Code Lavender – Help for the Healers
At the height of the pandemic’s first wave, Dr. Tazeen Beg was racing through Stony Brook University Hospital, administering anesthesia and placing patients with COVID-19 on ventilators.
A clinical anesthesiologist, Beg usually provided perioperative care for surgical patients. So when the coronavirus came close to home, she volunteered to join the hospital’s COVID airway team. The experiences she faced as a member of the response team that intubated patients with severe acute respiratory syndrome have stayed with her.
“It would just bring tears to our eyes watching those patients talk to their family at that time,” Beg said. “Telling them, ‘Okay, I love you, take care and I’ll come back’ – things like that. But I knew it was just not gonna happen.”
Dressed head to toe in personal protective equipment, Beg and the airway team visited patients who were struggling to breathe on their own. The team’s arrival would concern patients who heard on the news about the low survival rates among people who were intubated. This sparked questions Beg struggled to find answers for.
“A young guy, I still remember his eyes when I was talking to him, and he’s like, ‘Oh, am I gonna die?’” she recalled. “I just didn’t know what else to say. I’m like, ‘No, I’m gonna take care of you. It’s gonna help you breathe better.’”
He recovered, but that wasn’t always the case.
More than 400 COVID-19 patients were admitted to the hospital in April 2020 – and at times, Beg was intubating nearly 20 of them per shift. There was barely enough time to look after the patients, let alone herself.
“We were running in the hospital from emergency room to the ICU,” she explained. “We didn’t even get enough time to actually get ready for the next patient. It was just so busy. It was just too overwhelming for everybody at that time.”
Dr. Adam Gonzalez, director of behavioral health for Stony Brook Medicine, anticipated these experiences as soon as the virus showed up in New York. He met with the hospital’s disaster mental health committee in early March 2020 to address the approaching threat.
“It’s a lot of go go go to make sure that they’re able to do what they have to do to get the job done,” he said of doctors like Beg as well as nurses and other front-line medical workers. “Over time, the stress and the emotions that come up as a result of being involved in these traumatic experiences can really take a toll and add up.”
The hospital already had a remedy for what Gonzalez knew would be the emotional fallout of working on the vanguard of a pandemic. It was a crisis intervention program called Code Lavender that was pioneered by the Cleveland Clinic in Ohio and brought to Stony Brook less than a year before the coronavirus swooped in – thanks to an obstetrician-gynecologist who had had an epiphany.
When a routine delivery took a turn for the worse, Dr. Megan Lochner, a clinical assistant professor in the hospital’s gynecology and obstetrics department, performed an emergency hysterectomy on her patient and stopped internal bleeding twice. But in the end, Lochner was left alone to handle her own emotions.
“I never left and nobody, nobody in that room asked me if I was okay,” she said. “It was at that moment that I said, ‘I’m not letting this happen to anybody else.’ … I needed help and I couldn’t find it. I said to myself, ‘I have to help my colleagues not feel the way that I feel.’” Her answer was to start a mental health initiative as a pilot program in the highly stressful neonatal intensive care unit to provide support for health care workers who may feel overwhelmed.
Now, when a worker calls Code Lavender, a team composed of chaplains, physicians, social workers and psychologists as well as patient advocates and personnel from employee assistance jump into gear. They provide an immediate calming influence and decide if further assistance is needed – including one-on-one sessions with trained staff members called “wellness champions.”
From the start, Lochner said, the program showed employees that addressing the emotional side of their jobs shouldn’t be pushed aside until they were off the clock. “When you demonstrate that it’s okay to have feelings and to cry, be scared and angry, when you show people that that’s okay,” she said, “then they are going to also show their emotions.”
When the pandemic hit, the program went hospital-wide almost overnight, Lochner said, as more and more health care workers began to feel the pressure of taking care of more and more patients who were getting sicker and sicker. “It was just too much,” she remembered, “code blue after code blue every 10 minutes back in April and people got to the end of their rope.”
Once Code Lavender expanded, efforts aimed at general wellness and prevention were added. Employees could meet through daily virtual support groups and meditation sessions. Therapists taught de-stressing exercises and chaplains provided a hotline to discuss spiritual well-being.
The university’s Employee Assistance Program contributed to the effort by providing pet therapy and hardship funds to minimize the stress and burnout that is all too common among hospital workers – even when there isn’t a pandemic. These programs bring together a response team to provide holistic support following an adverse or traumatic event. Therapists are available around the clock to provide health care professionals with mental health advice.
Gonzalez, who is director of the Mind-Body Clinical Research Center in the university’s Renaissance School of Medicine, championed the creation of a respite room where employees can take breaks and decompress before returning to work. The hospital’s empty adolescent psychiatry unit was transformed into a space where stressed health care workers could relax, enjoy a snack or speak to the psychiatric staff available on hand.
With more than 19,000 visits in the first four months, the feedback helped create a new permanent respite room elsewhere in the hospital. The room features a calming environment with plants and soothing music, where workers relax with small Zen sand gardens or crossword puzzles or adult coloring books.
“We are continuing to build out our Code Lavender response work hospital-wide,” Gonzalez said. “We are identifying wellness champions on each unit that can serve as a point person for wellness and support.” And an inspiration exchange wall offers employees space to post messages to motivate, inspire and support each other.
Gonzalez said this approach helps remove the stigma associated with mental health care. “Engaging in mindfulness and meditation sessions focuses more on overall wellness,” he said, “promoting a skill that people can utilize to cope with the stress that they’re experiencing.”
Looking back on her own traumatic experience, Lochner said if it had happened today, “I would have called the Code Lavender. … We have created a culture of compassion here that did not exist, where we can look out for one another. It doesn’t even have to be an official code. If we see somebody is suffering, we’ll say, ‘Looks like you really need a lavender moment. Why don’t you go take a break? I’ll watch your patient for a little bit.’”
Danielle Curry, nurse manager in the hospital observation unit, was one of the many medical workers who took advantage of Code Lavender and its resources during the pandemic.
Last winter, during the so-called second wave, Curry treated a patient with COVID-19 who was in respiratory distress. She was giving the patient CPR while other health care workers put on protective equipment. Curry didn’t feel the need to completely protect herself since she’d already had a bout of COVID-19 and recovered. Besides, she was concentrating on saving the patient’s life.
But then, Curry said, “the patient’s color changed. It felt like an eternity before everyone came in there. I had never had a full blown code blue under COVID before.”
Curry described her own unexpected reaction. “I became very emotional,” she said. “Everything hit me at once. I was beside myself.”
She called Code Lavender. “It was very helpful because I was able to talk about how I felt at the moment,” she said, adding that the wellness champion who responded “cared and she helped.”
Psychiatric nurses, like those who helped Curry, offer in-person support, including meditations, empathic listening, encouragement and resource flyers. The nurses also organize donations for wellness baskets and snack packages for all units. The Department of Psychiatry and Behavioral Health developed a helpline for employees and their families that provide on-the-spot counseling and other resources, including COVID-19-related mental health counseling.
Lochner also explained what makes the hospital’s response to the mental health crisis of health care workers unique. “We anticipated the need, as opposed to responding to the need,” she said. “We got over 400 emails from kids and from community members with pictures and video clips that they made for us and we were able to print them out and display them throughout the whole hospital. We also had pet therapy with an iPad, which sounds kind of silly, but people loved it.”
Colleen Stanley, the lead coordinator of the Employee Assistance Program, and her colleagues also saw what was happening. Stress, she pointed out, can show in many forms – anxiety, depression, domestic violence, substance misuse, insomnia, nightmares, intrusive thoughts, fear of bringing the virus home, fear of joblessness, a sense of being out of control, and the list goes on.
These concerns prompted the Employee Assistance Program, in partnership with the hospital, to create a training program for supervisors to learn how to recognize when workers may be having difficulties that could impact their job performances. Special mental health response teams were formed to identify workers’ reactions to – and symptoms of – trauma and to provide tips for managers to deal with them.
A hardship fund was started to relieve the financial burdens of hospital workers, who can apply for grants up to $599 to help with non-recurring, unexpected, critical expenses such as family crises, acute illness, natural disasters or fires.
Dr. Cynthia Cervoni, a psychologist in the university’s consortium program and a contributor to the Code Lavender response effort, emphasized why her job is so important, especially in such turbulent times.
“On a very basic human level, protecting the mental health of hospital employees is important because they are people and they are suffering in their own way and we want to be able to provide that service,” she said.
Last year, Cervoni, Lochner and Gonzalez collaborated on a research paper with the American Psychological Association titled, “Supporting Health Care Workers During the COVID-19 Pandemic: Mental Health Support Initiatives and Lessons Learned From an Academic Medical Center.” It elaborates on the hospital’s efforts to support the mental health of its employees.
“Health care workers are such valuable members of our community,” Cervoni said. “They’re taking care of all of us at a time when it’s needed so it just makes sense to take care of them as best as we can.”
Listen to more of Cameron Albert’s report: