In mid-March of 2020, Mansi Patel had just finished her three-month nursing orientation for Nelson 5 when the unit was rapidly transformed to care for patients with COVID-19. Although she had already worked in health care as a physical therapist, nothing prepared the 36-year-old for what lay ahead.

“It was completely scary, especially being a new nurse,” she says. “It was like I was in the ocean and I didn’t know how to swim.”

She and her colleagues at The Johns Hopkins Hospital were taking care of a growing stream of patients with a mysterious and deadly disease that scientists were racing to understand. They were comforting critically ill people whose families couldn’t visit them. And they were worried about contracting the virus and bringing it home to their own loved ones.

As grim stories about the pandemic increased, however, Patel and other front-line hospital workers also began to be celebrated for their dedication as “health care heroes.”

For 14 months, staff members on the hospital’s COVID-19 units remained focused on fighting the pandemic, one patient at a time. In late May, as the number of patients requiring isolation at The Johns Hopkins Hospital dropped into the single digits, Nelson 5 was decommissioned as a COVID-19 unit.

Does a health care worker like Patel feel heroic?

“Honestly, I don’t think so,” she says. “[Nurses have] been taking care of people forever. … This is what I do. This is what I love doing.”

Typically a step-down unit from intensive care, Nelson 5 was the longest running COVID-19 unit at The Johns Hopkins Hospital. Andreas Andreou, the resident chaplain with Nelson 5 since August 2020, says the unit’s staff members, as well as others helping to fight the pandemic, refer to their work as a calling.

The chaplain has performed two “blessing of the hands” ceremonies for those working with COVID-19 patients at the hospital — one at Thanksgiving and one in March around the one-year commemoration of the pandemic. When he asked those receiving the blessing “what keeps you going?” the most common answer was “love.”

“That, to me, really speaks to what is the driving force, what moves them to be showing up in this environment every day,” he says. “It’s just that they love what they do. I don’t think you can become a nurse, or any health care worker, without having that. You don’t do it for the money.

“If you call them heroes, you’re taking that away. That’s their calling in the first place.”

Grateful Salutes

The nationwide honoring of health care providers started in spring 2020 as the pandemic took hold and forced worldwide lockdowns. In Maryland, the U.S. Air Force Thunderbirds and U.S. Navy Blue Angels flew over The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Sibley Memorial Hospital and Suburban Hospital. Car parades of grateful community members, police officers and firefighters drove through medical campuses. Donations of meals and supplies poured in from local restaurants and the community.

On Johns Hopkins Medicine’s website, the Extraordinary People, Extraordinary Moments feature was launched to showcase those working to keep patients and staff members safe, as was an internal appreciation board where people could post personal messages to thank Johns Hopkins “health care heroes.”

Although so much appreciation felt good at first, Patel says, the feeling was short-lived as infection rates climbed and safety precautions were, at times, ignored.

“As early as the summer [of 2020], people were saying ‘we feel forgotten,’” says Carolyn Cumpsty-Fowler, senior director for nursing well-being in the Johns Hopkins Medicine Office of Well-Being. “They were saying ‘There was all this attention on us, and now everybody’s gone on with their lives. And we’re still here.’”

She recalls learning from a nursing colleague on a COVID-19 unit about a group of exhausted health care workers on her team seeing television coverage of Labor Day weekend activities last year.

“There was video of people just blatantly disregarding any kind of social distancing, any kind of masking … and my colleague said that [people in the unit] were crying,” Cumpsty-Fowler says. “That just felt like a betrayal of everything health care providers are trying to do.”

Such images add to the anxiety that Patel says she and her colleagues already feel. On top of worrying about bringing COVID-19 home to her husband and 3-year-old daughter, Patel has avoided going grocery shopping in her scrubs during the pandemic because she read about uniformed health care workers being attacked.

“I’m scared that someone’s just going to hit me from behind if I’m wearing my scrubs,” she says. “Emotionally, it’s still there in my head, and I don’t know how long it’s going to take for me to recover.”

Patel hasn’t had time to grieve some of the patients who have died on the unit. She also suffers painful memories that can accompany caring for patients with COVID who are isolated from loved ones.

“If a patient is critical and you’re with them holding their hand, but you have to go take care of your other patient also — that guilt, it still affects me sometimes,” she says. “You just feel helpless. … The whole thing is very sad, and there’s nothing heroic about it.”

Albert Wu, professor of medicine and co-founder of RISE (Resilience in Stressful Events), has heard from front-line workers that the “hero” label rings hollow when the outside world has moved on.

“People have said, ‘we don’t feel like heroes anymore. That’s sort of worn off,’” he says. “‘Now we’re just exhausted. We’re not coping, we’re surviving.’”

Even Heroes Need Support

Lolita Moore, a safety and security officer at Sibley Memorial Hospital, fully embraces the hero title, but adds she also felt like one even before the pandemic.

“I don’t need anybody to clarify who I am and what I do,” she says. “When they said ‘health care heroes,’ I felt like they were talking about us. Even though we’re security, we work in the health care system.”

During the past year, Moore’s job has entailed taking the temperatures of arriving patients and wheeling them to the emergency department, helping people navigate the hospital and escorting discharged patients who have recovered from COVID-19 out of the facility. She says there is new awareness for how she and her colleagues keep the hospital safe; she points out that meals donated to various hospital departments have included security.

She has appreciated the weekly food pantry, where she and other Sibley employees were able to get fresh fruits and vegetables and dry goods to take home. And like many of her colleagues, Moore has used mySupport, a program providing free counseling for Johns Hopkins employees.

MySupport is one of the services that make up the MESH (Mental, Emotional and Spiritual Health) Collaborative, an initiative convened by the Office of Well-Being to support employees’ mental and emotional health (see contact information for MESH services here).

Overall use of such programs has increased greatly during the pandemic, according to Lee Biddison, chief wellness officer at the Office of Well-Being, and Cumpsty-Fowler.

· MySupport reported a 30% increase in calls between November 2020 and February 2021; the most common reasons were stress, depression, anxiety, grief and loss.

· RISE, which delivers peer support to health care workers coping with stressful patient-related events, responded to five times more staff members per month during the pandemic than before.

· Requests for spiritual services from employees at The Johns Hopkins Hospital are the highest they’ve been in at least four years and remain higher than normal, according to Ty Crowe, director of the Johns Hopkins Hospital Department of Spiritual Care and Chaplaincy.

As Biddison observes, “Our colleagues do the extraordinary, go above and beyond. But it is not infinite. The well is not bottomless.”

The Office of Well-Being team credits, in part, increased awareness and promotion of mental and spiritual health services during the pandemic.

This may explain why RISE has heard from a different group of employees during the pandemic, Wu says. While RISE has historically received most calls from nurses, which is still the case, more employees from the facilities department, nutrition, security, laundry, transportation and environmental services have also called in. Wu says these callers were more likely to have household income concerns, lack of child care, and perhaps even issues with food security as well as concerns about their health.

A New Phase

Most recently, there’s been a slight decrease in requests for support from employees.

“Now people seem like they are in a more resigned phase where they’re just putting their heads down and hoping things will go away,” Wu says.

Cumpsty-Fowler asks, “Does that mean people are getting better and don’t need help? Or does it mean they are so exhausted that they don’t even have the energy to ask for help. That’s very concerning to us.”

For her and her fellow MESH collaborators, this means increasing their vigilance.

“The concern is about the grief that has yet to be acknowledged,” Crowe says. “As we dwindle down our numbers, we really need to start to pay attention to our colleagues. … We don’t pause long enough to acknowledge the things we’ve lost, but also acknowledge the good we’ve done.”

When Nelson 5 unveiled a poster to commemorate the statistics of the patients with COVID-19 treated there during the first year of the pandemic, for instance, it said “644 patients, 58 losses” — until Chaplain Andreas Andreou added “586 wins.”

The unit was also recognized with Johns Hopkins Hospital’s first DAISY Team Award, to honor all the health care workers for their compassion and skill. Patel cried happy tears when she watched a video about the award.

“Reality hits you when you see something like that,” Patel says. “I work with these people every single day. I’m so proud of being on that team.”

Moore says she feels a similar sense of pride as she reflects on the pandemic. “I’ve always enjoyed what I do,” she says. “Now, I respect it a little more.”

Although the wide availability of vaccinations brings hope, the fight against the disease continues. Even though Nelson 5 has transitioned back to its traditional care model, Patel still takes care of patients with COVID, many of them younger and sicker than she has seen previously.

While some may call it heroic, she insists she’s simply showing up and doing what’s required in the job she loves.

“This work is nothing like being a hero. This is just extra pressure,” Patel says. “But I think everyone has realized this is probably going to be a new normal for a little while.”