Mariam Zakhary, an assistant professor in Mount Sinai Hospital’s department of rehabilitation medicine, remembers what 7 pm sounded like in Manhattan last April: residents clapping and cheering for frontline health care workers as they ended their shifts. It’s 2021—the celebrations have mostly stopped, Covid-19 cases are rising, and our medical workers are experiencing mental anguish well beyond burnout.
Before the pandemic, doctors died by suicide at double the rate of the US population. Covid-19 has strained health care workers’ capacity to bear witness to grievous suffering. A team of artists, technologists, neuroscientists, and medical researchers came together and created recharge rooms to tackle this problem.
Zakhary works in Mount Sinai’s post-acute Covid-19 clinic with “long haulers,” individuals still suffering post-Covid-19 symptoms, months after being diagnosed.
“It’s scary,” she says. “I see marathon runners who are unable to go up and down stairs, and attorneys unable to string proper sentences together without word searching due to severe ‘brain fog.’ We have seen thousands and have thousands more on the waitlist.”
She’s bracing for a surge of need in the coming months. “The worst is yet to come,” she says. “The hardest thing to say to these patients is that we don’t know what’s going on, but we are going to do our best to treat it. I’m not sure that was ever something we had to say to a patient, that science has failed us, and we can’t figure out the pathology.”
The long hours and difficult treatments take their toll on health care workers as well. For reference, some experts look back to 9/11 for clues about what the future will look like for frontline workers. In a 2020 study published in the Journal of Clinical Psychiatry, Mount Sinai researchers found 26.8 percent of police and 46 percent of “nontraditional responders,” such as construction workers, had PTSD symptoms 12 years after 9/11. These findings emphasize the importance of treating subthreshold PTSD for first responders.
A recent study from Italy, where the pandemic raged months earlier than in the US, offers more insight. All of the health care providers who were studied experienced a high level of psychological distress, suggesting that immense personal and emotional involvement in facing this grueling period can put their psychological health at risk in the near future.
Long before the summer’s spike in Covid-19 cases,, David Putrino, director of rehabilitation innovation at Mount Sinai, converted his neuroscience research lab into a nature-inspired relaxation space for frontline health care workers.
Putrino collaborated with Mirelle Phillips and her team at Studio Elsewhere to design and install the multisensory recharge rooms. The rooms use biophilic design principles, or decor that mimics nature, and the idea is that this can support healing. Phillips designed comfort and tranquility spaces to connect health care workers to nature to offset the hospital’s otherwise sterile environment. Biophilic design is also more than adding plants to indoor spaces. It’s an interior design philosophy intended to improve people’s mental and physical well-being.
Phillips, the daughter of a Mexican immigrant, wants to leverage emerging technologies to address health inequity—to design a more imaginative, inclusive, and connective experience of health, well-being, and care. “We’re on a mission to be co-creative with the communities we serve and ensure we get our interventions out to vulnerable populations who often get it last,” she says.
Phillips called on Jacob Marshall at EMBC Studio, his partner, Hai-Jin Marshall, and award-winning violinist Tim Fain to create immersive audio for the recharge rooms. “We built upon Mirelle’s ongoing work on how design with nature helps heal us and to use technology and artistry to deliver an immersive multisensory aesthetic experience that could break the cycle of stress and burnout,” says Marshall.
When asked about what the future looks like for health care workers, Zakhary says, “When the dust settles, we’ll have so many emotions to deal with—almost like the military on the front lines when they come back to real life, and the PTSD hits.” Reflecting on the beginning of the pandemic, she says, “The recharge rooms were a retreat. Every single thing around us was a negative statistic. How many more lives were lost on our unit? How many ventilators short were we? How many more beds did we need out in Central Park? How much PPE did we have left? But in the recharge room—for a few minutes, you weren’t in that world anymore.”
When you walk in, a fire is crackling. You instinctively lean forward. You hear the sounds of a forest—crickets, birds, and even butterflies fluttering past. Your mind, once a fraught jumble of stresses and worries, clears as your shoulders relax—you’re now focused solely on the scene in front of you.
When staff in Mount Sinai hospitals walk into the room, technology takes over. The rooms are voice-activated through Google Home, so workers don’t touch anything, to avoid spreading infections. Visitors typically spend 10 to 15 minutes in the space, which is sanitized after each visit. The rooms offer a brief respite from the anxiety, stress, and trauma health care workers face every day: rising new cases, supplies shortages, and death.
The rooms Putrino created in his lab are based on his research. “The underlying principle here is that space is never neutral—it hurts, or it helps.” When asked about his role, he says, “My job is to use technology to make people’s lives better. I don’t care about grants, getting papers published, going to conferences—all of that is just signaling that you’re part of a club, and totally peripheral to our actual goal of using science and technology to transform people’s lives,” he says. “When it comes to forming teams, it is all about stepping out of the ivory tower and being a part of an interdisciplinary team. Most of our problems are only problems because people aren’t stepping out of their own silos to solve them. It’s really that simple.”
A recent Frontiers in Psychology study indicates that just 15 minutes in the recharge room at the end of a shift can reduce stress by up to 60 percent. “It’s been important to create interventions that have the durability to impact the PTSD that nurses and doctors treating Covid-19 are experiencing,” says Phillips.
One of the paradoxes of natural disasters and pandemics is that they can strengthen common bonds and transform human behavior. Collective trauma can breed a stronger sense of empathy and resilience. “This work has been intense, heartbreaking at times, and challenging, to say the least,” says Marshall. Phillips concurs. “Health care is a team sport, and success requires a network of stakeholders. Dr. Putrino was the catalyst for what I was doing with Studio Elsewhere, and I constantly see him push every day in a complex industry to bring relief to those that are suffering as quickly as possible.”
An incredible bond formed between Putrino and his team. “I’ve loved working with Jacob, Mirelle, and the rest of the crew on this project so much,” he says. “A group of unqualified people—unqualified meaning we had no business solving this problem, but if not us, then who?” he added. “I think that, for me, the best part of working with this team during the pandemic was that every few nights, at the end of a tough shift, we got to sit down together, have a glass of wine, and just connect: talk about all the ways that we could work together when the pandemic was over. In many ways, that very simple act—having a glass of wine with new friends—felt like the ultimate privilege during the surge because we were all so isolated from our typical social circles.”
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Putrino’s gratitude is infectious. It’s no surprise that he and his collaborators are heroes to the health care workers they serve. “As an organization, I hope that we can reflect on how much growth we have had,” he says.
Phillips added, “Over the summer, when I was on site, we would estimate anywhere between 600 and 900 visits a day across all the rooms. Now, we’re working together to permanentize the spaces we created during the surge.”
This year, there’s cautious optimism about this pandemic coming to an end, yet its aftereffects will be with our frontline health care workers long after we’re all vaccinated. Mirelle and her team are working hard to bring more recharge rooms to public hospitals, serving at-risk populations, in partnership with the Greater New York Hospital Foundation.
2020 was a year of loss, and a lost year. Yet people like Putrino, Mirelle, Jacob, and their teams remind us that technology has a unique ability to convey a sense of “being there,” miles away from the assaulting effects of trauma. Virtual journeys can change mind and body for the better, even in the heart of a trauma center. Music powered by technology that heals isn’t new to Marshall, whose audio journeys resonate on individual levels. “It has been one of the most rewarding and important times of my life where my core belief that art is medicine has come to life,” says Marshall. In that spirit, he offers a rare opportunity to experience the healing sounds from the recharge rooms here.
If you or someone you know needs help, call 1-800-273-8255 for free, 24-hour support from the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for the Crisis Text Line. Outside the US, visit the International Association for Suicide Prevention for crisis centers around the world.
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