On a particularly dark night last March, after Governor Baker declared a state of emergency as COVID-19 cases surged, the anesthesia residency program director at Massachusetts General Hospital realized he needed help. And soon.
“We knew there was this tidal wave coming,” Dr. Dan Saddawi-Konefka says, “and we were climbing up toward the top. But we had no idea how much death or change we were likely to see.”
No one did. As the public first learned how to “flatten the curve” by social distancing and mask wearing, workers on the front line, face-to-face with a novel coronavirus, worried about a shortage of masks, respirators, and eye protection that would help keep them safe while saving lives.
Luckily, MGH had enough personal protective equipment, or PPE. But Saddawi-Konefka oversaw 80 residents, and he worried about protecting their mental health. How would new doctors, already averaging 65-hour workweeks, fare during the pandemic? What would happen to their spirits?
He conveyed his worries in a text exchange with Ariel Brown, a medical scientist and his Arlington neighbor with whom he often commiserated over their kids’ play dates. “Frankly, at this point I was thinking small scale, like are there ways we can remain connected while people are isolated?” he recalls. “And she was like, ‘Yeah, or we could do this.’”
Within hours, Brown started working on an ambitious solution. That very night, she distributed a Google form to mental health practitioners via social media and community listservs asking them to volunteer their time to counsel health care workers. By the next morning, 67 therapists had responded. Over the next two weeks, as cases climbed and field hospitals emerged at places such as the Boston Convention and Exhibition Center, Brown established a Web directory of licensed mental health practitioners willing to offer free therapy. She was running with the idea, and asked Saddawi-Konefka to partner with her. Together, they applied for nonprofit status for their new endeavor: The Emotional PPE Project.
Brown, who works at Sage Therapeutics in Cambridge, has a background in neuroscience and understands that medical professionals — while sparking global recognition for their role in stopping the pandemic — ”are not a population that typically reaches out for help and admits weakness.” So she made support easy and accessible. After piloting the program last April to Saddawi-Konefka’s medical residents, their website, emotionalppe.org, went live as an insurance-free, no-cost directory that guarantees anonymity.
The goal was, and still is, to break down barriers — for people seeking help and for those who want to contribute. “I felt helpless at the beginning of the pandemic,” says Adrien Asaff, a therapist in Scituate who has volunteered for the nonprofit since its inception and has counseled five health care workers. “It provides me with a sense of giving back.” Yenkuei Chuang, a mindfulness practitioner and psychologist in Newton who volunteers her time for the project, similarly finds “joy in the giving.” Vulnerability is part of being human, she says, and people who spend their lives “training to be the strong one, the competent one,” risk losing that part of their humanity. “It’s OK when you can’t give anymore, when you need to receive,” she says.
Within months — thanks to tireless networking, a growing board of volunteers, and the increasing need for mental health services — The Emotional PPE Project had gone national. In August, it was featured on The Today Show, which led to a spike in its growth and partnerships with other organizations. So far, the directory includes 535 therapists — 178 in Massachusetts — who have served 563 individuals in 31 health-related occupations across 41 states. In Massachusetts, more than 100 front-line workers have gotten hassle-free, confidential help. Each course of therapy is individualized. Sessions can range from a one-hour video call to a coaching session on breathing techniques, which Chuang recently did over FaceTime with a stressed worker on a shift break.
Cofounder Saddawi-Konefka is among those who’ve sought help. Weeks of being on perpetual high alert, resuscitating patient after patient, were leaving him feeling unmoored. He’d been living in his basement, isolated from his family so as not to expose them to the virus, and his wife was taking care of their four kids. He watched as his residents dealt with their own succession of losses. As the tidal wave approached, Saddawi-Konefka granted himself the same reprieve he’d insisted on for his residents.
Three therapy sessions in, he felt an unburdening he couldn’t find anywhere else. “It’s like you’re treading water, and occasionally finding yourself under water,” he says, describing what it feels like to work through each wave of increased cases. “You’re kicking and kicking and kicking, and here’s just an hour on a life raft, so you don’t have to hold the weight of everything going on. So you can let someone carry you.”
Brown, 43, who grappled with anxiety as a child and drug use as a young adult, knows all about needing a lifeline. “If I did not have the lived experience of struggles with my mental health,” she says, “I would not be interested in what I’m interested in.” Seeking support allowed Brown to steer herself in a better direction and helps drive her work to foster systemic change.
Brown speaks in a low voice that is subtly scratchy. She often emphasizes her point by adding “right” at the end of a sentence, not because she needs you to agree with her, but because in her mind, everyone’s bound to get on board.
Reflecting on her personal investment in the nonprofit, she brings up Project Semicolon, a suicide prevention initiative that became prominent on social media in 2015. “I was thinking a lot about the semicolon tattoo,” she says, which people get to represent the point where they could have ended their life, but chose to move forward instead. “The idea is that my story could have ended, but there’s a second part, right?”
Suicide has been a problem in the medical profession since long before COVID. In 2018, Medscape, a resource website for health care professionals, reported that every day, one doctor in the United States dies by suicide. Last April, the medical community was stunned when Lorna Breen, the emergency room director at New York-Presbyterian Hospital, took her life. (For those seeking help, call the National Suicide Prevention Lifeline, 800-273-8255.)
“I think about even one nurse in the throes of a crisis, who can have a semicolon moment and then live the rest of their life helping people who are ill,” says Brown, imagining The Emotional PPE Project’s positive ripple effect. “And the impact of that on a particular hospital, on the patients that person could have helped . . . that individual is such an important part of supporting our public health system.”
Brown was born in Virginia but grew up in Newton. In addition to her anxiety, she struggled with her sexuality, knowing that she was gay long before she felt ready to come out. By the time she was an undergraduate at Skidmore College in upstate New York, she was using substances to cope.
“I went to this guy’s house that I had met while scoring drugs, and we were sitting on his bed getting high,” Brown recalls, “and when I was looking at the walls I noticed that there were cockroaches on them.” She takes a breath. “It was just this moment where I was like, This is where my story has gone and I don’t think that I want it to continue on this path.”
At Skidmore, Brown met Holley Hodgins, a psychology professor (now emerita) who nudged her in another direction. “I saw that [Brown was] so smart, so quick, so capable, and so engaged. She was right there with every single research study she had read; she was just like a dream student, really,” Hodgins says. But as Brown started to talk about graduate school, Hodgins reviewed her record. “It was like all A’s or D’s — Ariel only worked if she was interested.”
Hodgins pulled Brown aside one day. “I said, ‘If you want this kind of life, it’s not out of reach but you’ve got to address this,’” Hodgins recalls.
Brown’s girlfriend at the time knew of an acupuncture program for people who wanted to get sober, and in 2003 Brown took part and stopped using substances. She’s quick to recognize her access to assistance, which not everyone has: supportive parents — a psychoanalyst and a social worker — who paid for her medication and therapy, and took her in while she got clean.
And so, Brown says, “I got to live a second part of my life.”
By 2004, Brown had published enough as a research assistant to be accepted into Boston University’s doctoral program in neuroscience. But she was still not comfortable being out in her professional life. In 2005 she met her future wife, Anne Moore, who describes herself, unapologetically, as a “creature of excess.”
Brown was both attracted to and repelled by Moore’s boldness, which often manifested in her colorful style of dress. “When we were dating I had this blazer,” Moore recalls, “and I had written the word ‘Fear’ on it in safety pins.” Brown was mortified. She had “a certain idea” of how she wanted people to see her, she explains, “and that was really, really motivated by shame.” She didn’t yet know Moore was destined to be her gutsy guide out of the shadows: Moore proposed in 2007, and the two married in 2008.
After completing her doctorate in four years, followed by an interdisciplinary post-doc in psychiatric neuroscience at Harvard University/MGH and the Massachusetts Institute of Technology, Brown gave birth to their daughter in 2011 and their son in 2016. Considering a career change from neuroscience research to medical writing, she explored what it would take to successfully make the shift. When she was offered an interview with Alkermes, a pharmaceutical company in Waltham, “I was able to walk into the interview and be like, ‘Here’s the seven actions that I took to prove to you that I’m actually committed to being a medical writer.’”
Brown got the job. Three years ago, she moved over to Sage Therapeutics, and was on the writing team when the company won FDA approval in 2019 for Zulresso, the first drug for treating postpartum depression.
In March, as the pandemic took hold and Brown built The Emotional PPE Project, she realized that she wanted to get back in the lab to run the kind of clinical trials she’d been writing about. Recognizing Brown’s experience and in-depth knowledge of Zulresso, Sage made her the scientific lead on a clinical trial for the drug, which also has anti-inflammatory effects, on COVID patients who are in respiratory failure. If the trial is successful, Zulresso could become an important new treatment for severely ill COVID patients.
There have been other dark hours since that night when Brown and Saddawi-Konefka connected. Brown still struggles privately with “productive insomnia” that is both introspective and expansive — quiet hours when she mines her experience to effect further change. After George Floyd’s brutal murder on May 25, she pitched the idea of a companywide diversity, equity, and inclusion group at Sage. “Some people struggle with the planning, the execution, the decision-making — she just moves forward,” says Erin Lanciani, a senior vice president at the company. “She does it with a tremendous amount of energy and passion and excitement. She has a great way of rallying people.”
The group formed, and for Coming Out Day, October 11, a company newsletter featured five LGBTQ employees who told their story. “[T]he people that did it were incredibly vulnerable and really brave,” Brown says proudly.
Now, as new variants of COVID emerge, infection levels spike, and hospitals face a new surge, Brown thinks constantly of how she can expand The Emotional PPE Project. After nearly a year of working through the pandemic, more health care workers are flocking to the website every day. “We have a giant mental health crisis in progress,” says a nurse anesthetist in Boston who has used the service but prefers to remain anonymous. “Literally everyone is struggling right now, and we can change the culture so it’s encouraged to seek help.”
The health care practitioners interviewed for this story were all hesitant to burden their families, their peers, or even a therapist. Yet, sustained high-stress levels can increase the risk of anxiety and depression, and other serious ailments, such as heart disease. With healers’ bodies, minds, and spirits all at risk, Brown would like The Emotional PPE Project to be the start of a lasting sea change for access to — and acceptance of — the need for mental health treatment.
For Melissa Tilton, an occupational therapist in Boston who now sees a volunteer practitioner weekly, therapy means “having somebody there to just tell you it will be all right.” Her voice catches for a moment. “Your mind knows it,” she says. “But your heart’s just a little bit tired.”
Melissa Karen Sances is a writer in Boston. Send comments to firstname.lastname@example.org.