The Heartbreaking ‘Last Shift’ of a New York City Nurse
The “angel” of the Kings County emergency room was only 5 feet tall but when she spoke, everyone listened.
At 8:15 p.m. on Friday, at the count of three, dozens of blue and white balloons rose into the Brooklyn night from outside the emergency entrance to Kings County Hospital.
One bunch was caught on the overhang above the ambulance bay, but somebody freed it with an extended IV pole. These balloons also rose moonward in tribute to Maria Guia Cabillon, a feisty, 5-foot-tall head nurse with an outsized voice who had been known to all as Mama Guia. Applause and cheers went up from the health-care workers who were gathered in her memory, many clad in protective gowns, a few also wearing face shields, all wearing masks.
Then at 8:30 p.m. came the sirens of 10 ambulances, three emergency response buses and a number of police vehicles assembled outside the entrance, all with their emergency lights flashing. For weeks, the whole city had filled with these same sirens as the virus killed thousands. Guia had lost her own life in the battle to save whomever they could. And this tribute made clear that her spirit lives on with them as the fight continues.
“This is not over,” Dr. Rob Gore, a longtime comrade, said. “We’re going to need her strength and her tenacity.”
Somebody else exclaimed, “Our personal angel who will always be there looking over us.”
Mama Guia had been the night head nurse at Kings County’s emergency room for decades and her strengths were those of all great leaders. She had wide-ranging knowledge and experience. She understood her people, from fellow nurses to doctors to techs to clerks. She knew how each one worked and how they all worked together.
Often, she was heard before she was seen. But she raised her voice to instruct, not to abuse. She always placed the interests of others ahead of her own. She never forgot the primary mission to help and heal.
And she had repeatedly demonstrated courage and cool long before the virus came. She had never hesitated to jump in when a patient suddenly went from unruly to crazed.
“Even with her small frame, she’s in the mix,” nurse Shane DeGracia told The Daily Beast. “She’s able to calm the most violent and psychotic patients. To this day, I’m trying to figure out the magic.”
Her magic met its biggest challenge when COVID-19 struck the city. The emergency room filled beyond capacity with people who were deathly ill with an unknown and unnervingly unpredictable disease for which there was no effective treatment.
“It was something we never experienced before, something she never experienced before,” De Gracia recalled. “We looked at her for guidance.”
Guia, 63, remained as steady as ever.
“She has a way of keeping the staff level-headed during a crisis, throughout stressful times,” DeGracia said. “If she’s calm, if she’s not really worried about it, we don't have much to worry about really.”
Nobody imagined that the virus would fell their indomitable Mama Guia.
Like other great leaders, Guia seemed to possess the invincibility of great purpose, doing exactly what she was born to do, exactly where and when she was doing it.
She had started out with what might have seemed to some to be a grander ambition and had left her native Iloilo City, Philippines, out of economic necessity.
“She really wanted to become a doctor, but they didn’t have the money and her aunt said, ‘Why don’t you take up nursing?’” her daughter, Fatima Cabillon, told The Daily Beast. “So, she did.”
Fatima was not yet 2 when her mother departed for America.
“I was like a baby,” Fatima said. “I didn’t really know who my mom was.”
Maria Guia sent money back home. She returned to Fatima and her two older daughters only once a year, usually in the summer, departing again after a month.
“I asked her why did she have to go, why did she have to leave us?” Fatima recalled. “She said we’re going to see each other next year. I didn’t understand what next year meant.”
For another 11 months, Guia would be a brief, occasional voice on the telephone. Calling from New York was expensive in the days before cell phones.
“We had a lot of quick calls,” Fatima recalled.
A fourth daughter named Papol, but called April, was born in New York. April was 3 months old when Guia brought her back to the Philippines. All four girls would follow their mother into nursing.
“We grew up with not enough money,” Fatima said. “We grew up every simply. Education was a big deal for us.”
Guia’s annual summer visits allowed her to attend graduations, but that meant she missed the holiday season.
“She’s never home for Christmas or New Year,” Fatima said.
Fatima did not spend the holidays with her mother until she was 21 and had also immigrated to New York as a nurse.
“Christmas and New Years, we got to Kings County,” Faitma said. “There’s always a big celebration there.”
The emergency room was one of the busiest in the city and could be especially wild during the 8 p.m. to 8:30 a.m. shift that Guia worked.
“It’s a trauma center,” Fatima said. “I was like shocked at first. I was like, ‘Wow, this is what my mom does.’”
And it was very clear who was running things.
“I thought, ‘I can’t believe she’s holding down the emergency room by herself,” Fatima remembered.
Fatima understood that the people who called her mom Mama Guia were as dear to her as if they were her kids.
“She loved, loved, loved Kings County,” Fatima said. “Anything for Kings County.”
Her family there included down-on-their-luck alcoholics who were regular night visitors.
“You’re here again,” Guia would say to them.
She would tell Fatima, “You can’t leave drunk people in the street.”
Fatima said of her mother’s approach to nursing, “You’re dealing with life. That’s what I saw from my mom.”
Fatima understood that at the core of it was the same generosity of spirit her mother showed off-duty.
“She would always think about other people first,” Fatima said. “She would put others first wherever she goes. Even in the supermarket.”
Fatima went to work in the emergency room at another Brooklyn hospital, New York Community, where Guia sometimes also worked.
“It’s been a dream of mine to be like her,” Faitma said. “She’s good at everything.”
Fatima proved to be very much her mother's daughter as COVID-19 suddenly began filling the hospital.
“When the coronavirus hit us, of course I worked,” she reported. “It was tough for everyone to see patients die left and right.”
She joined the city’s other health care workers in fighting to save whatever lives they could while risking their own.
“What can you do? You’re a nurse,” Fatima said. “It’s part of what we chose. I mean, we have to make sure everybody’s OK.”
Guia was marshaling the good fight at her beloved Kings County. There came a Tuesday night when she told DeGracia, her fellow nurse, that she was feeling ill.
“She said, ‘I should have called out today,’” DeGracia recalled. “She was not someone who would usually call out even if she had the sniffles of whatever. “
Guia was clearly still not feeling well when she returned Wednesday night.
“But she sucked it up and did her work,” DeGracia said.
Guia finished her shift and returned to the apartment she shared with Fatima and April, who grew up in the Philippines but was back in New York, studying for her boards to become the latest registered nurse in the family. Fatima was becoming concerned.
“When she came back after work, I said maybe she had the coronavirus,’’ Fatima recalled. “But they never tested her because her X-rays were clear.”
Guia was off the next two nights. But when the weekend arrived, there was no Guia in the emergency room as scheduled.
“We were all confused,” DeGracia said. “We were waiting to get our assignments. We were trying to figure out who was going to give us our assignments. We realized Guia wasn’t there. She was sick enough not to come in.”
They told themselves not to be alarmed.
“We knew this lady wasn’t feeling well,” DeGracia said. “It was more maybe she needed the rest... She’s taking a few days off to recuperate. We really didn’t think it would be severe.”
The following Monday night, word reached the emergency room that Guia had been hospitalized.
Guia had been admitted for observation to New York Community Hospital. She waged a personal fight against the virus, but her condition worsened. She was transferred to Maimonides Hospital Fatima figures she chose that over Kings County so her “kids” there would not be worried.
Guia was adamant that she did not want to be intubated.
“She was smart and stubborn,” Dr. Alyssa Nguyen-Phuc of Maimonides said. “She knew the odds once you were on a ventilator were low. She fought it for a long time.”
She spoke to Nguyen-Phuc through an oxygen mask.
“She said, ‘I don’t want it. I’m going to get through it. Give me some time. I’m going to figure it out,’” Nguyen-Phuc recalled.
Nguyen-Phuc, who spoke to The Daily Beast with Fatima’s permission, had met Guia when also working at New York Community. The doctor knew that even someone as determined as this legendary head nurse could reach a limit.
“I had a lot of concerns she was getting tired and might not be able to make it through,” Nguyen-Phuc recalled. “There’s only so much you can do on strength of will alone. She had already been doing it for three weeks, which is crazy.”
Nguyen-Phuc also knew that COVID-19 could take a sudden turn for the irretrievable worst.
“As her doctor, and also as her colleague, I didn't want to risk her crashing and dying in front of me,” Nguyen-Phuc later said.
The doctor advised Guia that if they were going to have to intubate, they should do it in the most controlled way possible, and not in some desperate last moment.
“She acknowledged that it seemed inevitable,” Nguyen-Phuc remembered. “She looked at me and she looked at the nurse and said, ‘You screw this up, I’m going to haunt you.’”
Nguyen-Phuc added, “That was her giving us permission.”
Nguyen-Phuc and the nurse most definitely did not screw up. But COVID was still COVID. Her daughters were able to talk to her on speaker phone as she lay unconscious. She died on April 26 despite everybody’s best efforts.
“Thank you for trusting me to take care of you, Guia,” Nguyen-Phuc wrote afterwards in a private GoFundMe appeal for Guia’s family.
“It was an honor and a privilege. Seeing your ferocity and tenacity break through the layers of oxygen masks as you asked pointed questions about your own intubation and medical course gave me glimpses of the outspoken, headstrong charge nurse you were ...I know you fought this wicked disease for over a month; I know you never gave up. I am sorry we could not do more. I will carry the memory of your spirit (hopefully not your ghost!) with me for all time.”
Among the others who will carry Guia’s spirit are the people at the emergency room at Kings County Hospital. Fatima reports that staffers are as heartbroken as might be expected when you lose your mother.
“I’ve seen people crying at work, DeGracia reported. “But we push forward.”
In the way of a great leader, the 5-foot giant with the outsized voice is still with them, urging them on as the fight continues.
“I tell them that this is how she would want us to continue,” DeGracia said. “She would probably have been standing right behind us, telling us.”
On Friday night, a few minutes after Guia would have begun an 8 p.m. to 8:30 a.m. shift, the people of the emergency room paused for a memorial. Fatima and April were there, as was DeGracia and dozens of others. They all stood ready with balloons.
“One! Two! Three!” they cried.
The balloons sailed up into night, followed by the bunch that had been briefly snagged and then freed. Applause and cheers were joined by sirens of the emergency vehicles that would then resume answering calls. The people in scrubs began to file back inside and somebody said on a video of the event that she could hear the outsized voice of the 5-foot giant they called Mama Guia.
“Go back to work!”