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Arkansas nurse drained watching covid come for children

by Jeannie Roberts | October 18, 2021 at 7:07 a.m.
Jocelyn Dennis, a registered nurse for Arkansas Children?s Hospital, poses for a photo Friday, Sept. 24, 2021 in the pediatric intensive care unit at Children?s Hospital in Little Rock. (Arkansas Democrat-Gazette/Staci Vandagriff)

In the nearly two years since the covid-19 pandemic hit Arkansas, Jocelyn Dennis, a nurse practitioner at Arkansas Children's Hospital in Little Rock, often finds herself exhausted from caring for children with the virus.

On one Monday in late August, Dennis woke up particularly defeated after a brutal weekend of caring for a very sick pediatric covid-19 patient.

"Woke up feeling like yesterday was a nightmare," Dennis posted on social media. "The parents' faces. This is real and I'm tired of seeing children suffer."

Dennis' role as a float nurse has her rotating through six specialty and ICU floors at the pediatric hospital.

In the beginning of the pandemic, the impact on children was minimal and limited mostly to those with preexisting conditions that made them particularly vulnerable. That all changed when the delta variant arrived.

"The delta variant is more transmissible to everyone -- children and adults the same," Danyelle McNeill, spokeswoman for the Arkansas Department of Health, said.

Since the pandemic began, more than 96,000 children ranging in age from newborn to 18 years old have tested positive for the virus. Nearly 900 have been hospitalized, with more than 110 requiring care in intensive care units and nearly 30 requiring ventilators.

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Three Arkansas children have died from the virus.

"When the pandemic first hit in March of 2020, I remember watching the news about it and initially thinking, 'Surely this isn't going to be this bad. Maybe the media is overdoing it a little bit. Is this going to be another flu?' I didn't consider it a big deal and thought we could manage it," Dennis said.

COVID AMONG YOUTH

For nearly all of 2020, Arkansas Children's Hospital saw minimal covid patients and was also postponing elective procedures.

"I can't describe what it felt like on the units. It was so quiet, almost eerie in a way," Dennis said. "Then later it starting hitting the children and RSV [respiratory synctial virus] hit too."

Her daily workload and routine drastically changed. She was at work at 6:30 a.m. for a 12-hour shift.

"I was taking care of really, really sick kids," Dennis said.

Jamie Wiggins, executive vice president and chief operations officer for Arkansas Children's, said the nurses at Children's have shown "heroic efforts" over the course of the pandemic, especially during the summer peak.

"We are beyond grateful for their service and we know this lifesaving work has an enormous impact on each of our team members, especially when caring for children who are critically ill," Wiggins said. "We are working on a number of initiatives to address compassion fatigue among our nurses and staff, including rounding conversations, increased unit visits with our therapy dogs and counseling sessions with grief experts. While the pandemic has certainly heightened this impact, we are aware of the responsibility nurses face when working with critically ill and injured children, period."

UNVACCINATED PATIENTS

The majority of Arkansas children 12 through 18 years old who were diagnosed with covid-19 were unvaccinated. Currently, those 11 and under are not eligible to take the vaccine.

"And their families were not vaccinated," Dennis said. "It was very disheartening to see a child suffering when I know this could've been prevented."

Children's Hospital, like others, makes families an integral part of the care team for the pediatric patients and includes them in planning.

"I approached families as individuals, as themselves only. I had to meet them where they are," Dennis said. "A lot of people in today's world speak very poorly of covid patients. It's pro-vax versus anti-vax. I always see if I can listen to them and see where they're coming from. I try to be as positive an influence as I can. It's very hard to see a child suffer. There is no sense of justice. I keep my personal feelings outside the door. If I walk through the door, I make sure that they're cared for, safe and that they're not hurting."

Dennis said she establishes who she is with the families and the patient when she walks in the room -- even if the patient is ventilated and sedated.

"I treat them as if they're away. I let them know I'm in the room and will be doing X-Y-Z," she said of the ventilated patient. "If they're agitated, I hold their hand, give them medication and offer comfort. I know from nursing school that we really don't know how much a ventilated patient can understand or hear. You still provide respect to that human being."

Covid-19 is vastly different from any other illness that she has treated, Dennis said.

"Children escalate very quickly. They deteriorate quickly," she said. "You have to notice every little change and constantly be watching them. Usually these children, once they do get to this point, they're extremely sick. They're usually on very high settings on the ventilator."

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CAREGIVERS' CONCERNS

The hardest thing for health care workers is that despite their best efforts, there is still a lot of suffering with covid patients, Dennis said.

"I worry about what's going to happen next to this child. It's hard for me to turn it off when I get home," she said. "When something does happen to the child, I ask myself all these questions. What did I do wrong? How could I have prevented that? I think about every little movement I made and ask what I could have done differently. And that night, I'll go home and I'll have nightmares about it. When I wake up in the morning I think, 'There's no way that happened yesterday.'"

The look on the parents' faces as they watch their child's health worsen is something she can't put into words, Dennis said.

"Their face changes in fear of watching their child potentially be dying," she said. "They have this look of regret. Most of the time, these parents have that sense of regret and say, 'I should have vaccinated myself. I should've gotten my child vaccinated.' It's very hard to turn that off."

She's there with the parents at those times when the end is near -- whether it's from covid or another illness or reason -- and works to make sure the child dies as comfortably as possible. While Dennis said she has to shut her emotions off to a certain degree to be able to function during this time, the tears still break through.

"They need to see that compassion from me as well," Dennis said. "After the death, I have to go off on my own for a short period of time. I let myself grieve at the loss of that child," she said. "The loss of a child for the parent is the most unnatural thing that can occur. That level of grief is something I cannot describe."

That night, Dennis reaches to a shelf in her closet and pulls out a small box.

"I never want their memory to die. Some of these children do not have families to grieve for them," Dennis said. "I never want them to be forgotten. I ordered these little star ornaments and I put their initials on them and the date of their death then put them in a little box. That's a way for me to honor and respect them."

Sometimes, after a particularly hard day, she pulls the box out again to remind herself of why she does what she does every day.

DEPARTING WORKERS

She has watched as her colleagues have left the nursing field because it's all just too much to bear.

"They're tired. They've exhausted their compassion," Dennis said. "I think that's what a lot of nurses are experiencing. Although I completely respect and understand why they would leave the field, it makes the job harder for those that choose to stay. Our workload gets even heavier."

Wiggins said the pandemic has impacted nurses immensely.

"We know this from our rounding conversations with nurses, where they share with us their daily experiences and we work alongside them to try to build solutions," Wiggins said.

Where possible, patient assignments are adjusted to provide nurses a break. The hospital also has dedicated space for the nurses to catch their breath, free their minds and find some quiet amid a tough work shift, Wiggins said.

"We also see the impact in our stretched staffing, as we know nurses are leaving to pursue other options. We have increased nursing pay and bonuses as a result," Wiggins said. "We are investing in programs directed at reducing compassion fatigue, giving nurses a voice and listening to their challenges and ensuring our teams are taking good care of themselves on and off the clock."

CASES DROPPING

In the last month, as more people have gotten vaccinated, the covid numbers have dropped drastically, giving a much-needed reprieve to the state's health care workers.

On Friday, Arkansas Children's Hospital had only three covid-19 positive patients. One is in intensive care.

"This is a significant decrease from August, when we were seeing as many as 31 patients admitted with COVID-19, many of whom were critically ill," Children's spokeswoman Hilary DeMillo said in an email. "Arkansans can help those numbers stay low by masking and taking the COVID-19 vaccine if they are 12 or older."

Dennis is grateful for the reprieve, but is bracing herself. Officials from the state Health Department worry about a possible spike this winter of both covid and flu cases.

"I am feeling hopeful, but cautious," Dennis said.

Print Headline: Arkansas nurse drained watching covid come for children

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