The Lost Souls in Purgatory

By Debbie Moore-Black, RN

In elementary Catholic school every day we sat at our school desks and the nuns had us pray for the lost souls in purgatory.
If we prayed hard enough, we would be able to pray them out of purgatory and lift them up into heaven.

Before I clock in, I say my Anti-assault prayers to the gods. I pray for safety. I pray for the next 12 hours to be uneventful.
I thought I would give ICU nursing a break after 33 years. No one lasts 33 years in ICU… but I did.

I thought I would find something easy and non-eventful to slide into my retirement.
ICU vs Behavioral Health. Kind of apples and oranges.

I encounter psychotics. Bipolar, borderline personalities, schizophrenia. They come homeless or from prison or from their tattered lives. Repeated admissions for the rest of their lives.

The adolescence unit patient grows up and after turning 18, they come to join us. In their outside world, there’s non-compliance with medication, noncompliance with their therapists. They re-enter their toxic environments from their homes before they enter a somewhat safety zone, a pretend sanctuary ie: the hospital; the Behavioral Health unit.

The young female in her 20-30’s who was sexually assaulted in her youth by known family members or abusive boyfriends, the men who for years diagnosed with schizophrenia but zero medication compliance. A lifetime of verbally, mentally and physically beaten down, never having a chance to get up for air… drowning.

I offer them their medications for the night. Some are gracious and polite. Some talk to the walls or talk to the TV blaring, or stare out their window seeing imaginary people that are real to them, drifting in the clouds.
The psychotic ones can’t focus. They talk rapidly non-stop to their invisible person.
The violent ones lash out randomly.
Was I a trigger? Do I look like someone from their past? Did I say something wrong?

I have been hit in the head several times at random. I’ve been placed in a wheelchair after a female patient hit me repeatedly in the head, all random all unprovoked, CT scan of my head because I became dizzy.
Despite our mandatory class of non-violence crisis intervention training, learning exact twists and turns to prevent an assault altercation…. I don’t know how to defend myself; I don’t know how to swat a fly.

What have I learned these last three years in behavioral health?
Drug abuse, narcotics cocaine, benzos, opiates, amphetamines, meth, alcohol, cutting, banging your head against the wall, cutting on their arms and legs, self mutilation. Or banging their fist against their head, make the voices go away. Make it stop.
And they repeat I want to Kill myself I want to jump into traffic I want to kill my mother. Mother hate.

In this controlled environment I pray they’ll take their medications without incident.
I pray they won’t harm themselves or others or us.
The mind can be a very dark place. A place that has stored unresolved years of abuse and anger and neglect.
It’s a different world of nursing.
My valuable lesson seems to carry me through day after day.
And that is to respect them. Be gentle. And most of all be kind.
Because kindness is something they haven’t felt in a very long time.

And I continue to pray for these lost souls….

The unsung heroes: Respiratory Therapists

By Debbie Moore-Black, RN

October is #Respiratory Therapists week/month!

Working day after day, year after year,in a busy high acuity ICU, we all have become that “second family.”

The public doesn’t hear much about Respiratory Therapists, especially during this Covid nightmare, but they have been the unsung heroes.
So who are the Respiratory Therapists and what do they do?

They are specialized healthcare professionals trained in critical care and cardio-pulmonary medicine. They work therapeutically with people suffering from acute critical conditions and cardiac and pulmonary diseases.
College educated with an Associates degree or a Bachelor’s degree, they put in hundreds of hours in their training with both theory and clinical practice.

We’re a tight fit unit and we all learn our roles and like clockwork, we intertwine in the intricate rhythm of actually saving lives.

Especially during covid, to the forefront stage; ER and ICU nurses and physicians were the focus of a dynamic life saving force.

But If you built a pyramid, the backbone would consist of Respiratory therapists.
Without them, our critical care units would tumble down and fall.
They are the right hand person to the Intensivists intubating a patient stat as the patient loses oxygenation.
They are there to obtain stat ABG’s (arterial blood gas) and assist the nurse and physician in interpreting whether a patient is going into respiratory or metabolic acidosis or alkalosis.
What’s the CO2? What is the bicarbonate level? How do they adjust a ventilator? Should they increase the FiO2 or increase the peep?

The concepts, protocols and intricacies of Respiratory therapists are enormous.
Without the lungs, without the heart, without the Respiratory therapists, we’re just a shell.

Without the respiratory therapists, this well oiled machine, this tight knit family of healthcare professionals would self destruct.

They are precise, professional and educated health care professionals in this pyramid of lifesaving events.

October is respiratory therapists week/month.
You are a vital force in our Heath care system.

You are our heroes and we sing your praises.
Thank you for your teamwork.
For your excellence.
For giving patients another chance at life.
Another chance to breathe again.
Resilience. Strength. Hope. 🫁 🩺

Repressed memories of a tragic ICU assignment. A mommy and her 4 year old son.

By Debbie Moore-Black, RN

Sometimes the most traumatic events that happened when I was young and new and just starting my ICU career; when you least expect it, those repressed memories come glaring at you.

Thinking I had tucked this tragedy away forever, and then within a flash… 25 plus years later, I see that little 4 year old boy, holding his daddy’s hand.
Watching doctors and nurses work on his mommy.

This mother. This wife.
After countless Code Blues, her final moments were asynchronous breathing with the ventilator. We called it “guppy breathing.”

We watched through the patient’s window as the Intensivist explained to the patient’s husband: “I’m sorry. We’ve done everything. Her organs have shut down. There’s nothing more we can do.”

Her husband came into her ICU room. And gave a final kiss to his wife.
Little Benny at 4 years old, knew his mommy was sick. His cheeks turned red. He cried out: “Mommy, mommy.”
As he watched his mommy slip away.
Forever.

My first assignment in this 24 bed ICU, was this 32 year old female who had pre-eclampsia. During her pregnancy her pre-eclampsia seemed well under control….until the emergency C-section.
After delivering her 6 lb 2 Oz baby girl, she was rushed to the ICU.

Eclampsia. Severe hypertension. 210/112. O2 sats dropping. Patient intubated stat. Central line and arterial line placed. Nipride drip started. Erratic seizure activity. Kidney failure. All systems down.

It was my first week in this very large ICU. I was still in orientation. There was nothing that could prepare me for this assignment.

This patient was internally hemorrhaging. BP out of control. Kidneys shut down. Liver failure.
We gave RBC’s and platelets, one after the other.
This was a 2:1 assignment.
Relentless.

The Intensivist stayed at her side. Screaming out whatever lifesaving measures we could provide. But short of a miracle, nothing was going to work.

I always wondered what happened to that little boy.

That image.

Of him holding his daddy’s hand as they both starred through the ICU window.
A mommy lost forever.

A little baby girl never ever knowing her real mommy. And a husband. Now left with his 4 year old son and newborn baby girl.

Repressed memories.
Sometimes come back to life.
Maybe when you’re strong enough to handle them emotionally.

But that image.
That little boy. With his cap on his head. Holding his daddy’s hand.
Forever lost in translation.


Domestic Violence: May the circle be broken

By: Debbie Moore-Black, RN

My youngest daughter just got married to a fine young man. She was beautiful and radiant.

As I gave my daughter away when the minister told me to, I sat down next to a picture of my deceased husband. He passed away four years ago.

Lisa was our last child. Most likely, she saw the truth.

She saw the way my husband treated me after the other two children had gone off to college.

She always said, “I saw how daddy treated you.”

Though I was happy that my daughter was marrying a good man, I felt my inner sadness for not having a good man in my life at my side.

I should have known better.

I should have known that domestic violence didn’t qualify you as just being physically beaten up and attacked.

There were 30-plus years of mental anguish, intimidation, infidelity and lots of “business” trips.

Though I was happy that my daughter was marrying a good man, I felt my inner sadness for not having a good man in my life at my side.

I should have known better.

I should have known that domestic violence didn’t qualify you as just being physically beaten up and attacked.

There were 30-plus years of mental anguish, intimidation, infidelity and lots of “business” trips.

Though I was sad throughout our marriage and felt emotionally “beaten down.” I didn’t know that this was labeled domestic violence.

I was happy for my daughter.

But I didn’t want to sit next to him — that framed picture.

Even though he was dead. The picture of him in his younger years with our daughter at two years old stared at me.

I always felt trapped. I didn’t know how to move. I didn’t know how to break free of this man. I lived my life through my children.

I always knew my life with this man was null and void. I was naive at first and then just numb.

What a sad existence.

Finally, four years gives you plenty of time to think when you’re by yourself when everything is unwrapped. When the naked truth stands in front of you.

He was there for the children. The plays and concerts and birthday parties and football and chorus and proms and high school and college graduations. But he was never there for me.

I misunderstood what domestic violence was.

I misunderstood that working 60 hours a week as a nurse was domestic violence. I misunderstood that his infidelities followed by “I’m sorry” were meaningless gestures.

I didn’t want to sit next to his picture.

We had scattered his ashes on top of a mountain top — cancer. To his liver. His pancreas. His lungs. His lymph nodes.

He never had cancer before.

I almost wondered if it was karma that attacked him.

This wedding was bitter-sweet.

I wanted a husband with me but a husband that loved me as much as I loved him.

I wish I could scream from the mountain tops.

Domestic violence. Yes, it can be physical violence. A black eye, a fractured arm, a punch in the gut.

But it can also be mental abuse like isolation. Intimidation. Infidelity. Manipulation. Put-downs and constant ridicule.

I grieve my last 30 years to a man I should have never been with.

But the light is shining on my daughter.

A new day. A bright tomorrow. With a young man that respects her. That cherishes her. That loves her endlessly.

May that circle be broken. That circle of sadness, isolation, and unspoken grief.

And may they both live a happy life together full of love and respect.

Originally Published on KevinMD.com

A night in the life of a mental health crisis counselor

By Debbie Moore-Black, RN in collaboration with a licensed masters social worker, LMSW

It was my turn again to sit for the next 8 hours in the middle of the night at the mental health crisis center. Run by a team of therapists and social workers with the community mental health center. We regularly collaborated with the local police department and EMS for people who were experiencing a mental heath crisis.

We never knew what to expect and every day was something different. We were a good hardworking team, and we couldn’t do our job without law enforcement by our side.

This night was different. This call came from a grandfather. Scared and nervous, he called the mental health crisis call center. “My granddaughter Kiesha. She’s 24 years old. She stopped taking her medicine. She has a 3 month old baby she holds onto tightly. She hasn’t taken the baby or herself to the doctors for wellness checks. She’s screams at the TV. She slams doors, paces all night long. I have to tell her to change the babies diapers.”

“She tried feeding her baby 2 pieces of bread with toilet paper neatly folded in between!! She put it up to the babies lips, not realizing what she was doing”.

Her Grandfather continued: “She screams at me and her grandma that we are the FBI. She washes her hands continuously saying she defies the Rona (corona virus).”
“She’s out of control. Pulling the tv plugs out of the wall, saying it’s the FBI, Jesus is watching, the chip in your brain is the devil…she’s talking out her head”.

The grandfather was frantic. His granddaughter held on tightly to her baby. We had to help them. Stat.

My partner and I agreed to meet the grandfather at the home. We notified the police and asked them to accompany us for a mental health assessment. This may be a tricky situation.

We arrived at her grandparents house. Keisha was already in treatment but had stopped taking her medication once pregnant. We found out that Keisha lost her mom a year ago. Her boyfriend left her when he found out she was pregnant. She lost control due to the stress and trauma and isolation.

She moved in with her grandparents.
Diagnosed as schizoaffective bipolar type, in the past, she was compliant with her medications. This time she quit taking her medications saying she could “do it on her own”. And as she decompensated, the psychosis came out.

We knocked on the door. Gently talking to Keisha. Keisha stared at the tv, and didn’t even look our way when we walked into her room. Keisha had her baby snuggled up to her but she seemed in a daze. “How many radio channels in Florence county?”, she said to no one in particular. Keisha then laughed out loud. “So many cameras outside and inside, what does it have to do with me?” “They said I could do whatever I please so long as the custodians have already cleaned and withdrew on the mantle place” “hey officer, when was the last time you had to track down a stolen cat who ran away and ended up on the east side of Columbus, Ohio” “Haha!”

We asked Kiesha a series of questions. She wasn’t alert or oriented. Her speech was disorganized, tangential, nonsensical. And still, she held her sleeping baby close to her as any mother would.

We walked back outside to consult with the officer and our supervisor. “She needs to go to the hospital; she is very sick.” There was no doubt that she needed to be involuntarily committed, but how would we separate a mother from her newborn?

We went back inside and tried to engage with Keisha again asking if she would stand up and show us around some.

As I calmly talked to Keisha, a female officer swiftly and gently gathered the baby in her arms while another officer helped Keisha to her feet. The police officer took the baby from her. That’s when I quickly took the baby from the officer and went with my partner to the other room. My partner and I stared at this beautiful little boy knowing we were getting his mommy some help.

The officers let Keisha know they were taking her to the hospital and that she wasn’t in trouble or under arrest. She attempted to fight, but gave in. She was in such a state that she didn’t even acknowledge that her baby was no longer in her presence.

We handed off the baby to the grandfather and grandmother. They said they would care for the baby and keep this little one safe while their granddaughter got help. Keisha was escorted to an emergency department that had the best mental health care in the area. My colleague and I called to give a report to the ER charge nurse. We later found out a routine admit urine drug screen was completely negative.

After several weeks at the inpatient mental health facility, Keisha took her medications daily. She was compliant with medications again, started showering, eating, and going to group therapy during the day and got restful sleep at night.

With a clear head, she was taught that this was a lifelong diagnosis. Schizophrenia and bipolar. And she would need to diligently take her medications every day without fail. And continue with a therapist to gain coping skills, learn warning signs and know when to ask for help.
After one month, Keisha was able to go home to live with her grandparents and get back to raising her little boy. This was not a situation of abuse or neglect and DSS was not called. This was a mother with mental illness postpartum in need of mental health treatment.

Kiesha eventually finished her GED, enrolled in a technical college, and decided that one day she too may become a social worker, a policewoman, a nurse. The sky had no limit.

As I think back to this event, sometimes this job is filled with anxiety, and unpredictable events. But sometimes we have a success story, that makes it all worth my pledge of being the best social worker and crisis clinician I can be to help my community.

The Nurses Revolt

(Google photo stock)

By Debbie Moore-Black, RN

Where do I begin?
Maybe at the beginning.
Let’s start with the degradation and devaluation of nurses across this country.

For decades, I lived the devaluing of nurses. Daily huddles from our nurse managers, to the ER nurses, ICU nurses, even Behavioral Health nurses. Emails and huddles about downsizing. Nurse- patient ratios. Decreasing nursing staff and increasing patients. ICU nurses typically had a 2:1 ratio and depending on the acuity of the patient, a 1:1 ratio. But as years went by, we watched our nursing world become increasingly unsafe. Decreasing our staff because we were told “for the sake of the budget.”

We watched the much needed and valued CNA’s and technicians disappear. Our EKG/secretaries disappear with less than a 2 week notice.

The degradation and devaluation of nurses.
We also watched the increase in CEO salaries… in the $millions/year not including their perks. The secrecy of “bonus checks” to our managers. The hospital board members receiving their financial bonus perks also. Every upper management padding their pockets as they rode on the backs of us nurses.

While we worked to keep patients alive. 12-14 hours a day. Rarely a 30 minute break. And rarely even a 15 minute break. The “tripling up” assignments. The dangerously unsafe assignments. The badgering and micromanage of managers. No matter what we did, how long we worked, Tripling our assignments… we were bad and awful and had to do better…. Better ….. or else we would pay the consequences. The threats.

The degradation.
The devaluation. Of us.

And then Covid happened. And then Delta/Covid happened. And with the mass refusal of receiving Covid vaccinations across our country, our ER’s and ICU’s filled up. Overfilled. Massive admissions of unvaccinated Covid patients desperately seeking to breathe. Desperately seeking ER and ICU admission.

And throughout these next two years, our ICU beds became scarce. It has become a vicious cycle. No ICU beds. No ICU/ER nurses. Ambulances and medics and paramedics backed up. 4 hour waits for a 911 call. Our healthcare system has become clogged, and failing.
And along with this crisis comes the emerging need for ICU nurses. For ER nurses. For Respiratory Therapists. Suddenly we are valued. And needed. And in high demand.
Suddenly, an ICU/ER nurse can make $5000- $10,000/ week with a travel agency.
And throughout years of physical and verbal abuse trickled down from CEO’s to our managers…. We fled for higher ground.

The staff members that stayed on board with their hospitals (without going to travel nursing) have not been compensated.

And a new degradation has begun.
ICU or ER staff nurse making $30-$40/hour standing and working next to a travel nurse making $5000 or more per week.
And hospitals not honoring the nurses that stayed on board but rewarding the travel nurses.
Is there an end in sight?

When this Covid potentially winds down… will we teach CEO’s, board members, upper management that we demand respect?
That we are college educated professionals?
Will Covid change the face of nurses throughout our country?

Time will only tell if lessons will be learned.
The greed of CEO’s and upper management is catching up with them.
And nurses are realizing and demanding their worth.

And I stand tall for all of the nurses who demand their respect and their worth.

By now, you know

By Debbie Moore-Black, RN

You know that if you don’t get vaccinated and you don’t wear a mask, you potentially will die.
You go to super spreader events, big groups at beaches, football games, baseball games… loads of people laughing and clapping and shoulder to shoulder.

Your refusal of the mask and Covid vaccination almost seems like a passage. Beating your chest. The survivor. It won’t happen to me.

Until you can’t breathe anymore. Delta, doesn’t care about your rights.
Delta could care less if you call the others “sheep”. Delta could care less that you refuse to wear what you call a “muzzle.”

Delta cares about you not having any vaccination protection and no masks and it jumps from one host to the next. Lodging in your lungs, heart, kidney and brain. Your lungs stop working. Delta throws clots to your lungs and heart, your brain.
It’s a virus. A deadly virus. It’s not a Republican and it’s not a Democrat.

So when you come gasping into any ER, begging to breathe because delta attacks your lungs first, we try to fix you if we have room in the ER or in the ICU. But now you’ve overcrowded ERs and ICU’s.
Now you’ve shut down elective surgeries even emergent surgeries because there’s no more room left in the hospitals.

You refuse a vaccine in your body. But when you come to the hospital everything will be forced into your body. An ETT (endotracheal tube), a central line, an arterial line, IV drips for low BP’s, a paralytic, steroids, Ativan drip and morphine.
A Nasal gastric tube through your nose and into your stomach. A sheath to introduce dialysis for your damaged non-functioning kidneys. Weeks to months on a ventilator and we can’t wean your oxygenation down.

You’ve seen the pictures. You see us nurses and doctors begging you all to social distance, wear a mask and get the vaccine.
But you refuse.
Is it your badge of honor to refuse the vaccine but choose to die?
You’ve refused the vaccination infecting your children and your children infecting other children.
Because of your self righteousness
You’ve played jeopardy on many lives.
No mask and no vaccinations

Picture what you’ll look like in a body bag.
Because this is your “the end.”

The COVID killing fields

By: Debbie Moore-Black, RN

I go to the hospital cafeteria to unwind from this night — another unpredictable one with irrational patients that randomly attempt to assault the staff.

This time, they missed. Behavioral health. Land of the psychotics and schizophrenics. But an incredible staff to work with.
This song blares out. “Easy Like Sunday Morning.” And I know that nothing is “easy” anymore.

I’ve heard it all about COVID vaccinations:

“It’s my body.”

“It’s not FDA-approved.”

“I have natural God-given immunity.”

“I’m not putting toxins in my body.”

But the facts are there.

The numbers keep rising.

The unvaccinated, who knew it “couldn’t happen to them.”

Certain states are overcrowded with COVID, Delta variant — mutated.

There are waiting lists to get into an ER or an ICU. Or to get intubated.

To say: “I should have gotten the vaccine.”

To say: “He didn’t make it.”

To say: “Death.”

Beyond ICU beds being rare, so are experienced ICU nurses.

You can’t clone an experienced ICU nurse, physician or respiratory therapist.

You can’t reawaken the soul of an ER nurse, paramedic or ICU nurse.

There’s a rationalization for the nurses. It’s coming down to quitting their profession because they are burnt to a crisp. Because they are afraid for themselves and their family. Or they are flocking to travel nurse agencies that offer as high as $5,700 per week.

This all creates a huge vacancy and vacuum in the nursing profession.

This could have been preventable.

But because of doubters, cynicism, resiliency, hoax theorists — your numbers are rising.

Soon, the light will go off.

The killing fields.

Unlike Motel 6, we won’t be able to keep the light on.

……

Originally published at KevinMD.com

The memories of a nurse’s old car

By: Debbie Moore-Black, RN

Today. Finally, a day off.

I could oversleep, roll out of bed, then make a pot of coffee — and prepare for a “do nothing” day.

But today is the day.

After dealing with more electrical problems on this 160,000-mile-plus car, I will say goodbye, turn in the keys, and walk away.

This car holds memories: Taking the kids to the beach. Driving to our last trip to the mountains. My best friend’s Miami wedding. Taking our kids back to college.

I’ll say goodbye to the other baggage, too: Watching my now-deceased husband back out of the driveway to anxiously go on another trip out of town to meet with his business partner/lover. Another speech to convince me, “it’s just business.” Another trip to the airport to watch him leave again to England to meet with health care officials to plan health care educational films with her.

And then there are the memories of pictures splashed across social media of the two of them snuggled up in the backseat of a taxi. Memories of the trip he took to Boston to meet his work crew. His business buddies. And her. And then more pictures of them toasting their glasses of wine at a restaurant.

Their smiles flashed before me as I worked my 60-hour week to afford nice clothes for our kids, nice vacations, and college for all three — to finally buy a lovely house and leave behind that dilapidated two-bedroom mobile home.

And then, there was that other trip he couldn’t wait to go on. Only he held onto a dark secret — excruciating abdominal pain. No one knew because he wanted to make that trip to see her. All in the name of “business.”

We all found out later that my husband suffered severe abdominal pain silently until he couldn’t take the pain anymore. We all found out later that he had liver and pancreatic cancer.

I drove him to the hospital over and over again in that car — for appointments to the surgeon, oncologists, pain control physicians, the hospital, and emergency rooms for his two heart attacks. I have the memories of “I’m not having a heart attack. Leave me alone and mind your own business,” to “Would you take me to the hospital … again?” to his funeral.

That trip was his final destination in the mountains. As the wind spread his ashes across the peaks, we all said the last goodbye.

This old car.

I tried to suppress the memories that it carried for me.

But today, I remove the anchor wrapped around my ankle that tried to sink me to the bottom of the ocean.

Today, I leave this car on the lot.

Today, I drive away — in a new car.

I open up the windows and breathe again.

………

Originally Published at KevinMD.com