When Augustina, then age 13, visited her doctor in early June because she wasn’t feeling well, she had no idea she’d be rushed to CHOC Hospital and spend the next two months fighting for her life.
“My doctor told my dad that we needed to get to CHOC right away,” Augustina says. “I don’t remember much right after that.”
Originally admitted to CHOC with respiratory distress, Augustina was soon diagnosed with COVID-19. She was initially on high flow nasal canula for supplemental oxygen. Eventually that was escalated to a BiPAP machine — bi-level positive airway pressure — a machine that pushes much-needed oxygen into a patient’s airway. Her condition continued to worsen, and she was put on a ventilator to increase her oxygen levels. She was medically sedated for most of her stay in order to tolerate the ventilator.
“She was in critical condition for a long time,” says Dr. Jason Knight, medical director of the Josie Y.S. Lee Pediatric Intensive Care Unit (PICU) at CHOC Hospital. “There were two different nights during her hospitalization when we thought we might lose her.”
During this extended hospitalization, Augustina’s father Jose visited her every day. Although his daughter was sedated, he spoke messages of support and encouragement to her.
“‘Mama, just relax. Everything is going to be OK’ is what I would tell her,” Jose says. “Even though she was asleep, I knew she could hear me.”
Indeed, when Augustina finally woke up from sedation, she thanked her dad – and her nurses, who had shared similar messages in her ear – for that encouragement.
“I couldn’t talk, but I could still hear them,” Augustina says.
At one point, her condition improved thanks to proning and nitric oxide.
Eventually, Augustina underwent a tracheostomy, where a surgeon created an opening in her neck to place a tube into her trachea, allowing oxygen to enter the lungs. Once her tracheotomy was in place, she was more awake and the team was able to wean her ventilator support.
Once she was off her ventilator, the next step was rehabilitation, in partnership with CHOC’s physical therapists. The first milestone was sitting up in bed, then standing next to her bed, then walking around a little bit at a time. That process took several weeks.
Working through physical challenges and coming to terms with all she had been through was an emotional experience for Augustina.
Dr. Knight recalls one particularly anxious day for Augustina. Doctors wanted to perform a small procedure and because she was now coherent, she felt anxious – even though the procedure was relatively small.
Dr. Knight shares how that anxiety lead to a pep talk and bonding moment for the physician and his patient.
Dr. Knight: Why are you so sad?
Augustina: I’m sick and I have a trach and I’m not going to get better.
Dr. Knight: Are you kidding me?
Augustina: What do you mean?
Dr. Knight: Augustina, you beat COVID! You were near death twice. One of those nights, I was on call and I thought we were going to lose you. COVID has killed hundreds of thousands of people and you were going to be one of them and you said no. It’s OK to be upset that you have a trach, but you also have to know that there’s a lot of people who weren’t always sure you were going to make it.
From then on, Augustina’s entire outlook changed for good.
After 57 days in CHOC’s PICU, Augustina was ready to be discharged to a local rehabilitation facility as a step toward going home. Wanting to make sure Augustina felt celebrated in her journey and give her the hero’s send-off she deserved, child life specialists from the Cherese Mari Laulhere child life department sprang into action. They created signs, organized gifts and planned a cheer tunnel filled with her favorite staff members holding streamers. The celebration brought tears to Augustina’s eyes.
After spending a few weeks – and celebrating her 14th birthday – at the rehabilitation facility, Augustina finally went home.
These days, Augustina is back in school – albeit virtually for now – and happy to be surrounded by family, whom she missed during her hospitalization.
The impact she made on CHOC’s PICU team remains strong.
“It’s important for people in the PICU to have victories like Augustina,” Dr. Knight says. “We don’t get victories all the time. There can be sadness and disappointment in the PICU. Everybody in the PICU knew Augustina and took care of her. Everyone knew how serious her case was. Our PICU team put a lot of time and effort and love into Augustina. It’s safe to say the entire PICU team is celebrating her success.”