in our arsenal now to help spark that discussion. Speaker 1: I can say I think without bias that this film really is an important masterpiece. And health is social, we're all interconnected, and we often don't see that in the fragmentation of our sick care system. Dr. Douge, what would you like to see going forward? Dr. Nathalie Douge: I feel like, especially for a lot of us particularly who are in New York City or who experienced their own version of a COVID-19 surge, that once we pass that surge, we forget all of the emotions that propelled us to want to act. That fire cannot dwindle, that's how we become complacent, that's how we come indifferent. And also, for my fellow health care workers, we need to speak up. At times, we feel like we're just factory workers on a line of a never ending list of patients, and we really need to be advocates for what we need as well, both mentally, physically, financially, all of that. And that's how we become better clinicians. Speaker 1: Matthew, you get the last word. Matthew Heineman: I think people want to move on from this pandemic, even though we're still very much living with it, depending on where you live in the country and who you are. And we can't forget, we can't move on. We've all been changed forever. What have we learned that we can apply to the present or the future? And I hope people can at least take 93 minutes to at least sit down and reflect on all that. Speaker 1: Thanks to you both for generating such a healthy conversation, for all the work you've done on this pandemic in this incredible film, in the past and into the future.