These are the last things Janice Cockfield remembers from the recesses of her fevered brain: The sound of the ambulance backing up. The sight of a canopy over the hospital entrance. A strange room with blue lights.
Then it’s blank for nearly two months. Nothing, except flashes of macabre dreams.
The Atlanta-based Delta Air Lines customer experience specialist had contracted COVID-19, and her symptoms grew increasingly severe over the course of a week. The ambulance trip to Emory University Hospital Midtown, her last conscious awareness, was on March 30.
The day before, her twin sister, Janese, had called from her home in Miami. It was their birthday, a day they usually celebrated with air travel.
They’d jetted to Germany, Switzerland, Italy, Norway, Japan, Kenya and dozens upon dozens of states. One year they celebrated by flying to Vermont to experience snow, then returned to Atlanta and changed planes to Panama.
This year, the pandemic changed everything.
Janese sang “Happy Birthday” to her sister but worried she was in danger. Janice had diabetes and asthma and struggled with her weight — health issues that could exacerbate a disease that had just weeks earlier locked down the nation and spread a sense of creeping communal terror. Already, 3,000 Americans had died.
The next day, March 30th, Janese called her sister again. Then repeatedly. No answer. Panicked, she asked a friend in Atlanta to stop by the house. The friend rang the doorbell, banged on the windows and peeked inside. Janice “looked like a zombie.”
For nearly two months, Janice hovered near death. She would spend another month and a half in two rehab facilities before finally going home, one of the sickest patients yet to survive COVID-19.
Credit: Sheila Cockfield
Credit: Sheila Cockfield
Families were forbidden from visiting hospitals during those early months of the pandemic. So Janese, like so many others whose loved ones were struck down by the virus, was left to wage a daily campaign over the phone to advocate for her comatose twin.
Eight Siblings, Three States
Janice and Janese Cockfield, 59, were raised on a South Carolina farm and lived most of their adult lives in Miami. Janice moved to metro Atlanta to resume working for Delta in 2010, a few years after the airline closed the location where she’d worked in Florida. Janese spent 37 years working at Florida Power & Light, most recently in a high-stress position as a senior project manager.
Janice is outgoing, loves travel, cooking and gardening, and bought a home in a South Fulton subdivision. At work, she was an office leader who threw herself into activities such as heading up blood drives — exhorting colleagues with the words, “One day you might need blood.”
Credit: Janese Cockfield
Credit: Janese Cockfield
The Cockfields are a close family. There are seven sisters, one brother and a host of nieces and nephews. As twins, Janice and Janese were even closer, living together until after they turned 30. That’s when Janese moved to the north of Miami, tired of living amid the devastation on the city’s south side wrought by Hurricane Andrew in 1992.
The twins, who have never married, often joke that they got a “divorce,” although it was amicable. They remained tight, and Janese is listed as Janice’s Delta flying companion.
It had been a banner year for Janice. In February, Delta employees got a stout bonus, about two months of pay. Janice planned to continue in her career for another five years or so, then shift her interests to her extended family. Janese intended to retire this year and then set off to see the world.
Janese’s dream afternoon, Janice jokes, is spent on a gondola in Venice.
This was to be the year, the start of a long-awaited time of wanderlust.
Credit: Sheila Cockfield
Credit: Sheila Cockfield
‘Janice Might Not Make It’
Janice’s body was failing. The emergency room team immediately decided to ventilate her, a drastic move to pump oxygen into her body. To do so, medical providers must administer a paralytic drug because working a tube down the throat and into the trachea is a dreadful experience that a patient will likely fight fiercely.
Janese caught a hurried ER doctor on the phone who explained all this. Then he added, “Your sister is very, very sick. I wish you guys the best.”
For the next three-plus months, Janese, from her Florida home, became the sole link between Emory and the Cockfield family. Another sister, Sheila Cockfield, had driven up to Atlanta but quickly returned to Florida after realizing there was nothing she could do here because of the hospital’s lockdown.
Janese kept copious notes of her relentless, monthslong phone campaign to extract information from the hospital. In normal times, it’s often difficult to get answers from medical officials — and that’s when families can haunt the hallways, waiting to catch a doctor on his or her rounds. During a lockdown, a family might as well be halfway around the world.
One entry in Janese’s notes from early on: “8:00 am started calling and waiting for call back.”
And this: “Another busy day in ICU which makes it difficult to get a call back on how Janice is doing.”
Also this: “When they answered at nurse station and I said that I was waiting for a call back, I was told that the nurses were just so busy and not to take it to heart. But my heart was aching to hear how Janice was doing.”
The first day’s log indicated Janice’s body was crashing. She had pneumonia, low blood pressure, was in shock, and was being readied for dialysis.
“Your sister is very, very sick. I wish you guys the best."
Janese gave a doctor approval to try a five-day dose of Hydroxychloroquine, a decades-old drug used for malaria that was often given to the sickest patients. A doctor in California at the time called it a “Hail Mary treatment.” But studies show it has little, if any, effect on COVID-19.
Janese called their niece Kisha Burgess — a graduating medical student at the time who’s now a doctor in residency at Grady Memorial Hospital — to gauge the situation. “She started crying because she knew being on a vent is a very bad thing,” Janese recalled. “But I’m still like, we have to be positive. I’m still thinking we got this.”
Each day, Janese updated her family with more upbeat versions of what she was told.
In the April 1 log to herself, she wrote: “Holding steady but very sick.”
But to her family, she wrote: “They are weaning down the sedation medicine and she is opening her eyes and responding to her name being called, and she is not fighting the machine. All in all she is going in the right direction.”
On April 5, Janice was flipped onto her stomach to help with oxygen flow. She stabilized. Her blood pressure was maintaining. Blood oxygen increased, her kidneys were functioning, and the fever had subsided.
“Hopefully with more improvements they can slowly try to wean her off the ventilator,” Janese told the family.
But it was just that — hopeful thinking.
Two days later, on April 7, it all changed. “They just told us Janice might not make it through the day,” Janese told the family.
The disease was still new, and medical teams were chasing constantly expanding crises. Her blood pressure increased. There was kidney damage. Oxygen levels dropped. A fever spiked. Janice was given blood thinners to prevent clots.
“They are running out of things they can try,” Janese wrote to herself. “She could die today, her heart could stop beating. General recommendation is we allow her to die naturally.”
Later, on a conference call with a palliative care nurse, the family agreed to sign a “do not resuscitate” order.
Special Strangers A Source Of Love
After hovering near death, Janice stabilized.
And then Janese settled into a numbing daily routine of calling and waiting and waiting and calling. For the next two weeks, her daily note to family was largely this: “Still stable, sedated and on ventilator. We continue praying.”
Janese prayed “for angels to be placed around her.”
Janice’s older sister Drucilla Burgess had her own prayer during this time: “God, don’t take her like that.”
“They are running out of things they can try. She could die today, her heart could stop beating. General recommendation is we allow her to die naturally."
On April 17, palliative care called to say Janice had not “made much progress and still requires a lot of support,” according to Janese’s notes. “We need to figure out next steps. We can’t get her to wake up. Keep our eye on but are at a crossroad. Not pushing to make a decision just yet.”
Hospital staff was concerned about how long Janice had been on the ventilator. Janese felt they were suggesting the family turn it off.
“I’m a person who will live in denial. I didn’t want to deal with the fact I wouldn’t have her in my life.”
The ICU staff was 650 miles away, just faceless voices on the phone. Janese tried to be thankful and not just frustrated. She knew how hard they were working while putting their own lives at risk.
Alison Gardner, a 33-year-old nurse practitioner, was one of Janese’s lifelines. She, too, felt the frustration of trying to communicate with families while also overseeing the care of half a dozen severely ill patients.
In March, the hospital had created a 20-bed intensive care unit for COVID-19 patients and opened others when the pandemic spiked in April. It was a confusing, scary time as they confronted a virulent new disease that manifests itself in many ways. One problem would beget another. Put a patient on a vent, they can get bacterial pneumonia. Then stiff lungs, lung collapse, blood clots. There’s kidney failure, shock, organ failure.
Gardner felt they were learning as they went.
And they were themselves living in fear. “It was a very equalizing experience with us and our patients,” she said. “Normally, you can distance yourself. When you see a patient with cancer, I don’t think, ‘This can happen to me.’”
Credit: Courtesy of Alison Gardner
Credit: Courtesy of Alison Gardner
Staff members did indeed get sick, she said. “You wondered if you were next.”
Gardner, like other nurses, worried she might bring the virus home to her family. But there was another concern: She was pregnant with her first child, a girl.
With Janese, Gardner tried to be hopeful about Janice’s prospects but not sugarcoat the truth. “I remember several times telling Janese that it was over, that her death was imminent, that we had exhausted every procedure, every machine,” she said. “We never saw anyone survive as sick as she was.”
The nurse asked Janese to send pictures of her sister.
“I cared for Janice, but I didn’t know her,” Gardner recalls. “What I remember most about Janice is Janese.”
She wanted to see the healthy Janice, her eyes alive, the woman with a personality, heart and soul.
Credit: Janese Cockfield
Credit: Janese Cockfield
Another nurse used her phone to play recorded messages from the family. They hoped Janice would hear their voices and know she was not alone.
On April 24, a young hospital chaplain used a baby monitor the staff had set up next to Janice’s bed to play the family’s recordings without entering the room. This time, Janice seemed to nod at a nurse. Maybe, they thought, they were getting through.
The chaplain texted Janese to say she thought of Janice as her “angel” because Janice’s family had “brought so much light to the hospital through the voice memos.”
“She is so very loved (and from what I hear, a very good cook!)” she texted.
Credit: Courtesy of Rachel Grace Breyer
Credit: Courtesy of Rachel Grace Breyer
The chaplain, Rachel Grace Breyer, told Janese that she often spoke to Janice.
“I remind her that her family is surrounding her and praying, and that she has everyone on her side rooting for her. It kills me that I can’t get into the room and hold her hand.”
Janese cried upon reading that text. She felt her prayers were answered.
Though Janice’s family could not be there, God had sent someone special to shower her with love.
Budding Terror Coupled With Confusion
Then came a troubling pattern: After what seemed like improvements, Janice regressed.
She was given a higher dose of sedatives. And to aid her breathing, doctors performed a tracheostomy, placing a plastic tube through the neck and into the windpipe. This is less invasive than a tube shoved down the throat, and they hoped it would allow her lungs to recover.
The calendar turned over. It was May. These are dispatches from Janese during this time: “Had a rough night. … Janice was turning and moving her head toward the sound. … Kidney function is getting worse. … Still on paralytic and sedation medicine.”
And repeatedly, “Vitals remain stable — no change from yesterday.”
Then on May 13, Janese wrote to herself, “She is not tolerating turning off the paralytic. Her body is working against her. Damage to lung still looks bad.”
However, she simply told her family, “Janice remains stable, still sedated and some small improvements on vent settings for today. We continue praying.”
Her updates stayed the same for 10 days until May 22, when Janese wrote, “Following commands!!!”
On the 23rd, Janese and several sisters got on a conference call as a nurse held her phone to Janice’s ear. “We were saying we love her and the nurse said she was lipping it back to us,” Janese wrote.
Janice’s first waking thought that she can recall is May 24, almost two months after the ambulance ride to the ER. There was no “Aha!” moment. It was like waking up any morning, except she was in a hospital. And connected to machines. And the staff surrounding her was thrilled.
“‘Oh, my God!’” Janice recalls an excited nurse exclaiming. “I’m like, ‘What’s the big deal?’”
“What day is it?” someone asked. She had no clue.
“Who is the president?” She knew that.
She also asked about food. “There’s your food hanging on that pole,” she was told.
Then came budding terror coupled with confusion. She could not move. Her arms were limp. Her body had atrophied.
Credit: Janese Cockfield
Credit: Janese Cockfield
She knew she was in a hospital. Her body ached. There were bed sores and scars from two months of medical procedures. She remembered the COVID. But what had happened?
“I was afraid for them to turn on the TV. I was afraid what I would see. It’s frightening waking up to a new world.”
While Janice lay unconscious, some 95,000 Americans had died from COVID-19 and the national toll approached 100,000.
As Janice came to, she recalled fragments of dreams from the past two months. Often, she was running away.
In one, she was taken to a seedy hotel. “I called a funeral home and told them to pick me up, I had already paid them. Then I sat in a chair, waiting.”
In another: “They were going to take my body, I’m still alive, and they’re going to dump me with other sick people in a field. Then they’re trying to take me in a truck, but the door wouldn’t close.
“Then the guy says, ‘I guess it’s not your time.’”
‘Trajectory Is Going Upward Now’
As May came to an end, lung capacity tests were conducted to determine if Janice could be weaned from the breathing machine.
She could move her legs but not her hands or arms. She nodded “yes” and “no” to questions and improved on breathing trials, making it eight hours without the vent.
But it was lonely in her room. To summon company, she had a ruse: She would kick her legs to get her blood pressure up. An alarm would sound, and a nurse would appear.
“I was afraid for them to turn on the TV. I was afraid what I would see. It's frightening waking up to a new world."
The family spoke with a residency doctor, only the second time during Janice’s stay in the ICU, Janese said. “She has made a remarkable recovery to this time,” he told her. “And the trajectory is going upward now.”
The family says the ICU bill hit $1.2 million. Yes, she has insurance.
On May 29, chaplain Breyer was leaving for a job at another facility. She put her hand to the glass to say goodbye to Janice, the patient she felt had brought light to the hospital during those dark times.
Janice put her hand up and waved back.
‘Your Posse Is Out There’
June started with “great news,” Janese wrote. “They fitted the trach with a sound device and all the siblings got to talk with and hear Janice speak!!! We were all almost screaming with excitement.”
Nurses described Janice as “eager and so motivated.” She was eased into therapy and exhausted easily.
On June 5, she left the ICU for an Emory long-term care hospital in Decatur.
“I believe it was the longest stay, the sickest person who survived,” said nurse practitioner Gardner, either at Emory or anywhere she has heard.
The nurses formed a line and applauded as Janice was rolled out. They called her their miracle lady.
Soon, Janice was sitting up on the side of the bed, washing her face, brushing her teeth and eating independently.
But getting that far was tiring and discouraging. “Your mind says ‘Go!’ and your body says, ‘What?!?’ The first time I stood up, you’d think I climbed Mount Everest,” Janice said. “You can’t pick your nose. You can’t feed yourself. You’re holding a spoon like a 2-year-old.”
To her, the eggs tasted like cardboard, the turkey sausage was dry and so was the French toast. She dreamed about homemade meatloaf and a Coke.
When Janice complained about the food, everyone knew she was improving.
“I believe it was the longest stay, the sickest person who survived."
By the end of June, Janice could stand on her own and lift a knee to the top of the walker.
The trach was removed, which allowed her to be transferred to a physical therapy center. She got up with a walker and stiff-legged 10 steps. Then 20.
In early July, she went to another Emory hospital for acute inpatient rehab, where four to six hours of therapy each day is the norm.
Credit: Janese Cockfield
Credit: Janese Cockfield
On Friday, July 17, Janice was released from the facility. Four sisters arrived an hour early and waited anxiously outside. It would be their first time seeing her since the ordeal began.
As an orderly wheeled Janice around a corner near the entrance, he told her, “Your posse is out there.” They exploded in cheers, laughing, clapping and crying. Lots of crying.
“Screw it, we’re hugging,” Janice told herself. And they did.
‘The Recovery Part Is Just As Hard’
Going home was a glowing apparition that had sustained Janice for weeks. But the initial happiness of walking through her living room was soon replaced by a harsh letdown. Being home simply underscored that life had drastically changed.
A yawning hollowness swallowed her, followed by depression and guilt.
“You’re so excited, ‘I’m going home! I’m going home!’” said sister Drucilla Burgess, who came from Miami to take the first shift helping Janice. “But then you are there and reality sets in. Nothing is the same.”
Credit: Janese Cockfield
Credit: Janese Cockfield
It’s hard to see light at the end of the tunnel when you’re still in it, Janice said. And in late July, her new reality was a dark void of hard reckoning.
“I’m trying to maneuver my walker and they’re all mother-henning me,” Janice said. “It’s easier when you don’t know the person taking care of you. I finally realized I can’t do it by myself. It was overwhelming. People are scared of me. They think I’m super fragile.”
Credit: Janese Cockfield
Credit: Janese Cockfield
She suffered pounding headaches, nausea, aching limbs and sore vocal cords. Grasping a hairbrush, or even picking up a potato chip, sent an intense nerve pain shooting through her fingers.
Janice always had a sweet tooth and longed for the day when she could drink an ice-cold Coke. When the moment finally arrived, she wanted to spit it out — it tasted like lighter fluid.
By late August, Janese had come to Atlanta to relieve their eldest sister for the long haul. Janice showed improvement in movement and strength while joking about her wobbly “Fred Sanford walk,” referring to the TV character played by Redd Foxx.
The twins went shopping, and Janice rolled her eyes when asked about the outing: “I can’t believe I’m in the old people’s cart.”
Credit: Janese Cockfield
Credit: Janese Cockfield
Janice could now perform small tasks to restore some routine and advance the physical improvement. She cleaned out her closet, chopped onions and potted a plant on her front porch using slow, deliberate — and often uncertain — movements. She likened her dexterity with a fork to wielding a shovel.
After living alone for decades, the omnipresence of family visitors and their cheerful insistence proved to be jarring.
“I try to get up (in the morning) before Janese to get my time,” Janice said.
Frustration ebbed, then returned. She wore a cheerful mask but remained forlorn. “I tell them I’m OK,” she said. “I wait until I’m alone to feel like I really do. Emotionally, the recovery part is just as hard as the part I slept through.”
Maybe harder, she says, because her stay in the ICU, a battle that Janese tells her about, was not her battle. “I was out, asleep.”
Life As Her Sister’s Keeper
By September, Janice had improved both physically and emotionally. She felt strong enough to visit her colleagues at the Delta reservations center.
Some co-workers had not even known she was sick, figuring she might have been furloughed. Others who knew her teared up at the sight of her shuffling along in the massive old building. The room erupted, and dozens of co-workers lined up to visit with her. Some wanted to hug her, although these days that’s a no-no.
“I felt like a rock star,” she said. It was a shot of adrenaline to her flagging spirit.
Janice and Janese also made the long drive to Florida to visit their family who months earlier had anxiously awaited the daily hospital updates. While driving there they repeatedly avoided video calls from their sister Barbara Cockfield-Hill. They didn’t want to answer and let her know they were headed her way.
Finally, they called Barbara. “Open your garage door,” Janice instructed.
She caught up with all her sisters, her brother and other family members. It was like Lazarus' return.
Credit: Janese Cockfield
Credit: Janese Cockfield
Janese noticed an improvement in her sister’s overall mood after that.
“When I see days like that, it makes me very happy,” she said.
Perhaps most brutal was that independence was gone. Janice welcomed the help from smiling siblings and delighted in their company. But she feared being a burden and had to somehow overcome the pride and inhibitions that arise when those you know best are babying you.
She keeps trying to get things done on her own, albeit under a watchful eye — one that is not always appreciated.
Credit: Janese Cockfield
Credit: Janese Cockfield
“I went and got a ladder to do something and Mama over here says, ‘What are you doing?’” Janice recalled. “And I’m thinking, ‘Why do you have to know?’”
Janese rolled her eyes hearing that. “Of course I’m going to ask her, ‘What are you doing?’” she said. “It’s a ladder.”
Right? Who wants someone who was comatose for a long stretch and is still unsteady up on a ladder? It makes all the sense in the world, yet is still so confining, and even insulting, to a strong-minded, independent person.
Janice understands the tightrope that each must tread. Janese is “good at giving me space when I’m getting emotional,” she said.
In August, Janese was still dealing with daily Zoom calls from her job at the Florida power company. The job, which had earlier been a positive challenge and afforded her a good living, had become almost soul-sucking. In recent years, she had kept her head down and was building a nest egg to free herself for a life of travel and volunteering.
By October, the pressures on her life had changed. She was now officially retired.
But the trips to Europe, the Far East or Anywhere, USA, would have to wait. Her sister was now her main retirement project. All those months of calling each day to lobby the medical establishment on her sister’s behalf … of letting them know she was watching them … of imploring them to keep trying and then keep trying even harder when all seemed lost.
Well, all that had led to this: She was now her sister’s keeper.
Credit: Janese Cockfield
Credit: Janese Cockfield
Sometimes it can be a lot. Janese sighs and admits this certainly wasn’t how she’d envisioned life in 2020. But compared to those dark, scary days of April and May, when her twin hovered near the abyss, locked away in ICU isolation, well, she could certainly take this. Standing on her head.
She dreamed about it, prayed about it, implored God that if Janice got out, if Janice got a break, that she would be there for Janice and willingly do anything she had to when the time came.
Now that time was here.
Janice smiled at her sister. She wants to get back to work sometime in early 2021. But she wants something else: “I can’t wait to get some stamps on my passport,” she said. “On our passports.”
“Hopefully before too long we’ll be on a plane somewhere arguing about something.”
Credit: Janice and Janese Cockfield
Credit: Janice and Janese Cockfield
Postscript: ‘Holding Out Hope’
A physician assistant named Colleen Hill recently wrote about Janice in a newsletter aimed at Emory’s critical care staff.
Hill spelled out practical considerations in caring for COVID-19 patients, like how immediately using an ultrasound can detect and treat a “tension pneumonthorax,” a life-threatening attack that occurs when air builds up between a patient’s lung and chest wall. That quick work allowed staff to place a tube in Janice’s chest and saved her life.
But Hill also addressed the vital need to build relationships with family, even when it has to be done remotely, by phone and Zoom.
“Janese was Janice’s clear voice to us, and that ultimately helped steer her management,” Hill wrote.
“Sometimes I worry about getting too close to patients and their families — What if they don’t make it? Won’t it be harder? — but really I think it makes the job easier.”
“Despite all the death and dying we see in this job, we’re not crazy for holding out hope. We put so much labor and even love into our work, but it’s rare that we get to see what happens to our patients after they leave.”
Seeing Janice’s smile in photos as she left rehab and headed home, Hill wrote, “made my day, and I hope when you look at it, you’ll think of your own patients.”
Because they can recover. Life can go on.
Credit: Janese Cockfield
Credit: Janese Cockfield
HOW WE GOT THE STORY
The Atlanta Journal-Constitution learned about Janice and Janese Cockfield’s COVID-19 odyssey from the twins’ cousin, Michelle Bolar Miller, who is an AJC story editor. Michelle regularly edits the Torpy at Large opinion column, and when she told Bill Torpy that her cousins had given permission to the AJC to tell their story, he immediately asked to be the one to write it. On numerous occasions over a span of three months, a mask-wearing Torpy sat down (socially distanced) with members of the Cockfield clan to learn about Janice’s protracted near-death ordeal, her unexpected recovery, and Janese’s singular role as her sister’s medical advocate. Torpy also interviewed members of the Emory University Hospital Midtown care team. Invaluable editing and guidance were provided by AJC narrative writing consultant Jan Winburn.
