Her mom, Hillary Richard, was concerned, but not overly. She kept an eye on her eldest daughter and monitored her condition. Haylee didn’t have a high fever and the pulse oximeter readings showed her oxygen saturation levels within normal range.

In fact, on Sept. 18, which was the seventh day of being sick, Haylee appeared on the mend, even requesting her favorite Chinese food for dinner. But, without warning, that rapidly changed.

When Hillary went to bed that night, Haylee was asleep, she says. Her daughter had taken a few bites of dinner, but she figured Haylee would wake up to finish it sometime later. But “she took a dive overnight,” Hillary says, adding “she went from OK to not—fast.”

She began feeling weird during the night, Haylee says, and couldn’t sleep. She propped herself up with a mountain of pillows trying to get comfortable. Intense pressure on her chest and lungs made it tough to breathe. She started coughing up bloody phlegm. She checked her oximeter through the night and saw the numbers going down each time. But she was too out-of-it to let her parents—who were sleeping one room over—know how she felt.

“I didn’t really realize what was going on, so I’d try to nod off back to sleep,” Haylee says. “I wasn’t fully present.”

When her mom checked on her the next morning, Haylee didn’t look right. She was extremely pale, Hillary says, and when she checked her oxygen saturation level, it had plummeted to a dangerous 38%. (The normal range is 95% to 100%, and anything under 90% is considered low.)

Her mother immediately called 911 and EMTs arrived within a few minutes. They put Haylee on oxygen and took her by ambulance to the Emergency Department of a local hospital. There, it was determined she had severe Covid-19 pneumonia and needed to be transported to a children’s hospital right away.

At first, they couldn’t find an available bed for her, Hillary says, until Cook Children’s Medical Center offered one. Hillary jumped at it and agreed to a helicopter transport. She wasn’t allowed to accompany Haylee but saw her off, crying as she watched the helicopter take flight with her child inside.

“That’s when it really started sinking in for me,” Hillary says, still emotional as she describes the beginning of Haylee’s battle with COVID-19. “Seeing her take off in that helicopter, and I couldn’t be with her? That was hard, you know? That’s my baby.”

Still in her pajamas, she and her husband, Keith, rushed home, threw some clothes in a bag, jumped back in their truck and barreled toward Fort Worth, the longest most “excruciating ride” she’d ever taken, she says. But the ride ahead was about to become even more rough for her and her family.

Not what a parent wants to hear

Inside the helicopter, Haylee knew her condition wasn’t good, she says, but didn’t grasp the gravity of it. She played on her phone, texting a friend a selfie with the message: “Guess where I am?” Her friend responded, asking what was happening, but Haylee wouldn’t be able to answer that text until almost two weeks later.

“I barely remember anything after arriving on the helicopter,” she says. “I couldn’t stand on my own. I was very weak. My body had kind of given out on me, and the nurses were having to help me into bed. And that’s the last thing I remember.”

Ryan Meyer, M.D., a pediatric intensivist at Cook Children’s, says Haylee was hypoxic (low oxygen levels in the blood) when she arrived. She was put on a BiPAP mask, a noninvasive machine used to oxygenate the blood, and placed in the Intensive Care Unit (ICU).

Initially, Haylee responded to the noninvasive measure, but less than 24 hours later, she began worsening, Dr. Meyer says.

“We take these things one hour at a time, one day at a time. And unfortunately, there came a point when noninvasive therapy was no longer sufficient for her,” he says. “We noticed her breathing was worsening, air movement on her lung exam was worsening and her CO2, meaning her ability to ventilate, was also worsening. Everything continued to decline, including her oxygen saturation.”

Physicians needed to intubate her and put her on a ventilator. But Hillary and her husband initially refused to intubate their daughter.

“You hear the horror stories about people with COVID being intubated and never coming off the ventilator,” she says. “That doctor looked at me and said, ‘Ms. Richard, Haylee’s really sick. If we don’t do this right now, she only has a 10% chance of making it.’

“Wow. I lost it. I just looked at him and said, ‘Save my baby. Please, save my baby,’” she says.

Despite the ventilator, Haylee’s condition continued to wane. In less than an hour, doctors decided she needed to be placed on extracorporeal membrane oxygenation (ECMO), a machine that allows patients’ blood to flow out through a tube into an oxygenator before flowing back into the body, similar to a heart-lung bypass machine used in open-heart surgery.

“Unfortunately, even after she was intubated, there was still great difficulty keeping her oxygen saturation levels at a satisfactory level,” Dr. Meyer says. “We’re not even talking about keeping them in the 90s—we’re talking about keeping them in the 80s.”

Her lungs had gotten too sick to support her oxygen needs, Dr. Meyer says.

“We see this in our teenagers who do wind up being intubated,” he adds. “They have very poor air movement, oftentimes they have white-out of their lungs, and are difficult to manage on a mechanical vent support, even on maximum settings.”

Before her daughter was put on the ventilator, doctors had mentioned the ECMO machine as another possibility if needed, Hillary says. But, in her mind, it was a last resort. Watching Haylee on the ventilator, taking note that her numbers weren’t improving, Hillary knew her daughter was in trouble, she says. Haylee’s respiratory rate remained at about 44 to 48 breaths per minute, she says, more than double the rate it should have been.

She and her husband were taken into a consultation room where a chaplain was waiting to pray with them. The doctor came in, telling them the ventilator wasn’t helping Haylee. They wanted to move forward with ECMO, she says.

“At that point, it’s whatever it takes to save my kid,” Hillary recalls. “He told us there was still only a 40% chance she’d even survive. Those were the worst odds. No parent wants to hear that.”

Eight Long Days

The first few days on ECMO her daughter’s condition remained touch-and-go, Hillary says, adding “she didn’t immediately improve.”

In fact, her daughter started swelling, which scared her. Haylee had an allergy wrist band on, and Hillary would stick her fingers between the band and her daughter’s skin to monitor the swelling.

“I started out with two fingers. It got to where my one finger would barely fit in there,” she says.

Helplessly waiting, Hillary and her husband found themselves staring for hours on end at Haylee and the blinking numbers on the machines connected to their daughter. They slept little and prayed a lot, she says. The doctors prepared them with the possibility Haylee could be on ECMO for six weeks or six months. No one knew for sure.

Hillary fretted over what Haylee might be feeling. They had sedated her daughter, “but they told us she could still hear us,” Hillary says.

“And if she could hear us, I worried about what was going on in her head—was she scared? I didn’t want her to be scared,” she says, even though as a mom, she was terrified seeing her child so ill.

On Day Five a bit of bright news came to the Richard family. An X-ray of Haylee’s lungs showed minor improvement. They shared the hopeful results to their “army” of family and friends who’d been supporting them since Haylee’s hospitalization.

“It felt so good to share some good news,” Hillary says. “So many people were concerned about her and were there for us. We had an army—and we still do.”

On Day Six, another good report came in. The top of Haylee’s lungs opened up. The next day, the left side started opening, Hillary says. The following day, after an X-ray showed her lungs partially cleared, doctors decided to take her off of ECMO.

Haylee stayed on ECMO for eight days—the “longest eight days I’ve ever lived,” Hillary says, adding her daughter stayed on a ventilator another two days after that. She was on ECMO for a shorter period than most patients, Hillary says.

“When they first took out the ventilator, she was able to whisper,” Hillary says. “I will never forget walking into her ICU room, and she says, ‘Hi, Mom.’ And it was like the day she was born all over again, you know. It was the most beautiful sound. I could have had a heaven full of angels singing to me at that point, just to hear her little voice again.”

Hearing Haylee’s voice “gave me that, ‘OK, we’re going to get through this. My baby girl is back,’” she adds.

She attributes Haylee’s recovery to Cook Children’s doctors, nurses, technicians—all who helped during one of her darkest times as a parent.

“They were amazing,” Hillary says. “They made us feel comforted in a time when it was hard to feel good about anything.”

Although Haylee was on the mend, their troubles weren’t entirely over. The medications Haylee received caused side effects, and her blood pressure and blood sugar had to be constantly monitored, Hillary says, but it was so much better than where they’d started out.

The Richard family wasn’t the only ones thrilled to see Haylee off of ECMO. The nursing and medical staff were as well, Dr. Meyer says.

“Haylee was definitely one of our more severe cases. Anyone who goes on ECMO is considered quite ill. You always worry once they’re going on ECMO—is this somebody who’s going to leave the hospital alive?” Dr. Meyer says. “It was exciting to be part of seeing her slowly, every day, get a little bit better, to the point we were able to actually begin trailing her off, then remove the tubes.”

“These times, for any family, are extremely crushing. This is a family who was very supportive of the nursing staff and the medical staff. That was greatly appreciated,” he says. “We’re very thankful that she had the outcome she did. Quite honestly, we feel blessed.”

Here Comes the Sun

Haylee doesn’t remember much about the earlier days of her hospital stay using a BiPAP mask or when she was placed on a ventilator and then ECMO. Most of the time, she was dreaming in “la la land,” she jokes. But it pains her to know her family and friends suffered through it.

“Hearing this, it’s heartbreaking. Even though it’s not my fault, I felt bad about it,” she says. “And I’ve apologized because it’s a hard thing for other people to see. I can’t begin to imagine what my parents and my sister (Bella, 12) went through this entire time.”

She does remember first waking up after they took her off the ECMO machine. Haylee couldn’t speak because she was still intubated on a ventilator, but she was able to write on a whiteboard.

“I was confused—I don’t think I was afraid,” she says. “I had no idea what was going on past showing up at Cook Children’s. Once I found out what had happened and how long it had been, I was grateful—I really was. And I was happy.”

She also recalls a few days later when she left the ICU and moved into Cook Children’s COVID unit. She felt like she hadn’t seen sunlight in days, she says.

“So, when they pushed my bed into the regular room, I looked out the window, and there was the sun, and I started crying,” Haylee says with a smile. “I was overwhelmed and happy just to see the sun.”

She was released Oct. 5 and the family celebrated by staying overnight in Fort Worth. The next morning, they went to a mall as an outing for Haylee, who was in a wheelchair. While in one of the stores she wanted to visit, she had “an odd spell” in which she giggled involuntarily, found it difficult to form words and her heart raced. The employees called an ambulance, but the spell passed, and she felt fine. The family headed home.

Back in Denison, they took Haylee into the house to see her grandma. About 30 minutes later, the teen lay on the floor in the throes of a full seizure. The family called 911 and landed at the local hospital Emergency Department before Hillary requested her daughter be sent back to Cook Children’s. Hillary again found herself watching medical personnel put Haylee on a helicopter bound for Fort Worth.

“But that time I knew she was headed for the right place, and no matter what was going on, they were going to help her. I didn’t want anybody else taking care of her because they were so good to us and so good to her,” Hillary says. “She wouldn’t be here today if it weren’t for Cook Children’s. It’s hard to say out loud, but it’s the truth.”

After three days of testing, Haylee was released. Everything checked out, Hillary says, although they don’t know exactly what caused her daughter’s seizure that day.

Haylee continues to recover, attending physical therapy and catching up with school work online. She sometimes gets overwhelmed mentally, she says, but feels good physically. She hopes to go back to school in-person in the spring and is preparing for the role of Cruella de Vil in her high school theatre’s upcoming musical production of “101 Dalmatians.”

She tries to see the good that came from her near-fatal brush with COVID.

“I wouldn’t be the person I am today if I hadn’t gone through that because it changed me,” Haylee says. “I’ve become a lot more thankful and grateful for everything in life, even the little things, like what I said about the sun. You don’t realize that you take those things for granted. The smallest things—showers, the sun, being able to stand, being able to see your family. It’s life-changing.”

Lessons Learned, A Story to Share

While Hillary is thankful all turned out well, she still feels bad for not letting her daughter get vaccinated even though she had begged her.

“There were a lot of ‘I told you so’s when she woke up,” Hillary says.  “We were scared as parents. There was so much mixed information, and it’s hard to know what is real and what is not. You go through that mind-frame of it’s not going to happen to us—it can’t happen to us. And then it did.”

While Haylee was in the hospital, Hillary says, she mentally beat herself up for not giving her the vaccine and not educating herself about it.

 “You don’t realize how bad it is until you’re in that situation. And then it hits you, and it’s terrifying,” she says. “Your job as a parent is to watch out for your kid and to take care of them and keep them away from harm, and I didn’t feel like I had done that. I felt responsible for her being in that bed.”

Since Haylee is now cleared to receive the vaccine, Hillary and her daughters plan to get vaccinated together at the girls’ upcoming doctor’s appointment on Jan. 7, she says.

Dr. Meyer says he’s a proponent of “getting teenagers vaccinated, especially if they have any other medical conditions, such as diabetes, cardiac conditions, asthma, things of that nature.”

“Even if you have an otherwise healthy teenager, I’m still a fan of getting vaccinated,” he says. “I don’t want to see you in our ICU. I don’t want to have to care for you here. We know now vaccinations are quite safe and very effective.”

Both Hillary and Haylee wanted to share their family’s story to give hope to others who may be facing a COVID hospitalization as parents or as patients. And perhaps their story will help others avoid what happened to them, Hillary says, so some good can come from it.

Hillary also wants other parents to know COVID is a real thing.

“It’s still out there,” she says. “I was the person that it would never happen to—and then it did. I want other people who feel that way to see our story and realize they need to be careful. They need to wear their masks. Use sanitizer. And get the vaccine.”

“You don’t want to go through what Haylee went through,” Hillary adds. “Nobody should have to go through that from a patient’s standpoint or a parent’s either.”

Home is many things for different people, but where most people feel ‘at home’ usually comes with a sense of safety, security, and love. That is how Amber feels about Cook Children’s Medical Center. Although she lives more than 500 miles away from the castle with the blue peaks in downtown Fort Worth, she has a story that began (and ended) right where she felt the safest.

In early June, Amber, 40, found herself on the road traveling from Kansas to Texas. However, this was no vacation. She was headed to have open-heart surgery at Cook Children’s. You may be thinking, “But that’s a children’s hospital, how is that possible?”

Amber worked as a nurse at Cook Children’s from 2006-2014 on several different units at the medical center. In 2014, she and her family moved to Kansas, but she still had ties to Cook Children’s. Amber’s sister, Kathleen Powderly, M.D., is a pediatrician at the Cook Children’s Magnolia Clinic.

In the fall of 2020, Amber went for a routine checkup with her primary care physician and after running some tests, she learned she had a heart murmur. After getting an abnormal echo test and being referred to a cardiologist, she learned she had a subaortic membrane that had gone undetected.

“The symptoms I'd been having, I attributed it to turning 40,” Amber said. “I had just started exercising, so I thought some of those symptoms were just part of getting older.”

Knowing she would need surgery, Amber began her search for a cardiologist in Kansas. After that search led to a dead end, she called her sister in Fort Worth for help.

“I was talking to my sister, Kathleen, and she told me that there was a congenital heart program for adults at Cook Children’s, which I didn't know,” Amber explained. “I had been trying to find a surgeon in Kansas and didn’t have any luck.”

Amber’s sister connected her with Scott Pilgrim, M.D., medical director of adult congenital heart disease at Cook Children’s, who performed an evaluation and determined she was a candidate for surgery.

“Amber’s case was a little unique in that she was not diagnosed with her heart problem until later in life,” Dr. Pilgrim said. “Her diagnosis was a subaortic membrane or tissue that had developed underneath the level of the aortic valve. While not necessarily truly congenital, it is something that we do see in children as little as infants, all the way up into adulthood. Our surgeons are very versed in taking care of these types of problems. Her case fell right within our purview and right within our expertise of being able to handle that problem.”

Phillip Burch, M.D., a cardiothoracic surgeon at Cook Children’s, performed Amber’s surgery. On that early Monday morning in June, he met Amber in her hospital room and explained what would take place detail by detail.

“It feels just like coming home,” Amber said. “I loved it when I worked here. I thought it was one of the best places to work. I have always had every confidence in my fellow nurses and the physicians, and I honestly feel more at ease being here than even at the adult hospital back home. I know how skilled and compassionate they are here and I am very confident and happy to be back.”

There was not a dry eye in Amber’s hospital room as the medical staff prepared to wheel her back to the operating room. Amber embraced her husband tightly, as the nerves of being minutes away from open-heart surgery began to get the best of her. Next, she would embrace her sister. As her sister handed her a rosary, they prayed.

“Can I take this into surgery with me?” Amber asked. The medical staff agreed and moments later Amber was on her way. Her family was only able to walk so far before the waiting game began.

“Kathleen let me take her rosary because I’d left mine in my bag,” Amber said. “Faith has always been important to me. We have lost our parents and a sister, and I knew they were there with me. Kathleen even had holy oil with her that she put on me right before surgery and it was automatically calming to me.”

Amber’s successful surgery was followed by a short Cardiac Intensive Care Unit (ICU) stay before she was released to recover at her sister’s home. She spent four weeks healing, but the process was hard on her physically and mentally.

“I have my good days and bad days,” Amber said. “With open-heart surgery, Dr. Pilgrim explained there would be a great occurrence of depression and emotional instability, and I’ve noticed that. My emotions go up and down, one moment I'll be fine and all of a sudden I'll be crying. It's been a lot to take in and I find myself frustrated with not being able to do what I’m used to right now.”

She says while it was nice to be able to visit her sister and spend time with the family in Texas, it was hard to be away from her five children. She spent a lot of time on FaceTime with her children and played games with them on her phone to make the time pass by.

Amber was able to reunite with her family just in time for the Fourth of July, but being back home came with a hard adjustment period.

“It feels so good to be home,” Amber said. “I am still taking it easy. I’ve been using my arms more to push myself up and I even tried driving recently. I have been trying to use those muscles that I haven’t used in a while, I’ve just been sore.”

She says the best part of being back in the comfort of her own home was reuniting with her husband and children. The younger children were fearful and careful not to ‘hurt’ their mommy as they knew she was still recovering.

For now, Amber will continue to take it slow and regain her strength before she gets back to taking care of patients and working long nursing shifts. She says she needs more strength and endurance before she can be on her feet for a long time.

Amber and her sister, Dr. Powderly, say that while Amber gains her strength to get back to work, they will always reflect on the strong team of employees at Cook Children’s that made what could have been a scary experience, seamless.

“From the time that we walked in for registration that morning to when we walked out about nine days later, I can't even tell you the level of exceptional care that we received,” Dr. Powderly explained. “When you work at a place, you have a sense that what you provide is good, compassionate care. When you are then a patient or a family and you see it from the other side, it is just a total validation of why I’ve spent my whole career at Cook Children’s.”

Amber says she agrees with that sentiment, from being an employee to becoming a patient, she is thankful her story started and ended at home.

“Thank you would never be enough,” Amber said. “Every single person was amazing. They are responsible for giving me my life back, and there is no amount of gratitude in the world that I think would cover it. I am very blessed to have been a patient and been a part of an amazing team.”

This campaign will help fund an expansion project that will ensure the precise combination of clinical facilities and operations are in place to treat the sickest children, while best protecting Cook Children’s staff and the community from the spread of infectious diseases.

The expansion will include the construction of a new 6-bed infectious diseases critical care unit (CCU) and a 24-hour solutions center with dedicated incident command space. An existing 20-bed unit will become a dedicated infectious diseases unit for the treatment of non-critical contagious patients such as those hospitalized for flu, COVID-19, respiratory syncytial virus (RSV) and other viruses. A 32-bed medical surgical unit will be added, and the hospital’s simulation lab will be relocated.

“I am beyond excited about the new infectious diseases critical care unit,” Mary Suzanne Whitworth, M.D., medical director of pediatric infectious diseases at Cook Children’s Medical Center, said. “It is humbling to work for a system like Cook Children’s that is always looking for the next thing needed to make pediatric health care better. After spending the last 25 years of my career here I must say, however, that I am not at all surprised that this is in the works. This is a system that never stops rising to the occasion.”

Family-Centered Safety

Since the start of the pandemic, much has been learned about how to maintain safety for staff and guests and expertly care for infectious disease patients now and in the future. These best practices and protocols will be standard design in the infectious diseases units, which will feature specialized air ventilation systems, dedicated areas to put on and take off personal protective equipment (PPE), technology that allows clinicians to closely monitor a patient without having to be directly at the bedside and other heightened protection measures to contain disease spread.

“These units will be used in an effort to place potentially contagious patients in one area,” said Dr. Whitworth. “The goal is to have everybody in one unit with every employee in that specific unit dedicated to being experts in proper PPE donning and doffing, patient and visitor flow and all of the aspects of interrupting the spread of an infectious disease.”

Maintaining a family-centered and supported environment also influenced the design of the new infectious diseases CCU. The decision to limit visitors to Cook Children’s Medical Center during the pandemic was a difficult one for everyone. While Cook Children’s patients have always been allowed at least one family member at their bedside during the outbreak, the spread of the virus demanded that administrators take steps to protect employees and vulnerable patients by restricting the visitation of others within the family unit.

“Segregating families is not who we are as an organization,” said Stan Davis, chief operating officer at Cook Children’s Medical Center. “We promote that when a child is sick and in our hospital, they need family at their bedside to help with treatment and healing. This unit allows our staff to feel comfortable that they’re in the right environment and have the right precautions to be comfortable treating patients, and it allows for our community to understand that in addition to having the best nurses, therapists and support folks in the world, we have the right environment to keep families together.”

Each of the new infectious diseases CCU rooms will have a private bathroom, an accommodation not available in the current critical care space used for contagious patients. This allows parents to stay in the room with their child as long as they would like and reduces the in and out traffic of a parent who may have the same illness as the child due to exposure. Dedicated entrances and exits to these units for staff and visitors will help protect the general hospital environment.

“Re-tooling to deal with the re-emergence of SARS which resulted in lots of health care worker deaths in Canada, for COVID-19 variants already circulating, for Middle East respiratory syndrome (MERS), for avian flu, for new and old world hemorrhagic fever viruses, or for bioterrorism-related infections like anthrax, is our responsibility,” said Marc Mazade, M.D., medical director of Cook Children’s infection prevention and control. “We’re looking forward to having the facility to do that better than ever.”

To open up space for the infectious diseases CCU, the Cook Children’s simulation lab will be relocated. The simulation lab is an educational space where staff practice using new technologies, innovations and research. Last year, Cook Children’s was the first freestanding children’s hospital in the world to receive full accreditation through the Society for Simulation in Healthcare. The relocated lab will allow for future expansion and growth of this program.

A new 32-bed medical surgical unit will be built to gain back beds repurposed for the infectious diseases unit and to expand Cook Children’s ability to meet the hospitalization needs of the growing communities it serves.

System-Wide Solutions

The design of the new 24-hour solutions center was inspired by lessons learned about system-wide coordination and cooperation throughout the pandemic. Members of all 14 of Cook Children’s Health Care System’s entities worked together in the medical center’s incident command center to coordinate a consistent response to COVID-19 across the entire organization. This consolidation and cooperation allowed Cook Children’s to be nimble, flexible and quick to the ever-changing environment.

The new solutions center will operate year-round under the same premise of consolidation, coordination and consistency. It will be a one-stop-shop for staff and guests of any one of Cook Children’s entities to report or request assistance with a facility or operations issue.

“The solutions center will be a single touch point for staff, patients and families in terms of who they contact for assistance with an operations issue at one of our facilities,” Davis said. The consolidation that will occur is that there will be a joint information system—a communication hub, if you will—that everyone in the system uses, and the issue will be triaged and assigned from there. It’s similar to what you see with a technology help desk.”

Inside the solutions center will be a dedicated incident command center equipped with meeting space that accommodates proper social distancing protocols and communication technology that supports real-time global health updates for rapid, informed decision-making. This is a much needed upgrade from the classroom that doubled as an incident command center during the height of the pandemic.

“We’ve learned with COVID-19 that hospitals can become overwhelmed rapidly,” Dr. Mazade said. “Planning for staff shortages, getting supplies, developing protocols, and getting our teams the most up-to-date information ASAP while combating misinformation is vital to everyone in the organization, to our community partners, and to our community. We need an up-to-date, world-class incident command station built for that.”

Construction for this expansion is currently underway and slated to be complete in 12 months. If you’d like to join the Protecting Your Tomorrows fundraising effort, contact Cook Children’s Health Foundation at 682-885-4105.

Rebecca Benson had a feeling the weather predictions would be wrong when she woke up Thursday, Feb. 11. As she suspected, no winter storm arrived overnight to cancel school for her two children. Like any other day, she quietly put on her scrubs while her family slept and left her North Fort Worth home in the dark. A diligent nurse at Cook Children’s Medical Center for six years, Rebecca didn’t want to be late for her 7 a.m. shift.

As she traveled down Interstate 35’s expressway, everything seemed normal – until it wasn’t.

“The roads were completely dry. There was not even a mist on my windshield, absolutely nothing,” said Rebecca. “All the bridges I went over were perfectly fine until I came across the big Trinity River bridge.”

Driving down the highway for nearly 20 minutes, she had no reason to suspect what lay ahead – black ice, and a crumpled mess of metal and people. Approaching a curve at the top of a hill, Rebecca’s car began to swerve. As she confidently corrected the wheel, she noticed shining taillights getting closer. It was a pileup that would ultimately involve more than 130 vehicles, killing six people.

“I look in front of me and see all of the carnage from the accident. There's absolutely nothing I can do,” she said. “It’s the expressway. There's barriers on both sides of you. You can’t go to a shoulder. You can't do anything.”

Knowing she was about to crash, she aimed her red SUV in between two semi-trucks.

“I put my foot on the brake, said a prayer, and I literally thought to myself, ‘I could very possibly die in two seconds,” she said.

Rebecca tried to relax her body to avoid broken bones and readied herself for impact. She hit the trucks so hard, her ponytail holder came out of her hair.

“I got through that and thought, ‘Okay, I'm alive. I'm not severely injured. And then I looked in my rearview mirror and see all of these lights coming right at me,” she said.

Rebecca says that’s when she realized she wasn’t out of the woods. The chances of her being injured or worse by the oncoming traffic were high. But thanks to her quick thinking before the crash, she had positioned her vehicle in what she calls “God’s triangle,” because the trucks stuck out past her SUV, protecting her.

“Everything that hit behind me, the trucks took the impact from that. Every time another semi would hit, you would hear and feel the car move. It was so unbelievably terrifying,” she said. “I've seen it on videos, but to actually be there, waiting to see if something even worse is going to happen was awful.”

Rebecca stayed in her SUV until she stopped hearing crashes. All four doors were blocked by the trucks, so she waited until someone opened the back hatch of her vehicle. She crawled out and surveyed the situation in shock.

“I'm like, ‘Okay, I'm a nurse. I got this. Who can I help? What can I do?’” Rebecca explained. “But Fort Worth Fire Department was working a wreck on the non-express side of 35 (when the pileup began) so they were already there. There was a car behind me that they were working on with the Jaws of Life to try to help somebody. Everyone from Fort Worth Fire was amazing.”

After the crash, Rebecca called her husband who was ready to come get her. She also had a text message from her coworker, Ed, warning her not to take I-35 because traffic was backed up. Knowing Ed was stuck nearby, she decided to find him and hitch a ride to work.

“I was like, ‘All right, I'm gonna hop the barrier and I'm walking your way because there's nothing I can do. But I can at least get in your nice warm car and be safe that way,” she said. “I walked up I-35 in the ice. It was the weirdest thing to be walking on a highway.”

When she found Ed and his girlfriend, Kim, she told them to take her to work. Rebecca explained that she could have gone to the reunification center set up by first responders and waited for her husband, but she knew that drive would likely take hours due to the shutdown. She also felt the need to do something other than think about what she had just survived.

“Being able to be at work and helping instead of reliving that,” she explained. “I was like, ‘I need to get to work and just see where I can help.’”

Rebecca acknowledges this is something she will be processing for a very long time. She allowed her husband to come get her a few hours later and take her to a hospital. Thankfully, she only suffered bruises. But she’s already dealing with survivor’s guilt, wondering why she was able to walk away when so many others couldn’t.

“My heart breaks for all the people who lost loved ones, and who have loved ones in serious condition,” she said. “It's horrible, awful, terrifying.”

Rebecca remembers seeing many people in scrubs as she was walking along the interstate and calls the situation a ‘perfect storm’ for health care workers, all trying to get to work at the same time. Asked if she felt like a hero, she adamantly says ‘no.’

“I feel like I'm absolutely blessed and had guardian angels surrounding me,” she said. “I did what any other nurse I know would do. I didn't save anybody. I didn't do anything extraordinary. I just did what I'm supposed to do.”

She says the experience also gives her hope. From the first responders to good Samaritans, she says she saw the good in people. Even when she was safely waiting with Ed and Kim, she remembers a man walking car to car with a box of granola bars for anyone who may have skipped breakfast and needed something to eat.

“It gave me a lot more faith in humanity.”

“These are a couple of toys for our PICU and TCU families,” she says, donning a plaid scarf and a Cook Children’s mask.

Coffee mug in hand, she speed walks to the door – partly to get out of the cold and partly to check in with the charge nurse as soon as possible before the COVID-19 Command Center call in 30 minutes. By her side is Lori Parrott, a pediatric intensive care unit (PICU) nurse manager, who’s helping carry in Christmas presents for patients.

“It sounds like we may have gotten two more overnight,” Melodie tells her as they briskly cross the sky bridge linking the garage and medical center.

As the director of the PICU and the Transitional Care Unit (TCU) at Cook Children’s Medical Center, Melodie wears a lot of hats. She’s a decision maker. A trusted leader. A master juggler. And she oversees a special wing dedicated to critically-ill COVID-19 patients known as 2North.

She quickly sets the bags down in her small, windowless office and heads to the nurses’ station without pause. Sitting next to a small Christmas tree, the charge nurse fills Melodie in on what happened overnight. A med alert, or medical emergency on the 3P, the stepdown COVID-19 unit, and a DKA, otherwise known as diabetic ketoacidosis. But the big news is the latest patient admitted to 2North. It’s a teenager transported in from another hospital. This patient makes eight on the unit, which has a total of 10 beds. This admission means her team will soon have to find more space to house the patients that are increasingly filling up the COVID-19 unit.

Back in her office, Melodie awaits her turn to speak on the Command Center call, a tri-weekly meeting for leaders entrenched in COVID-19 planning and processes. While sipping coffee, she listens as the director of infectious diseases rattles off the latest number of children who’ve tested positive for the virus. Today, it’s 112 in 24 hours, with 25 currently in the hospital.

Soon, it’s Melodie’s turn to share bad news.

“We may need to think about moving kids over to ‘A’ depending on what the continued census is, and especially if we get down to one bed,” she says as clearly and concisely as possible. “These kids continue to be quite ill and I don’t think any will go out today.”

Moving patients to ‘A’ means opening up a new COVID-19 ICU wing. The hospital is being stretched, but you wouldn’t know it by the positive tone of the call. People are optimistic; there’s hope on the way. They’re waiting on notification from Pfizer that the hospital’s allotment of the COVID-19 vaccine has shipped, which could happen at any moment.

We’re with Melodie this Wednesday morning, the week before Christmas, because she’s offered to show us something we have not seen before. She’s volunteered to take us inside 2North.

Inside the COVID-19 ICU

After the call, we follow Melodie down the hallway, her heeled-boots clicking on the confetti-laden floors. Big, purple double doors are ahead of us with 8-by-11, paper signs. They read, “Doors Must Remain Closed,” and “Isolation Garb for COVID (+) rooms,” with a long list of recommended attire: N95 or PAPR, surgical mask, gown, goggles or face shield, gloves, hair covering, and booties. Immediately upon entering, we see all of this gear in action. To the right, there’s a doctor towering over two nurses. All three are concealed inside in personal protective equipment (PPE) – yellow gowns, white masks and blue headcovers. The physician’s goggles resemble something you’d see on the ski slopes, but he’s not on vacation. He’s just left the room of a child who’s suffering a heart arrhythmia due to the virus.

It feels like we’ve just stepped inside a beehive or an ant bed. Every worker has a job and they’re busy doing it. The energy is fast-paced, but controlled. We watch as a respiratory therapist just a few feet in front of us straps on a PAPR, a small backpack that pumps air through a hose into a sealed helmet. Her speed and skill reveal that she’s done this many times.

To the right, a gloved nurse gives us a thumbs up through a window in a patient’s room. She’s talking to her colleague, who’s sitting at a computer on the other side of the wall. The two are communicating through a mini walkie-talkie type device called a ‘Vocera’ that’s clipped onto their scrubs.

“Can I bring you anything,” said the one sitting near us.

The nurse inside the room can’t leave. She’s halfway through a 12-hour shift, meticulously monitoring the many machines keeping her patient, a 12-year-old girl, alive. This is not a job for the weary. She’s an ECMO specialist, meaning she is precisely trained to take care of children who need extracorporeal membrane oxygenation (ECMO). This treatment is a last resort in which blood is pumped to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back into the body.

When a child is on ECMO, two of these specialized nurses or respiratory therapists remain at the bedside at all times. Breaks for food and the restroom are limited. Layers of PPE keep them safe from the virus, but not comfortable. They wear two masks, a surgical mask on top of an N95, plus a face shield, gown, gloves and headcover. If they were soldiers, they’d be ready for war. Their enemy, though, can’t been seen – only the ravages it’s left on their young patient.

Melodie has asked if the girl’s mother would be willing to speak to us. She’s just woken up from the small couch/bed in the room and agrees to step into the hallway. Obviously exhausted, she tells us her name is Florence and that her daughter was diagnosed with COVID 11 days prior.

“She was having a mild temperature, so I brought her to the emergency room just so they could check her out, and we ended up here,” she said in a low, hushed tone. A steady beeping flows in the background.

“That visit was the best decision I made,” she said.

Due to the virus, Florence is the only person allowed to be in the hospital with her daughter. And she can’t leave the room, unless she is leaving the property. All meals are delivered. Anything she needs will be brought to the room for her.

We asked about her time at Cook Children’s, and how things have been.

“I love this place, and I love the staff,” she said.

Florence breaks down. She says everyone she has encountered at the hospital has treated her as if they were the only family there.

“That matters a lot,” she said with tears soaking into her mask.

Ready to return to her room, she shares one last thought: “The ECMO machine is a lifesaver.”

As she walks away, Melodie asks ECMO Manager Jill Pittman to suit up and join the two nurses inside the girl’s room. Shanna Senay and Sara Morgan are the ECMO specialists on duty today. They show us the machine that’s taken the place of the child’s lungs and heart. It’s a bulky contraption with multiple screens, tanks, and tubes, which are red with blood pumping through them.

“ECMO is allowing her lungs to rest and heal from the pneumonia, while we oxygenate her blood and circulate it throughout her body,” Shanna says.

She’s the nurse who gave us the thumbs up from behind the window.

“ECMO is the highest form of medical care that we offer at Cook Children’s, and it requires a lot of training,” said Jill, who’s been a nurse at the hospital for 23 years and now leads the ECMO program. “To be able to facilitate that and have an active role is very meaningful to me.”

ECMO patients are often on the machine for weeks, not just a few days. Because of that, ECMO specialists have to have endurance and the mental fortitude to keep going, even when there is no end in sight.

We’re curious and ask ‘Why do you do this?’

“There’s something special about being able to take care of these kids when they’re so sick and their parents can no longer give them the care they need. Then, it’s up to us,” Sara said with clean air being pumped inside her PAPR helmet. “It’s the last chance these kids have, so we fight every day, every night until they get to the point where they can get better on their own.”

Shanna nods in agreement.

“These kids are warriors. They’re why we push through and why we come out of here sweating bullets and having held our bladders for hours,” she says. “If it were my kid, I would want somebody doing the same thing.”

Back in the hallway, another group of 2North staff members gather to talk to us. One is a young nurse named MyKayla. She has bandages across the ridge of her nose and both ears to protect herself from her N95, which cuts into her skin and leaves sores. Five bandages total, but she’s not complaining. She says she loves taking care of children. It’s her calling.

A respiratory therapist named Joanna is with her, along with another nurse named Megan. They both echo MyKayla, saying they love what they do. We ask if they’ve ever felt scared. There’s a pause.

“Yes, I’ll say it. Especially with it affecting the Hispanic population, it worries me for my family,” says Joanna, who is Hispanic. “But, if God forbid, any of my family members get it and had to be in the hospital, I feel completely comfortable with our doctors, nurses, and respiratory therapists taking care of them.”

Megan jumps in.

“I’m not scared, but I have a healthy respect for it,” she says point blank.

Megan, tall and blonde, moved to Fort Worth a couple of years ago when her husband was sent to work at the Naval Air Station Joint Reserve Base. She was accepted into the competitive nurse residency program at Cook Children’s, and after six months was selected to work full-time in the PICU. She had just a few months under her belt before the pandemic hit. Nearly 10 months on 2North, she now seems like a seasoned nurse.

“I came into this profession knowing anything is game,” she says. “Since COVID, our teamwork as a unit has exponentially increased. It’s been stressful, it’s been frustrating, things are constantly changing, but we keep plugging through, trying to keep our spirits up, and the kids’ spirits up too.”

Off to the side, Jennifer Hayes has just exited a patient’s room. She’s a chaplain on the floor and is accustomed to the tougher moments of an ICU setting.

“The PICU is a hard and heavy place to work, and then you add COVID on top of that, it’s tough,” Jennifer tells us, her appearance failing to match her words.

She’s wearing a bright red shirt with a snowman on it. Her hair is short and brown, pulled up into two spunky knots. She explains her role, how she helps patients and families deal with difficult situations both emotionally and spiritually. She provides the same support to the PICU staff.

“I’m trying to bring joy and fun into the unit,” she says while showing off her fanny pack, creatively decorated to look like a taco for a contest she spearheaded.

She also tells us about the ‘COVID Café,’ a space she established on the unit for worn-out frontline staff to retreat to during their shift. They can watch TV, enjoy the snacks or one of the many word searches, games, or funny memes she’s left at the half-dozen socially distanced tables.

Jennifer is the caretaker of the caretakers, and one of the many moms on the unit. She, like everyone else on this floor, has had to change the way things are done at home. She explains how her 2 year old always wants to hug her as soon as she walks in the door, but can’t for fear that some microscopic particle of COVID-19 has made the trip home with her.

“It has been a big change and has created a delicate balance where we are trying to keep normalcy for our kids, but also we have to be mindful keeping them safe,” she says.

Ashley Miller, the charge nurse we saw filling Melodie in early this morning, agrees. She is also a mom and shares how her 14-year-old son watches the news and worries. She oversees the entire 43-bed PICU and is in charge of admitting each patient. She says the now is by far the worst they’ve seen of the pandemic.

“It’s a reality that kids can get COVID and they can become very, very sick,” she says. “It’s definitely a change from March, we’re seeing many more now.”

While we’re talking, Melodie reminds us about an 11:30 a.m. meeting we’re due to attend. It’s with PICU leaders, and they have a lot to discuss.

Leading During a Pandemic

We make our way down to the basement of the hospital where five women have gathered in a classroom. More are on a conference line. Their top concern today is overflow for COVID-19 patients.

“It’s hard to put a target on when we should open a new wing, because we don’t want to turn around and close it if our census lowers,” Melodie tells the group, which is spaced out around the large room. “But once we get to nine patients, that’s it, and that can change in five minutes.”

Until recently, 2North only had two to three patients at one time. Now, it’s pushing capacity. Finding more space and beds is not an issue. The problem is staffing. With a new COVID-19 ICU unit, more staff will be pulled in to take care of the children in the beds. That’s worrisome because burnout is already top of mind for these leaders. They will do anything to prevent losing essential caretakers. That includes Linda Thompson, M.D., medical director of the PICU, who’s sitting in the corner of the room. She is so concerned about burnout, she offers up her vacation home on the Texas coast for fatigued staff to escape to with their families. Everyone here is willing to do whatever they can to prevent from losing people in the pandemic.

“Ding, ding, ding – Ashley Miller.”

This is the sound of a call coming into a Vocera. Ashley, the charge nurse, is alerting the leaders that another COVID-19 patient is being admitted as they speak. Their discussion about overflow may take shape sooner than expected. They hurry to get through their agenda, knowing there is work to be done on 2North.

After the meeting, we part ways with Melodie. She’s off to do what she does best, leading her team during a challenging situation. We’re gathering our cameras and equipment to capture another area we’ve never seen, the step-down COVID-19 unit known as 3Pavilion, or 3P. Until today, 2North and 3P had been restricted to ‘necessary’ personnel only. Somehow, we got lucky, and are being allowed inside both.

Inside 3P – the COVID-19 Step-Down Unit

We take the nearest elevator to the third floor. As soon as we step off, Valerie Badgett, the day nurse manager, is waiting for us. She’s worked on this unit for 17 years and recalls the day this past March when administrators gathered everyone into a break room and told them they were about to be taking care of COVID-19 patients.

“This was a specialty med surge unit prior to COVID. We treated patients with renal disease, from acute kidney failure to children who received kidney transplants, and GI patients,” she explained. “When they told us we were going to become a COVID unit, people were understandably nervous.”

The administrators explained that their floor has a unique airflow system, which allows air to vent directly outside. This prevents airborne viruses from circulating through the ventilation system.

Valerie tells us more about that day in March, and how they had to quickly move their patients to other floors. They thought they had days to prepare for their first suspected COVID-19 patients. In reality, they had just hours before seven children under investigation for COVID-19 were admitted to their floor.

“There were a lot of questions at first because we didn’t know enough about it,” Valerie said. “But Dr. Whitworth came over the very next day and eased a lot of people’s concerns. She has always been there to answer our questions.”

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s. Valerie credits her composed leadership for helping the staff on 3P not only accept the challenge ahead of them but take it on as a mission they were called to serve.

Unlike 2North, the atmosphere on 3P is calm. It’s quiet and much larger than the ICU. Patient room doors stretch down two long hallways lined with purple and blue carpet. The only thing that visually sets this floor apart from other non-critical areas of the hospital is the donning and doffing of PPE happening all around us. Doctors and nurses are suiting up in PAPRs, gowns, goggles, and gloves before entering rooms. Knowing this team didn’t necessarily sign up to take care of COVID-19 patients gives us a whole new respect for them.

“It has brought a lot of new diagnoses that we didn’t take care of before, chemo patients, newly diagnosed diabetes, a lot of patients that we’ve gotten have come in the emergency department because they’re sick from something else, and then coincidentally they test positive for COVID,” Valerie said. “Many of our nurses have become certified in chemotherapy so they can take care of the patients we’re now seeing.”

Hearing how this unit has stayed together the past 10 months, even when they had opportunities to abandon ship to work in other areas, is inspiring. They’ve overcome fear, learned how to care for an array of injuries and illnesses, and built an unbreakable bond. They’ve proven resilient, and their strength is needed now more than ever.

“We have 20 beds on this floor, and today we have 17 patients,” says Ashley Kovacev, the night nurse manager who’s volunteered to give us a tour.

She walks us down the hallway, pointing out the negative pressure rooms they never had to use for isolation purposes until this year. We round a corner and an alarm is dinging. A light overhead flashes. Ashely peeks into the room.

“Are you ok?” she asks.

Inside, a mother needs help getting her child to the restroom. Ashley calls for a nurse.

Families on 3P rely on the staff for everything, including food and water. Like 2North, only one parent at a time is allowed per patient and they can’t leave the room unless they are leaving the hospital. Because of COVID-19, the floor’s family lounge and playroom are closed. Patients and parents are stuck in their rooms, but everyone tries to make the best of it.

One small glimmer of hope is the child life specialists and music therapists who don and doff PPE to deliver activities to the children’s rooms. We spot one, a young woman with long blonde hair, sitting alone in the closed playroom. She’s teaching a patient how to play guitar via Zoom, just one of the many creative ways the child life team is engaging isolated patients.

To the left, down a short hallway, a woman in a blue scrub top and black pants is pushing a large cart.

“That’s Rebecca. She’s been absolutely phenomenal since day one,” Ashley says. “We tease her because she literally wipes down the walls non-stop.”

Rebecca is an environmental services worker. She looks uncomfortable as Ashley gushes about how she has kept the team safe throughout the pandemic.

“Not a single person here has contracted COVID from our unit,” says Ashley, crediting Rebecca for their protection.

Reluctant to accept the praise, Rebecca says simply through her mask, “We have to take care of each other.”

As we near the end of the tour, a food services employee in a mask and goggles delivers a plastic bag full of Styrofoam containers to the nurses’ station. It’s just one of the many trips he will make to 3P today, delivering three meals to each of the 17 families on the unit. He, like everyone else we’ve met, smiles as he drops off the food.

It’s no small feat for any of these people – the changes they’ve adapted to. The anxiety of the unknown. The courage they’ve displayed. After spending eight hours behind-the-scenes of Cook Children’s COVID-19 units, we can attest to the following statement:

“Our staff truly honor our ‘Promise’ every single day,” Ashley says holding back tears. “It makes me emotional. These people are so resilient. They care for these kids like they’re their own. It’s truly amazing.”

“Similar to what has happened with adults, Hispanic children have been most affected during the COVID-19 pandemic,” said Ana Maria Rios, M.D., infectious diseases pediatrician at Cook Children’s. “Hispanic people have the highest burden of all the races and ethnicities in the U.S. and they have the highest risk of contracting infection, and becoming severely ill.”

The Centers for Disease Control and Prevention (CDC) reports similar statistics nationwide. According to a report released in August, Hispanic children are eight times as likely to be hospitalized for COVID-19 as white children. For Black children, the risk is five times as high.

In Tarrant County, overall infection rates for COVID-19 have hit the Hispanic community hardest. This group accounts for 27% of all positive tests, which is the largest percentage across all races and ethnicities.

Why are Hispanic families being hit the hardest?

Out of the 181 children hospitalized with COVID-19 at Cook Children’s between March and October, 96 were Hispanic. But how can this be when white (non-Hispanic) people make up the majority of Tarrant County and surrounding areas?

One reason many experts point to is large numbers of Hispanic workers who are on the frontlines and considered essential.

“A lot of people don’t have the luxury of being able to work from home,” said Vida Amin, M.D., medical director of Cook Children’s Neighborhood Clinics. “It’s kind of the worst recipe. You have adults who have to keep working to put food on the table. You have kids who have to go to daycare or school. All of these factors go into play.”

She says another risk is that Hispanic families are more likely to have multiple generations living under one roof.

“We saw this in Italy early in the pandemic. I remember I was curious about why is this happening in Italy and I started to look at the literature. I saw many younger people, in their twenties and teens, were working in the city and they'd come back home where they were living with their grandparents,” said Dr. Amin. “I think it’s a very similar situation here.”

Bianka Soria-Olmos, D.O., a pediatrician at Cook Children’s office in Haslet, has been an outspoken advocate in the Hispanic community throughout the pandemic. After speaking on various Facebook Live events and news interviews targeted toward Spanish-speaking audiences, Dr. Soria-Olmos says getting information out has been critical.

“I think for some people, unless they've known someone who has been personally affected, they may not realize how dangerous and unpredictable the virus is, including the wide range of presentations it can cause from mild symptoms of a cold to life threatening illness that requires intensive care and in some cases even death,” said Dr. Soria-Olmos. “I also feel like the great things about our culture, like the importance of family and celebrations and the act of gathering, have been an Achilles heel for us.”

She says the most important thing for everyone to remember, not just Hispanics, is to be mindful of activities she calls ‘extracurricular.’

“It’s choosing not to do those things where you could potentially become exposed,” said Dr. Soria-Olmos. “The bottom line is leaving your house is a risk when you have transmission rates this high in the community.”

Tarrant County is currently averaging more than 1,000 cases of COVID-19 a day.

Why do Hispanic children end up getting sicker?

It’s important to remember that most children who contract COVID-19 have mild symptoms or are asymptomatic. In fact, overall hospitalizations among children remain low. However, Hispanic children are at the greatest risk of becoming severely ill and needing hospitalization. Experts believe higher rates of underlying health conditions in this population may play a pivotal role.

According to the CDC, obesity, chronic lung disease and prematurity are the most prevalent underlying conditions for children hospitalized with COVID-19. They report nearly 46% of Hispanic children have one or more of these conditions.

“I have to be honest with you that even though I am Hispanic, I didn't realize how much inequities we have in the medical system,” said Dr. Rios. “I think this pandemic is making everyone aware of the public health crisis we’re in. The silver lining is that public health has to be reinvented and we need to work harder in prevention.”

Another issue that can lead to children of any race or ethnicity becoming sicker is delaying medical care.

“I think it's really important that we ask families and schools to remain vigilant about any kind of severe symptoms that they may be noticing in children,” said Dr. Amin. “Don’t just ignore it because children are supposed to be safe from the virus. Some kids do get very sick and we need to be taking these cases seriously and seeking out medical care.”

Symptoms of COVID-19 in children include:

• Fever or chills
• Cough
• Nasal congestion or runny nose
• New loss of taste or smell
• Sore throat
• Shortness of breath or difficulty breathing
• Diarrhea
• Nausea or vomiting
• Stomachache
• Tiredness
• Headache
• Muscle or body aches
• Poor appetite or poor feeding, especially in babies under 1 year old

Dr. Amin adds, “As a clinician, I hope my families will recognize if their child is in a high-risk category, and that they take it seriously when their child becomes ill and seek out care early.”

What can families do to protect their children?

First and foremost, take COVID-19 safety precautions as seriously. This means wearing a mask in public, washing your hands frequently and using hand sanitizer when handwashing is not possible.

“Wash your hands every chance you get and wear a mask,” said Dr. Rios. “We now know masks work both ways. At first, we thought they would only protect others, but we now know masks make a big difference in the amount of virus that can get to us and make us sick.”

It’s also critically important to stay home from work and school when sick. If your child is exhibiting any symptoms of COVID-19, make an appointment with your pediatrician or a Cook Children’s Urgent Care. These visits can be in person or virtual from your phone or computer using a MyCookChildren’s account, which you can easily sign up for here.

“Not everyone is aware that we offer virtual appointments at our urgent care clinics and at our community based (Neighborhood) clinics,” said Dr. Amin. “For families who are working and juggling other things, signing up for MyCookChildren’s is a great way to schedule appointments and to make sure they can see a doctor quickly.”

Dr. Amin also urges parents not to skip well-visits and vaccines.

“These appointments are our chance to discuss their child’s health, prevent serious illnesses through vaccines and help them understand what to do in case their child becomes sick,” she says. “If anyone out there is wondering if they should get their child’s flu shot this year, they should know the influenza vaccine is recommended for all children over 6 months of age, with rare exception. Please discuss it with your primary care physician. As for our clinics, we have safety protocols in place to allow families to wait in their cars until they’re called in and have taken many other safety precautions as well.”

Another thing families can do to protect themselves and their children is to limit gatherings with people outside of their household, which can be increasingly difficult with the holidays in full swing.

“We realize how hard it is to say ‘We’re not going to get together this year,’” said Dr. Soria Olmos. “But we have to do our part to get the community numbers down. To do that, we need to keep our holiday celebrations to our households, and we hope that we will not have to do this ever again.”

Medical Director of Infectious Diseases, Suzanne Whitworth, M.D., hosted a Q&A with reporters today about this latest update.  

What’s the capacity like at your hospital?

We have devoted 10 beds to COVID-19-infected intensive care patients. So those 10 beds are available. We have two or three of them occupied right now. I believe the most we've had occupied in the ICU with COVID-19 at one time is five. We have plenty of room to expand and we are okay. The volume of children in the hospital with COVID-19 is much less than the volume of adults. We are almost at capacity for our floor COVID-19 unit. We have 20 beds there and 17 patients in those beds, but we are already looking at which other unit we can add so that we should have plenty of room for our patients. We're not worried about running out of beds.

Just hearing the amount of children that are in the hospital is gut-wrenching enough, but I'm wondering what those children are like right now. What are their symptoms? How are they feeling?

I think our children are like most of the children hospitalized nationally. We have some children in the hospital who are not very ill. They need oxygen for a day or two, and then they go home and they're fine. We have some children who are really more ill with COVID-19 pneumonia. Those children we've been treating with remdesivir, and dexamethazone, we have some that wind up in the ICU with COVID-19 infection. We have some children who have the multi-system inflammatory syndrome, that MIS-C that you've read about. We've reported about 21 to 24 of those to the health department so far since the beginning of the pandemic. And I believe we have a couple of those kids in the hospital currently, too. Some of those children are even sicker and require ventilation in the ICU also. So it's really a full spectrum.

Did you expect this exponential growth in cases and is this something you’re anticipating going forward?

We have been very hopeful that this would not happen like all the rest of the world, but it has. And we do think that the number of children that will require hospitalization over the next few weeks or months will very likely go up. We think this will increase.

Are you planning on adding additional beds?

I think we will have to change a little bit of what we're doing. I am not fearful that we will not have enough beds, period. I think we will have plenty of beds in the hospital, but we want to maintain areas that are devoted completely to COVID-19. We have one area completely devoted to COVID-19 on the floor and one in the ICU. We're probably going to need to add another floor unit to take care of COVID-19 patients over the next few days or the next week. So we look at which units we can do that with based on air flow and staffing and those kinds of issues.

What are your feelings moving forward into the holiday as we're dealing with this and what are your fears?

It's hard for me to imagine a way that this is going to get better before January or February at the earliest. My fear is that at this moment, we have so much more community disease. When people gather at Thanksgiving and Christmas, I'm worried that our more vulnerable populations will get sick. Right now, the people that are ramping up the numbers of COVID-19 infections are younger, and many of those do not require hospitalization. So at the moment, our hospitals are getting full, especially the adult facilities. I'm worried about those adult facilities and their capacity, but we're okay in pediatrics.

The problem I see could get worse if over Thanksgiving, there are family gatherings where elderly people become exposed and more of those require hospitalization. My fear about the holidays is that we will increase disease and then increase hospitalization at a time when many of the adult facilities are already maxed out. My sincere hope is that there will be minimal family gatherings and minimal disease transmission over the holidays. We haven't had holidays during a pandemic, so we really don't know how it's going to go. But I'm hopeful that everyone will continue to do their social distancing and masking and staying six feet apart and hand-washing and all of those kinds of things that we've been talking about since the beginning, so that things won't get worse during the holidays.

A lot of parents are wondering if children are getting infected at school or if they're actually getting infected at extra-curricular activities. What are your thoughts?

The numbers of kids that are believed to have gotten infected at school really has not been bad. We had been concerned about how kids in schools would do. I know there have been outbreaks with football and volleyball and some other team sports. And I think the classroom has gone probably better than what we expected. The problem that you run into is that kids are together all day at school, wearing a mask, six-feet apart and often behind Plexiglas shields. And after that, the parents feel like it's normal to say, they're at school together all day anyway, let's have the birthday party. What they don't realize is the birthday party is unmasked because people are eating, several parents show up at birthday parties who would not normally be in the same space, and I worry that it is more, the extracurricular events than it is actually in the classroom.

I think a lot of people were under the impression that kids don't get COVID-19. Not true?

We are living proof that that is not the case. We know that we're really lucky that children do not get as sick in high volumes as adults do. But certainly kids get sick and certainly kids get intensive care unit sick with this disease. Absolutely they can. We are very fortunate we have not had any deaths here. It is my understanding that there have been a couple of deaths in the Texas Panhandle. Certainly there are isolated cases with pediatric deaths in the country.

Biggest takeaway that you would hope people would take from hearing these statistics today that you guys have the most patients at one time?

Overall, things are worse. And when you look at the population of America, we have so many people that remain at risk. It isn't just the elderly. It's thought that 150 million American citizens have a pre-existing condition that puts them at risk for severe COVID-19 disease. That's almost half of our population. So even though it's the holidays and even though we're tired of staying home and wearing masks every time we leave the house, we just can't stop it. You just have to keep wearing your mask because you never know if you're carrying this virus asymptomatically, you could be putting other people at risk. When you're out in public, begin to think about standing six feet away from whoever you're talking to. Many people already have, but make it your habit to stay feet away from other people, and wear your mask. I think we just have to be more aggressive and do that more thoughtfully and not stop over the next few months.

Have you seen children without underlying conditions become hospitalized with COVID-19?

Yes, we have seen perfectly healthy children come into the hospital who have COVID-19, who wind up on a ventilator and life support. That does happen. It's not a high number, but you can't say that children are not at risk. That has happened here and it does happen.

Earlier this summer, my 17-year-old patient Tryston just wasn’t feeling like himself.

“I was tired all the time. My energy was low. I was losing some weight.”

Then, things quickly turned downhill. He started having chills. He was feeling really exhausted all the time, was nauseous, and had some fevers.

When he started becoming short of breath and having some chest pain, he and his mother decided it was time to head to an urgent care clinic, where he was given antibiotics and flu medications.

In 24 hours, he felt worse. His breathing became more difficult. Something was definitely wrong.

He came to Cook Children’s, and the doctors and nurses quickly realized what poor shape he was in. X-rays showed something that looked like pneumonia on both sides of his chest. But the specialists were confused, because it just wasn’t obvious.

Within 48 hours however, what WAS obvious was that Tryston was getting worse.

As his Cook Children’s pediatrician, I was sent daily updates about him. I found myself holding my breath every time I opened the update – and audibly gasped the moment I realized that he was intubated.

This means a tube was stuck down into his windpipe to breathe for him.

And the tube stayed there for the next 10 days. Machines were keeping Tryston alive. He was in the ICU, where the sickest children in the hospital stay.

“I lost a lot of sleep over this kid,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. Dr. Whitworth wasn’t sure what was going on, and became very close with the family.

Was it an infection? No organism seemed to grow from cultures. Was it an autoimmune disease? The rheumatologists didn’t think so.

Even a lung biopsy – a piece of his lung which was cut out and examined under a microscope – didn’t seem to hold any clear and obvious clue as to why he was so sick. His lungs just failed, and he was in something called respiratory distress.

He was put on numerous antibiotics and antifungal medications to see if they’d help. He was needing more and more oxygen. He even needed special high-frequency ventilations (think little tiny rapid puffs of air) to keep his lungs open and working.

There’s one thing I haven’t mentioned yet. The one thing that was in the back of everyone’s minds.

One thing that Tryston mentioned to the staff of Cook Children’s before he got very ill is something I already knew, and had talked to him about the year prior.

Tryston liked to vape.

Most of you have heard about “vaping” in some way or another, but if you haven’t watched the news lately (or been in my office lately - because jeez, I am hearing more and more about it daily), “vaping” is when someone smokes an aerosolized chemical, usually from something called an e-cigarette.

Vaping is becoming VERY popular amongst teenagers. Statistics show 45% of U.S. teens have tried it. The Centers for Disease Control and Prevention is now investigating the "sudden emergence of severe lung disease linked to vaping in 14 states. Ninety-four possible cases of severe lung illness associated with vaping have been reported from the end of June to Aug. 15, the CDC reports.

Corwin Warmink, M.D., the medical director of Emergency Services at Cook Children’s, says he has seen multiple patients come through the ER and his team sees a child every week for vaping. But it’s not just teens, we are also seeing younger children, 5 and under, who have ingested vaping liquid. Scary stuff.

The most popular types look like USB devices. They’re super easy to hide. They have different “fun flavors” like mango, crème brulee and fruit medley. Some of the devices are even cute, with teddy bears on them.

They are more addictive than cigarettes. One Juul pod (currently the most popular brand) has the same amount of nicotine as an entire pack of cigarettes! “And I know lots of kids smoking 2 or 3 pods a week,” Tryston told me.

And though they claim to be a “healthier option” to regular cigarettes, I beg to differ. Inhaling chemicals is inhaling chemicals. There are over 40 different chemicals in vaping liquids. And they can cause some major damage.

They can hurt delicate lung tissue. We are seeing more and more reports of teenagers and young adults suffering severe lung injuries and seizures coming out in the news lately.

I’m really worried about how addictive these things are. Kids who want to quit are finding it more difficult to do so than if they’d smoked a pack a day.

Want to know why you should quit?

Tryston spent 18 days at Cook Children’s.

He lost almost 30 pounds. He is re-learning how to walk normally again. He has no muscle mass in his legs anymore from being bedridden for almost three weeks. He is still coughing at times. He feels very tired.

A clear answer for why his lungs failed him was never found.

“We don't know for sure. But there are literature reports of hypersensitivity pneumonitis from vaping. I told him no inhaling anything again, ever. We still don't know for sure what the trigger was. But it is very plausible that it could be due to his vaping,” Dr. Whitworth said.

The general consensus was that his lungs were severely injured, and I believe his vaping habits had a lot to do with it.

Two days after going home, he walked into my office for a follow-up visit. We had a very real, very brutal heart-to-heart.

I said, “Tryston, buddy…you know you could have died, right?” and he looked me in the eye and said “I’ll never touch the stuff again, Dr. Diane. And I want everyone to know that. I want to tell my story. And if I can just keep one kid from going through what I did, it’ll all be worth it.”

So here I am, telling you his story. Tryston is a great kid with a great heart. He made a mistake, one that LOTS of kids are making, because they assume e-cigarettes are “healthier” than regular cigarettes.

And Tryston wants us all to learn from it. Do me a favor and do what he has asked: print this out, and give it to your teenage son or daughter. Ask them to read it.

Let them know it’s just not worth it.

Learn More About This Topic:

• Vaping, Juuling, Dabbing (AAP Environmental Health) - Source for statistics in article
• New York Times: Dozens of Young People Hospitalized for Breathing and Lung Problems After Vaping
• Huffington Post: CDC Launches Probe Into Surge of Severe Lung Disease Cases Linked To Vaping
• Juul, Other E-Cigarettes Called an 'Epidemic' By FDA Chief
• E-Cigarettes Exposes Teens to Cancer-Causing Chemicals, Future Cigarette Smoking
• Adding flavors to e-cigarette liquids changes chemistry, creates irritants (Duke University)
• Tobacco Use Increases By More Than 38 Percent Among High School Students

Clark couldn’t resist. Just like all the times she’s spent playing with some of the long-term ventilated patient population, actually getting on the floor mats along with the children. She says this helps keep her grounded in Cook Children’s nursing philosophy of caring.

It’s that attitude that helps someone like Clark stand out and be named as one of the 2015 DFW Great 100 Nurses, sponsored by DFW Great 100 Nurses Inc.

Clark was one of four Cook Children’s nurses named to the DFW Great 100, along with Melissa Irving, Bernadette Kelly and Elizabeth Leper.

The nurses were chosen based on the following categories - role model, leadership qualities, service to the community, compassionate caregiver and significant contributions.

Here’s a glimpse of the nomination letters sent on behalf of the recipients:

Melissa Irving, Teddy Bear Transport, Neonatal Transport Nurse

Melissa has been a member of the Teddy Bear Transport team since1985. Melissa was one of the first team members; she set the standard for the qualities that we look for in our nurses today: compassion, leadership, critical thinking, and stewardship. Being a transport nurse is not exactly the same as being a bed side nurse. You play many different roles, as the team is comprised of a nurse, RT and a paramedic. You have to be able to assess and relay the information to the accepting physicians without hesitation. Melissa is an excellent teacher and often provides her expertise to the referring staff to help with the care they provide prior to our arrival …

Melissa leaves a lasting impression on her patients. She becomes that beacon of hope for those she cares for; it could be the gentle voice or the assuring touch and the ever-present smile. She has consistently received cards and emails from the families that she has cared for over the past 30 years; she just connects with people …

Melissa is such a compassionate caregiver; she has an amazing affinity to calm those around her. She cares for the entire team, the referring staff as well as her patients. She treats every child as if they were her very own; it is her calling to provide the best care.

Bernadette Kelly, Cardiac Intensive Care Unit Nurse Manager

Recently the CICU cared for a patient (baby) whose mother never left the bedside. The patient was constantly fussy and crying secondary to his diagnosis. This family had been on the unit for a few weeks and was noted to have no additional family support and difficulty communicating with staff as English was their second spoken language.

(Kelly) was a resource nurse that day and did not have a patient assignment. She noticed the mom looked exhausted and took this as a time to discuss self-care. It was around 4 p.m. when she asked the mother if she had eaten. She said, “No, I can’t leave because he will cry if I put him down.”

(Kelly) knew due to his defect he could not cry for long periods without having status changes. This nominee volunteered to take the baby and he immediately went to sleep with her rocking him. Once his mother noticed her compassion toward her ill infant she left to go eat. When she came back, (Kelly) encouraged her to lie down and that she would still be available to hold him. Caregiver fatigue is often seen in parents that care for ill children. (Kelly) provided education to a mother with minimal family support about the importance of her eating and resting while her son was in the ICU. This young mother was so grateful for the time this nominee spent holding her baby so she could take care of herself. (Kelly’s) compassion for pediatric cardiac patients has been at the forefront of her career and secondary to her skill set, compassion and empathy, she was the PICU Employee of the Year in 2012.

Elizabeth Leeper, Perioperative Services Nurse Manager

(Leeper) is a compassionate caregiver to patients, families and staff. This nurse follows our philosophy of being a patient advocate and promoting a culture of serving others with respect for individuality and diversity. I have seen her make allowances for special needs patients collaborating with anesthesia and nurses.

For example, we have older autistic children that have extreme separation anxiety making it difficult for a nurse to push them back on a hospital bed to surgery. This nurse will step up and make special provisions for a parent to go back to the OR with the patient until they are asleep. This consideration promotes the organizations promise of a save environment for our patients and families. This candidate is very caring to staff in times of family emergencies, personal problems and need for time away from work.

Her kindness and concern for her staff make you feel you are a family member of hers. I have seen her cry and comfort her colleagues during times of lost loved ones, sick or injured children or spouse or simply having a bad day. I was stuck in Houston when my loved one was having surgery and we had to stay longer due to complications. Not only did she empathize and console me but helped me cover my shifts so I could stay and look after my loved one and not worry about my job.

Teresa Clark, Chief Nursing Officer

This nurse has been a role model for those around her for three decades. At our institution alone, she has practiced and offered sound leadership for over 25 years. She has both an advanced certification and a master’s degree. From my own conversations with this nurse, I know that she has always felt called to our profession … this calling is not something you can teach ...

While this candidate has a long history in nursing and one that illustrates her wonderful work, this past year’s contributions are remarkable. She was promoted to CNO following the retirement of a long tenured CNO. She demonstrated her strength as she held together a large nursing staff – encouraging teamwork, professionalism and collaboration during this change in leadership. She led efforts to finalize and implement a new professional development program, restructured our nursing org chart and updated our nursing practice model and nursing strategic plan. She has accomplished all of this while enrolled in her DNP program and battling metastatic breast cancer.

Still, I think her most significant contribution is her caring … which is really the defining characteristic of our profession. She cares about the children in our community, the staff she leads, the organization she works for and the profession she was called to serve.

This Great 100 nominee displays such dedication to our profession of healing hands and caring hearts that inspires me even today.