Monday, September 28, 2020

Pandemic demands toll on familes of health-care providers

Apr 29. 2020
Leah Lujan hugs her daughter Tamina Tracy, 6. Lujan, 51, and her husband, Jimmy Tracy, 38, are both nurse practitioners who work with high-risk patients. MUST CREDIT: Washington Post photo by Salwan Georges
Leah Lujan hugs her daughter Tamina Tracy, 6. Lujan, 51, and her husband, Jimmy Tracy, 38, are both nurse practitioners who work with high-risk patients. MUST CREDIT: Washington Post photo by Salwan Georges
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By The Washington Post · John Woodrow Cox · NATIONAL, FEATURES, HEALTH 

WASHINGTON - What the pandemic is doing to the children of doctors and nurses Children of doctors and nurses have kept anguished journals, written parents goodbye letters and created detailed plans in case they never see their moms or dads again

A month had passed since the first-grader last saw her dad, and her mom hadn't stopped by in nearly a week, but now, from the kitchen, she heard a tapping on the front window. Tamina Tracy looked over, and when she saw the woman in a blue surgical mask standing outside the northwest Washington rowhouse, the girl's hazel eyes widened.

"Mama! My mama is here!" said Tamina, 6, as she hopped into the air and sprinted barefoot toward the door, her pigtails bouncing.

Taylor Lindsey, about to be 11, plays with her cat, Bruno, outside of her home in Olympia, Wash.. Her mother, Amber Lindsey, works the night shift as an emergency room nurse at Capitol Medical Center. MUST CREDIT: Photo for The Washington Post photo by Daniel Berman

She wasn't expecting her mother, Leah Lujan, that April Saturday. When her parents, both nurse practitioners, started treating patients with a scary new virus, they'd sent Tamina to live with her cousins. Her dad, Jimmy Tracy, also left their home, moving into a relative's empty apartment. Tamina didn't know he'd developed a fever a few days later or that her parents feared he had the virus until his test came back negative, allowing her mother to visit the day before Easter.

Tamina, an only child, had struggled with the move, at times finding the separation unbearable, so they didn't tell her Jimmy was sick. She understood it could happen, though. Before schools closed, a classmate explained that everyone who gets infected with the coronavirus dies. Then she overheard her parents talking about how they both expected to catch it, and she thought that meant they would die, too.

Tamina Tracy, 6, visits with her mother, Leah Lujan, who takes a shower, puts on clothes straight from the dryer and covers her face with a mask before seeing her daughter. MUST CREDIT: Washington Post photo by Salwan Georges

No, Leah told her daughter. That wasn't true. Most people who get sick recover. But Leah didn't lie, either. Some people, she acknowledged, do not make it.

That terrified Tamina, one of thousands of children across the country who have suddenly confronted the possibility that their parents' jobs - to care for the ill - could cost them their lives. Already, more than 9,200 health-care workers have tested positive for covid-19, according to the Centers for Disease Control and Prevention. The illness has killed at least 27 of them, the CDC says, but the true number is much higher. National Nurses United found that more than 50 registered nurses, alone, have died.

Some health-care workers have moved away from their families, and many others have isolated in spare bedrooms or basements, trying to explain to their kids that they can no longer hug them because the consequences of even a single touch could be dire.

Most of all, parents have wrestled with how much to divulge, because what their children do and don't know about the pandemic could consume them. In many cases, it already has: Kids have endured nightmares and recorded their anguish in journals, written parents goodbye letters and created detailed plans of what they'll do in case they never see their mom or dad again.

Tamina's anxiety seldom relented. Nearly every time her mother visited, the girl asked the same questions.

"When can I come home?"

"Why can't daddy be here, too?"

"When is this going to be over?"

This time, though, Tamina was distracted.

"I brought you all kinds of stuff," Leah said as she opened a shopping bag packed with toys and clothes.

Tamina pulled out her green Easter dress and decided she didn't want to wait until the next day to wear it. She was excited for the holiday, but also worried. Tamina wondered whether the Easter Bunny would realize she wasn't at home.

"Does he know that you guys work at a clinic so I have to live somewhere else?" she asked her mom.

That's what her young life had become - glimpses of normalcy abruptly interrupted by reminders that nothing was normal. While Tamina picked through the bag, she spotted a bottle of hand sanitizer and immediately squirted a dollop on her hands, then insisted her mom do the same. Later, when she was zipping a toy boat across the red-brick porch, her 10-year-old cousin knocked a ball over the metal fence into a neighbor's yard. Tamina stopped the boat and stared.

"Don't catch anything over there," she said.

Even the lightest moments were tinged with sorrow.

"I wanna dance," she announced, yellow tulips blooming in pots all around her.

"Should we put music on?" Leah asked, and Tamina said she wanted to hear "Budapest."

"Oh, Papa would be so happy," Leah said, because that was one of Jimmy and Tamina's favorite songs. Before all this, the two of them would play it in their house a few blocks away and shimmy together, hand in hand.

Now, Tamina danced alone.

On Easter, she put her green dress back on and hunted for eggs and ate the head off a chocolate rabbit. Tamina thought about her papa again, too, but still didn't know he was sick.

That night, as she got ready for bed, he began feeling worse. Then his temperature spiked to 102.9. Then came a cough.

- - - 

In the other Washington, 2,800 miles away, where covid-19 first exploded in the United States, Keis Alagba-Green knew all about what the virus could do to people, and that's why the boy was still awake one evening early this month when his mom went into his bedroom to check on him.

Niran Alagba is a pediatrician in Silverdale, Washington, and her husband, Lawrence Green, an Army veteran, manages her clinic an hour's drive from Seattle. Niran knew she'd treated patients who were infected, and so did her four children.

"What happens if you and daddy die?" Keis asked her as she lay next to him, two weeks before his 10th birthday.

At dinner soon after he posed the question, his parents answered it for him and his siblings. Their close friends, they explained, had agreed to care for the kids if Niran and Lawrence couldn't. In the days that followed, each child processed the reality that their mom and dad might not survive in starkly different ways.

Third-grader Laila, quiet and matter-of-fact, seldom talked about it, while the 8-year-old's oldest brother, Laith, 11, did all the time. An aspiring paleontologist and Lego devotee, Laith liked to plan. Right away, he wanted to know how their new life would work.

The family's friends also have four kids and they don't live in a home big enough for four more. He decided that the other family should move into his house, then he mapped out where each kid would sleep.

Preparing for his parents' absence made Laith sad - in a nightmare, he saw them laying in hospital beds - but the fifth-grader believed it was his responsibility to consider the "hardship things" his siblings wanted to avoid.

Those things troubled Keis the most. One afternoon in early April, the two boys contemplated what the virus might do in the coming months.

"It could clear up over the summer," Laith said. "It could just keep going on -."

"And kill everybody," Keis interjected.

"No, not kill everybody, Keis. It wouldn't kill everybody."

"Yeah, but it could kill a lot of people."

"It could kill a lot of people," Laith conceded.

Keis could never hide how he felt. He hated visiting the hospital when a heart attack took his grandfather's life two years earlier, and he hated the idea of his parents ending up in one now.

He was convinced that both of them would eventually contract the virus, but he also knew his mom had access to hydroxychloroquine, the unproven drug President Trump touted as a potential cure. Niran explained to her son that the medication might not help, but Keis fixated on it anyway.

He needed to believe it would work, especially after the bad thoughts bubbled at night, when he would read books, concoct Dungeons & Dragons strategies, go give his parents' hugs - anything not to obsess over losing them.

But his youngest sibling, Zade, who is 6, had decided he should do the opposite.

"I don't want to stop thinking about them dying," he explained, because Zade believed that if he forced himself to imagine his mom and dad being gone, he wouldn't forget them when they were.

- - - 

Taylor Lindsey didn't know when she would see her mother again, so the fifth-grader sat in the pink chair at her desk and picked up a pencil. To prepare for a potential surge of infected patients, Amber Lindsey, a registered nurse, was about to embark on a 10-day stint of overnight shifts at her community hospital in Olympia, Washinbgton, an hour's drive south of Silverdale. That meant Taylor, whose parents were divorced, would head back to her dad's place.

"Dear Mom, I love you so much I have no idea what I would do with out you I would never forget you," Taylor, 10, jotted on a sheet of paper. "Stay safe don't get sick I be thinking about you everyday!"

She tucked the letter under her mom's pillow, and soon, they said goodbye.

Taylor's mother is her closest friend. They tended to their chickens and painted canvases in acrylic and kayaked Puget Sound, always as a pair. They traveled together every summer, hiking in central Oregon's forest, sunning on Southern California's beaches. Before the pandemic, each had given the other a beloved gift: for Amber, it was a heart-shaped necklace, inscribed with "BEST MOM EVER," that she wore to work every day; for Taylor, a teddy bear dressed in pink scrubs that, when she squeezed its paw, played "I'll Be There."

On March 18, the night her mother returned to work, Taylor added an entry to her journal.

"Day 2," it read at the top, next to "CoronaVirus." "I really cried because I dont want her to get the Virus... I dont want her to get sick and be home alone. I cant be without her."

The pandemic has instilled a sense of helplessness in children whose parents work in hospitals and clinics, but that feeling is especially acute for those like Taylor, the only child of a single woman living by herself while she treats sick patients. Her worries are not unique. Three-quarters of those 9,200 covid-positive health-care workers identified by the CDC were women, some undoubtedly raising children alone.

For Lexa Sterritt, 12, what might happen if her mother got sick was so unnerving that she tried never to think about it.

She and Elise Sterritt moved about six months ago from Chicago to Las Vegas, where the nurse practitioner took a job at a primary-care clinic. In March, the single mother developed a cough a few days after being exposed to two people who were later diagnosed with covid-19. Though she eventually tested negative, the episode shook her and Lexa.

What if Elise did get sick, and what if she was hospitalized? Would Lexa have to fly back to stay with relatives in Chicago, 1,700 miles away? Would she have to leave her mother?

Lexa didn't let herself ask any of those questions aloud, and when Elise confided she might have to quit her job because the answers were too painful, her daughter assured her she understood.

Daniel Shum tried to understand when his mother explained things, too, but he was only 6.

"Mama has to take care of very sick people," Lila Abassi, a physician, told her son on the day in March she dropped him off at her ex-husband's place across town in New York City. She didn't come back for Daniel the next week or the next or the one after that.

Daniel is smart. He reads at a fifth-grade level and can describe the differences among solids, gases and liquids in detail. He also wants to be a doctor, the kind "who save lives when people get very big boo-boos and is about to pass away."

He grasped the immense risk his mother was taking, but Lila spared him from the worst of it - that nearly all of the patients at Mount Sinai Hospital in Manhattan, where she works, were coronavirus cases and that each time she admitted somebody new from the emergency room, Lila wondered whether this would be the one who infected her.

Daniel tried not to blame her for the separation during their FaceTime calls, but he couldn't always help it. In his saddest moments, he closed his eyes and pictured the New Year's Eve ball in Times Square.

After nearly a month apart, Lila told Daniel she was going to pick him up. The news thrilled him, at first, but then he overheard an argument between his mom and dad, who contended it was too dangerous for Daniel to see her. Lila insisted it wasn't and that she'd taken every precaution and shown no symptoms. Eventually, her ex-husband relented.

When at last she picked Daniel up and they returned to her East Harlem apartment, he followed her everywhere, even when she took out the trash. At night, as he listened to his Harry Potter audiobooks, he fell asleep with both arms wrapped around her neck.

He was proud of his mom, but sometimes, Daniel wished he didn't have a reason to be.

"I think why," he said. "I think why did she pick the job to be a doctor?"

- - - 

"Is it OK if I hold your hand?" Tamina Tracy asked her mother on a mild, spring afternoon.

It was the first time they had seen each other in person since Tamina moved in with her cousins two weeks earlier. They decided to walk to Rock Creek Park, one of their favorite places. Tamina took her shoes off and waded in the cool water. She ate a Lunchable with two Oreos. She held her mom's hand.

Tamina knew her parents were doing something important. Leah and Jimmy, who'd volunteered together in Haiti after the 2010 earthquake, both spoke Spanish and worked in District of Columbia clinics that treat many immigrants who lack insurance and are at a high risk of contracting the coronavirus. Tamina often talked about wanting to help people, like her parents did, and now, they told her, she could. Her job was to stay healthy and not get anyone else sick, and to do that, she couldn't live at home.

At her aunt and uncle's house, she reveled in her role as the baby sister to her four cousins - all girls, all older - and embraced her newly assigned chores, aside from cleaning up after Crespa, the dog. Her aunt, Julie Lujan, set up a mattress in the living room and built a fort of sheets over it. Tamina found a strung-together wad of faux dogwood flowers and decorated the wall next to her bed with them.

This wasn't home, though, and she never forgot that.

Her mother painted a 12-by-8-inch portrait of the two of them and gave it to Tamina to keep while they were apart. She would lug it all over the house, then sit and stare at it.

She saw her dad only through FaceTime calls, but he'd also begun to write her letters, telling his daughter that she made him proud and recounting the parts of his days that wouldn't frighten her.

"So she doesn't forget me," said Jimmy, who wrote them even after the chills took hold and he couldn't breathe for more than a few seconds without coughing. He ended each note with a request that his daughter send one back, and she did.

"I love you so MUCH," she wrote him.

But she sometimes felt abandoned by her father and mother, and would refuse to accept the arrangement, throwing tantrums, demanding that things return to normal.

Once, she threatened to run away to her house and sounded so serious that her aunt slept that evening with her back against the front door.

Then came the afternoon of her walk through the park with her mom.

When they got back and Leah readied to leave, Tamina unraveled. She grabbed onto her mom and tried to wrap a hair tie around her wrist, imagining that it would keep her there forever. Tamina begged her to stay and screamed at her aunt when she pulled her away.

"I hate you," Tamina said, weeping.

She looked into her mother's eyes, peering back from above the surgical mask.

"Why aren't you crying?" Tamina asked, and as her mother walked away, she did.

Leah returned the following day, because she'd promised to, but the goodbye was no easier. After that, they made a deal: When Leah left, Tamina could call her on FaceTime and stay on until she fell asleep.

That's what they did at the end of the next visit, a week before Easter, and as Tamina lay in bed, inside her fort, she listened to her mom name the many people who loved her: her grandparents, her cousins, her aunts, her uncles, her Mama, her Papa.

Before she finished, Tamina's eyes closed.

- - - 

Tamina didn't want to be mad at her mom, just as Daniel, the 6-year-old in New York, didn't want to be mad at his. But as the pandemic upends thousands of doctors' and nurses' lives, it's left many of their children grappling with a rage they've never shown before and that their parents don't know how to manage.

The bitterness in Sophie Babb, 7, emerged in ways her mother never expected.

Megan, a physician who treats infants in Folsom, California, was seldom exposed to infected patients - and told Sophie that - but the workdays had gotten longer, mostly because of her push for new health-care reforms in response to the outbreak.

It wasn't the first time Megan's job had left her with little time for her daughter. Only now, as Sophie became increasingly preoccupied with the virus, had she lashed out over her mom's absence. She would ignore Megan when she came home late at night and snap at her when she apologized for going in early - "I know, mom, you're sorry."

For Gabriel Lipkin-Moore, 9, the resentment began to build in early March, when he was on vacation in Florida and his parents told him they couldn't go to the beach anymore. On the trip back to Lancaster, Pennsylvania, his mom, Ericka Powell, the medical director of an emergency department, made him wear a mask on the plane, even though no one else was.

"They don't understand yet," she told him, but neither did he.

Like most kids, he sulked because he wasn't allowed to see his classmates or go outside as much, but then his parents delivered far worse news: His mother couldn't touch him anymore. He would sleep in his dad's room, and she would move into Gabriel's, which had its own shower.

After she came home from the hospital one day that first week, he walked up to her. His mother stopped him.

"I need you to stay six feet away," she said.

Gabriel tried to distract himself, playing video games and practicing violin, but he couldn't shake his anger. At the heart of it, his parents knew, was fear - fear for his mom, whose hospital was quickly filling with infected patients, and for his father, who at 65, Gabriel learned, was much more likely than younger people to die if he caught the virus.

His frustration simmered until one day when his grandmother stopped by to drop something off and he learned that he couldn't see her either. Gabriel obeyed, then later exploded, yelling at his mother that he couldn't live this way. He needed her.

"I would rather die than not hug you, mom," he said, and at last, she took him into her arms.

- - - 

Walt Awdish wasn't angry, and the third-grader tried not to feel afraid either, though he couldn't always help that.

Usually, the more he grasped something, the better he felt, so Walt - a straight-A student who called his parents by their first names and repeated Simpsons jokes few 9-year-olds would get - found out all he could about the coronavirus.

He learned that it started in China, ravaged Italy and hit his hometown, Detroit, harder than almost anywhere in the country outside New York. He learned how viruses spread when his mom, Rana, a critical-care physician, used tiny foam balls floating in slime to illustrate. He learned that nearly every patient where she worked, Henry Ford Hospital, was infected, and that helped him understand why his parents converted the laundry room into an off-limits space, marked by orange tape on the floor, for her to change clothes when she got home.

Not everything he discovered made him feel better, though. His mom told him she wore protective gear, but he knew it didn't always make a difference. More than 700 people who worked for the Henry Ford Health System had tested positive.

He also suspected that on the days she came home with puffy red eyes, it meant she had been crying, and that meant she had seen something sad at the hospital.

Walt didn't want to imagine her getting sick, but he needed to find out what could happen if she did. That led him back to his computer.

He searched fatality rates on Google and clicked on a chart. In his mother's age group, 40 to 49, he saw 0.4%.

"Out of like a hundred, like that's - that's like very small," he explained. "It would actually be four-tenths of a person for a death rate out of 100 people."

Walt decided that was good news.

In Tucson, Arizona, Kaya Dreifuss found her own way to cope.

The 10-year-old's father, Brad, an emergency medicine physician, had launched an effort to aid people on the front lines in getting mental health support and finding comfortable housing away from their families. To help, Kaya, who'd just learned to sew, made fabric pouches - more than a dozen - and packed each with dried lavender. She gave them to her dad to sell so he could raise money for his project.

"Keep doing it," he encouraged, because he knew that his daughter helping him would help her just as much.

She did keep sewing, and the work made her feel good, but the outbreak in Arizona soon intensified. Brad decided that he, too, needed to move away from his wife and daughter.

After he packed his car, Kaya, as usual, squeezed between her parents and pulled them toward her in a tight embrace, the "meat between the bread."

Then she watched her father drive away.

- - -

Tamina's father still hadn't come to see her, and she still didn't know why.

By then, Jimmy had taken a second test for the coronavirus. This time it came back positive. The week after Easter, though, his fever broke and his cough gradually waned. Tamina's parents didn't assume he was clear of all danger. Covid sometimes subsided only to roar back, sending people who thought they'd recovered to intensive care. But Jimmy and Leah also worried their daughter would somehow find out, on her own, about his illness. If she overheard a cousin mention it, would she melt down again or, worse, feel betrayed?

They decided it was time to tell her the truth.

On a walk with her mom, Jimmy called over FaceTime. Leah handed her daughter the phone, and she looked at her dad's face on the screen. Jimmy, by then able to get through a few sentences without coughing, explained that he'd been sick and, after a test, learned he had the coronavirus.

"Huh?" she replied, her dark eyebrows raised.

Everything would be OK, her dad continued. He was already feeling better. They still couldn't see each other, though, because he might be contagious.

"Okay," Tamina responded, and she didn't say much else.

The next day, Leah took her daughter over to his apartment, where they stood on the back deck and peered inside. Tamina, who wore a colorful, miniature mask, brought him his favorite Girl Scout cookies, Samoas, the ones she couldn't pronounce.

She was nervous, her mother could tell. When Jimmy came to the window and started to open it, Tamina backed away.

He shut the window.

They spoke for a few minutes on speakerphone, but Tamina didn't talk much. At the end, as they left, she looked back and blew him a kiss.

That afternoon, at her aunt's house, Tamina was quiet. Out on the front porch, she sat on her mom's lap. Leah wondered what she was thinking.

Would her daughter want to know why they didn't tell her sooner? Whether she should be afraid of her dad? If he was going to die?

But Tamina didn't ask any of that. She had only one question.

When could she give Papa a hug?

 

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