For the last 10 months, Tiffany Pennington has been caring for COVID-19 patients as an ICU nurse at Atrium Health Pineville, witnessing the extremes of the coronavirus: debilitating sickness, miraculous recovery and death.
On Jan. 7, she found herself masked, gowned and gloved at yet another COVID-19 bedside. This time, though, her grandmother was the patient, and the bed was in a Columbia, South Carolina, hospital.
For the next four days, Pennington was given the gift that most family of COVID-19 patients could only hope for — the ability to sit beside her 79-year-old grandmother as she endured the virus’ physical and emotional rollercoaster.
For Pennington, it was a new role in COVID-19 caregiving — to simply be at the bedside to comfort and support.
What she didn’t anticipate was how four days in that role would make her a better nurse.
‘My Greatest Fear’
Carol Long, or “Granny,” as her family calls her, was Pennington’s biggest cheerleader. She was always in the stands at sporting events and graduations, and the first person Pennington would dial while driving home after her shifts in the Pineville ICU.
Long loved being around people, so ever since COVID-19 started spreading last March, Pennington made it a point to constantly remind her of the dangers of the virus.
“I was trying to almost scare her, so she wouldn’t be too freely running around the neighborhood,” Pennington says.
On Christmas Eve, Pennington got the news she’d feared for months: Long called to say that she and Pennington’s grandfather, Kenneth, were feeling extremely fatigued, and that two family members they live with had tested positive for COVID-19.
By Christmas Day, their exhaustion was worse.
They got tested, and Kenneth’s test came back positive. Carol’s test never came back and was apparently lost, but doctors said to assume she had COVID-19.
On Jan. 5, the Longs were scheduled to receive medicines given to COVID-19 patients at high risk for complications called anti-monoclonal antibody infusions. But when they arrived at the appointment, Carol Long’s oxygen and blood pressure readings had plummeted.
She was admitted to the hospital. No family members were allowed inside, so the family decided that Pennington, although she lived 90 miles away, would be the hospital’s point of contact.
The Other End Of The Phone Call
For the next two days, Pennington juggled her hospital shifts, her duties at home caring for her kids — 6-year-told Titus and 3-year-old Tinsley — and keeping tabs on Long’s care.
When they talked by phone, Pennington could tell Long was getting progressively more winded and weary.
And Pennington was growing more anxious.
She worried she’d miss a call from Long’s doctor or nurse while she was taking care of her own patients. If a nurse said she’d call back “in a little bit,” Pennington’s mind raced. When is a little bit? Is that a minute? An hour? Two hours?
She made a mental note to remember those desperate, confused feelings when dealing with her own patients’ families: Don’t get annoyed when relatives don’t answer. Be understanding when families call multiple times during a shift; they feel out of control and terrified that they may never see their loved one again. Give families a window for when you’ll call, and stick to it — otherwise, they’ll fear the worst.
On Jan. 7, Pennington was at work when a doctor called to say that Long had had a rough night. She’d experienced atrial fibrillation (a rapid heartbeat), had pulled off her high-flow oxygen mask and was anxious.
Pennington knew those things meant her condition was worsening.
She and the doctor discussed treatment options, and before she hung up the phone, she summoned the courage to make a big request:
“Sir? I work with COVID patients. I would be more than happy to come and sit with her. I won’t be in y’all’s way,’” she told the doctor.
He seemed open to the idea. Pennington was shocked. But he’d have to run it up the chain and call her back.
Her phone rang five hours later: She could come.
She raced home after her hospital shift, tossed some clothes in a bag, kissed her husband, Terry, goodbye, and told Titus and Tinsley she’d be back once Granny was done with her fight.
Granddaughter On A Mission
Long was asleep when Pennington arrived, but once she awoke, Pennington could see how anxious and restless she was, trying to rip off the mask for her BiPAP machine that was forcing oxygen into her lungs.
Pennington coached Long through panic attacks, holding her hand and locking her gaze. She urged Long to turn her fear into motivation.
“I’m glad you’re here with me,” her grandmother said, over and over.
Pennington was a granddaughter on a mission to get her grandmother well. Intravenous lines wouldn’t allow for walking, so she had Long march in place next to her bed. She kept making her breathe into a machine that exercises the lungs, known as an incentive spirometer.
She had to stifle her muscle memory that wanted to change IV bags and fetch medications, and instead busied her hands with mundane tasks like taking out garbage and turning off IV pumps when IV bags were empty.
She asked questions of the medical team and sometimes offered suggestions based on what she’d experienced with her patients in Pineville. The nurses saw that Long’s breathing would improve with her granddaughter there to calm her. They brought Pennington a recliner so she’d be more comfortable.
Pennington knew that COVID-19 patients as sick as her grandmother rarely come home. But then her thoughts would turn to the miracles she’s seen in her ICU — patients that defied the odds and survived.
One minute, she’d text her family: “It’s not looking good.” And then a few hours later: “She has a chance, if she could just have another good 12 hours.”
Granny’s Final Days
On Pennington’s third day with Long, she could tell her grandmother was wearing out.
“I’m so tired, Tiffany,” Long would say.
“I know, Granny. Give me 12 more hours,” Pennington would reply.
Long’s supplemental oxygen was turned up as high as it would go, and she had signed a do-not-resuscitate order that made it clear she did not want to be intubated.
Pennington continually asked her: Are you sure that’s what you want, Granny?
Yes, her grandmother would reply.
By the morning of Pennington’s fourth day in Columbia, Long’s breathing sped up, her heart rate became erratic and she was restless.
Pennington flashed back to the patients she’s taken care of and realized — this is how they look right before they need to be intubated.
She called her grandfather to come.
(The Columbia hospital where Long was being treated had a policy, like many other hospitals, to allow family members to be present with patients when death is imminent.)
The doctor counseled: Intubation is still an option. She’s unable to make the decision — you can go against her wishes.
Pennington flinched. As a nurse, she’d silently question a family’s decision to intubate someone so sick, given that patients like her grandmother have such a slim chance of surviving after intubation.
But as a granddaughter? She was tempted to ask the doctors to intubate, if it would give her grandmother one last chance.
However, she didn’t. She and her grandfather decided to begin end-of-life comfort care.
Nurses administered morphine and Pennington called family members on FaceTime so Long could hear their voices and they could see her face. They removed Long’s BiPAP mask, sat beside her bed, and held her hands as she peacefully slipped away.
Gaining Insight
Pennington returned to work six days later, and colleagues enveloped her in support. Members of Atrium-Pineville’s spiritual care team came to find out how she was doing.
Before her grandmother got sick, Pennington says she thought about taking a break from nursing when the days seemed too much to bear.
“But then, I’d look around and I’d say, ‘We are making an impact on people, and there’s no better team than what we have,’” she says.
Now, there’s something else to consider. She’s gained insight on what it’s like to be on the other end of those hospital phone calls, and the one who must decide whether to let a loved one surrender their fight.
“I saw what it’s like to be the patient’s family, to look at what’s going on here in the nursing world from the outside,” Pennington said.
It was an experience that Pennington says she’s still processing. It’s one that she says has changed some aspects of how she cares for COVID-19 patients, given her more compassion for the desperation family members endure and made her grateful for the place where she works.
Her grief hits her especially hard during the drives home from work, when she realizes she can’t dial Granny up and hear her voice again. But she feels blessed that they had those final days together. Days that, she says, have made her a better nurse.
This story first appeared in the Charlotte Ledger Business Newsletter. It is reprinted with permission.