On Friday morning, a nurse at Alamo Women’s Reproductive Services in San Antonio ushered a patient into an exam room. She gave her a gown, told her the doctor would be in shortly, and stepped back out of the room into a changed world.
“I saw the other nurses standing in the hallway,” said Jenny, a nurse who has been with the clinic for five years and asked to be identified only by her first name for fear of being targeted by anti-abortion protesters. “And I just knew.”
In the few minutes she’d been inside the exam room, the U.S. Supreme Court had overturned Roe v. Wade, clearing the way for Texas to fully ban the procedure she had just prepped a patient for.
Jenny and four other staff members stood in the hallway, paralyzed. They had a dozen patients sitting in the lobby awaiting abortions, all seemingly unaware of the seismic shift that had just rocked the reproductive health care world.
Before they could even decide how to proceed, the door to the clinic slammed open and a young woman ran in, yelling about Roe v. Wade and saving babies. They didn’t recognize her but believed she was associated with the anti-abortion protesters who often massed outside the clinic.
The woman quickly fled, leaving the clinic staff alone with a dozen sets of eyes staring back at them from the waiting room chairs.
“Obviously, that wasn’t how we had wanted it to come out,” Jenny said.
While other nurses addressed the elephant in the waiting room, Jenny returned to the patient she had just left.
“I just said, ‘You have to get dressed and come back out to the lobby,’” she said. “I told her, ‘The doctor will explain more … but we can’t even give you a consultation today.’”
The legal status of abortion in Texas was murky in the immediate aftermath of Friday’s ruling. The state has a “trigger law” that automatically bans abortion 30 days after the ruling is certified, a process that could take a month or more.
But in an advisory issued Friday, Texas Attorney General Ken Paxton said that abortion providers could be held criminally liable immediately because the state never repealed the abortion prohibitions that were on the books before Roe v. Wade was decided in 1973.
Rather than risking criminal charges, Texas’ clinics stopped providing abortions Friday.
Andrea Gallegos, executive director of Alamo Women’s Reproductive Services, said she’s hopeful that the clinic’s lawyers may find a way to allow it to resume abortions briefly before the trigger ban goes into effect.
But either way, abortion will soon be banned in the second-largest state in the country. The clinics will close. The staff will relocate or find new jobs. And the people they would have served will melt into the shadows, fleeing over state lines, seeking out illegal abortions or quietly consigning themselves to decades of raising children they never wanted.
Bearing the bad news
The staff at Alamo Women’s Reproductive Services are no strangers to bad news. For years, they’ve had to navigate ever-tightening restrictions that force them to delay care or turn patients away.
But never have they had to deliver so much bad news in such a short period of time. Dr. Alan Braid, who owns the clinic, told the women in the waiting room — and those who had already been admitted to exam rooms — that they were halting all abortions immediately.
Some just got up and left. One woman got upset, angrily demanding that Braid go through with the abortion anyway. She had driven hours to make it to this appointment after her home state of Oklahoma banned all abortions.
“I understand why she’s upset, and she has every right to be upset, but we’re not the enemy here,” Gallegos said. “The only thing we could tell her was this wasn’t because of us, it was because of the Supreme Court.“
One woman was on her fourth visit to the clinic. She’d been too early in the pregnancy for an abortion during the first two appointments, but finally, yesterday, staff were able to detect a pregnancy on the sonogram. But Texas requires clinics to wait 24 hours after a sonogram to perform an abortion, so they sent her home.
She arrived at the clinic Friday morning, not long after the Supreme Court ruled. When staff told her the news, she was bereft — rocking back and forth, wailing, begging for the staff to help her.
“I just told her, you did everything right and we did everything that we could, but unfortunately, our hands are tied today,” clinic director Kristina Hernandez said.
Gallegos said it’s devastating to know just how easily they could have helped that patient.
“Sometimes it’s just a matter of handing somebody a pill, and for the surgical [abortion], it’s less than five minutes,” she said. “It’s fast, it’s easy, it’s safe, it’s done. It’s health care.”
Instead, they had to send her away.
After they cleared the waiting room, the staff turned to the stack of two dozen appointments scheduled for the rest of the day. They distributed the files, took deep breaths, and started dialing.
They explained, again and again: No, you can’t get an abortion here anymore. No, you can’t reschedule. No, you can’t go to another clinic in Texas, or even Oklahoma, or a lot of other states. No, it doesn’t matter if you’re under six weeks. No, not even if you come in right now. No, this isn’t our fault. No, no, no, no.
They offered a list of out-of-state clinics and groups that help fund abortions and travel that they put together when Texas banned abortions after about six weeks of pregnancy. They spent most of the day listening to the busy signals and voicemail boxes of clinics in New Mexico, where abortion will remain legal.
They make this effort because there is little else they can do. But they are well aware that many of their patients struggle to find babysitters for the duration of their appointments, let alone traveling out of state to get abortions.
And even if they can find babysitters, and get time off from work, and safely leave the state, Friday’s ruling is only going to make it harder for low-income Texans to access resources to pay for these journeys. Texas abortion funds have stopped paying for out-of-state travel and abortions until they can better assess the legal implications of their work.
Fear for the future
As the pandemonium of the morning subsided, something far worse settled over the clinic: silence. Staff sat around the check-in desk, filing paperwork and tidying up. Someone ordered pizza.
They listened in to televised press conferences, hoping to glean information about their own fates. They talked about where the fight might go from here, and some of the bigger battles they’ve had to wage over the years. They talked about what this meant for their daughters, and the patients they’d treated over the years, and those they would likely never get the chance to see.
A lot of the staff members have been working for the clinic for years. Hernandez was there with Braid when this location opened in 2015.
“This is my baby,” she said. “This is my life, right? This is what I’m good at. This is what I want to keep doing. I can’t do anything else. I mean, I can, but I don’t want to.”
When Hernandez thinks about all the patients she’s been able to help over the years, it’s overwhelming. She’s had women come up to her in H-E-B, years after she helped with their abortions, and give her hugs before disappearing into the aisles.
On days like this, she thinks a lot about a young woman she spent three hours having a theological discussion with before the woman ultimately decided to have an abortion, and her own sister, who decided not to.
The clinic plans to keep the doors open and the staff employed as long as it can. They’re holding on to hope that they may be able to squeeze in a few more patients before the trigger ban goes into effect.
And they’re still offering follow-up appointments for patients who had abortions recently — perhaps the final patients the clinic will ever get to treat.
A young woman showed up Friday afternoon for her follow-up appointment, with her 3-month-old in tow. She’s a single mom in her early 30s, raising four children already.
When she found out she was pregnant again, she decided she couldn’t responsibly raise another child. She’s already struggling financially, and she was trying to leave her boyfriend, who she said was physically abusive.
“I have to figure out who’s gonna watch my babies on the weekends so I can go to work, and it’s stressful,” she said. “So I’m not gonna bring another baby into this.”
She got the two-drug medication abortion regimen at the clinic earlier this week. It was an easy process, she said, and she was hugely relieved to hear that it had been successful.
But with four kids, if she’d been turned away, she said she wouldn’t have even tried to leave the state or find another way.
“It’s not worth all that effort,” she said. “I would have just kept it.”
Published courtesy of The Texas Tribune, a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.
On June 24, 2022, the U.S. Supreme Court overruled Roe v. Wade, the landmark 1973 decision that established the nationwide right to choose an abortion.
For decades, the rancorous debate about the ruling has often been dominated by politics. Ethics garners less attention, although it lies at the heart of the legal controversy. As a philosopher and bioethicist, I study moral problems in medicine and health policy, including abortion.
Bioethical approaches to abortion often appeal to four principles: respect for patients’ autonomy; nonmaleficence, or “do no harm”; beneficence, or providing beneficial care; and justice. These principles were first developed during the 1970s to guide research involving human subjects. Today, they are essential guides for many doctors and ethicists in challenging medical cases.
Patient autonomy
The ethical principle of autonomy states that patients are entitled to make decisions about their own medical care when able. The American Medical Association’s Code of Medical Ethics recognizes a patient’s right to “receive information and ask questions about recommended treatments” in order to “make well-considered decisions about care.” Respect for autonomy is enshrined in laws governing informed consent, which protects patients’ right to know the medical options available and make an informed voluntary decision.
Some bioethicists regard respect for autonomy as lending firm support to the right to choose abortion, arguing that if a pregnant person wishes to end their pregnancy, the state should not interfere. According to one interpretation of this view, the principle of autonomy means that a person owns their body and should be free to decide what happens in and to it.
Abortion opponents do not necessarily challenge the soundness of respecting people’s autonomy, but may disagree about how to interpret this principle. Some regard a pregnant person as “two patients” – the pregnant person and the fetus.
One way to reconcile these views is to say that as an immature human being becomes “increasingly self-conscious, rational and autonomous it is harmed to an increasing degree,” as philosopher Jeff McMahan writes. In this view, a late-stage fetus has more interest in its future than a fertilized egg, and therefore the later in pregnancy an abortion takes place, the more it may hinder the fetus’s developing interests. In the U.S., where 92.7% of abortions occur at or before 13 weeks’ gestation, a pregnant person’s rights may often outweigh those attributed to the fetus. Later in pregnancy, however, rights attributed to the fetus may assume greater weight. Balancing these competing claims remains contentious.
Nonmaleficence and beneficence
The ethical principle of “do no harm” forbids intentionally harming or injuring a patient. It demands medically competent care that minimizes risks. Nonmaleficence is often paired with a principle of beneficence, a duty to benefit patients. Together, these principles emphasize doing more good than harm.
Although 97% of unsafe abortions occur in developing countries, developed countries that have narrowed abortion access have produced unintended harms. In Poland, for example, doctors fearing prosecution have hesitated to administer cancer treatments during pregnancy or remove a fetus after a pregnant person’s water breaks early in the pregnancy, before the fetus is viable. In the U.S., restrictive abortion laws in some states, like Texas, have complicated care for miscarriages and high-risk pregnancies, putting pregnant people’s lives at risk.
Justice, a final principle of bioethics, requires treating similar cases similarly. If the pregnant person and fetus are moral equals, many argue that it would be unjust to kill the fetus except in self-defense, if the fetus threatens the pregnant person’s life. Others hold that even in self-defense, terminating the fetus’s life is wrong because a fetus is not morally responsible for any threat it poses.
Yet defenders of abortion point out that even if abortion results in the death of an innocent person, that is not its goal. If the ethics of an action is judged by its goals, then abortion might be justified in cases where it realizes an ethical aim, such as saving a woman’s life or protecting a family’s ability to care for their current children. Defenders of abortion also argue that even if the fetus has a right to life, a person does not have a right to everything they need to stay alive. For example, having a right to life does not entail a right to threaten another’s health or life, or ride roughshod over another’s life plans and goals.
Justice also deals with the fair distribution of benefits and burdens. Among wealthy countries, the U.S. has the highest rate of deaths linked to pregnancy and childbirth. Without legal protection for abortion, pregnancy and childbirth for Americans could become even riskier. Studies show that women are more likely to die while pregnant or shortly thereafter in states with the most restrictive abortion policies.
Other marginalized groups, including low-income families, could also be hard hit by abortion restrictions because abortions are expected to get pricier.
Politics aside, abortion raises profound ethical questions that remain unsettled, which courts are left to settle using the blunt instrument of law. In this sense, abortion “begins as a moral argument and ends as a legal argument,” in the words of law and ethics scholar Katherine Watson.
Putting to rest legal controversies surrounding abortion would require reaching moral consensus. Short of that, articulating our own moral views and understanding others’ can bring all sides closer to a principled compromise.
The U.S. Preventive Services Task Force issued a draft statement in April 2022 recommending screening for anxiety in children and adolescents between the ages of 8 and 18. This recommendation – which is still open for public comment – is timely, given the impact of the COVID-19 pandemic on children’s mental health. The Conversation asked Elana Bernstein, a school psychologist who researches child and adolescent anxiety, to explain the task force’s new draft recommendations and what they might mean for kids, parents and providers.
1. Why is the task force recommending young kids be screened?
Nearly 80% of chronic mental health conditions emerge in childhood, and when help is eventually sought, it is often years after the problem’s onset. In general, recommendations to screen for mental health disorders are based on research demonstrating that youths do not typically seek help independently, and that parents and teachers are not always skilled at correctly identifying problems or knowing how to respond.
Anxiety is the most common mental health problem affecting children and adolescents. Epidemiological studies indicate that 7.1% of children are diagnosed with anxiety disorders. However, studies also estimate that upwards of 10% to 21% of children and adolescents struggle with an anxiety disorder and as many as 30% of children experience moderate anxiety that interferes with their daily functioning at some time in their life.
This tells us that many kids experience anxiety at a level that interferes with their daily functioning, even if they are never formally diagnosed. Additionally, there is an established evidence base for treating childhood anxiety.
The opportunity to prevent potentially chronic lifelong mental health conditions through a combination of early identification and evidence-based treatment certainly informed the task force’s recommendation. Untreated anxiety disorders in children result in added burdens to the public health system. So from a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventive treatment is favorable, while, as the task force pointed out, the harms are negligible.
The task force recommendation to screen kids as young as age 8 is driven by the research literature. Anxiety disorders are most likely to first show up during the elementary school years. And the typical age of onset for anxiety is among the earliest of all childhood mental health diagnoses.
Anxiety disorders can persist into adulthood, particularly those disorders with early onsets and those that are left untreated. Individuals who experience anxiety in childhood are more likely to deal with it in adulthood, too, along with other mental health disorders like depression and an overall diminished quality of life.
2. How can care providers identify anxiety in young kids?
Fortunately, in the past three decades, considerable advances have been made in mental health screening tools, including for anxiety. The evidence-based strategies for identifying anxiety in children and adolescents are centered on collecting observations from multiple perspectives, including child, parent and teacher, to provide a complete picture of the child’s functioning in school, at home and in the community.
Anxiety is what’s called an internalizing trait, meaning that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, though certainly possible. Therefore, psychologists recommend including the child in the screening process to the degree possible based on age and development.
In general, it is easier to accurately identify anxiety when the child’s symptoms are behavioral in nature, such as refusing to go to school or avoiding social situations. While the task force recommended that screening take place in primary care settings, the research literature also supports in-school screening for mental health problems, including anxiety.
Among the youths who are actually treated for mental health problems, nearly two-thirds receive those services at school, making school-based screening a logical practice.
3. How would the screening be carried out?
Universal screening for all children is a preventive approach to identifying youths who are at risk. This includes those who may need further diagnostic evaluation or those would benefit from early intervention.
In both cases, the aim is to reduce symptoms and to prevent lifelong chronic mental health problems. But it is important to note that a screening does not equal a diagnosis. Diagnostic assessment is more in-depth and costs more, while screening is intended to be brief, efficient and cost-effective. Screening for anxiety in a primary care setting may involve completion of short questionnaires by the child and/or parent, similar to how pediatricians frequently screen kids for attention-deficit/hyperactivity disorder, or ADHD.
The task force did not recommend a single method or tool, nor a particular time interval, for screening. Instead, it pointed to multiple tools such as The Screen for Child Anxiety Related Emotional Disorders and the Pediatric Symptom Checklist. These assess general emotional and behavioral health, including questions specific to anxiety. Both are available at no cost.
4. What are care providers looking for when screening for anxiety?
A child’s symptoms can vary depending on the type of anxiety they have. For instance, social anxiety disorder involves fear and anxiety in social situations, while specific phobias involve fear of a particular stimulus, such as vomiting or thunderstorms. However, many anxiety disorders share symptoms, and children typically do not fit neatly into one category.
But psychologists typically observe some common patterns when it comes to anxiety. These include negative self-talk such as “I’m going to fail my math test” or “Everyone will laugh at me,” and emotion regulation difficulties, like increased tantrums, anger or sensitivity to criticism. Other typical patterns include behavioral avoidance, such as reluctance or refusal to participate in activities or interact with others.
Anxiety can also show up as physical symptoms that lack a root physiological cause. For example, a child may complain of stomachaches or headaches or general malaise. In fact, studies suggest that spotting youths with anxiety in pediatric settings may simply occur through identification of children with medically unexplained physical symptoms.
The distinction we are aiming for in screening is identifying the magnitude of symptoms and their impact. In other words, how much do they interfere with the child’s daily functioning? Some anxiety is normal and, in fact, necessary and helpful.
5. What are the recommendations for supporting kids with anxiety?
The key to an effective screening process is that it be connected to evidence-based care. One strategy that is clearly supported by research is for schools to establish a continuum of care that involves universal screening, schoolwide prevention programming and evidence-based treatment options.
The good news is that we have decades of high-quality research demonstrating how to effectively intervene to reduce symptoms and to help anxious youth cope and function better. These include both medical and nonmedical interventions like cognitive behavioral therapy, which studies show to be safe and effective.
”Three decades of evidence have shown that nurse practitioners with full practice authority play a vital role in improving health outcomes, especially in underserved communities, Ramos observed in his remarks. Focusing on the connections between FPA, access to care, and health outcomes, the Dean presented his case to the state’s Joint Legislative Committee on Access to Healthcare and Medicaid Expansion at the North Carolina General Assembly and urged them to pass the SAVE Act to grant full practice authority for NPs providing primary care. Ramos, who is also the vice-chancellor of nursing affairs for Duke, was among eight experts presenting varied views on full practice authority.
“Full practice authority isn’t new. This isn’t innovative. We have 30 years of evidence from 24 states, D.C., and several US territories about the benefit of granting full practice authority to NPs.”
In speaking to the joint committee presided over by Sen. Joyce Krawiec, Ramos addressed the role that nurse practitioners have in transforming health care access and outcomes in North Carolina, including the opportunity to expand care in rural areas that face health care shortages. The joint committee is hearing from experts as they consider passing the SAVE Act, which was first introduced in 2021 to expand full practice authority for primary care NPs in North Carolina. A similar version of the SAVE Act has been introduced in previous legislative sessions, but no action was taken on the legislation.
Role of FPA in Access to Care and Health Outcomes
“Nurse practitioners should be able to practice at the highest level of their competencies, education, and licensing,” Ramos said. “Full practice authority isn’t new. This isn’t innovative. We have 30 years of evidence from 24 states, D.C., and several US territories about the benefit of granting full practice authority to NPs. This improves health outcomes and expands health care to underserved populations and will benefit the people of North Carolina.”
Across the state, 97 of 100 counties face a health professional shortage.
Ramos reflected on his role as dean of the top school of nursing in the state and the second-ranked school in the U.S., and the intense pride he has seeing Duke graduates strengthen their career opportunities with the education they gain at Duke. “The nurse practitioner workforce growth is faster in states with full practice laws than in states with restricted practice,” said Ramos, who is interested in attracting NPs to practice in the state.
Ramos observed that the first states to authorize full NP practice authority began doing so in 1994 — nearly three decades ago — and that, once passed, full NP practice authority has never been repealed. “Full practice authority for primary care NPs improves care access, improves care outcomes, and improves workforce supply,” said Ramos, who also addressed a systematic review of 33 studies that showed no evidence for better NP care outcomes in states with more practice restrictions.
NPs with FPA Increase Efficacy of a State’s Health Workforce
In addressing the critical nursing workforce shortages across the U.S., Ramos notes that NP workforce growth is faster in states with full practice laws compared to states with restricted practice. Across the U.S., during the COVID-19 pandemic, states issued temporary waivers of NP practice restrictions. “This enabled more time-responsive NP practice and care provision as well as a streamlined process for NP orders in the absence of physician signature requirements and an increased capacity of the health care workforce to respond to COVID-19,” Ramos said.
Ramos observes that the reliance of nurses in this manner during a pandemic and health care crisis demonstrates the clinical, scientific, and relational expertise that support nurse influence in improving health outcomes, and it demonstrates the confidence that the health care systems and public have in nurses, who have been considered the most trusted and most ethical profession for more than 20 years.
In conclusion, Ramos pointed out to the committee that:
NP practice restrictions contribute to inadequate care access and primary care workforce shortages, particularly in rural areas.
NP practice restrictions can be a barrier to improving health outcomes and reducing health outcomes and reducing health-related economic costs.
NP practice restrictions requirements can lead to an unsafe and fragile care model, including risks such as the possibility of immediate NP loss of ability to care for patients if a physician can no longer provide supervision for any reason, including moving, retiring, and so on.
NP practice restrictions weaken health workforce responsiveness to emergencies.
Physician supervision agreements can contribute to unnecessary and excessive costs.
The SAVE Act (House Bill 277/Senate Bill 249) did not receive a committee hearing during the 2021 legislative long session. However, following the conclusion of the committee’s work later this spring, the bill could move forward when the legislature returns for the 2022 short session on May 18, 2022.
Being a family nurse practitioner (FNP) can be a rewarding path for just about anyone who dreams of making a difference as a nurse. An FNP allows you to become a trusted primary care providerin most states and opens the door to a range of ongoing opportunities for learning and professional growth. And, if you want to do it all… or at least as much as possible, an FNP degree will give you maximum career flexibility. It can position you to create your ideal tailor-made nursing career, whether you want to work in a hospital or clinic setting—or both—while running your own business or pursuing research projects if you wish!
The heart of being an FNP, though, is of course family care… and here’s an overview of what a day in the life of an FNP entails.
Diagnosing a variety of medical conditions for patients of all ages
A family nurse practitioner can care for a wide age range of patients. An FNP may treat everyone from infants to geriatric persons, and this is just one of the reasons the job is almost always lively and interesting.
Am FNP might arrive at the clinic in the morning with or without an idea of their patient caseload on any given day. However, one thing they can count on is variety. You may start your morning with an annual physical of a 35-year-old, then pivot to managing hypertension and diabetes medications for a 71-year-old, before quickly peeking at another patient’s rash, and looking in another patient’s throat. While this may seem intimidating at first, family nurse practitioner certification ensures that you have the necessary breadth of medical acumen and will be prepared to manage whatever comes your way.
Creating treatment plans
After taking a medical history and performing a physical exam, an FNP will formulate a diagnosis for any given condition. Each day, they may use a variety of tools to arrive at their diagnoses—including cultures, blood work, imaging tests, and other medical diagnostics. After reaching a suspected or confirmed diagnosis, an FNP will work with each patient to create a treatment plan, which may include a lifestyle modification, a new medicine, a referral, or another kind of treatment.
Providing a lifetime of primary care
When family nurse practitioners serve as primary care providers, they identify and treat problems, and follow up to ensure the best possible health outcome for each patient. One of the most valuable aspects of being a family nurse practitioner is being able to follow patients throughout their lifespan, anticipating and addressing conditions across decades, and providing patient education.
Preparing for the Next Day
At the end of the day, an FNP may spend time reviewing messages in their electronic medical record inbox, and return phone calls from patients or pharmacies. They will need to catch up on documentation in some patient charts from earlier in the day, communicate with staff members, and make sure everyone on that patient’s team is receiving the assessments and care that they need.
Having a patient say they want to do what YOU do, or receiving Facebook friend invitations from their family are among the happiest side effects of nursing excellence. The first-hand experience of making a real difference in peoples’ lives is one of the main reasons bedside nurses love their incredibly hard — and profoundly important job.
The nurses and other staff at University of California Davis Health Burn Institute Regional Burn Center will remember a recent patient and his loved ones long after the 92 thank-you cards are stored away (though as you can see, the cards are awesome too!). And when their former patient, Mexican truckdriver J. Guadalupe Romo Fonseca says he wishes he was a nurse—after spending some 8 months fighting through third-degree burns, a stroke, and the loss of his leg—it is evident that he had some truly inspiring caregivers.
“He pulled through so many times…”
During any other holiday season, truck driver J. Guadalupe Romo Fonseca would be traveling Northern California roadways, hauling heavy loads alongside FedEx, Amazon, and UPS drivers.
But this year, he’s off the road and thankful to be alive.
“For me, I was dead. I don’t remember nothing for six months,” Fonseca recalled.
That was his reality in November 2020 after a propane stove tank explosion tossed him outside his mobile home in Chico. The Guanajuato, Mexico native was making local hauls before his planned return to family in Mexico for Christmas.
Instead, he spent the holidays — and 235 days total — in the Firefighter’s Burn Institute Regional Burn Center at UC Davis Health. His wife, Berta, and their sons Silvestre and Jesus flew in and remained by his side. Alicia and Carlos, his daughter and other son, were not able to be there in person, but their minds and hearts were with their father.
“When my dad’s boss called and told us about dad’s serious burns on his body, we were just like, ‘Oh my God! Maybe it’s not that bad,’” said Silvestre Romo Llamas. “He is the strongest man I ever met. For me, seeing him like that was hard. It was heartbreaking.”
For the next six months, Fonseca drifted in and out of consciousness while recovering from third-degree burns over 60% of his body. He suffered a stroke, lost his right leg, experienced multiple bouts of sepsis, and underwent more than 10 surgeries.
“Twice I told the family to say their goodbyes. At times, it looked really bad. And then he pulled through. He pulled through so many times,” said Marianne MacLachlan, RN, one of Fonseca’s nurses.
“They were taking care of my dad, but also taking care of us.”
While Fonseca fought for his life, his family found support in MacLachlan and the team of nurses, therapists, and support staff in the Burn Center.
“It was so much love they were showing to my dad. They had great teamwork,” Llamas explained. “They were taking care of my dad but also taking care of us. They were angels for us.”
The Burn Center team consists of more than 25 experts: physicians, nurses, researchers, and administrative personnel who support patients and families in the largest burn treatment center in Northern California.
While it’s their job to care for those with serious burn injuries, doctors and nurses believe their role extends beyond the patient. Tina Palmieri, chief burn surgeon, says that “Patients and families spend many days in the hospital, with multiple operations, dressing changes, and physical therapy sessions. We work with them to envision what the patient can become and then help them get there. Our goal goes beyond survival: it is about helping the patient live a quality life.”
“It’s amazing what you can do for people when they trust you.
In 20 years, I’ll remember them. These are the people who stick with you.”
—Marianne MacLachlan, RN, UC Davis Health
“When you have a patient who’s very sick and not interactive with you, you do all you can to care for them, but you’re also caring for the family. They become the patient, too,” added MacLachlan.
MacLachlan added that of the many patients she has tended to over the years, this family was special.
“I’ve never seen such a beautiful connection with a family. Regardless of whether you speak the same language or not, compassion and love are the same,” she said.
It took a village—of 92 nurses, therapists, and physicians. And his son thanked each one of them with a personal card.
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As the only nurse on the unit fluent in Spanish, Adrian Montano, RN bonded with the family and helped them navigate every challenge they faced.
“Everything that could have gone wrong did. But they stood by him and were there every day and very appreciative of staff,” Montano said. “You don’t see families like this very often, not to that extent. Every day they took the time to interact with everyone and get to know everyone.”
Once Fonseca was out of the woods and his discharge was imminent, his family surprised those who had cared for them with an unexpected thanks — handmade cards, created by Jesus Romo Llamas, for the 92 nurses, therapists, physicians and various other staff who tended to their needs.
“The cards were just a little token of appreciation for all the intensive work I saw happening in the ICU.
Staff there gives everything they have so patients and family have another opportunity to be together. I wish I could give more than cards back.”
—Jesus Fonseca, son of J. Guadalupe
“Every so often we’ll get something from a family. But it’s very unusual for them to go out of their way to make something individual for everyone,” Montano said.
“It’s amazing what you can do for people when they trust you,” added MacLachlan. “In 20 years, I’ll remember them. These are the people who stick with you.”
“I’ve never liked hospitals to be honest, but now I’m thinking about being a nurse”
The compassion and care from UC Davis Health nurses not only paved the way for Fonseca’s recovery, they made an indelible impression on Silvestre Romo Llamas and his future.
“I’ve never liked hospitals to be honest, but now I’m thinking about being a nurse,” he said. “It’s incredible how you feel in this situation in such vulnerable moments. I want to help people.”
More than a year after that fateful day when an explosion rocked this family’s world, Silvestre Romo Llamas is taking a home health aide course and Fonseca is learning everything again.
“Since I got out of the hospital, everything was new for me again,” Fonseca said. “I’m doing a lot better. I got my prosthesis and I’m taking my first steps.”
Fonseca says his future, most likely, will not include driving a big rig. He hopes it includes a return home. But for now, gratitude: “This Christmas has special meaning, to be thankful of everything that’s happened through the year.”
Now they look forward to next year when they can return home to Mexico. And they stay in touch through Facebook with the team who healed them.
During any other holiday season, truck driver J. Guadalupe Romo Fonseca would be traveling Northern