All Intensivists are not created equal
By: Debbie Moore-Black, RN
1986. I graduated from LPN to RN. And I was immediately offered a new job. Manager of a six-bed ER.
This hospital had three surgical suites — 50 inpatient beds and 2 L&D suites. This was a private Catholic hospital run by the nuns. The computer system was new and a foreign object.
Sister Ursula* (name changed) of medical records was so overwhelmed by the volume of paper charts that she hid many charts underneath her bed in the nearby convent. The nuns ran around during dayshift praying for all the patients and sprinkling “holy water” on those that requested it … or didn’t request it. There were crucifixes everywhere.
Our truly beloved CEO had just retired. He was a good, honest family man that knew everyone by their first names. We actually liked him!
But he quickly retired and moved himself and his wife to the mountains.
We were a small hospital out in “nowhere land” where you’d find farms loaded with cows, goats and chickens. Miles and miles away from any “real hospital.”
But we had it all in that ED!
Young women coming in with abdominal pain, only to find they were ready to deliver a non-prenatal care baby. The one ED doctor at hand did the delivery … while I caught the placenta.
We took care of gunshot wounds, stab wounds and cardiac and respiratory arrests, child abuse and rape cases, “done fallouts” during church services, diarrhea and constipation and runny noses and coughs from little kids.
We truly got it all.
We were a smorgasbord of every possible diagnosis. One nurse, one doctor and one secretary in that ED.
I thought I was hot stuff.
The CEO that retired gave me carte blanche to order EKG monitors and defibrillators, surgical equipment, crash carts. Beyond taking courses on “how to be a manager.”
I also took those CEUs on emergency nursing, staffing, public relations, and public education.
I was young and on fire.
I loved the code blues, emergent deliveries, chest tube insertions, intubation, calling medics to transfer a patient to a larger hospital, writing protocols, dealing with JCAHO. The list was endless.
And then we were notified by human resources that we had a new CEO.
He was 35-ish. Seemed like a baby. But apparently, he had experience and came from a much larger hospital.
He had shiny shoes and a perfectly starched shirt. I was always on guard and suspicious of shiny shoes.
He was our new CEO.
Immediately, I could feel the difference in this small-town hospital. The family atmosphere was disappearing. The staff was on guard and on edge. At any given time, especially at night, the CEO would come to visit us to make sure everything was OK.
It seemed odd, and he’d drop in at random hours in the middle of the night.
Our pharmacy was closed at night. Only the nursing supervisor had a key for meds that were needed stat throughout the hospital. Meds that hadn’t already been stocked.
But he had a key to the pharmacy.
He would tell us that he had to make sure the pharmacy was locked and that there was no suspicious activity. No one said anything out loud, but if you could just hear our thoughts.
Month after month and the same routine.
Rumor had it that the CEO started to fall asleep during executive meetings, board meetings. He’d visit us nightly in the ED. Slurred speech. Incomplete sentences.
We knew something was wrong.
We also knew if we said or mentioned anything, we could get into big trouble.
Every day the pharmacist clocked in. The pharmacy techs would assist the pharmacists in filling carts, restocking code carts, checking on the narcotics. The pharmacist knew something was missing. The Percocets, the Ativans, and Xanax, the morphine injectables. There was a dent in the narcotics. The narcotic inventory was reduced but without rhyme or reason.
The pharmacist called the pharmacy company (separate from the hospital), and cameras were installed.
And there he was some nights with a paper bag in his hand. Taking whatever he needed.
He was caught on camera. Immediately whisked away to some rehab facility.
And we never heard from him again.
He was a tormented soul thinking he could get away with stealing and using narcotics because his cover was being the CEO.
By: Debbie Moore-Black, RN
I never have a problem going to sleep. In fact, after I work night shift, I easily go into a “semi-coma”.
But tonight is different. 2 days off from work, with a regular sleep schedule at night, but my mind is twirling.
I can’t sleep.
So at 0300, I took a shower. Took an ibuprofen with some ginger ale….. and I started to drift….. back to Catholic elementary school. We were 7th graders. I was in a group that did a “hip” musical mass with us kids playing drums, guitars and cymbals and tambourines.
We were cool.
I wanted to play the Beatles song “Let it be”.
“Mother Mary comes to me, speaking words of wisdom, Let it be”
I thought the song was about the Mother Mary, you know, Jesus’ mother. It was actually about Paul McCartney’s mother, Mary. A tribute to her.
But the kids voted me down. They said the song was sacrilegious. And I never got to play it at the guitar mass.
Fast forward…. when my kids were little, we joined a Presbyterian Church. I taught 3rd and 4th graders bible school on Wednesday nights. I loved it. We had decided to put a concert on with music and skits for our congregation and for the public. All donations would go to a local Soup kitchen.
Since I was the director/producer of this awesome show, I got to pick and choose. Of course the children had a say so of what they wanted too.
So with cymbals and guitars and drums and tambourines in hand, we put on the grandest show. “This little light of mine”, “Kumbaya, my Lord”, “I can only imagine”, and other social awareness skits were played out.
And now it was my turn.
I propped myself on the stool. My cherished guitar in hand, and strummed out the song I was forbidden to play 30 years ago.
Let it be.
Tonight, my memories of such an awesome, meaningful event came back to me.
We are living in a harsh, sad and tragic world filled with turmoil. But the words are profound and comforting.
“When I find myself in times of trouble, Mother Mary comes to me, speaking words of wisdom, Let it be, let it be”.
And when the broken hearted people living in the world agree, there will be an answer, Let it be. 🎶
We collected over $200 that night and handed it over to the minister in charge of the soup kitchen.
That was a special night. I hope I taught my 3rd and 4th graders something special. Like caring for one another. Love one another. Respect each other.
We sure could use this today. And always.
So I’m going to attempt to go to sleep again, and hope for a better tomorrow. A kinder tomorrow.
There will be an answer.
Let it be.
(The Beatles: Let it be)
By: Debbie Moore-Black, RN
I had to earn my “stripes” in ICU. After I graduated from nursing school, the “big” hospitals wouldn’t take me in to work ICU, as I had no experience as an ICU nurse. Back in the early 1980’s, there was no such thing as an internship program.
I desperately wanted to become an ICU nurse. So a small town county hospital took me in. It was a 6 bed “ICU” and I slowly learned the basics of ICU nursing. The county hospital sent me on a 60 hour hemodynamics class, which opened up my eyes even more! After one year at this hospital, I was ready to spread my wings.
I applied to the big hospital, big city ICU. And they took me in. Orientation was 4 weeks.
16 beds. Ventilator’s, EKG monitors, nurses in light blue scrubs, code blue’s, computers … I was in awe. THIS was the big times. I had entered paradise!!
Eventually I worked and assisted physicians and respiratory therapists in intubating patients, inserting central lines, swan ganz (PA line) monitoring, learning about PCWP and fluid overload and deadly arrhythmias.
But there was one ICU nurse who I instinctively knew I must gravitate towards.
Carolyn. She had a “glow” about her. She had wisdom and knowledge. She was calm but a strong force. She was kind but direct. She explained arrhythmias and irregular EKGs to me. But she taught me with kindness and patience. She was never condescending. Never a bully. Never a “know it all.”
She challenged upper management and physicians for the sake of our patients and for the sake of us fellow nurses.
I knew that “when I grew up” I wanted to be just like her…. if possible.
I adored Carolyn. I loved her dry wit, her intelligence, her spunk.
She gladly took us young ones under her wing.
When she clocked out, she had a whole other life. A loving wife and mother to several children, she was the neighborhood mom too.
I’ll never understand how she had so much energy. Her plate was full.
She did finally retire and consumed her time with her family and her grand babies she adored.
Sadly, we received the news the other day. Her husband tried to wake her up. She was unresponsive. Medics rushed her into the Emergency Department. She coded several times. She never made it to the ICU. This time as a patient.
There are frequent tears in my eyes. Even writing this. She was the epitome of an ICU nurse. Her intelligence surpassed many. But she was the quiet storm in a chaotic ICU.
Though Carolyn had a heart of gold, her physical heart had taken its toll.
You will always be my hero. My shining star.
Sing with the angels Carolyn, because you were certainly an angel here on earth.
(*Fictitious name used)
By: Debbie Moore-Black, RN
Hi Mary and Susan and Heather and Ashley and Cathy and anyone else I’m sure I missed.
I was twenty something when I met him. He was smart and funny and different. And I desperately wanted something “different.”
I wanted to be set free from my strict Catholic upbringing. From my domineering mother and IBM executive father turned alcoholic. I wanted to shed the confessionals on Thursday, the mass on Friday and then church again on Sunday. The screams and haunts that failed to escape me of being told over and over again that I was dumb and stupid and fat. I wanted to explore and dance and sing.
And there you were.
The strangest man. 1978. With your Afro hair and long beard and beady blue eyes and a thin body as you smoked cigarette after cigarette.
We listened to the Doors and Led Zeppelin and Pink Floyd as we stared into each other’s eyes.
You told me I was beautiful and smart and talented. I desperately grabbed on to this… those breadcrumbs of love.
You became my everything.
My heart and soul.
Can you imagine being this beautiful porcelain doll, and someone comes and smashes you with a hammer? Smashes you to shreds?
That was me.
I loved you. You were my everything. We had three beautiful children. I loved them even more; as I had to learn to build my life around them, and not you.
I preached to others “Women’s liberation.” Unchain yourself, I even hyphenated my last name. Strange thing though, was that I was really trapped. I didn’t know how to escape.
You were my “magic man” until I found out the truth.
And then the hammer that came down on me, also came down on my spirit.
Our children loved you. We all played fairly well… except for the screaming fights of me begging you to get a second job or a better job as I worked my 60 hours a week as a nurse. I was exhausted but I knew someone had to do it. Or of that “next time” you were unfaithful to me. Many various affairs with other women. The marriage counseling, the therapy sessions never made you stop. I was a wounded soldier, craving for this man to love me. And finally realizing it would never happen.
Breadcrumbs of love.
Everyone loved you, your folks at work, the community, even the church. You also loved their adulation towards you.
Narcissism is a strange disease. It’s a self-serving one. And you get wrapped up into yourself. And I was left behind. Forgotten.
And after 34 years of marriage, I was finally ready for a divorce…. because you had one more. One more woman to love other than me.
And I didn’t divorce because he received his death notice. Liver and pancreatic and lung cancer ravaged his body. And I just couldn’t make my children take care of him. I knew it would be hard, but I just couldn’t make them deal with this pain.
So, Mary and Susan and Heather and Ashley and Cathy and all the rest…. where were you when he lost over 40 lbs, stopped eating, skeletal and jaundiced? Where were you when he climbed out of bed, only sometimes falling to the floor or urinating on the floor? Where were you when he accidentally had a bowel movement in the bed? Where were you when he tried to flush towels down the toilet?
And even at the end, the funeral. Where were you? Did you forget to come and pay this man homage?
So whether you’re a man or woman and you’re in it for the thrill. Or in it for fun.. you all, including him, played havoc on my life. My psyche.
His ashes were scattered across the mountain top. And I swore to myself…. never again.
I trust few. But every day I heal, I hug and cuddle my dogs. I laugh with my children and grand-babies… and I carry on.
IF you are in a domestic abusive, cruel, negative, demoralizing partnership, get out! I plead with you loud and clear. Get out. No one deserves this life.
It’s never too late.
The Center for relationship abuse awareness
National Domestic Violence Hotline
If you are in immediate danger call: 911
By: Debbie Moore-Black, RN
She was naked in her seclusion room. Padded cell. Gown on the floor. Drenched in her urine. I was her nurse. I gave her lithium. She put the pill in her mouth and than spit it at me. In my face. And then her tirade began. “I’m Jesus”. “The FBI is watching us.” “The computer chip in my head said to kill kill kill you.” “They’re watching me.” “They’re watching you.”
“I’m Jesus. Watch out.”
She spun out of control. She started to bang her head against the padded cell wall. We all gathered around her as she screamed out Satan and demons and Lucifer. I injected her with Thorazine. And finally she slept.
Exhaustion and medication took over.
She was in her 50’s and I knew her well. After a week of seclusion and scheduled medications, she got better. She graduated to the main psychiatric unit. Walking amongst the others. Chit chatting with other patients. She was better. Her gray hair was neatly combed. She wore a dress.
I was giving out medications to others.
Mrs. Mary came up to me. Two inches from my face. She said, “I know you. I know you from somewhere.”
And I told her yes, she was correct.
I let her know that 3 years ago she was my English professor while I was in college.
She apologized for her behavior, though she vaguely remembered being naked and spitting pills at me and talking of Jesus and Satan and the FBI. I told her no need to apologize. You are so much better. I’m so happy for you.
3 years ago, I had been in nursing school. English class was a requirement. I was a young depressed woman going into a profession my mother had dictated for me to go into. It was my delusional thoughts that I would escape my dysfunctional home of an alcoholic father and a domineering mother. I would become a journalist and live in New York City and work for the New York Times. I would escape my household I grew up in and go to the best liberal arts school and become famous with my writings.
I wanted to escape but I wasn’t allowed to.
Instead I was told I would stay at home and go to a local college and become a nurse. I wrote paper after paper using my creativity in this English class. I excelled at something I loved. Writing. And it was Professor Mary who asked me to stay after class. She told me I could be a journalist. That I didn’t have to go into nursing. That I could write.
She also told me that she sensed I experienced depression. I was 19 years old. 20 years old. How did she know so much about me in so little time?
Professor Mary was probably the first person in my life that had an ounce of insight into myself. Years of neglect, the screaming of mom as dad ran into the walls after he drank his daily gallon of wine.
I had never known that Professor Mary held onto a secret. She was a genius within a schizophrenic mind. With her compliance of her medication, she was a warm, tender and caring lady. I looked up to her. I cherished her. She seemed to be the first person in my life who showed she cared about me.
My confidence had lifted because of her.
I became that nurse and I first ventured into psychiatric nursing.
And there Professor Mary was. My patient.
I gave her love and kindness and encouraged her to get better.
In a twist of fate, I was able to return everything that she had given me. Hope.
Professor Mary died not too long ago. I read about her in the newspaper. She died a peaceful death. Many long years she taught.
Professor Mary lit a candle for me in my heart. She may have been the true reason why I was able to become a caring nurse to others. She’ll always be that spark in me that I thought had died at the young age of 19.
Rest peacefully Professor Mary.
You were my shining star.
I can’t breathe…..
By: Debbie Moore-Black, RN
Mommy why are there separate water fountains?
Mommy why aren’t there any “colored” people in my school?
Mommy why are their houses so small?
It was the 1960’s. And all around me were symbols and movements and chaos and hate and love and conflict.
Mary, our maid, slept on our couch, and I told my mother she was sleeping. My mother said “Let her sleep.”
We were walking downtown and we heard the “N” word, and daddy pulled us aside and told us to never ever use that word.
Daddy gave a poor black man a $20 bill. He didn’t know him. But he did that just because.
I found out early what respect for each other meant. What love meant. What color blind meant. The great leaders spoke to us from our small black and white TV. Martin Luther King Jr. Malcolm X. John F Kennedy, Robert Kennedy. And one by one, I watched them gunned down.
Greatness gunned down.
I am sad. We have been giants in this Universe.
Our USA. And now we are all breadcrumbs.
Hate has replaced love.
My high school years in the 1970’s was a battleground. Blacks against whites. Riots through out the country in high schools. Smoke bombs. The National Guards. Integration. I didn’t understand.
I was taught to love one another. That we are all God’s children. And by our senior years we figured out that it was other people in our universe that attempted to instill hate in us. But we didn’t want to hate. We ended up going to football games and basketball games together and singing in the choir, and studying together and learning to heal from all of the previous hate. We became good friends and we embraced each other’s culture. And we flooded with tears when we graduated from high school. We created a strong bond that we wouldn’t allow anyone to break.
It is such a sad time again. We’ve spiraled out of control.
Anger. Racism. Fighting. Looting. Disrespect. Sadness. Destruction.
Where has our love gone?
When this life is over with, can you even say you led a good life?
Can you even say you were kind and gentle and caring to each other?
The visions run through my head.
They won’t escape.
A black man jogging gets shot down. A man with a possible alleged bad $20 bill gets tackled and shackled and thrown to the ground. And begs: “ I can’t breathe.” And cries to his mama.
Modern day lynching. It’s no different than watching that black man or woman hang from a tree. Dangling. With a large rope around their neck.
Or a large foot pressing down for 8 minutes and occluding a man’s carotid.
Where is our modern day Martin Luther King Jr? Where is our new Malcolm X. Where is our JFK and brother Robert Kennedy.
Please. Stop the racism.
Please. Stop the destruction and looting.
Please. Stop the killings.
We have just this one life to live.
Make it right.
Cause I can’t breathe anymore.
Abusers love isolation.
The mandate came across the television screen. “Stay at home”
The USA is in lockdown.
And unless you are an essential worker, like a nurse or doctor or healthcare employee or medic or police officer or work at a grocery store, you must stay at home. This coronavirus is wicked and travels from one person to the next. Not only thousands have died from this virus, it easily leaps from one country to the next.
Some would think it was a relief to sit at home and watch tv. Others would become restless and uneasy and knowing that a paycheck wouldn’t come in nor bills would be paid like the rent or mortgage or utilities or food.
And to the man or woman who knew the sting of domestic violence, this isolation would become an inescapable trap.
Isolation is an abuser’s best friend.
And with isolation came their ultimate control.
Emma was a young beautiful girl. But as a child, her parents ridiculed her day in and day out. Though Emma was a natural beauty, her entire life growing up, her mother and father would tell her she was fat and ugly and stupid. Her neglect and abuse was early on, as she watched her mother dress in the finest clothing, and her dad drink his gallon of wine a night.
Emma would frequently stay away from the high school parties and football games because she was convinced she was fat and stupid and ugly.
And then she met Ted. He was a big guy. Kind and protecting and eventually never left Emma’s side.
Emma thought his “protection” and always wanting to know where she was, was his way of showing love and affection.
They married. And she was determined to be that perfect wife. Ted would come home from work and the table would be set with a magnificent dinner. But Emma realized that everything had to be perfect with Ted. It’s hard to always be perfect. He eventually became cruel to her and verbally abusive. If Emma’s hair wasn’t just right, he’d scream at her. If the house wasn’t clean, he’d push her into a corner leaving bruise marks on her arms. And the pattern of control and abuse grew. She wasn’t allowed to see her old friends much less her parents. She wasn’t allowed to buy new clothes without his ok. Is she was napping, he’d accuse her of being tired because she must be having an affair. The neglect and torment and control would escalate. And Emma was doomed in her mind to be a worthless person.
And then the pandemic hit. More isolation. And Emma felt paralyzed. She was confined to her home. Ted became more aggressive and angry as he couldn’t work and couldn’t pay his bills. Screaming and hitting Emma to “keep her in her place” and the nightmare was endless.
Emma wanted to get help. She wanted to reach out. But Ted told her if she left the house the coronavirus would kill her. She wasn’t able to get on the phone to talk to her friends. Nor was she allowed on her laptop. The control and isolation grew. Easily she would be punched in her stomach, or shoved into a corner of something was out of place or the TV had the wrong channel on.
Emma tried to get on her laptop to signal one of her friends to help. But Ted slammed the laptop onto the floor.
Emma was trapped in her own house where the isolation got more intense and Ted’s control of her became unbearable.
At 3:00 am, when she thought Ted was sound asleep, she tiptoed down the stairs, with only her clothes, no suitcase.
She had to make an escape. It was now or never.
Slowly and quietly she walked down the staircase. And she made it to the front door.
Ted ran down the staircase and grabbed her arm. Stating that she would never leave him.
He pushed her against the wall. And put his gun to her head. And fired three times.
Emma fell to the floor.
Blood splattered everywhere.
Ted calmly got on the phone and called 911.
I did it.
I killed my wife.
There were no tears.
Domestic Violence Hotline:
Or text: LOVEIS to 22522
They scream and holler and march. First Amendment, it’s our right. Open up the USA.
This is Socialism. This is a hoax.
THIS, coronavirus, is deadly.
Invisible as the virus makes its trek across our USA. Across the Universe.
Nurses and doctors and respiratory therapists are being named hero’s. Signs and banners and free meals and cookies and doughnuts and loads of adoration come our way. But we don’t want to be named a hero. We are doing our job, our profession, our passion.
What the health care professionals want are safety, and protection, and experienced staff and PPE’s like N-95 masks, and gloves and gowns and face shields. And respect for this virus.
When you go out and march and protest without a mask, without social distancing, you are compromising fellow citizens, nurses and doctors and respiratory therapists. You are endangering us and your family and friends. This virus doesn’t care what you think. It searches for the next host to hook on to. Are you in your 30’s, or 40’s or 60’s… the virus doesn’t care.
Are you washing your hands with soap and water, sanitizer, keeping your distance? Do you walk freely through essential stores without a care; without a bother?
To you, it doesn’t matter.
Because you haven’t been affected yet.
We say our prayers going in. The hospitals test us before we clock in. They take our temperature and ask us questions. We are allowed to stay and work if we are afebrile, lack a dry cough, no loss of smell or taste, no shortness of breath, no congestion. And then we are allowed entrance to work in that ER or that ICU or any unit in that hospital. ICU’s and ER’s are now deemed as Hell.
There are no short breaks. It is 12 hours of relentless pain. Masks and shields and gowns and gloves and the very sickest Covid-19 enter our ICU’s. Pouring blood into these patients and oxygenating with emergent intubation, and vasopressins and lungs crashing and kidneys dying despite dialysis, despite our last ditch efforts of proning a patient, despite telling family members they can’t see their loved ones last breath on earth.
Despite hospitals allowing us ONE N-95 mask per 12 hour shift. Despite us knowing that this special mask should be used only once and then disposed of. Despite hospital units and surgeries closing down, despite nurses being furloughed or physicians being fired for speaking out against the lack of PPE’s, despite administrators receiving $250,000 bonus checks in this turmoil.
Frontline nurses and doctors have died from this virus helping you to survive.
Ministers and protesters, funeral sessions and greater than 10 social functions continue and you go on “blind faith.”
This coronavirus attacks our lungs our heart our kidneys and brain. It attaches and attacks until the patient goes into multi-system organ failure and then death.
To date the US has 58,947 deaths from coronavirus. This number continues to grow.
So please, help yourself to protesting, to screaming and shouting. You certainly don’t scare or intimidate this virus.
Wear your masks, keep your distance.
But if you keep your guard down, you may become the next fatal number.