May 6, 2020

As Frank Rummo died of COVID-19, his family gathered to tell him they loved him — through an iPad and the touch of his nurse, Maddie Hayes.

“If his family had been there, they would have wanted to hold and touch his hand and rub his head, so that’s what I did”

MICU nurse Maddie Hayes recently went to extraordinary measures to help a dying COVID patient and his family.. Photos by Donn Jones/Vanderbilt University Medical Center

Maddie Hayes volunteered to move from her regular job in the Medical Intensive Care Unit to the dedicated COVID unit at VUMC. Photo by Donn Jones

As 81-year-old Frank Rummo neared death early on April 24, his family spoke quietly to him, thanking him for his love and generosity. They told him how much they loved him and how much they appreciated all he had done for them.

But Frank’s wife, Elaine, and three children, Paul, Pamela and Francine, weren’t physically in his room in Vanderbilt University Medical Center’s COVID unit.

“She was our only way to be there. I think my mom probably summed it up the best: Maddie was my dad’s angel in the room.”

Due to the highly infectious nature of the COVID-19 virus, responsible for the rapidly deteriorating condition of this otherwise healthy man, Elaine and Paul made the painful decision to remain just outside the glass doors of his room to protect Paul’s wife, Becky, and their four children at home. Frank’s daughters and their husbands, who live in Massachusetts, and Becky were present via Zoom loaded onto an iPad.

But Frank wasn’t alone.

For more than three hours, Maddie Hayes, RN, stood by his side, rubbing his hand and head with one hand and holding an iPad above his head with the other so his family could see him, talk to him and be with him as he took his final breaths. She stood on the far side of his bed so she didn’t block the view for Elaine and Paul outside his room.

Frank Rummo was remembered by his family as an outgoing, hard-working man who loved his family.

“If his family had been there, they would have wanted to hold and touch his hand and rub his head, so that’s what I did, one hand holding the iPad and the other providing the therapeutic touch that his family members weren’t able to,” recounted Hayes, a nurse in VUMC’s Medical Intensive Care Unit (MICU) for the past two years. Because of travel and hospital restrictions she had been unable to be with her own great-grandmother who died two weeks before in an Indiana hospital.

“I was unable to say my goodbyes to my great-grandmother or attend her funeral. Her hospital also did not have Zoom as an option. I think having this personal experience impacted the manner in which I provided care to this patient and his family,” Hayes said. “I knew the importance of having closure with death through having the ability to express gratitude and love to the dying, even if that meant through an iPad screen. I knew the importance of actually seeing the dying’s face as you talk to them and to have certainty that they did not experience pain while passing. I think that by allowing this patient’s family to experience and watch his death, I was actually able to experience some closure for my own family member’s isolated death, too.”

“He never met a stranger”

For the past several weeks Hayes and other MICU nurses have volunteered to care for patients in the special COVID unit located on the eighth floor of Medical Center East.

VUMC’s policy during the COVID pandemic is to allow two family members wearing personal protective equipment (PPE) to be present in the room at the end of life for a patient with COVID.

Hayes said Elaine and Paul’s choice not to enter the COVID unit was an “unimaginable decision,” and she feels honored to have been by Frank’s side when they couldn’t.

Francis “Frank” Rummo, a resident of Milford, Massachusetts, was a member of a large Italian family who never met a stranger, said his youngest child, Paul Rummo, DO, who is an assistant professor of Orthopaedic Surgery at VUMC. “He was a simple, hard-working blue-collar man. He dropped out of high school to join the Navy, got his high school diploma in night school after his tour of duty in the Navy, and never went to college. In those days, you did what you did to support your family. He worked hard to provide for me, my mom and my sisters.”

“It was a tremendous thing that she did for us since we couldn’t be in the room. She was our only way to be there.”

The Rummos were passing through Franklin, Tennessee, for a visit with Paul and his family in late March on their way home from Florida. During their stay, Paul contracted COVID, as did his mother, and his father shortly after. Both Paul and his mom had mild cases.

On Frank’s 81st birthday, April 7, he became short of breath and was admitted to VUMC’s COVID unit. He improved, declined, improved again, then had to be put on a ventilator on April 10.

“He could hear us through Maddie’s iPad”

At 8 p.m. on April 23, the Rummo family had a Zoom family meeting with Hayes holding the iPad in Frank’s room. The staff wanted his family to understand how critically ill he had become. His condition began to rapidly decline around 2 a.m. the morning of April 24. Paul and Elaine arrived at the hospital soon after and joined other family members on Zoom with Hayes holding the iPad inside the room.

As a COVID unit nurse, Maddie Hayes is accustomed to working in full PPE to care for patients. An iPad allows communication with family not at the bedside. Photo by Donn Jones

“He could hear us through Maddie’s iPad,” Paul said. “It was a tremendous thing that she did for us since we couldn’t be in the room. She was our only way to be there. I think my mom probably summed it up the best: Maddie was my dad’s angel in the room.”

Hayes said it was an honor to be part of such an intimate time in the Rummo family’s life. “But it was also really heartbreaking hearing all of those communications,” she said.

Two hours into the Zoom session, a Catholic priest joined the call to give Frank last rites. VUMC chaplain Sherry Perry came in early to sit with the wife and son outside the room.

Sometime after 5 a.m. life support was removed and comfort care (medications to ease the dying process) was provided. “I kept his family on Zoom as long as they needed until they felt they had adequately been able to express everything they needed to express to him,” Hayes said.

“I knelt down beside them and joined them in their prayers.”

After ending the Zoom call, Hayes removed her PPE, disinfected and joined Paul and Elaine outside the COVID unit. “I knelt down beside them and joined them in their prayers. I told them how sorry I was he had passed. They expressed gratitude to me for allowing all of that happen. They were very thankful.”

Kristin Nguyen, RN, who was the charge nurse on the COVID unit that morning, said that Hayes was “a rock.”

“We’re used to having the families there with the patients when they die. We’re used to comforting the families as well as the patients, but now we’re the liaison, and we’re the ones comforting the patients when they die,” Nguyen said. “For us, the hardest part is knowing that a stranger is providing that comfort, a stranger who can’t even touch skin to skin.

“Maddie was very methodical in speaking to them, but she also had so much compassion, making sure they understood what was going on as each step was happening, and giving them time to speak to him.”

“It was an honor to be with him”

Nguyen said nurses in the COVID unit wear headsets so they can call for help if needed.

“A lot of us were on the headset and could hear the conversation between the family and the patient and Maddie and the family, and I’m not sure there was a dry eye on the floor,” she said. “After the patient died, the family expressed so much gratitude for Maddie. I don’t think anybody was expecting that. When someone dies, there’s crying and emotions that go along with death, but the family’s first thought was gratitude for Maddie and what she had given them in this patient’s last moments. I finally had to take off my headset. I just couldn’t listen to it anymore. It was silent on the floor for a little while.”

“No one wanted to be in the situation we were in that night, but Maddie was a rock star.”

Paul said Hayes went above and beyond. “No one wanted to be in the situation we were in that night, but Maddie was a rock star,” he said. “She held that iPad in one hand for more than two hours. It’s hard to hold something up for that long. I don’t know how she did it.”

After Hayes’ shift was over, at a physical therapy appointment at VUMC for her knee, she asked the physical therapist to put her through a really hard session. “I went and cranked it out on the treadmill,” she said.

Nguyen said that nurses on the COVID unit are taking care of themselves in different ways. “Maddie had a good workout in her physical therapy session. I went home and played with my dogs.”

Hayes said although she is trained to care for critically ill patients, many of whom have serious pulmonary issues, taking care of COVID patients has been different. “They require the same types of life support we usually use, but the biggest difference in COVID is the lack of knowledge about the disease process,” she said.

She said she thinks it will take a while to work through Frank’s death.

“It was an honor to be with him, and I know that we did everything we could to provide him with the best care possible,” she said. “At the same time, I feel a sense of inadequacy being in that position. I was not his wife, or his family, and it’s just not the same. It sure is a weird, sad and lonely time we find ourselves in as we manage this pandemic.”