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July 2024: Giann Karlo Vazquez, BSN, RN (PICU)
At the time of writing, Hannah, our daughter with Glycogen Storage Disease Type 1a turned 4 months old, nearing the end of what is now her third hospitalization at Nicklaus Children’s hospital. Having been hospitalized 3 times within 4 months, we have experienced a wide range of nursing staff that has cared for our daughter. To care for our daughter requires high critical thinking skills for quick decision-making during an acute hypoglycemic episode where there is, quite literally, not even 5 minutes to go and speak with a resident or attending physician. Furthermore, a sense of urgency is a MUST due to the time sensitive nature of her condition. Feeding her just 5 minutes late represents a 20 mg/dl difference in her serum glucose. And, as a result, nurses that adequately care for Hannah must carry a tenancy to move heaven and earth, when necessary, to assure that no (normal) external stressors or systems within the hospital do not inadvertently provoke a hypoglycemic episode. There are many nurses that carry these qualities in varying degrees. One nurse that stood out to us held all these qualities and, on top of them, made a personal connection with us and our daughter was Karlo Vazquez.<br />
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Because our daughter is an infant, the stereotype in our parent brains is that a female nurse usually carries those motherly instincts to care for her baby needs. That is true, but man, were we wrongs about guys! First, Karlo is a father, and being one, empathized with our pain of being in the PICU for the third time. After making a personal connection, Karlo essentially adopted Hannah as his “PICU daughter!” I remember calling at 5 am to ask him how Hannah did throughout the night, and him responding, “She did great - no hypoglycemias as all feeds were administered on time and I was watching the d10 to ensure no occlusion… and I swaddled her and put her back to sleep the only time she did wake up”. I thought to myself, “This dude swaddled and rocked my baby girl?! AWESOME!” That’s when I knew there was something different about the way Karlo cared about Hannah.<br />
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The next evening, we experienced the moment that Karlo fully earned our trust as parents, proving just how great a nurse he truly is. That evening, we were beginning to give Hannah feeds to begin a slow wean off process from D10. Sometimes, however, even when following the orders, it’s possible for Hannah to experience a dip in her blood sugar in the evening - and you must know how to act. What has often frustrated us as parents is when nurses feel insecure to act and go to try and find a physician whenever Hannah is have a hypoglycemic episode. Truthfully, this tends to be the WORST option in the moment. Most of the time, the physician either isn’t readily available over the phone, so they wonder around the PICU floor trying to find the fellow or resident. This is usually a 5-7 minute process. GSD kids don’t have 5-7 minutes. In just 5 minutes, she’s under 40 mg/dl. And by the time they either raise the continuous infusion of D10 or give her a bolus, she’s in the low 30s. It’s very stressful and should NEVER get to that point if they just act in the moment, rescue Hannah from the hypoglycemia with either glucose gel, raising the D10, or a small volume feed, and then confirm with the physician to make adjustments as necessary.<br />
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Karlo, however, understood that there was NO time to waste and knew he could not leave the room. As the Dexcom warned us that Hannah was dropping to critical levels, he ran and grabbed the glucometer. When other nurses had been hesitant to check Hannah’s glucose outside of the bounds of her order (Q2), Karlo understood along with us that getting a glucose value in the moment was of high importance - and it confirmed that she was dropping, already in the low 50s. Immediately, he raised the infusion of D10 by 15 mls/hr to bring her back to her maintenance rate and helped us quickly administer 3 mls of glucose gel, and did not leave the room monitoring her dexcom. He re-prepped the glucometer to check again, and 3 minutes later, she still was not rising - so he administered another 2 mls of glucose gel. Another 3 minutes later, he rechecked on the glucometer and finally it showed an upward trend back into the 70s. All of this happened within 5-7 minutes (the same amount of time it had taken other nurses just to go and find a resident or attending physician to then begin a triage process). After performing the rescue, he spoke with the attending physician to confirm everything was ok, and the doctor agreed with all his decisions.<br />
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The event gave us such peace as parents to leave Hannah in Karlo’s care knowing that in an acute hypoglycemic episode, our baby would not be left alone and quickly triaged and rescued. After observing Karlo for the 4 nights that we had him, he proved himself to an extremely skillful, intelligent nurse with the keen ability to assess a critical situation and make split-second life-saving decisions. He is a “no-nonse” kind of guy that knows what he is doing and does it well. He is very honest and communicative, always letting us as parents know what was happening in the middle of the night when we weren’t there.<br />
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But above all, Karlo repeatedly demonstrated what nursing in a PICU setting, in my opinion, is all about. As I mentioned above, with critical patients, nurses need to be able to make decisions in the moment that will ensure the safety and care of their patient. Sometimes, there is no time to ask questions, and action is required, and a nurse needs to be able to tell the difference. With Hannah, time is of the essence, and a nurse like Karlo that acts quickly and confidently to ensure the safety of his patient is the kind of nurse I want Hannah to always have. Beyond his nursing skill and prowess, Karlo has become a friend. He connected with our family and followed up with us to see how Hannah was doing. His care for our daughter was more than a “night shift” for him - it was genuine act of fatherly embrace and love. Please consider endowing Karlo Vazquez with the DAISY award to serve as an encouragement for this amazing nurse you have on your staff.