My wife, Sally, is an infusion nurse at Lurie Children’s Hospital and is now in her 43rd year on the front lines. She received the COVID-19 vaccine on January 2nd.
I have been working from home as the NICU Quality Improvement neonatologist for Comer Children’s Hospital at University of Chicago and came down to get my COVID-19 vaccine #1. I have had the opportunity to see a number of frontline providers, friends, and colleagues and spend some time in my office. As I walked by the NICU and the Emergency Department in the Children’s Hospital, I have a lot of mixed feelings. Practicing clinically was always my favorite part of my “job” and I miss it. At the same time, I am now 69 years old and am still also teaching, editing, writing, and helping nurses, nurse practitioners (NP), medical students, residents, fellows, faculty, and physician assistant (PA) students with their education, research, and writing. But I am now also in a high risk group for severe COVID-19 disease having had a four vessel bypass in 2013.
I have so much respect and admiration for all of the nurses, PAs, NPs, and physicians at every level of training and practice who are on the front lines during this COVID-19 pandemic. My feelings are so much greater when I am on site and seeing the challenges you all face to protect yourselves and still provide care for the children and their families.
One of the great challenges we face during this pandemic is figuring out which of our patients is at greatest risk for developing severe SARS-COV-2 infection or COVID-19 disease. Using epidemiological and descriptive studies we have been able to identify some high risk groups including older adult patients, those pediatric and adults patients with chronic disease, are pregnant, and/or who are immuncompromised. Children, in general, unless they have an underlying disease, tend to have milder clinical courses, unless they develop multi-inflammatory systemic disease (MIS-C). So, we have to be concerned about every one of our patients when we see them and follow them closely. Around 30% of adults may have ongoing clinical manifestations including fatigue, dyspnea, joint pain, and chest pain as long as 6 weeks after their acute course. The fact that there are viral variants and evidence from other studies about immunity post other coronavirus infections suggests that we will not have lifelong immunity post having the clinical infection. We are not sure how long the immunity will last post clinical infection or with the vaccine as well. The pandemic and our knowledge base continues to evolve.
We also have the challenge of encouraging our patients and their families to get the COVID-19 vaccine(s) when they become available and are determined to be safe for children and pregnant women.
And what looking after ourselves? As I talk with Sally after she comes home from caring for her pediatric patients, most of whom have chronic disease including cancer, autoimmune diseases, inborn errors of metabolism, the stress on her and all of you who are on the front lines is increased to levels that are exhausting. As a former intensive care pediatrician for 30+ years, I can only empathize and imagine what you are all dealing with during this pandemic.
So please continue to follow the newest, evolving clinical recommendations from the Center for Disease Control and Prevention (CDC), after careful review. Please also realize how much all of us who are watching all of you care for patients on the front lines respect and admire you for your dedication. But please, take care of yourselves!
As I said in my previous blog entitled “The Joy of Working with Pediatric and Neonatal Nurses,” when I took care of critically ill newborn infants and children, young adults for about 30 years, I relied on the nurses I had the privilege of working with in the infant special care unit, the pediatric floor, the emergency department, and in the intensive care unit. These nurses are truly on the front lines and are first responders for these patients and their families, just as paramedics, EMTs, and battlefield paramedics are on the front lines!
Wherever I was, including when we were transporting these infants and children, I listened critically and thoughtfully to everything they told me about the patients we cared for. When they were worried and concerned, it was important that I also worried. I can literally give you hundreds of anecdotes of clinical situations, including instances in the delivery room with newly born critically ill infants when the nurse and I worked together to stabilize the baby with clinical issues ranging from being born at 24 weeks gestation with respiratory distress to a term newborn with undiagnosed probable Down syndrome.
In the ED, we had a well tanned 19-year-old male who presented in cardiac arrest one winter evening and a young girl with fever and purpuric lesions who presented in shock with meningococcemia.
On the pediatric floor, the nurse called me when her infant patient was having apneic episodes with oxygen desaturation with an RSV infection.
In the intensive care unit, there was a young girl with malignant cerebral edema after head trauma. Her nurse and I stayed by her bedside all day and night as we needed to manage her increased intracranial pressure. Thanks to our team, she survived and is now living a normal life.
In each of these clinical situations, I relied on the nurses I worked with who were almost literally on the front lines! I also worked with my wife, Sally, at Children’s Memorial Hospital, when I was a senior resident in 1979 when I covered our patients on our service. She worked on the front lines with a number of critically ill children and came up with some instrumental clinical observations and interventions that helped us in the care of these patients. She and her colleagues in the infusion area at what is now Ann and Robert H. Lurie Children’s Hospital of Chicago are on the front lines caring for children with cancer, inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythematosus, and numerous other chronic illnesses. They do clinical assessments in addition to providing intravenous access for chemotherapy, infusion of biologics, and enzyme infusions for these sometimes critically ill patients. They work with nurse practitioners to care for these children.
I hope everyone has a sense for what these nurses do on the front lines and how instrumental they are in the care of these children and their families.
Over the past 40 years, I have accumulated so many amazing anecdotes about working with and relying upon the pediatric and intensive care nurses in all of the hospitals I have worked in. The main message here for all physicians is to be able to trust, rely on and respect the nurses you work and will work with in the hospital or clinic setting. The fact that I feel this way has almost nothing to do with the fact that Sally, who is a former PICU, ER, clinic, consultant, quality improvement (QI), Daisy Award winning, mother of 3, unofficial Spanish translator and social worker, now infusion area nurse at the Ann and Robert H. Lurie Children’s Hospital of Chicago, for 40 years, and I have been married for 37 years. I think our greatest challenges have been after I had a sudden cardiac arrest and required 5 shocks 5 years ago…and when we worked together when I was a senior pediatric resident at what is now Lurie and Sally and I cared for some very critically ill children in the pediatric intensive care unit….
Pediatric and intensive care nurses are remarkably smart and well organized care providers and once you, as a physician, recognize that fact and begin to rely on them to provide the exemplary care of your patients and their families, you will be able to relax a little bit more. In my practice situation at NorthShore University HealthSystem, I was the attending, without residents or fellows, for these children in the intensive care unit with the nurses and respiratory therapists. When these infants and children presented to the Emergency Department (ED), I worked with the exceptional ED nurses and attending physicians to stabilize them before admission to the ICU and in some situations, the ICU nurse and I transported them to the children’ hospital for advanced care when the necessary resources were not available at Evanston Hospital.
My experience with neonatal intensive care (NICU) nurses during the 10 or so years I practiced neonatology in the NICU at Evanston Hospital, Children’s Memorial Hospital and Prentice Women’s Hospital was just as amazing. Once again, these nurses know their patients and their families so well when they were their primary nurse or, for that matter, whenever they had that patient, even for the day or night. One rule to keep in mind, is when the nurse who was caring for that patient called you to tell you they were concerned, it was best to respond and come to see that infant immediately. Wherever I have cared for infants and children, this rule is one to follow at all times. And wherever we were, whether it was in the NICU, the delivery room, on transport in the ambulance or at another hospital, or even in the ED at times, I always relied on the nurses I worked with to provide the best care of the infants and children I was responsible for.
Even now as the QI physician in the NICU at Comer Children’s Hospital, I continue to be amazed at the clinical judgement of the nurses. They are bright, insightful and continue to provide the best care of these very complex and critically ill babies. They also are sensitive to the parents who are most frequently from underprivileged areas of Chicago. Moreover, they have interest in improving the quality of care of the infants and their families and come up with new ideas for QI projects. I have also found the nursing managers to be outstanding in the ongoing management of the nursing staff of over 170 nurses in a NICU with a total over 60 beds.
The best way to summarize pediatric and intensive care (and ED nurses for that matter) is to say they are a joy to work with no matter how challenging the clinical, social, or for that matter QI or administrative situation is that you are facing.