Sound On
How did it feel to be a medical student during the pandemic, when for safety’s sake and to preserve PPE, providing direct patient care was no longer a possibility? What went through a Community Service Officer’s mind as she informed every person entering the hospital that temperature screening and wearing a mask were mandatory? And what did it feel like to be an infectious disease expert during the pandemic’s early months, when often the only response to so many questions was, “We just don’t know”?
The voices of those who lived these experiences, and much more, are being captured through the efforts of a group of current and former medical students, residents and faculty at Vanderbilt University School of Medicine and Vanderbilt University Medical Center through the Vanderbilt COVID-19 Community Oral History Project.
To date, they’ve recorded 46 oral histories, and they are continuing to build an audio archive of memories related to COVID-19. Medical students, residents, physicians, nurse practitioners, registered nurses, physician assistants, other clinical staff and a small number of nonclinical VU/VUMC staff have shared their unique experiences through interviews that began in April 2021. The group is broadening the spectrum of participants even further, inviting those who experienced COVID-19 at the Medical Center, in all roles, to share their thoughts for the record.
“This is so different than a traditional medical/scientific study or even a more journalistic piece,” said CeCe Cihang Gu, a fourth-year VUSM student who is the project’s coordinator. “It has been a chance for individuals to share a first-person account of what they experienced.
“As medical students, we were pulled out of clinical duties in mid-March 2020. We came back in June 2020, but we were still protected from seeing COVID-positive patients pretty much until August 2021. Then, we could opt in to see these patients. So, from a student’s perspective, I really don’t know what exactly went on at Vanderbilt on the front lines with the COVID patients. Through this project, it was great to talk to people and hear what they’ve done, in a very unadulterated way.”
Gu has an undergraduate degree in history from Johns Hopkins and for her senior project collected the oral histories of Chinese Americans who immigrated to the United States as they fled Mao Zedong’s tumultuous Cultural Revolution. She was thrilled to leverage her past experience to document the COVID-19 pandemic, an intensely significant period in both societal and medical history.
“I feel like in this day and age, when there’s so much noise everywhere, coming from the media and social media, it’s really refreshing to just hear people talk one on one about their experiences,” Gu said. “As a medical student, I didn’t get to interact with a lot of people outside of physicians. Through this project, I got to talk to a lot of nurse practitioners, bedside RNs, COVID Unit care partners, community service officers, chaplains — people who do very different jobs than what we do. It’s so important for these individuals’ stories to be heard because in commemorating history, and as someone who studies history, I always want to go back to the primary source. One day, when people want to study this pandemic, they can get firsthand exposure through these oral histories.”
Gu worked closely with the project’s initial principal investigator, Michael Neuss, MD, PhD. Neuss, who holds a doctorate in history from Columbia University, worked as a VUMC hospitalist, an assistant professor of Clinical Medicine and a historian of science and medicine. In late 2021, he moved to fill a similar role at Perelman School of Medicine at the University of Pennsylvania.
The Vanderbilt COVID-19 Community Oral History Project was born as the pandemic began unfolding in the United States in March 2020. At that time, a group of VUSM students poured through archives looking for any documentation of Vanderbilt’s contributions and involvement in the historic 1918 influenza pandemic. The 1918 flu, which continued into 1919, infected most of the world’s population and killed an estimated 50 million people, including 8,000 Tennesseans.
The curious students, some of whom were affiliated with a recently formed student group, the Society for History of Medicine and Surgery, searched the online archival resources of Vanderbilt’s Jean & Alexander Heard Libraries, and particularly the Annette and Irwin Eskind Family Biomedical Library and Learning Center. They also scanned state and national electronic resources such as the Tennessee State Library and Archives and the National Archives, but they found little mention of the Vanderbilt community’s contributions during what was until recently the nation’s deadliest pandemic.
Neuss and others were determined to preserve the archives for the COVID-19 pandemic, and especially as they related to Vanderbilt’s role. Collecting oral histories was felt to be the best way to preserve the personal experiences of those in the Vanderbilt community. As the project was forming, he sought guidance from University of Michigan’s Melissa Borja, PhD, a senior adviser to Princeton University’s Religion and Forced Migration Initiative. This oral history project examines the role of religion in refugees’ lives as they resettle in the United States. Borja now serves as senior external adviser for the Vanderbilt COVID-19 Community Oral History Project.
“Hearing people share their own stories and on their own terms is tremendously powerful as a way of illuminating complex, lived experiences,” Borja said. “Years from now, I hope students, teachers, researchers and everyday people will be able to look to these oral histories not simply as a way of remembering that this event happened, but to truly understand what it was like to work in a hospital, to lose a loved one, and to navigate the complicated decisions that went into caring for our families and our communities during such fraught times.
“During this pandemic, the public has been regularly bombarded with data — figures and graphs about the number of positive cases and the rates of hospitalization. These numbers matter, of course, but people are moved by stories just as much as by data. Ultimately, we need to remember that there are people behind those numbers: real human beings who experience hope, fear, joy and love. Oral history, in the end, helps us to center the humanity of others, and of ourselves.”
Borja added that there is not one story of the pandemic, and people have suffered through and responded to this public health crisis in very different ways. She believes a major contribution of this project is that it calls attention to the diversity of experiences and how they intersect with and exacerbate preexisting circumstances of inequality related to issues such as race, gender, class, religion and ability.
With Borja’s advice, Gu and Neuss worked together on the project’s design, and Gu took the lead in designing the oral history protocol and interview guide for those volunteering to conduct interviews. The project received approval from the Vanderbilt Institutional Review Board and Medical School leadership in March 2021. Oral histories, which began soon after approvals were in place, were initially conducted through Zoom interviews to reduce the risk of exposure. While the process might have otherwise seemed impersonal or disconnected in another context, because everyone was rapidly becoming well-versed in conducting much of life via video calls, the interviews were seamless.
“We were lucky that CeCe was interested and had a background in this type of work through her undergraduate work at Hopkins,” Neuss said. “She immediately was sensitized to the stakes and the opportunity for the work in a way I think many people might not be. And then I was interested in the question of ephemera — things that are fleeting.
“So much of our history at Vanderbilt around the 1918 flu is just gone,” he said. “Clearly, there were people from the Vanderbilt medical community who were involved in the city’s response and are likely to have done things elsewhere. But there really is only the barest mention of Vanderbilt’s response to the pandemic in one of the yearbooks from the era.”
Because we are bombarded with information from so many fronts now, collecting and presenting these oral histories responsibly and thoughtfully is critical in these voices reaching others, Neuss said, something this project’s creators have been mindful of throughout the process.
“We often assume that things are recorded and kept in some kind of stable form — this is the so-called age of big data and surveillance capitalism — but the reality is much more complex. Unless you’re really intentional and thoughtful about exactly how you create a record of an event like this, people might not have a complete picture of it.”
While there were many initial offers to both conduct interviews and to be interviewed, as the pandemic continued to roll on in waves and other demands consumed time, the effort distilled to a dedicated core group. Gu; Neuss, now serving as a senior external adviser along with Borja; current principal investigator Chase Webber, DO, assistant professor of Clinical Medicine; resident Jonathan Kooiman, MD, (Medicine-Pediatrics PGY4); Raeann Whitney, MD, (Internal Medicine PGY2); and third-year medical student Beth Cosby, are the key team members driving the project.
Laura Stark, PhD, associate professor of History at Vanderbilt University’s Department for Medicine, Health and Society, also advised the group regarding their ethical commitments to the narrators and the importance of engaging responsibly with the community.
“During the pandemic, the distance between what society understands of medicine and what medicine understands of society has diminished significantly,” Webber said. “What can only be described as a trauma has unfolded, at very large scale, and we’ve seen individuals and groups grappling with the trauma of the pandemic in different ways. But after the surges and mitigation strategies, the advances of science and political missteps, what lessons can we learn from those who were truly there? How can we process what has taken place to better inform our future decisions and anticipate the hazards of the future?
“Our team continues to have hope that the voices and stories that otherwise would have gone unheard will paint a more complete and human picture of this precarious moment, both for our own understanding and for future generations.”
There is both art and science in the collection of oral histories, and those conducting and transcribing the interviews were trained before beginning. Open-ended interview questions were carefully crafted to gently spur memories but not to influence or adulterate responses.
Gu said the project gave her a much greater appreciation for the critical roles of many individuals at the Medical Center who contributed to the successful pandemic response.
“The occupational therapists I interviewed worked to get patients back to independence and helped them achieve their activities of daily living,” Gu said. “Their perspective on the impact of isolation and what patients are capable of when the family is there versus not was very interesting to me.”
She was also struck by how often themes of trauma and the pandemic’s destructive impact on mental health came up during interviews.
“I was surprised by just how much of a traumatic experience it has been for many people who worked on the COVID floors and in the COVID ICUs, especially when their own family members have either gotten sick, or even unfortunately passed from COVID,” Gu said. “I’m certainly not a licensed therapist, but talking about it seemed to be a cathartic experience for many. Several people told me during interviews that it was the first time they had really sat down and thought about everything.
“And so many people told me that they have either started therapy or are seeking help for mental health or started taking medications due to anxiety or depression. I just hope if there’s another pandemic that we will address the mental health of health care workers at an earlier stage.”
Neuss said that the project was eye-opening for him as well and has even transformed how he practices medicine now. As a hospitalist at Vanderbilt University Hospital, he was often busy with overnight COVID-19 admissions, particularly during infection surges. While he was highly involved in these patients’ care, as a result of the oral history project he realized even more clearly that he was operating from a privileged perspective as a physician.
“I had a very different level of physical contact with these patients compared to many who were more physically close to these individuals for longer periods of time,” he said. “It’s made me more conscious of being more courteous, deferential and appreciative of so many other staff working in the hospital and more aware of what they contend with in order to do their jobs and in order for people to get safe care.”
Webber agreed that the oral history project has also meaningfully affected him and said it has been gratifying to watch other team members experience their own expansion.
“I was inspired seeing the medical students and residents on the team who understand that history isn’t something that just happens to us; that there are methods and procedures to inform how we gather, process and frame the story,” he said. “I studied literary theory prior to medical school, and certainly from a personal point of view I’ve always been interested in acquiring tools and methods that help us as physicians to build rapport and relationships with our patients.
“I guess I never realized the extent to which we (clinicians and patients) would experience and face the pandemic together. I’ve heard it said that the ‘state of emergency’ in which we have lived and practiced medicine over the past few years has paradoxically deepened our connections with patients. I believe that to be true and feel it vitally important that this moment be thoroughly and authentically documented.”
The Vanderbilt COVID-19 Community Oral History Project will ultimately be accessible through the Vanderbilt COVID-19 Community Archive, coordinated by Chris Ryland, curator of the History of Medicine Collections and Archives. In this effort, Vanderbilt University’s Special Collections librarians are gathering additional personal stories, artifacts and recollections related to the pandemic.
“We hope that the oral histories can serve as a living archive and a resource to give perspective to future research, to those who look back for answers in the next 50-100 years,” Webber said. “It is said that ‘history never repeats itself, but it does rhyme,’ and we hope to be more informed and better prepared for the unexpected challenges that lie ahead.”
Because interviews are still being completed, and because participants were given the option of embargoing or delaying release of their interview content to the public, a date has not yet been set for when the Vanderbilt COVID-19 Community Oral History Project will be made available through electronic archives and possibly in other ways.
“There are some professions, and especially nonclinical staff, that are a bit underrepresented in our repertoire right now,” Gu said. “As we continue with interviews, we are really recruiting narrators from all backgrounds, as we want the archive to be as diverse as possible. We tell those being interviewed that it’s roughly an hour commitment, but it really depends on how much that person wants to talk. And those participating also have the option to remain anonymous.”
If you would like to share your experience related to the COVID-19 pandemic or be an interviewer for the Vanderbilt COVID-19 Community Oral History Project, contact CeCe Gu at cece.cihang.gu@vanderbilt.edu or Chase Webber at chase.j.webber@vumc.org.