That time my patient swallowed an entire bag of crack

By Debbie Moore-Black, RN

He was the middleman — the man that took the crack cocaine from the main guy, the drug dealer and then sold it to his “clients” and kept a percentage of the money for himself and the rest to the dealer.

It was a fine-tuned operation. You could make a lot of money. But you had to be precise, or else.


The patient was a tall, slim 20-something man. He had a fistful of crack cocaine rocks to sell. Before selling it, he decided he’d sample some of the crack. So he smoked it. And then he could feel his heart rate go rapidly. He got short of breath. Told his mom he didn’t feel well and that his heart was beating really fast. Mom called 911. He had sickle cell, which, apparently, doesn’t like samples of crack cocaine.

The medics hooked him up to their EKG monitor. Heart rate 180s. The medics sped to the ER, starting an IV and applying O2. He was in SVT.

Oxygen was applied, and adenosine was given, quickly, IVP.

He was transferred to the ICU step-down unit. After one night in the step-down unit, he was getting nervous. He had to get out of that hospital. He had a job to do. He had to sell this crack.

He cut his IV line with a razor blade. The nurses were suspicious, and they called the public safety officers (PSOs) to the patient’s room.

In his hospital room, PSO’s found razor blades and other drug paraphernalia, including crack cocaine pipes. The nurse and PSOs were quite suspicious. So the PSOs hung around as the nurse restarted his IV.

The PSOs did a visual check of his room, and he got scared. He was afraid they would find his crack. He had to leave that hospital soon, and he could not let them find the crack — that was money.

That was his money, his dealer’s money and product for his clients. He was a dead man if he didn’t get out of there soon. So making sure they wouldn’t take crack from him, he ingested a large clear lunch bag with crack cocaine rocks in front of the nurse and the PSOs.

What he swallowed was the size of a large round Christmas ornament.

And then I got the call. I was on call for ICU. Come in, stat. “You have a patient coming to you who just ingested a large bag of crack cocaine.”

This was a first.

Should the bag burst in the patient’s GI tract, he could have a sudden cardiac arrest., seizures or brain bleed. The crash cart was pulled up to the patient’s new room in the ICU.

I explained to the patient why he had to have an IV, why he had to be on an EKG monitor and why he had to have a crash cart in front of his room.

That what he just did was a recipe for disaster and sudden death.

Per poison control, I started a bicarbonate drip to potentially neutralize this lethal dose should it burst inside of him. We also gave the patient kayexalate, hoping that the crack cocaine would increase motility through this induced diarrhea and have crack come out while he excreted.

Everything we did, we explained extensively to him. We now had to attempt to save his life.

During this course of this regimen of care, we frequently had to change the patient’s bed sheets. Sometimes the patient would put his fingers up his rectum. Unsure of exactly what was happening, I sensed that the kayexalate was working its magic.

And there it was: A plastic baggy partially hanging out of his rectum.

“There it is,” a fellow nurse yelled. And with that, the patient jumped out of his ICU bed, tore off his gown, tore his IV out and ripped off his EKG electrodes. He was naked, and he took off running out of the ICU. I chased after him, along with another ICU nurse and a CNA to follow.

A “code gray” was repeatedly called overhead. Code gray is a call for all PSOs, stat.

The potential danger, assault, aggression is why we call a code gray.

Our ICU is on the same floor as the walkway to our orthopedic hospital. A clear glass walkway where cars could drive underneath this bridge/walkway. A large oversized banner proclaimed, “Excellence in care. Excellence in medicine,” right where all of the motorists could see.

The patient almost made it to that walkway. This tall, thin, naked man with a baggy of crack cocaine halfway hanging out of his rectum.

And the PSOs finally grabbed him and pulled him to the floor. He was a strong man. It took four PSOs to tackle him to the ground.
And there it was. A lunch-sized bag, intact and filled with light gray colored crack cocaine rocks.

With my latex gloves on, I pulled the bag of rocks out of the patient’s rectum and handed the bag to the PSOs.

The patient was wheeled back to his ICU room.

Two days later, during our busy visiting hours, the patient put his civilian clothes on and slipped out, looking like one of the many family member visitors.

He slipped out, and no one noticed he was gone. He slipped out somewhere into this large city, most likely hoping not to be found by his dealer or by his clients. We’ll never know his outcome, but we can’t imagine it was a good outcome.

Though this story is a decade old, it is repeated by nurses and doctors as if it were folklore.

But it is, most likely, a one-time-only true story.

Originally published at KevinMD.com

Image credit: Shutterstock.com

An executive father. Alcoholism. And the gallon of wine.


By: Debbie Moore-Black, RN

By: Debbie Moore-Black, RN

As I walked through the wine section at the grocery store, I spotted those gallon jugs of wine. I was searching for Christmas presents for my friends. But that brand glared at me.
Daddy.
My IBM executive daddy. We loved him so. But year by year, his demons took over. Every night, a gallon of wine. On weekends he’d alternate with a case of beer. But it was one or the other. No fail.

When I finally got my driver’s license at 17 years old, my job every weekend was to get dad his case of beer. I knew it was wrong. But I felt I didn’t have a choice. He was a loving father for a long time. And funny. His dad came straight from Ireland and my dad was proud of his heritage.

As kids, we only saw dad on the weekends. But he always brought us toys. He was engaging while we were young. He made us laugh. He was our world.

Dad moved up the corporate ladder. The big house was built on the “right” side of town. Private school for us 4 kids. A lake house with a matching boat. Mom wore designer clothes.

On the outside, we were this prosperous family.
On the inside was neglect and verbal abuse, and taunting. Our perfect family began to spiral out of control. I was the forgotten child. The invisible one. And I tried to stay invisible. Because, why would I want to go to proms or football games or basketball games when I was told repeatedly by my mom and dad, that I was fat, and stupid and ugly?

By the time I was in highschool, I watched my dad run into the walls, sometimes he’d fall to the ground. I’d hear my mother cry at night.

We all have our baggage, but by the time we became adults, I was certain it was guardian angels that raised us.

Dad lost his executive job. We were told he took “an early retirement”…. But that was just another lie.
He lost his lake house. The place I loved for its calm waters, gentle breeze through the trees and the quiet peacefulness.
Dad started working for another accounting company and shortly thereafter lost that job too.

As I got older, and finished college and became a nurse, my husband and I had our first child. My pride and joy. By the time we had our second child, I sank into a deep depression. I wasn’t sure if it was postpartum depression. But I felt frequent gloom and doom.
I diagnosed myself and felt it had to do with my parents … the depression and the suppressed thoughts I lived with for so long.
I started therapy sessions and I joined “Adult Children of alcoholics.”
There was one important message I learned from this: you can’t go through life blaming your parents. Eventually you have to deal with the past and grow from the cards that were dealt to you.

Some things can’t be forgotten.
Sometimes it’s that one thing that scrapes the cobwebs of your mind.
Like those gallons of wine at the grocery store.
Like those pretty dresses at the stores that were never attainable because we frequently wore the same clothes every day…. And were laughed at… while mommy wore designer clothes…

Mom died at the age of 63. Colon cancer. I felt no remorse. I cleaned her bowel movements in her bed along with the assistance of the hospice technician. I felt obligated, but I held no love.
I had sadness when my mother died. Sadness for the mother I never had.
Dad died at the age of 77. I ripe old age for an alcoholic. End stage liver disease. I saw him minutes before he died. Just a shell.
A sad life consumed in misery and alcohol.

I chose to remember dad’s sense of humor. The times he made me laugh. The time he brought me flowers when I graduated from Catholic school. The time he insisted on walking me down the aisle, though my mother warned him not to since my husband and I had “lived in sin” before we got married.

A controlled, sad life.
That gallon of wine.

Start with yourself: A reminder to give love and kindness

By: Debbie Moore-Black, RN

Were you neglected by your parents? Neglected of basics like clothes to wear or a tender hug or a simple “I love you?” from mom or dad, or both?
Were you shunned by your classmates because you wore the same clothes every day while your mom wore designer clothes and your dad was a business executive?
Were you called short and fat and ugly.
Did you have the lowest opinion of yourself and not even know that you were this beautiful shining bright star?
Did you crave the first drop of breadcrumbs from a man/or woman who was really just interested in themselves?
Did you marry that man/woman? Always craving for them to love you?
Did you religiously go to church and scream out your “Christianity” while all along you bashed the shy guy, the gay guy, the different guy.
Did you cast stones at others to make you feel better about yourself?
Did you embezzle, cheat on your wife or your husband….multiple infidelities?

You know what?
We all have cast the stones.
And now it’s Christmas time.
A time of cheer and hope.
A time of renewal.
A time to be that better person.
A time to shed your layers of coats. A time to look at yourself deeply in the mirror. Put down your addictions. Go to AA. Go to Narcotics Anonymous. Find and go to a licensed therapist. Seek a higher power.
Help out at soup kitchens, give to the poor, the destitute, the forgotten children.
Throw your troubles in your bucket.

And start anew.

#Kindness begins with yourself.

There is a light at the end of this tunnel.
There is a hope for a new tomorrow.
That door that closed on you, the window has just opened.
There is peace and harmony and love within yourself.
And it begins with yourself.
Reach out.
And send peace and kindness.
It could be that first step that you breathe a new breath.
Live and love.

#kindness begins with yourself.

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.