Remembrance and resilience at Penn Medicine five years after COVID-19
The worst pandemic in a century is behind us, but its toll and lessons light the way to health care’s future.
All nurses wanted was for COVID to end, and for patients to stop dying. It was nice to have their vigilance at patients’ bedsides be acknowledged, but more than anything, they wished the public would get vaccinated, wear masks, and acknowledge the disease’s severity.
This is one of the powerful sentiments relayed in the new book, Nurses’ Extraordinary Experiences During the COVID-19 Pandemic: There Was Something in the Air, written by a group of nursing leaders at Penn Presbyterian Medical Center. Woven through the book are quotes from interviews with 26 Presbyterian nurses conducted in 2022.
“These nurses worked really hard, and so it meant a lot to us to share their stories. We wanted to honor them, so people could really see the hard work that they did and their dedication in the face of … a really tough time,” said Kirsten B. Smith, MSN, RN, now a clinical nurse specialist in Quality and manager of Resuscitation Services at Pennsylvania Hospital, reflecting on the book. She was a co-author with Paula M. Gabriel, MSN, RN, Margaret Mullen-Fortino, PhD, RN, James Ballinghoff, DNP, MBA, and Pamela Z. Cacchione, PHD, CRNP.
Five years since the onset of the pandemic, the anniversary serves as a time to look back on all the health system and its people survived and achieved, even as much of the world at large seems to have moved on. In health care, “moving on” after COVID-19 means not forgetting about the hard times, but acknowledging both the shadows and the light of innovation that grew in that darkness—from the COVID vaccines developed at Penn, to transformations that enable us to deliver patients more convenient care through telehealth, and much more.
Remembering the toll of COVID-19 is part of the story that is still unfolding today as health care contends with rising costs, an aging population, technologies that complicate care as much as they may help, and other pain points. It’s a story of resilience and transformation among our nurses, doctors, and everyone caring for patients in challenging times.
“During the pandemic, I witnessed an incredible response from our nursing workforce. There seemed to be boundless capacity for innovation, empathy, and compassion—even under the most challenging circumstances,” said Ballinghoff, chief nursing executive of the University of Pennsylvania Health System, and formerly Presbyterian’s chief nursing officer. “It gives me great hope for the future. I don’t think there is anything we can’t handle.”
Trauma and transformation through COVID times
Oxford, PA, public works employee Jeff Dillard will never forget the ravages of COVID; on his arm, he wears a tattoo of the molecular model of the virus, under a face mask, to make sure of it. The image reminds him of everything he almost lost when, in early 2022, he nearly died.
“When I’m having a bad day, I see it and it tells me of a time when I was very sick, and I couldn't wait for my life to return to normal,” said Dillard, who spent nearly three months at the Hospital of the University of Pennsylvania (HUP), much of it in a coma and on a ventilator. “I use it to try and stay positive. It's for me, it's for the people who saved my life.”
Against the odds, he was discharged and is back working, playing in several bluegrass bands, and enjoying his friends and family, with minimal lasting effects. He’ll never take his life—or the people who saved him—for granted, he said. In November 2024, he came back to HUP to thank his care team in person.
“I’m thankful for every day,” he told a crowd that had gathered to greet him at the Perelman Center for Advanced Medicine, “and I appreciate each and every one of you.”
Hospitalist Jennifer Olenik, MD, was part of the team taking care of Dillard from the time he finally left the intensive care unit until he was discharged to an acute rehabilitation facility. She thanked him for bringing the team together, telling him, “Your gratitude helped lift us up, and your story gave us hope.”
While patient reunions like Dillard’s have given some frontline workers the opportunity to reflect on what they went through, many haven’t had the time—or emotional capacity—to look back. The authors of the Presbyterian book said it was important to honor the collective trauma that nurses experienced.
Some nurses left the profession altogether or changed where they were working, as they felt they couldn’t come back and work in their own units anymore and wanted a fresh start somewhere else, said Gabriel, a clinical practice leader at Penn Presbyterian Medical Center. Across the nation, the pandemic left a void in the nursing ranks: Approximately 100,000 nurses left the workforce during that time, according to the National Council of State Boards of Nursing. That left the remaining nurses with the task of welcoming and training more new staff than ever, in a short span of time—nurses whose pandemic-era online training, in some cases, left them without strong clinical experience.
“The nursing profession throughout history has been very resilient, but nurses aren’t rubber bands—people don’t just snap back into place after something as traumatic as the pandemic. It has deeply affected the profession,” Gabriel said.
In health care, there is often the assumption that providers can and should cope with tremendous amounts of illness and death, says Nora Brier, Psy.D., a psychologist at Penn’s Center for the Treatment and Study of Anxiety. But “the frequency, intensity, and duration of deaths and the nature of the unknown illness of COVID was unprecedented, and therefore it should not be expected to be processed in the same way,” she said.“Purposeful remembering,” or honoring the difficulty of the time through deliberate reflection or conversation, is a healthy way to process a collective trauma, Brier added. “It is through this active process, instead of avoiding thoughts and feelings, that individuals are able to cope with the emotional stress of these memories.”
Readying for the health care challenges of today and tomorrow
Across Penn Medicine, though, COVID silver linings are among the inspirations lighting the way forward. Amid the challenges of that time, the pandemic was also a catalyst for innovations that are making the future of medicine today, and a powerful source of institutional pride.
The vaccines that rapidly brought the pandemic under control came about through groundbreaking discoveries in Penn Medicine labs that harness the power of mRNA—and earned Penn scientists Drew Weissman, MD, PhD, and Katalin Karikó, PhD, the Nobel Prize. Today, hundreds of Penn researchers are busy developing and testing new mRNA-based vaccines and treatments for everything from avian flu to autoimmune diseases and heart disease.
The urgent need to find treatments for COVID-19 as a brand-new disease led to some remarkable breakthroughs, too. New insights into how the immune system works in patients fighting COVID led to Penn’s heightened focus on Immune Health and harnessing the power of the immune system to fight all kinds of diseases.
As the crisis unfolded, Penn Medicine staff across all specialties innovated to meet all patients’ care needs safely, at scale, and keep hospital beds open for the sickest patients. These new strategies included technology that made virtual appointments a new norm, virtual monitoring programs that allowed patients to recover at home while being connected to care teams when they needed them, and expanded patient access to chemotherapy infusions at home. Building on these lessons, teams today are continuing to smooth the path for patients to get the right care, in the right place.
“It’s been a long road, but one we’ve traveled together,” said Kevin B. Mahoney, CEO of the University of Pennsylvania Health System. “During the pandemic, our doctors, nurses, allied health professionals, housekeeping staff, and many more on the front lines, along with colleagues across the organization, showed extraordinary dedication and ingenuity. This spirit of teamwork and creative problem-solving revealed new ways to strengthen public health, support providers, and connect with patients—whether at home, in their communities, or through telehealth.”
These experiences continue to guide the health system "as we innovate and lead in an ever-changing health care landscape,” Mahoney said. “Perhaps the most important takeaway from the pandemic is that, even in the toughest times, we have the power to redefine what’s possible.”
May 11, 2023, marked the official end of the Public Health Emergency for COVID-19. Hear Penn Medicine doctors, nurses, and staff reflect on their experiences during the pandemic.