About this story: Metro columnist Sharon Grigsby and photojournalist Lynda M. González spent Tuesday shadowing an executive nurse at Parkland Memorial Hospital — from the time she woke up to her late-night bedtime — to see firsthand what caregivers face as COVID-19 cases surge to dangerous new levels in North Texas.
Inside Parkland’s COVID-19 ward, a swarm of caregivers Tuesday afternoon circled the bed of a critically ill patient who was fast tipping toward the dreaded question:
How much longer to delay intubating the middle-aged man, whose entire body shuddered with his 50-gasps-a-minute fight for breath? Would the extra oxygen already in place eventually allow him to turn the corner or would he code into cardiac arrest because his heart gave out?
The assessment was unanimous: This slow suffocation had to be stopped. All of the dozen or so medical staffers in the room knew their precise roles in what came next.
Alongside the caregivers was Samantha Rowley, the Parkland executive in charge of the Tactical Care Unit. Tough and sturdy, she scanned the action, detail by detail, and said a quiet thanks for her team’s skills.
At the head of the bed, using a laryngoscope, a steel tool with a light at its end, a nurse anesthetist guided a tube almost 9 inches into the patient’s windpipe.
Amid this complicated choreography, one detail — easily missed amid the bigger medical drama — was most significant. Every caregiver in the room, Rowley included, was touching the critically ill patient in some way: Holding his hand, rubbing his shoulder, cradling his feet, speaking quietly in his ear.
Each wanted to make sure he knew he wasn’t alone. Just before he slipped into a sedated sleep, he whispered, “Thank you so very much.”
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Once Rowley had helped turn the patient onto his stomach, to enable better breathing on the ventilator, she bagged soiled sheets and helped adjust the bed’s padding. Then she was back on the “run, run, run” treadmill that’s only moving faster as the pandemic’s grip tightens on North Texas.
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Trained as a certified registered nurse anesthetist, Rowley left bedside work for hospital management about 10 years ago. But this mother of four works — and looks — like one of the team.
Rowley always leads from the front, said Dr. Catherine Chen, one of the Tactical Care Unit’s lead doctors since March and who made the final ventilation call Tuesday. “It’s not a style but a true belief. That makes her different.”
The 40-year-old Rowley can’t imagine leading any other way: “If I can’t be reminded of what they do every day — and how they change lives — how can I ever guide them and inspire them?” she said.
“They actually remind me why I do what I do.”
Predawn drive
Like most predawn mornings since March, Rowley had hit the road from her Frisco home while her husband, young children and even the family dog were still deep in their dreams. Like most weekdays — and sometimes Saturday and Sunday too — they won’t see her until shortly before the children’s bedtime.
Rowley’s alarm went off at 4:17 a.m., the last possible minute she can lie under the covers yet still make it downtown by 5:30. She hadn’t even gotten the five hours of sleep she had hoped for.
Rowley is never really off the clock, especially not in the middle of a pandemic: Texts, emails and phone calls incessantly clamor for attention.
What most interferes with sleep are the fears, which now clutch around what these next long and hard winter weeks will bring: “Where will we put all those people and who will care for them?” she said as we began the 33-mile drive to work.
Nothing about Rowley’s workload — pandemic responsibilities on top of her regular job and being on call 24-7 — is unique. Every other administrator at the public hospital is doing the same in order to care for Dallas County’s underserved and most vulnerable residents.
The hospital wouldn’t be able to wage its COVID-19 battle without the hundreds of leaders — not to mention thousands of caregivers and support staff — who oversee operations that are just as critical as Rowley’s.
That’s why Sam — as everyone calls her — wasn’t crazy about the idea of being singled out. She spent a lot of Tuesday pointing to many others she believes are far more worthy of the spotlight.
But Rowley is the leader who mostly lives in the scariest space of the pandemic fight. The Tactical Care Unit is where every serious case begins and ends; folks may breathe their last breath there, on their own or with mechanical ventilation.
With what she calls her “COVID mix” of hip-hop turned up loud and her foot heavy on her minivan’s accelerator, Rowley drove south as she ticked through what must get done that day. The Tactical Care Unit is her “add-on”; her official job is senior vice president of nursing for surgical services.
Rowley’s cluttered third-floor office is stacked high with cartons of chips, cookies, candy — and even toys — for surgeons and staff.
The walls are a mess of morale-boosting signs — “A smooth sea never made a skilled sailor” and “I’m not bossy. I’m motivational” — and family photos and children’s artwork. Near Rowley’s monitor is perhaps the most fitting: a snapshot of daughter Avery in a T-shirt that says, “I got my hustle from my Mama.”
Even before we had our surgical scrubs securely tied, Rowley wrangled phone calls and spreadsheets as she prepped for her 6:15 a.m. meeting.
Her back-and-forth with staff echoed the gallows humor of frontline workers everywhere as the charge nurse described the overnight shift as starting off “very rocky because people kept trying to die on us.”
Only one of the patients had passed away; the staff saved several others who were in crisis. Two more would die later that morning.
Balancing act
Nearly every conversation that day and many of the meetings — and there are a lot of meetings at Rowley’s level — focused on two precious and diminishing resources: beds and staff. It’s a tense hour-to-hour hospital-wide assessment of who and what to move — and when — to best ensure patient and staff safety.
A few meetings were lined with a glimmer of hope, such as discussions around the coming vaccines. At another point, Rowley joined a brief celebration of the 30- and 35-year anniversaries for two nurses in the burn unit.
But top of mind was how the Tactical Care Unit would just handle the next 24 hours.
Rowley carried an oversized travel mug from meeting to meeting, but that first cup of coffee — like sleep — was mostly aspirational. She finally got her caffeine fix about 9:15, courtesy of Dr. Matt Leveno, the Tactical Care Unit’s medical director.
Breakfast, a single chocolate chip cookie, came amid a terse staffing discussion just before lunchtime. A bit of turkey, cheese and a honey bun would get her through the afternoon.
We sprinted between meetings into the Tactical Care Unit operations so Rowley could lay eyes on any potential problems. Although she’s focused on the big picture, sometimes she spots a room where an extra set of hands is needed or where a doctor, nurse or visiting family member is struggling in some way.
Rowley always wants to know why.
Kathy Doherty, senior director of surgical services, told me her boss “exhales truth serum. People just tell her everything.”
“She has this ability to cut through the superficial things and get to the real issue.”
Rowley is unapologetic about pushing her staff hard. She was intent Tuesday on going over every patient’s status with Mikayla Svach, the dayside Tactical Care Unit charge nurse, to determine whether any of them could be moved elsewhere in the hospital to free up COVID beds.
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She simultaneously responded to messages on her phone, which flares with a bright light each time a text, email or call hits, asked her own pointed questions and peeked repeatedly into individual patient rooms.
When it comes to relaying information, Rowley’s staff knows the rule: Make it tight. Terse and blunt communication throughout the COVID units is softened by staff members’ lighter moments around a surprise treat as simple as free doughnuts.
Even at her busiest, each time Rowley crossed paths with anyone, she took time to greet them and often ask if they needed anything. Many of these COVID fighters have lived through nine months of sustained trauma. Their exhaustion is reflected in their eyes, but they wouldn’t be anywhere else right now.
It’s clear they trust Rowley’s hard-nosed leadership because of her accessibility. Even on a day as complicated as Tuesday, she broke away to talk one-on-one with staff members unexpectedly in need of help.
“I like my staff and I like them not to revolt,” she quipped.
A stretched staff
The latest patient surge has forced Parkland to further expand its multifloor Tactical Care Unit by again taking over part of the third-floor operating room complex. That’s where the original open ward resided at the beginning of the COVID-19 fight — and where so many patients died in the summer months.
Unlike in the other units, the patients clinging to life here aren’t behind closed doors in private rooms. There’s just not enough space. Instead, a line of beds held six sedated patients tethered to ventilators — their faces ashen and their bodies splayed and motionless.
“Some of the nurses are reliving some of what they went through on three [third floor], and they need to get my time to work through that,” Rowley told me.
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In moments like these, it’s easy to see why Rowley — who knows she’s hard to work for — nonetheless inspires people around her to push through incredibly difficult challenges.
Rowley’s leadership core developed out of her own tragedy. As a 20-year-old pre-law student in her home state of Delaware, she was severely injured in a car crash. T-boned by another vehicle, she awoke in a trauma unit with broken bones from head to hip.
“Everyone at the hospital was descending on me and all I wanted was my dad,” she recalled. In response, a nurse demanded that every single person step back and phoned Sam’s father.
That moment of humanity changed Rowley’s life because it led her to go into nursing. Eventually, she carried those same beliefs forward into the administrative side.
Rowley’s boss at Parkland, Karen Watts, executive vice president and chief nursing executive, told me that Sam brings that rare double-punch to her job: She dreams up creative, effective ideas and she knows how to implement them.
Watts also said that Rowley’s advocacy for her patients extends to going up against anyone she has to — and holding her ground — to get what is necessary.
“You have to have the moral courage in nursing and medicine in general to do the right thing no matter how unpopular you may be, and that’s what I see in Sam,” Watts said.
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A mom’s worries
It was after dark before Rowley began to think about heading home. As her juggling-act days go, this was a good one: She’d leave after only 13 hours, not the more common 15.
She’s undaunted by the hours, the juggling, the workload. “There’s a lot to do. There’s a lot for all of us to do.”
Rowley acknowledged that her work-life balance has always been “awful,” and she worries now more than ever about her diminishing presence in her family’s life. “That’s where my insecurities are, it’s not work,” she said.
She talked haltingly about a recent Thursday when she surprised her 4-year-old son, Jaxson, by picking him up at pre-K. When she arrived, the teacher had no clue she was his mother. “That’s not right. I should know my kids’ teachers.”
In her previous high-pressure jobs in Miami and Asheville, N.C., Rowley had on-site child care. “I knew the teachers, I had the car rides. … Now my husband has a connection with them, especially this past nine months, that I don’t have.
“They still love me. I’m their mom. But I’m not the one they always go to now, and I don’t like that.
“This is only temporary, but that’s still a hard tradeoff and I haven’t figured out if it’s the right tradeoff,” she said just before we left the building.
That was also the only time Rowley took the long way Tuesday: Despite the bitter cold, she exited a side door that allowed her to detour through the hospital garden on her way to the parking garage. “It’s the only time I get any fresh air,” she said.
Rowley was hardly in the door at home before she was besieged by her four kids and 110-pound Lucas, the St. Bernard-mutt mix.
Her 8-year-old mini-me, Emily, immediately clued everyone in on the nightly routine: “We ask her whether she was in the COVID unit, and if she was, we can’t touch her until she took a shower.”
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Emily’s assessment got blunter as Rowley headed to the bathroom: “It stinks when she’s gone, and sometimes she doesn’t get home until 3 in the morning.”
Nine-year-old Emery also had plenty of complaints about Rowley’s schedule, but he was impressed that now his friends might believe him when he explains what his mother’s job is.
Avery, 6, most wanted to tell me about “Mamas,” as the kids call Rowley, not only being home for Thanksgiving but “cooking everything! It was so good.”
When Brian and Sam Rowley married 12 years ago, he never imagined he would give up his own career, first as a Border Patrol agent and then as a federal air marshal. “But we had four kids and something had to give.”
His self-proclaimed title nowadays is “executive vice president of household affairs and financial services,” and he can make a mean batch of Texas chili and cornbread.
“I don’t do it for the money, but for the prestige,” the 44-year-old said, laughing.
Sam said her husband does all the things she forgets and regularly “saves my life.” He’s the one, for instance, who makes sure her minivan doesn’t run out of gas on the tollway and who “doesn’t just do the laundry but puts it away.”
Brian kept much of the conversation light, but he’s worried about the heavy load his wife is carrying — and her increasing reluctance to share its toll with him. His concern extends to all the medical professionals and the lack of understanding the public has: “I’d like everyone to see this and maybe help out more.”
As Brian first pointed out to Sam several months ago, “You did not sign up to do flu shots.” But that means he and the children will “do our entire day, then at 8, she comes back, we have dinner and she puts the kids to bed and that’s about it.”
After repeated trips upstairs to settle the kids, a little before 10 p.m., Rowley walked us to the door — flashing phone still in hand.
“This day needs to end,” she said. But not before one more scan of messages and texts to check on her patients and caregivers.
Rowley reminded me one final time that everyone who signs on to the Parkland team is special. “People come in here with this undying desire that they are going to change the world. They just won’t quit. They almost put themselves aside.”
The same should be said for Sam Rowley.
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