Poonam Agarwal, CRNP is Finding Her Way

Poonam Agarwal CRNP

It was bright and sunny–the deep blue sky was cloudless. It was her second week at NYU in Lower Manhattan. Having left the protective cocoon of her hometown in South Central Pennsylvania, Poonam wanted to be part of the city she had often visited with her parents. She did not want to be isolated on a college campus. 

Her freshman chemistry class ended early, and there was time to enjoy the warm weather that Tuesday morning. But as she was leaving the building and heading toward her dorm near Washington Park, only two blocks away, she heard a kid yelling, “A plane ran into the Twin Towers!” She looked around and saw that people were sitting on the ground, crying into their phones. She didn’t know what to think. 

The TV was on when she got back to her room, and she saw that, she said, “This was real.” Her neighbor’s suite had a shocking head-on view of the Towers, directly confirming the horror of the day.  When Poonam and her classmates went out to the street again, it was, she said, “surreal.” Looking toward the billowing smoke from massive burning structures, she realized that she was seeing people who had leapt from the suffocating buildings and that they were falling through the air to their deaths. 

After a while, the father of one of her classmates came to the dorm in a daze, “covered in dust and dirt,” dragging his jacket behind him, looking “like a homeless person.”  He banged on his daughter’s door: “Let me in!” The situation was terrifyingly grim. 

Stunned New Yorkers on 9/11/01 (Credit: Mario Tama)

Poonam and her stunned colleagues didn’t know what to do. They wanted to help. Could they, for instance, donate blood? No, they didn’t have the required donor cards needed for emergency situations. Where to turn?

Poonam called her aunt, who lived in the city, and she was safe. She called her mom. She talked with her father, the trauma surgeon Nikhilesh Agarwal, who offered help. Though in New York for only a few weeks, she felt connected to the city under attack and didn’t want to leave. The following day, as she walked down the middle of Sixth Avenue, she said, “It was like a dead city, a ghost town.”  But “you felt part of something,” and “one with the city.” 

Looking back nearly twenty-five years later, Poonam feels “honored” to have been there in 2001. But she is unable to watch the anniversary programs. She doesn’t like the fact that a “giant grave-site,” a sacred place, has been turned into just another casual tourist destination to be checked off.  

(One of her father’s close colleagues, the heart surgeon Dr. John Mathai, lost his brother that day. The 49-year-old Joseph “Minoo” Mathai was attending an important tech conference on the 107th floor of the North Tower of the World Trade Center when the first plane struck. Years later, Poonam searched for, and found, his name inscribed on the bronze parapet surrounding the deep, unfilled reflecting pools precisely where the iconic Towers once stood.)

9/11 Memorial Reflecting Pool (Credit: Marley White)

Poonam said that 9/11 made it “extra hard to focus on her classwork in college as she was “struggling” with finding “purpose.” She engaged in deep “self-reflecting at the time.”  And she believes that the experience probably affected her later career path.

As the daughter of a physician-father (who never thought of his practice as “work”) and an ICU nurse-mother, Poonam entered NYU, in her words, “as a medical student wanna be.” But she didn’t start college as a premed; she was a Liberal Arts major. 

Biology was her favorite subject at Country Day School in York, and she was quite discouraged when she got a C on her first college exam in that discipline.  The large Freshman classes were taught by a team of professors with different styles, and “shy and introverted” Poonam, accustomed to the intimacy of a small private school, was in culture shock. 

For that formative first semester (after dropping calculus following the first class), she did better in chemistry and did okay in the required writing course (though Poonam said that her much-older half-sister was “the writer” in the family). As the goal of being a physician slowly faded, and she had enjoyed an economics course, when it was time to declare a specific major, she innocently picked economics.  

She recalled that in the early 2000s, healthcare public policy was a topical issue. She could combine her interest in medicine with her studies in economics. So, as a student, she got a job in the planning department of the prestigious NYU Wagner Graduate School of Public Service. Within the health policy division, she worked with spreadsheets, set up events for the bigwig donors in the city, and made labels.   It wasn't fulfilling.

Still undecided about what to do, Poonam took a summer semester job at Time Warner Publishing. She was part of an all-female department of sales and marketing. One of the highlights was meeting humorist David Sedaris, who signed his new book (probably Dress Your Family in Corduroy and Denim, but she couldn’t recall) for her. While there, she witnessed the “glass ceiling” preventing women from moving into the highest management positions. And by the end of the summer, she sensed that all women working together may sometimes hurt themselves; she didn’t want to be part of that.

View of Columbus Circle and Central Park
from the Time Warner Center (Credit: enclos)

As her wise father had already planted the idea of a nursing career, where she would have plenty of options to choose from for a career, Poonam decided to stay at NYU, at the Rory Meyers College of Nursing (a very competitive school), for a nursing degree. She wanted to stay in the wounded city that, after four years, had become part of her. She could have done the accelerated program, but as she desired to be a New Yorker as long as possible, she took the “extended route.” 

She enjoyed nursing school, did well, and as she finished the two years of study, she looked for a job near home, near her parents. She applied for a plum job in the cardiac ICU at the University of Maryland (the same institution where her father had done his advanced training in trauma care). When it was offered to her, she said that she “couldn’t turn it down.”

Poonam accepted the position. She told me that she greatly enjoyed working with such a “unique group” of people on the night shift, as they took care of “really sick patients.”  She didn’t feel that it was “work.”  She was happy there.

Nurses in the Critical Care Resuscitation Unit
at the University of Maryland (Credit: UM) 

Unfortunately, she hurt her back (as nurses often do) during "the first year or two," and she eventually had to negotiate the unfriendly Worker’s Compensation system. As the nagging lower back pain continued, Poonam felt that she could not function as an ICU nurse forever, and after four rewarding years at the busy downtown Baltimore university, she searched for less physically demanding (but still fulfilling) work.

What was the next step? What does a former ICU nurse do next to keep the adrenaline rush she was used to?  Poonam quickly rejected the idea of becoming a Nurse Practitioner, seeing routine patients and sending in prescriptions for their medicines. She wanted to utilize the skills she developed in the ICU.  Skills such as monitoring and treating dangerous blood pressure fluctuations and potentially fatal heart rhythms. It seemed that working in the OR as a nurse anesthetist might be ideal, being, in her words, “what an ICU nurse does.”

She was accepted to the York College and the University of Maryland programs; she decided on York. So she moved back home and lived with her parents. At first, she was happy with things, and she really liked the didactic material. But as time passed, and she got into the clinical work, she became increasingly uncomfortable with the brusque, sometimes military style of teaching (a simulated intubation went especially poorly). After taking some time off to think, and a trip to India for her cousin’s wedding, Poonam reluctantly resumed her studies

York College of Pennsylvania (Credit: York Dispatch)

But with only two semesters to go, she was so unhappy that she was compelled to withdraw from the program altogether. It was a difficult (and costly) decision. As a perfectionist, she felt like a failure, but her concerned parents were supportive. (We do want our children to be happy.)

Poonam could not return to bedside nursing, risking recurring back troubles. So, in 2015, she took a telemedicine ICU job with the University of Maryland Health System. Intently watching a bank of computer screens, the nurses covered eleven small outlying hospitals that did not have an in-house intensivist at night. 

This sedentary job allowed Poonam to pursue a Master of Science in Nursing at York College, after which she could be certified as a Nurse Practitioner. As she worked nights in Maryland, she studied diligently in Pennsylvania during the day. Her declared focus was geriatric primary care, and she especially enjoyed her rotations in orthopedics and palliative care. After completing the rigorous two-year program in 2018, she took a job with Orthopaedic and Spine Specialists (OSS) inYork. 

After a while, working at OSS was not her thing, and she began to dread Mondays. So, in June of 2020, as COVID-19 was impacting the community terribly and the ICUs were full, Poonam took a position in the other area she had been drawn to, given some of her experiences of critical illness and death and dying in the ICU, palliative care.  

This comprehensive, holistic, patient-centered consultative service is designed to help individuals and families navigate chronic progressive illness. It can be employed at any stage; it is not to be confused with end-of-life hospice care, though it does deal with issues surrounding death. The local UPMC program, based in Harrisburg, involves working at seven central Pennsylvania sites. 

Elements of palliative care (Credit: SSMHealth)

As of late 2025 (the time of our interview), Poonam had been doing palliative care for more than five years. She has learned much. Among other insights, she has seen that chronic illness and death “will either bring a family together or tear it apart.” 

Her words reminded me of something I was told many years ago by a woman working in oncology (I believe she was a seasoned nurse, but I’m not certain). She said that, in her experience, fifty percent of people can handle illness and dying in their loved ones and can be present and compassionate. The remaining fifty percent, for whatever reason, simply cannot. It seems to be built into their nature. 

Poonam has seen this dichotomy of reactions even in her own family, as her dying mother was hospitalized five times in 2023 and was eventually transitioned to hospice.  But Poonam, as a palliative care nurse, knew the importance of being there for her mother (and her father). 

Despite the demands of her own work, her family was her priority at that difficult time, and she took the necessary time off to be with them. However, the absences strained her position with UPMC, though she couldn’t be in two places at the same time. She was conflicted, and even thought about resigning, but things eventually worked out. Her mother passed away peacefully in December 2024 with the loving end-of-life support from her husband and her two daughters.

Poonam is optimistic that the quality of such care (including sufficient education for all involved parties) can be improved, especially if the palliative care team (and it requires a team) is engaged earlier in the disease process instead of often waiting until nearly the end. And one might even consider changing the name of the service altogether to just “supportive care,” to reflect the real goal of better management of advanced disease while avoiding the often dark "hospice" specter of “giving up.” 

Poonam had been making the rushed and harried commute to Harrisburg from York, but she was subsequently transferred to Hanover, making her life a bit easier. While things are not fully in place yet, she’s working on developing a program for patients with late-stage heart failure. She told me that barriers to effective communication, both among the medical staff and with (and within) the families, remain, and are real challenges. In her frustrated words: “We all just need to talk to each other!”  

And when the clinical situation requires urgent critical input, those responsible for making decisions must be readily available (she had found that they are too often not). 

This reminded Poonam of a recurring scene from her childhood: As a trauma surgeon, her father usually took his “beeper” or pager with him everywhere. But if he was outside working on the lawn, he left it in the house.  When it beeped, when it summoned him, Poonam would quickly rush out to find her father to let him know that he was needed.  Her mother’s illness taught her a lot about the painful process of dying. He father’s dedication taught her something else. She carries both lessons with her as she waits to be needed.

Suggested Readings:

1. Boston University Staff. "How 9/11 Changed the World: BU faculty reflect on how that day's events have reshaped our lives over the last 20 years." BU Today, September 8, 2021. ("The fires of 9/11 continue to burn.")

2. Brown, Deborah X, RN, BSN. "Nurses and Preventable Back Injuries."  American Journal of Critical Care, September 2003, Volume 12, No. 5, p. 400-401. ("Disabling back injury and back pain affect 38% of nursing staff." The author recommends the use of a dedicated "lift team" for all total body transfers," to prevent potentially career-ending injuries.)

3. Strand, Jacob, MD, Mihir Kamdar, MD, and Elise Cary, MD. "Top 10 Things Palliative Care Clinicians Wished Everyone Knew About Palliative Care." Mayo Clin Proc.  August 2013; 88(8): 859-865. (#2: "Palliative care is appropriate at any stage of serious illness.")

By Anita Cherry 1/14/26

Odd cloud formation at Reservoir Park (Photo by SC)

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