There was little information about COVID-19 when the pandemic began, but one important piece of information we did have was that the virus was not causing children to become critically ill. This particular fact was of interest to me because I’m a pediatric critical care nurse on the pediatric transport team. When New York City became the epicenter of the pandemic, my 12 team members and I felt an uncertainty of what our future would hold. Our volume of transport calls had already decreased significantly, and we found ourselves sitting in our office most days with little do but wait.
Our manager was transparent from the beginning that there was discussion from senior leaders of what to do with our team when the situation worsened. With little for our team to do and other parts of the hospital bursting at the seams, it didn’t make sense to let our critical care experience go to waste. We were told to prepare to take care of adults in some capacity and sometime soon. We waited 3 weeks from the time when our numbers were beginning to rise concerningly to the time when we were finally deployed.
In those 3 weeks I felt a sense of guilt knowing that I was safer sitting in our office with minimal patient interaction, while my colleagues on other units of the hospital were stretched thin, caring for highly contagious and multiple critically ill patients at a time. I felt useless but also terrified of the thought of caring for an adult patient. In my 9 years as a nurse I had never taken care of an adult patient. I found myself thinking back to my nursing school days and wondering if I would remember.
We finally got the news that we were to be deployed to the pediatric ICU that had been converted to a COVID-19 ICU, where more than half the patients were critically ill adults. Upon hearing the news my anxiety and fears continued to build. I had 2 days before my first shift, so I took time to prepare and review an adult COVID-19 ICU training packet the hospital had put together. As my team members began to have their first shifts on the unit, they would share their experiences and any tips they had through a group text. Most of these experiences increased my fear and anxiety. I had never seen or used a rectal tube before, and I certainly didn’t want to.
My first shift on the unit started out intense. I was helping a colleague with the sickest patient on the unit who turned out to be a 30-year-old with no co-morbidities. Seeing this patient intubated, on a minimum of six continuous medication infusions, and continuing to decompensate rapidly changed my fear from “How am I going to take care of these patients?” to “I hope I don’t become one of these patients.” After some time, the patient was transferred to a floor that could perform extracorporeal membrane oxygenation and I was asked to help take care of Mr. F., an 82-year-old man who was incoherent and unable to speak, but able to express his love of listening to Frank Sinatra when a Sinatra song came on the iPad. He was the only do-not-resuscitate/do-not-intubate patient on the unit. That night I gave Mr. F. a bed bath, checked his blood sugar, administered medications as necessary, started an I.V., and monitored his vital signs and respiratory effort. I also held his hand whenever he grabbed for it, sang to him when his favorite song came on, and swayed to the music along with him. Before I left my shift that morning, I tucked him in and told him I’d be back in 2 days to see him. I had a feeling in my gut that I might not see him again.
After I left, I decided to add a tip for my colleagues to the group text, but this tip was going to be different. I didn’t want to send them a text that would increase their fears and anxieties about what their next shift would entail. I wanted to send them something a little more positive, maybe even something to look forward to: “Covid-land pro-tip: go visit Mr. F. in room 32. He likes to sing and dance to Frank Sinatra and loves a hand to hold. He may not be completely aware, but he will certainly express his happiness to you!” My fellow team members all responded that they couldn’t wait to visit Mr. F. One of my friends and fellow team members texted me the next day “I got Mr. F. all tucked in this morning, he is ready to see you tonight!” I felt a sense of happiness that he was still alive but also a little sad for him, although I knew the inevitable was going to be more peaceful for him. I couldn’t believe it, but I was actually looking forward to my shift that night.
That night during shift change I was talking to my friend and fellow team member about how I was happy to get to see Mr. F. That was when she informed me that Mr. F. had passed away that morning. They were moving him to an adult floor when he died in the hallway. “We pediatric nurses must have taken such good care of him that he didn’t want to leave us” she said. I smiled feeling a sense of honor for getting to take care of him in his final days, and a sense of relief knowing he was at peace.
Mr. F. has made me realize that being a nurse is more than having expert knowledge in one area of practice. It’s about being present, holding your patient’s hand when they reach for it, giving them a bed bath because it will make them feel better, and not being afraid to sing and dance with them to bring a few moments of joy into their final days.
Jessica AuCoin is a member of the pediatric transport team at NYU Langone Medical Center and a graduate student in nursing administration at NYU Rory Meyers College of Nursing.