Francisco Rosales lies in a hospital bed, his head turned slightly to the side, while a white and blue tube runs from his nose and pumps him with oxygen.
Machines roar next to the 9-year-old’s bed, keeping him alive and filtering the air. Board games, two boxes of colored pencils and a plush toy moose — a gift from his sister — are scattered around the room.
But he does not play with them.
Wearing a yellow face mask, Rosales’ mother, Yessica Gonzalez, rests on a couch under a blanket imprinted with photos of their family. “You are our greatest adventure,” it says.
It’s the only thing Francisco grabbed when the ambulance picked him up after his lungs stopped bringing enough fresh air into his body.
Gonzalez’s son was admitted to the pediatric intensive care unit at Children’s Medical Center Dallas a week ago on Aug. 8 for COVID-19 complications.
“What day is it?” she asks.
It’s Friday. She’s been here, at her son’s side, the entire time.
Inside the PICU
Health care workers at Children’s Medical Center Dallas say their hospital’s capacity is higher than it has been since the pandemic began. The new delta variant — combined with a spike in cases of other, common respiratory viruses like respiratory syncytial virus (RSV) — are stretching staff and bed space to its limit.
On Saturday, Children’s had 33 patients admitted for COVID-19 and 37 patients admitted for RSV.
In May, only 1% of patients at Children’s tested positive for COVID-19. Now that’s up to 10%.
“We’re tired. We’re worried. We’re stressed,” said Dr. Cindy Darnell Bowens, medical director of the Children’s Dallas PICU who is also a UT Southwestern associate professor. “This is what we do. We take care of the sickest children in the hospital every day.”
There are 387 operational beds in the Dallas hospital. Most are full, but only 7% of the patients were COVID-19 positive on Friday. The others are kids with broken arms and appendicitis and cancer and all the other ailments for which kids end up in the hospital.
Forty-two patients were in Children’s Dallas PICU on Friday afternoon, out of 44 staffed beds. Four were positive for COVID-19.
The Dallas-Fort Worth Hospital Council said Thursday that the region had run out of staffed pediatric ICU beds. On Friday, Dallas County Judge Clay Jenkins stated during a news conference that if a child is injured and needs an ICU bed, “your child will wait for another child to die.”
But doctors at the hospital say they have open beds — and they’ll always make room for an injured or sick child.
Children’s and other North Texas hospitals say that bed availability is a hard number to pin down. Since patients are often moved from one space to another during surges like this, it’s unlikely the hospital will ever be completely full for too long.
“What happened an hour ago is not what’s happening now,” said Victoria Washington, another one of the clinical managers at the Dallas PICU.
To keep the hospital moving and space ready for new children, doctors and administrators are constantly evaluating and re-evaluating needs and space. As many as 50 to 60 patients are admitted each day, but the same number are discharged.
Joe Don Cavender, the hospital’s senior vice president of patient care services, said he’s on the phone with other hospitals in the region and in surrounding states twice a day to make sure the community’s needs are met. It’s a team effort, he said, with case counts going up everywhere — not just in Dallas.
It’s part of why Children’s doesn’t have a dedicated COVID-19 unit like Dallas’ public hospital, Parkland Memorial.
“When we’re tight like this,” Cavender said, “when you get a bed, you put a patient in a bed.”
All along the walls of the PICU at Children’s — two floors of intensive care beds where the sickest kids are treated — drawings of giraffes, elephants and antelopes adorn the walls. Bright-colored tile and stacks of toys in each room are a reminder that the severely ill patients here are children.
The PICU is full of kids with all kinds of maladies. Some have brain injuries, some are recovering from surgery. Some have COVID-19. Outside the doors of the contagious patients, a sign with a red stop sign instructs anyone entering to suit up in extra PPE.
First, they clean their hands with a squirt of hand sanitizer, or “gel in.” Next, they don a yellow gown with fitted wrist cuffs. Then, the blue gloves. Finally, the big cone-shaped helmet that contains an external battery pack, personal fan for airflow and a plastic screen that tucks under their chin.
It all takes a few minutes to put on, and it all goes in the trash as soon as someone steps out of the room.
Over the past almost year and a half of the pandemic, kids still got sick from COVID-19 — especially if they had underlying conditions like obesity — but they didn’t die as frequently as adults.
Then, as the vaccine became available and mask mandates ended in the spring and early summer, the nurses here began to see a spike in other viruses.
That’s normal enough. The hospital is used to operating at near-full capacity during winter surges every year. Unlike an adult hospital, Children’s is usually slower in the summer and fills up during the winter when kids come down with respiratory illnesses.
It’s stressful, but manageable.
But a spike like that during the summer, when staffing was already low due to nurses leaving the hospital during the pandemic, is strange and concerning. Beds are limited. Nurses have begun taking extra shifts to care for more patients.
Care depends on the number of nurses and physicians available to work. At Children’s Medical Center Plano, a staffing shortage has left some beds empty. The PICU’s leaders says they have the space, but not the staff, to accept more patients.
They planned to hire more nurses in October or November in anticipation of the annual winter surge. An August spike in RSV and COVID-19 cases was not in the plan.
At the Plano PICU, a toddler wriggled as three adults in big yellow gowns and protective helmets adjusted wires. Next door, a clean bed with fresh sheets sat ready, but empty, complete with the big air filter.
Dr. Paige Volk, medical director of the Plano PICU who is also a UT Southwestern associate professor, said there’s not enough nurses to take on more patients there. If someone comes in and needs the care, they may be transferred to another hospital.
“I have space,” Volk said, “but what I don’t have is staff.”
‘In the thick of it’
Front and center of the many ID badges on Ginny Leinweber’s hospital lanyard at the Dallas PICU is a laminated name tag with a drawing of a lioness.
She’s one of two clinical managers who oversee the PICU nursing staff. She’s their pride leader, their protector. She got into nursing — specifically pediatric nursing — to help protect kids, and she says the work she’s doing now is stressful but exactly why she’s here.
“Taking care of critically ill children is something I was called to do,” she said. “We’re giving back, supporting people who can’t help themselves.”
The workload in recent weeks has taken a toll on the team, mentally and physically. They’re exhausted after living on the pandemic’s front lines for months. The latest surge only added to that sense of fatigue.
There’s frustration and some anger, especially when medical experts across the country say the latest wave could have been prevented with more widespread vaccination — only 54% of Texans are fully inoculated.The nurses and doctors are all tired.
“I’m in the thick of it,” Washington said. “It’s more difficult emotionally to treat kids, period.”
The nursing leaders say they help monitor the mental health of their co-workers, and monthly sessions with the team help them all decompress. But each day, they have to suit up again and walk into rooms filled with a dangerous virus and a young patient struggling to breathe.
“It’s what we’re here for,” said Dr. Dai Chung, chief medical officer of the joint pediatric enterprise. “We’re going to look back and say we did something good for the community of children.”
Care for patients, parents
Gonzalez’s family has been vaccinated — they signed up as soon as they were eligible, but Francisco and another son, who is 5, are too young to get the shot.
Then the family got sick with COVID-19. Francisco was the first to fall ill.
Most had moderate symptoms — loss of smell and taste, a little throat soreness — but Francisco’s temperature kept rising to 104 degrees Fahrenheit. His blood-oxygen level was at 62% by the time medics rushed him to the emergency room.
“He’s doing better,” his mother said Friday. The loud whirring of a heavy-duty air filter next to her muffled her words, but she spoke up.
“I thought he wouldn’t make it.”
Unlike other hospitals, Children’s nurses are not simply caring for young patients — but also their parents. The hospital system allows two adult caregivers to stay with each child, even during the pandemic.
It’s an exception not granted at other hospitals for two reasons: Doctors talk about how important moral support can be for any patient, but for minors, an adult also must give consent for any medical procedure.
So for 12 hours at a time, the nurses on shift also must tend to the parents’ needs. They remind them to eat, and to shower, and to call home, all while keeping them informed about their child’s health.
They’re also there to answer questions from parents worried about their sick children. With severe COVID-19 patients, they sometimes ask if this was preventable.
Bowens, the medical director of Dallas’ PICU, answers them succinctly.
“Chances would be very low that you’d be standing here looking at me if you’d been vaccinated,” she says.
Although many of the severe cases of COVID pneumonia are among teenagers, who are eligible for the vaccine, the doctors say, 70% of hospital patients are under 12 — too young for a shot. For them, wearing masks and making sure the adults around them are vaccinated are the best forms of protection from the virus.
Volk puts it this way: She knows the risk of her job. She has trained to work in severely contagious environments her entire career. Her family knows that sometimes they can’t hug her when she gets home because she has to shower first.
It is her calling, and it takes courage.
Now, she says, parents should do the same.
“Choose courage,” she said. “Do the right thing for our community.”
How to keep children safe from COVID-19
- Get the vaccine: Anyone 12 and older is eligible. Getting the vaccine can help prevent severe illness and passing the virus to children who may not yet be old enough to get the shot.
- Wear a mask: Mask-wearing indoors — even if vaccinated — is important to slow the delta variant’s spread, according to the Centers for Disease Control and Prevention. Talking to children about the importance of wearing a mask while in public can help them stay safe, too.
- Keep sick children home: Especially with cases of other respiratory viruses like RSV spiking, it is important to keep children home from school if they have a fever, diarrhea, vomiting or a cough.
- Encourage hand washing: Teaching children to frequently wash their hands instills good hygiene. Especially before or after touching their face, after touching their face mask, after leaving a public place or after using the restroom, hand-washing and using hand sanitizer can stop germs from spreading.
- Stay up to date with other vaccines: All vaccines and check-up appointments are important to keep children healthy. They may not be eligible for the COVID-19 vaccine, but other shots can prevent them from having to go to the doctor’s office or the hospital.
- Rest: Children ages 3 to 5 need 10 to 13 hours of sleep per day, including naps. Children ages 6 to 12 need 9 to 12 hours of sleep. Teenagers need 8 to 10 hours of sleep. A good night’s sleep can help a child’s body stay healthy and ready to fight off infections.
- Eat healthy: A balanced diet of lean proteins, fruits and vegetables, whole grains and low-fat dairy products can help children’s bodies function well and prevent disease.
- Talk about stress and mental health: The pandemic has added extra stress on everyone — including children. Talking to children about stress and mental health is important, and watch for warning signs like changes in sleep, eating or behavior.
Source: Children’s Health System of Texas
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