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Emily Silverman
You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. During the peak of the pandemic, the demand for physicians far outstripped the supply. Urgent calls went out for doctors who could help: people who could come out of retirement, or leave the comfort of their medical specialty, to staff up the hospital wards and ICUs.

Today's episode features the voices of two of those doctors: Jackie Howitt and Gretchen Volk. Jackie retired from her clinical OB/GYN practice in 2019, and educates med students as a Clinical Associate Professor in the Department of Health Humanities at the University of Rochester. Gretchen is an Urgent Care pediatrician in Rochester, who completed her Pediatric residency at Strong Memorial Hospital. When Jackie and Gretchen first reached out to me about their story, I was very intrigued, because they were proposing that they tell their story together as a dialogue. We had never done that before at The Nocturnists; usually our stories are monologues. But in this case, it made all the sense in the world, since this particular story is about friendship and solidarity.

So we paired Jackie and Gretchen with one of our amazing story coaches, screenwriter Melissa Brandt, who helps them shape their story for the stage. And, wow, the results were incredible. Before I speak with Jackie and Gretchen, take a listen to their amazing live performance at The Nocturnists in San Francisco, in June of 2022. Here's Jackie and Gretchen.

Jackie Howitt
It's April 2020, and I am obsessively watching these COVID cases rise; watching those enlarging red dots on the US maps. Watching the COVID death numbers increase; seeing images of refrigerator trucks, used as temporary morgues, in New York City. I'm in the Rochester airport and it's quiet. Lots of bright lights, but no hustle and bustle of people. The marquees all have listed the canceled departures and arrivals. The only flight out today is the one that's taking me to JFK.

Gretchen Volk
Two weeks ago, Governor Cuomo came on TV and said, Come to New York!" to health care workers. And so I signed up to volunteer, not truly expecting they would accept an offer of help from a general pediatrician. But they did.

Jackie Howitt
I didn't think they would want a retired OBGYN either. But they did.

Gretchen Volk
So, it's Easter morning 2020. I'm walking through this ghostly, quiet Rochester airport. It feels like a church, if you get there too early for a funeral. It's very somber, and it fits my mood because I'm scared. I make my way to the Jet Blue departure gate, and I'm surprised to find a party unfolding. There's a mountain of doughnuts. There's urns of coffee. There's a big, bubbling group of University of Rochester Medical personnel. They're all wearing matching fleece vests, and they're arranging themselves into a clumsy pyramid for a group photo. "Hey, I'll take that for you, guys."

Jackie Howitt
Oh, it's okay. I'm not with them. Are you?

Gretchen Volk
No, I'm Gretchen.

Jackie Howitt
Gretchen... Jackie, nice to meet you.

Gretchen Volk
Oh, I just took a big breath. I had been feeling so alone, until that moment. And now, maybe, it'll be me and Jackie. Us against the world. Us against COVID! Or just us against this inappropriately giddy U of R group. Before we board, Jackie gives me her phone number, just in case.

Jackie Howitt
So we get on the plane, and we're each assigned our own row. There's no one beside me. There's no one in front of me. There's no one behind me. I'm masked and gloved. I take out my Clorox wipe and dutifully wipe down all the surfaces near me. All of a sudden, the flight attendants go running up the aisle, whooping and carrying a banner that says "Thank you for your contributions!" I'm very frightened.

Gretchen Volk
A week earlier, I had been contacted by a TV producer from Japanese public television. And she wanted to make a documentary about the experiences I was about to have in New York City. So I text her from my seat on the airplane. "Maki. I just made a friend!" And she texts me right back. "Ask her if she wants to be in the documentary." Jackie, do you want to be famous in Japan?

Jackie Howitt
Sure. Seemed like a good idea at the time... But then we're de-planing, and this woman who I've now linked up with stops, and offers the Jet Blue pilot Easter candy. Did I just give my phone number to a missionary?

Gretchen Volk
Not a missionary... very pro-candy.

So, Maki films us walking through Jet Blue's deserted baggage claim area. And the next shot she wanted to get was us getting into the Uber that was going to take us to our hotels. But the Uber driver's super spooked by the TV cameras, so he takes off without us. And, I guess it's against Japanese public television policy to invite people into your van, but Maki does, because we're stranded there.

Jackie Howitt
So we're driving from JFK to Brooklyn and the streets are empty. I keep thinking about my dad. He was born and raised in Brooklyn, but I've never been. Gretchen, this is weird....there's no traffic.

Gretchen Volk
Oh, and I'll never get over these empty airports. The last time I flew, it was November. It was nothing like this.

Jackie Howitt
I last flew in November too. It was chaotic. Where were you headed?

Gretchen Volk
I was trying to get from Rochester to Los Angeles, before my dad died.

Jackie Howitt
Wait! When did your dad die?

Gretchen Volk
November 17.

Jackie Howitt
I struggle against my seatbelt. Suddenly, it's too tight. I have to look her in the face. November 17, 2019?

Gretchen Volk
Yes.

Jackie Howitt
That's when my dad died too.

Gretchen Volk
Okay, she's fucking with me, right? This complete stranger, you know, weasels her way onto my Japanese TV show. And, like, fabricates when her dad died. Like... But that doesn't make sense... Who would...? Nobody would do that. That, that's crazy. I mean, it's just like a kind of a cool coincidence. Like, our dads.... They're sitting up in heaven, like, together. And, they're like, "Yeah, our daughters should meet." You're being such an infant; don't be like that. Okay, just slow down. Think it through. What would Oprah say? Oprah would say, "Gretchen, you were meant to meet Jackie today."

Jackie Howitt
So, we meet for dinner. But almost everything is closed. We finally find a place where we can get takeout sushi. And we sit, and we talk about our day-to-day lives, our families, our careers, and we find other connections. For example, I grew up in Gainesville, Florida.

Gretchen Volk
Oh, my daughter lives there. She goes to UF. Where does... Where did your daughter go to school?

Jackie Howitt
In Rhode Island. Brown. I went there too.

Gretchen Volk
Oh, yeah, of course you did. That's where I went.

Jackie Howitt
I did my residency in Hartford.

Gretchen Volk
I did a trauma rotation there.

Jackie Howitt
So I still have a lot of family in Gainesville. But... it's complicated.

Gretchen Volk
Yeah, I get it. I don't talk to my mom.

Jackie Howitt
I don't talk to mine either.

Gretchen Volk
I've been assigned to work on a COVID unit at an inner-city hospital in Brooklyn.

Jackie Howitt
I'm on a Labor and Delivery unit in a different inner-city hospital in Brooklyn.

Gretchen Volk
Every morning, Maki meets me outside the hospital and films me going in, but she's not allowed inside.

Jackie Howitt
No visitors are allowed, including family. Laboring women have to labor alone. Moms and babies are separated until the COVID tests return. Sometimes, that takes more than 24 hours.

Gretchen Volk
I look, and feel, like a space alien in my PPE and walk around with three masks on at a time. It's hard to find anything to eat and all the drinking fountains are turned off.

Jackie Howitt
Probably a good thing since all the bathrooms are locked. My ears hurt from these mask loops and the Hazmat suits are so hot. And I am so tired.

Gretchen Volk
Every night, I return to my marijuana-scented Days Inn hotel room, and I eat the food I had scrounged up in the vending machines in the hospital lobby. And I FaceTime Maki and tell her, you know, what happened. And then I call Jackie, because I really need to talk.

Jackie Howitt
Hi, Gretchen, how was your day?

Gretchen Volk
The ICU team blasted through our unit today. They pointed at a few patients and said they would take them. Then they pointed at these others and called them "unsalvageable". That's just not a word I generally use, as a pediatrician, but I get it. I mean, I can see with my own eyes what's going on around here. And as heartbreaking as this is at a human level, some of what we're doing is just hotel management. The ED is desperate for our beds.

Jackie Howitt
I had to do an emergency C-section on a patient today, who only spoke Spanish. The baby was born with Down Syndrome and the Pediatric team rushed him off to the Neonatal ICU. When she woke up from anesthesia, she started crying and asking about her son. Crying louder... But none of us spoke Spanish, so we couldn't answer. There are no translation services available in the operating rooms.

Gretchen Volk
On rounds this morning, there was this young man. He was sitting up in bed, he'd a sparkle in his eye. He looked really good. And he explained to us, it was because his family had sent in some honey for him to eat every day. And they had told him the honey was going to help him beat COVID. And it seemed to actually be working better than anything else we were offering. Later in the afternoon, he unexpectedly coded and died. And the hospital staff seemed to be taking it really hard, and I learned it was because he worked on our unit, and they all knew him. And I just can't believe... Like, he was telling us about honey and then within a few short hours he was dead.

Jackie Howitt
As I'm running from patient to patient, and floor to floor, I keep hearing Alicia Keys belting out "Empire State of Mind," which our hospital plays every time a COVID patient comes off a ventilator. But it stops me, every time, because I remember that so many people are dying, and dying alone. I am so grateful that my father didn't have to die in the hospital, alone, from COVID.

Gretchen Volk
Jackie, if you ever get sick and have to go to the hospital, bring a phone-charging cord with you. So many of my patients didn't think to do that on the day they went to the emergency room. And once their phones died, they're just completely out of touch with their family. So I spend my afternoons FaceTiming people's families from their bedside. And it's often the first time they've seen their loved ones in many days or over a week. And I'm doing that because I want them to have a chance to say goodbye. It's really hard. I was in Dulles Airport when my dad died, and I still feel like I never had my last phone call with him.

Jackie Howitt
Sometimes all we can manage is, "It was a tough day."

Gretchen Volk
A week after coming home, Jackie and I decide to meet for a walk in Highland Park. It's a sunny Spring day, but the park is quieter than usual. Jackie, are... Are we allowed to walk near each other? Am I dangerous to you?

Jackie Howitt
I'm not sure. I think we're okay to walk, but let's stay masked.

Gretchen Volk
Oh look, they're planting the pansy bed. I wonder what the design will be this year.

Jackie Howitt
The gardener tells us when it's done, it will read "Hope."

Gretchen Volk
My neighbor gave me one of those cute cards. It says, "Not all superheroes wear capes."

Jackie Howitt
I'm getting the opposite reaction. When I walk down the sidewalk in my neighborhood, as people say hello, they kind of back up from me. They're a little scared.

Gretchen Volk
I get it. My family is acting brave, but I think they're a little worried they might get COVID from me. So the other day I put on my bike helmet, my oven mitts and my masks. I'm just trying to reassure them that I'm okay, but I'm really looking forward to sitting closer to them at dinnertime one day.

Jackie Howitt
How's it going at work?

Gretchen Volk
I was really looking forward to getting back to work after spending all that time on the COVID unit. I love playing with baby toes, and shooting the breeze with three-year-olds. But my partners asked me to stay away for two weeks; they're worried that I'm going to get them or our patients sick. I never thought I'd be ostracized like this.

Jackie Howitt
The CDC guidelines say you'll be fine with a mask.

Gretchen Volk
They just don't care about the guidelines. They're just really afraid. I feel like I'm being punished for stepping up to the plate.

Jackie Howitt
Coming home was harder than we expected it to be.

Gretchen Volk
You know, in all the preparation we did to go to Brooklyn, no one ever explained to us how we were supposed to come home.

Jackie Howitt
Remember all those modules? We had to have the EMR crash course in Epic.

Gretchen Volk
Oh, yeah....

Jackie Howitt
I feel like it would have been helpful to have a return "entry module".

Gretchen Volk
I agree. Yeah. Hey, by the way, I just found out we had to cancel the Celebration of Life we were going to have for my dad next month. We never had a service for him after his death. We are waiting 'til his birthday to do this, but because of COVID we cancelled it. And now it just feels really awful that we haven't done anything.

Jackie Howitt
I light a candle on the 17th of every month for my dad, which helps. But this month, on the 17th, I was in Brooklyn. Want to do that with me?

Gretchen Volk
Jackie is right. It does help. So, on the 17th of every month, I light a candle. And then I take a picture of it, and I text it to Jackie.

By the way, we are famous in Japan. At least, .

Jackie Howitt
...we think we are.

Gretchen Volk
But, if you're bored, you can Google the NHK TV report about Jackie's and my time in Brooklyn. And so, while I am not grateful to COVID for much, I am grateful that it has brought me this lifelong friend in Jackie.

Jackie Howitt
And I am grateful for having found my friend Gretchen. I think we should write that module about how to return home.

Gretchen Volk
Step one. Find a friend.

Emily Silverman
So, I am sitting here with Jackie and Gretchen. Jackie and Gretchen, thank you for being here.

Jackie Howitt
Thank you for having us.

Gretchen Volk It's our pleasure.

Emily Silverman
So the two of you are in the same room right now, and I'm in a different city. And the two of you live in Rochester, and are currently in Rochester. So, I'm curious: Is this the first time you've seen each other in a while, or do you see each other all the time? What is your relationship like these days?

Gretchen Volk Our relationship is based around coffee. So, we get together at least once a week, impromptu. One of us will text the other: "I am very near this Starbucks. Can you meet me?" "Yes."

Jackie Howitt
And Gretchen's working, like... a lot. I am not working very much, so it works out very well for me to spontaneously meet for coffee.

Emily Silverman I love that. So we have the yin and the yang. We heard your story just now, and I cannot overstate how amazing it was. The experience of sitting in the audience, and watching that, in person, was one of the greatest Nocturnist experiences that I've ever had. And actually, probably one of the greatest theater experiences that I've ever had. So I just wanted to say thank you for sharing that beautiful story.

Gretchen Volk Oh, my goodness, Thank you.

Jackie Howitt
Thank you.

Gretchen Volk Yeah, we had no idea how joyful it was going to be -performing that. I didn't know what to expect, but I'm super used to just being anxious in front of groups of people. So I expected like a pounding heart, and just nervousness, and getting through it with Jackie by my side. But, right off the bat, the audience was so warm and receptive. We just received that spirit from them. So it was a pleasure to perform there.

Jackie Howitt
A lot of people came up afterwards, and shared experiences that they had. I was very surprised by that. And delighted.

Gretchen Volk Yeah. It was just like a big community hug afterwards.

Emily Silverman So before we dive into the story... For the audience, I'd love just to hear a little bit from each of you about your clinical path. So Gretchen, you are a Pediatrician; you're still practicing - very actively. Jackie, you are a retired OB/GYN. You still do some work, but not doing clinical work anymore. Gretchen, let's start with you. Tell us a bit about your clinical role.

Gretchen Volk I had been in General Pediatric practice for just about 20 years. And, as of this past March 31st, I left my practice, and started working at a Pediatric Urgent Care. I decided, with a lot of intention, to make a shift in my career, with the idea that I have a good chunk of clinical work left in me, and I didn't want to spend it doing General Peds. So, from April to now, my life has become a little chaotic, and I'm now working at four Pediatric Urgent Cares. So I'm driving around Western New York, like a maniac, having a lot of fun. I really do like the work; I think it was a good shift for me. But I'm a little nomadic and unsettled. Like, I used to have a desk, with pictures of my children on it, and I knew who my secretary was... Just all gone. So, that's my path and hoping to do a lot more international work, with the freedom that this Urgent Care work has given me. So, that's what I'm up to.

Emily Silverman Jackie, how about you?

Jackie Howitt
I started out in high-risk OB. I had a Fellowship in Maternal-Fetal Medicine. I did that for a good number of years. I would say, I burned out... And turned to general OB/GYN, which I loved, for many, many, many years, and had a private practice. When that closed, I decided to pursue a Master's in Public Health, which had begun when COVID hit. And during my training of Public Health, I discovered the Medical Humanities program, which I loved. Switched over to Medical Humanities. So, I completed my training, and I now have a Master's in Medical Humanities and Bioethics, with an interest in Public Health.

Emily Silverman So, Gretchen, you have an eye toward international work. And, Jackie, you have an eye toward public health and storytelling and medical humanities. Do you feel like those shifts were catalyzed by the pandemic and your decision to volunteer during the pandemic? Or do you feel like it's unrelated? Or, how did the pandemic tip your career path into these new directions, if at all?

Jackie Howitt
Wow, what a good question.

Gretchen Volk Yeah...100% catalyzed by the pandemic, for me. I think the pandemic led me to have a lot of really big thoughts about "What is the purpose of anything, and what are we doing?" And, in my general practice, which I had a fair bit of love for, there became so many things that I lost a love for, and that just didn't seem important anymore. And I'd had many opportunities to work in clinics in Guatemala, which is completely unpaid, and just thought, like, that's where it's at. This is where medicine is, and this is where helping people is. You know, we're not checking boxes to fulfill metrics; not arguing with insurance companies. So, I just really realized that I didn't want to end my career retiring from General Pediatrics. And that, because I still had a lot of energy, and I'm thinking 10 to 12 years left of a working life, that I... I wanted to make the shift sooner, rather than later. And yeah, that was all brought on by the pandemic, causing these big thoughts. And also, I think it really caused me to analyze the people around me, that I was working with, and it really clarified for me that I'm different than them. And it's just really easy to wake up every day and just keep doing what you've been doing for 15-20 years. But, it just became necessary for me to say, "I need to make a change."

Jackie Howitt
My answer's a little bit different. Coincident with the pandemic, I started to experience family members going through the health care system. And between that, and what was happening with my patients, I was rapidly becoming disillusioned with medical care, and how we administer it. The humanities helped fill something in that void, that made me think that medicine can still be human; that there is the potential for kindness. The volunteering fit into that. And I would say, what I learned from the pandemic, and volunteering in the pandemic, solidified for me, that I was heading in the right direction.

Emily Silverman So your story begins in the airport, where you meet almost as a fluke. But both of you have, independently, already made the decision that you're going to volunteer. To help. In a pandemic. We don't really get to see the moment where you make that decision. Can you talk... each of you... a bit about that? How did you find out about the volunteer opportunities? And was it like an immediate "Yes, I'm signing up," or did you have to think about it for a while? Or, what was this process of signing up for this big scary task?

Jackie Howitt
So, I was in New York City at the time, helping my uncle who had just had surgery, when things started closing. And I realized that I was able to volunteer. And it was a little bit harder than I expected, to find the people to let them know I was available to volunteer. So I had given up, and all of a sudden, got an email saying, "Are you interested in volunteering?" And said, "Yes, I was." I understood that there was a need; I understood the gravity of the request, and prepared to do it. And the night before I went, I realized how very frightened I was. And I was afraid, of the virus. I was afraid of bringing the virus to my family, and I was afraid of dying. But it wasn't until the night before I left that really hit me.

Gretchen Volk We had heard Governor Cuomo come on TV, and tell everyone, "Come to New York," and I'm, like, "Oh, my gosh." And then, I think this mass email went out to all health care providers in New York, that you could respond to. So I'm, like, "Okay"... Like, it's easy, replying to an email: click. And my husband, who's an internist, had actually replied, too. I think there was... I wouldn't call it one-upsmanship, but like, "Okay." She's saying, "Yes"; I'll say "yes". And then... I think it was, like, a Sunday afternoon, and our cell phones started ringing. And it was, like, a real person calling, saying, "Did you mean it?" And I'm, like, "Oh, God." And I'm, like, "Yes. Yeah, absolutely. Sign me up." And my husband had gotten the heads-up from the hospital system he works for: "Don't go anywhere; we're probably going to call you up to our local hospital." So, he said, "No," and then, I said, "Yes." And then, we were, like, "Oh, my gosh." I'm a Pediatrician; he's a grown-up doctor. Like, how did this happen? And then, all of a sudden, I'm just getting bombarded with all the, "Okay, you need to learn our electronic medical records. You need to learn how not to sexually harass other employees. You need to sign off on these modules," and "These are the days you're going." And I'm, like, "Okayyyy...". Actually, before all of that, they asked me (probably seven times) if I knew how to work a ventilator, and I told them (like eight times), "No, I do not know how to work a ventilator. Put me a few notches down from that kind of person." But there was just, like, this huge snowball of: it's happening.

Emily Silverman
I think both of those stories really just hammer home for me how lonely and scary it must have been to be in that empty airport, getting ready to go do this thing. And also how much this encounter and this friendship was needed in that moment. And that came through in the story. But I'm really glad to hear a bit more about the back-story, because it just makes it all the more powerful that the two of you met each other, and had somebody else doing this, in parallel, with you.

Jackie Howitt
The other part of that, that is fun looking back, is: I'm an Obstetrician in general practice; she's a Pediatrician in general practice. We had patients in common. I knew the mothers; I knew the babies that became Gretchen's patients. So, it's not that big a town, in a way. So it was fun that this be the place that we meet.

Emily Silverman So, let's talk about the story a bit. For the audience, this story was a dialogue, as you heard. So, we had Gretchen and Jackie standing on stage together, alternating telling the story. And we had never done this before, at The Nocturnists. And I want to give a shout out to the amazing screenwriter Melissa Brandt, who served as the story coach for this, as well as the wonderful Molly Rose-Williams, who's the head story coach. Tell me about the process of building up this story with Melissa. Because I feel like when you initially submitted the idea, it was really more of just an idea. So how did you actually take that idea, and build it into this very structured, very cinematic story?

Jackie Howitt
Well, first of all, we really hit it off with Melissa.

Gretchen Volk Yeah.

Jackie Howitt
So, when we spoke with her, it was very conversational. She was able to understand us, I feel like...

Gretchen Volk Yeah.

Jackie Howitt
...pretty quickly. Her perspective on what had happened during the beginning of the pandemic was totally different than ours, which was an interesting part of the journey of the storytelling. And by that, I mean, she was explaining that in Minnesota, for them, it was just a time off from work. So that, at first, I think she couldn't relate to the heaviness of the fear that we were talking about with the story. I feel like it helped for us to convince her, by explaining how afraid and worried we were during the beginning of it. And I feel like it helped us to understand that many of the people couldn't understand our experiences, so that we had to tell it in a different way than we were used to.

Gretchen Volk Actually, I think one of the first sentences Melissa ever said to us, I just love, and I just keep it in my head, a lot. And she said, "We're all women over 50. We can just tell the truth here." Man, that's liberating! I didn't know we were allowed to do that after a certain age, so... I've continued to attempt to do that. But yeah, somehow it arrived into, like, a three-act story, with the beginning, some patient stories, and then how we came back together afterwards. And so, I think, when we kind of got the framework, we could work on the different sections. And then how to throw the story back and forth to each other.

Jackie Howitt
I would say, as part of that, as you know, now knowing us, we default to humor a lot. That I think is something that happens in medicine anyway. And our first couple of versions, we injected quite a lot of humor. Partly, I think that's how we got through it. And I think Melissa, and then Molly, helped us keep some of that, but lose enough of it to tell the real story.

Gretchen Volk I think that's so true. I think we put a bunch of funny stuff in there to protect ourselves, and to protect the audience from the horror. So, some of it still really is quite funny.

Emily Silverman
One of the reasons I love this story so much is that it does take you on this roller coaster, where we have really real moments of what unfolded on the ground, in New York City, during the first wave. But we also have those moments of humor. And so for me as a listener, it really felt like a roller coaster. And the other thing I noticed, is that it was a really sophisticated use of narrative. So, for example, there were moments of more exposition, but then there were moments of dialogue, which is part of why I think Melissa was so successful in bringing this story to fruition. Because she's a screenwriter. So she knows how to work with dialogue and with scenes. And so there's these moments where you turn to the other, and suddenly, it's dialogue. And then, we're back in a scene. And then, we're back in dialogue. And, I'm just wondering, was that something that Melissa taught you? You know, you taught Melissa about the truth of the story, and the reality of what that experience was, but then did she teach you anything about narrative devices, and how to shift back and forth in time, and things of that nature?

Jackie Howitt
Not overtly. I think she let us know, as we were telling our versions, what was landing.

Gretchen Volk
One really helpful thing, I think, she pushed us towards, was talking in the present tense, and then that just made it happening now; it's real. And I think that helped us be vivid. Think about it... We're walking; what's happening while we're walking? I think that nudge from her really set it into motion.

Jackie Howitt
I agree with that. One of the things that was striking for both of us, and many a cup of caffeine helped... We were surprised at how much emotion we felt in re-telling the story, to each other, as we were developing it. Once we put it into present tense, we both felt it a lot more intensely than telling it as a thing that had already happened, and we had moved on.

Emily Silverman
The fact that you're picking up on that is so interesting, because I've noticed with other storytellers....So Molly and I will drop in, for the audience, into these coaching sessions, and offer edits and things like that. When you switch from the past tense to the present tense, there's something really interesting that happens, where you go from remembering an experience to having an experience. You're having the experience once again, which can be very intense for the storyteller. And, of course, we have to do all of the things around making sure we want to tell the story; it's the right time to tell the story; we feel like we're in a psychological place to tell the story. But, I think once you check all of those boxes, and you say, "Yes, I am here to tell this story. And this is the gift that I want to give right now." Switching into that present tense, and having that experience... That is what makes the audience have the experience. And, I wonder if there's anything you want to say about that? Maybe about the night of? So standing on stage and telling the story in the present tense, could you feel the audience responding? Or... I'm just curious.

Gretchen Volk Yeah, the instant wave of love. And, even just re-listening to it last night, to hear them respond to things. I mean, we practiced a lot, to get ready. We didn't even know where all the laugh lines were. What the audience gave us credit for... the generosity of their hearing us. It was a gift. It was lovely.

Jackie Howitt
And coming up afterwards and expressing that. I completely agree.

Emily Silverman
One part of the story that really stood out to me was the part where you talk about re-entry. So, we can all imagine how difficult it must have been to make that decision, to go to New York and see what you saw. But you talk about coming back, and the whiplash of that, and the way that you were received by your communities. And I'm just curious, now that it's been a year plus from your return, how did that end up shaking out? Did that response from your community evolve over time? Or have things quote unquote, gone back to normal with them? Or is there any lingering dissonance where you feel... And Gretchen, you sort of alluded to this... "I'm different from these people in some way." Like, how is that landing these days?

Gretchen Volk We'll say lingering dissonance... Yeah, it was heartbreaking to me. When I came back, we had these just big community Zoom meetings of all the General Pediatricians, so we're all synched up. And like a complete idiot, I put in the chat: "I just got back from Brooklyn. If anyone else is going, let me know." You know, "I'll fill you in." and I got nothing. Fuck. Oh... Nobody else is going. I just... I thought we'd all line up and take a turn. It really was startling to me. And I don't want to be judgy about it; everybody's got their reasons. But it clarified for me that I was super different. And then, to be received by my own partners at my practice with such fear, was so painful to me. To not be let in the building. It wasn't like they barricaded me. They just let me know, in no uncertain terms, they weren't comfortable with me entering that building for two weeks. It was very frustrating.

Jackie Howitt
The other thing that... As we were developing this story, it reminded us that we are now in a very different mental space with COVID and masking and fear than we were then. At the time, people were afraid enough of my presence to physically back up, because they knew I had been in New York City. Now, they look askance at me when I wear a mask.

Gretchen Volk
Yeah...You're the weird one.

Jackie Howitt
I'm the weird one. Right.

Gretchen Volk Yeah.

Jackie Howitt
So, I almost feel like that didn't happen? So that when we were talking about it again, it was reinforcing that it had happened. It was as frightening as we remembered. And now we have evolved into a different place. Maybe evolved isn't the right word...

Gretchen Volk
I'm, like, thinking of any other verb... sidled over to a different place...

Emily Silverman
Did either of you end up getting COVID-19?

Gretchen Volk
Jackie remains in her pure state. Very proud to report on Jackie.

Jackie Howitt
Hopeful. Still.

Gretchen Volk
I finally got it the end of July. And it was just emotionally devastating, because I thought I was special. But my son brought it into our house. And...

Jackie Howitt
She taught him sharing.

Gretchen Volk
Yeah. It stank. I mean, I didn't get super sick. But I was really tired. And I feel like it took me about a month to get back to my sparkly ways.

Emily Silverman
I have to ask about the Japanese documentary. Did that ever work out?

Gretchen Volk
Yeah. It was such an unusual experience. Every day, when I would get back to my hotel, Maki would want to FaceTime with me. And she would film that - just describing the events of the day. And she also interviewed my family while I was away, "What's it like having your mom away?" My son's oblivious: "Mom?" But whatever. But then, to see the total package that she put together... of course, just reading the subtitles under it... It was pretty neat what she put together. There's a blip in it about the Emergency Room doctor who committed suicide during that time. She had an angle on it, about the mental health toll on the health care providers. But it was neat just to have some extra person out there who was interested, and caring. So yeah...Sometimes I'd be walking to the hospital and her news van would be there, like filming me walking in. I'm like, "Hey..."

Jackie Howitt One of the things she did, which was so lovely, was every night, she would text us the audio and a little bit of a text screen thing of the people in New York clapping and making noise. And, where I was in Brooklyn, I couldn't hear any of that. In fact, when I looked out the window, all I could see was, on a public building next door, the flag at half-mast.

Gretchen Volk
Oh, wow.

Jackie Howitt
And so, it was very heartening to get that from her.

Yeah, it was nice. I think they did it at seven o'clock every night, and I was still in the hospital then. So then I would leave, and I'd play my, like, Bang Bang Bang Bang. It was very nice. Yeah.

Emily Silverman We talked a little bit about your plans for the future. So Gretchen, you talked about international work. And Jackie, you talked about really leaning into the medical humanities and public health. But, do you have anything more specific in mind? Or any dreams for you, Gretchen, that remaining 10 or 12 years? Or for you, Jackie, blossoming into your retirement? What do you have in mind for yourselves?

Gretchen Volk
I'm going to Guatemala in a couple of weeks. There are a couple of groups that I've gone down with. And my hope this year, would be to go three to four times for 8-day trips. And I would love to think about doing different opportunities. Although, if my life is such that, for the rest of my days, three to four times a year, I go down to Guatemala and work in a clinic, I think I will be very content with that. It's very satisfying. But I've heard of other opportunities. Like, there are some boats that sail around, and offer birth control to people on islands in the South Pacific. I'm like, "That sounds magical." So, I'm definitely open to learning about more opportunities that are out there, or places that could use a Pediatrician. So, the world is my oyster? Maybe? We'll see. Yeah.

Jackie Howitt
And I have no idea. I am very uncertain about what my next path will be. I have very much enjoyed working with The Nocturnists. I'm so hopeful that medicine can recover from this. And, by this, I'm not sure if I mean COVID or what preceded it. I think that, if there is a way to bring it back around to the medicine that I fell in love with, I would love to be involved in that.

Emily Silverman
As women over 50, who have been around the block in medicine, and who have also seen the arc of medicine change a lot over the last couple of decades, what are your thoughts about the future of medicine? How might we bring it back around? Or, if you have a message for the younger generations, what would you want them to know? Or what are your thoughts about the medicine after you?

Jackie Howitt
I'm very pessimistic. I feel like the past couple of years has furthered a trend in distancing ourselves from our patients. And I think that both sides lose with that. There's enough fragmentation of patient care itself, that once you lose that connection, you lose interest in stopping the fragmentation. And, I feel like you lose something of the return of medicine. What we love about it is how we can help, and how we can help the individuals. And I think that's getting harder to see. I'm hopeful that training will bring it back. But I don't honestly see how it can, because even the training is fragmented.

Gretchen Volk
I'm incredibly pessimistic. Sadly, I just... It's all about money. What's happening with insurance companies, physicians, hospitals... A lot of people made a lot of money during COVID, and, I would say that is disgusting. So I just don't think our country can ever address the real issues. So I just try, you know, in Urgent Care: I'm just gonna give this family the best 10-15 minutes of their life. Like, I'm just going to do my best. But, there are so many other, bigger forces and problems at play. I wish I had the energy to fix them. Like, just watching... Like Bernie Sanders, he has given it a good old try. And he got close, but somebody with that degree of prestige and power has not succeeded. I'm just not optimistic. So I really just see, if we're lucky enough to have a good provider in a room with a family that wants care... to just give it as much as we have. But that's not enough for society. Yeah, I wish I could be more optimistic. I'm usually very optimistic, but I'm not. Yeah.

Emily Silverman
What about the medical students and residents out there?

Gretchen Volk
God love 'em.

Emily Silverman Can they fix it?

Gretchen Volk
My heart goes out to them. I mean, I think we can address their own humanity; prevent their burnout as long as possible. Show them the joyful things. Like today, in Urgent Care, I had... There were three... They're pre-med students. They're as adorable, and as shiny as they come. And nobody tells them anything. So I showed them what poop looks like on an X-ray, and they were just... seemed very pleased with that. We try to show them a good time, because we need them to take our place in a few years. But I'm just so pessimistic about the larger overall structure of what we're all trying to work under. It's just about money. It's too sad.

Jackie Howitt
And I would add that, those that are already having trouble accessing care... That's getting worse. It's getting so much more separate. That if you can afford and access care, you do. And if you can't, it's getting even harder to access consistent care, it seems.

Emily Silverman
Well, I think it's important to keep it real. And I think what you said, Gretchen... These little moments, even if it's something as simple as seeing poop on an X-ray... It's in the next generations' hands and we'll hope for something better. Is there anything else that you'd like to share with our audience before we end?

Yes.

Gretchen Volk
All right, Jackie time.

Jackie Howitt
One of the things that came of this, from our story, was how close we both were to our fathers. And, my father was a physician. He had that old-time patient-doctor interaction. And I felt that this was a lovely way to honor his memory.

Gretchen Volk
I think my dad would have been pretty tickled by all this. Yeah.

Emily Silverman And they died on the same day.

Gretchen Volk
Yeah.

Emily Silverman So maybe they're hanging right now.

Gretchen Volk
Yeah.

Jackie Howitt I like thinking that.

Gretchen Volk
Beam this podcast somewhere, Emily.

Emily Silverman
Well, if you're listening, boys, howdy, and your daughters are amazing. Gretchen and Jackie, thank you so much for being with me today. Thank you for your service. And thank you for telling your story on The Nocturnists stage. It's been a pleasure.

Jackie Howitt
Thank you.

Gretchen Volk
Thank you, Emily.