By: Debbie Moore-Black, RN

Her back is mottled. She could barely sit up. Weak from her invasive cancer

I visited her on this Easter Sunday.  Maybe it was God’s will that I didn’t have a pageantry of an Easter spread dinner table with ham and rolls and pies and house decor filled with decorative bunnies…

And I go to visit this dear friend I met by happenstance years ago.  She and her dear husband  always seemed to help me out.
Pure. Unconditional. Love.
Always kind and helpful to me.

I held her weak hand and said I did not know how I stood on the hierarchy of the ladder to Jesus but that I always keep her in my prayers.
And in her whisper she told me that God heard the smallest of prayers.
It was comforting but sad.

Till the end she held strong in her faith as cancer invaded her breast and lungs and lymph nodes and bone and spine and liver.

I assisted her husband changing the dressing surrounding her chest tube poking out of her. This day we drained 650 cc’s off of her lungs as it slowly trickled into the pleurovac.

Such a vibrant life filled with love and family and books, as she loved to read, and her deep love for her church family and her spirituality.

I was amazed and perplexed over the sadness of this all but I could feel the love of her husband and daughter.
There was a peaceful aura of Godness in the air. Not a panic. But a calmness that filled the air.

I knew it was only a matter of time before God opened the skies and lifted this dear friend into His kingdom.
She was only in her 60’s and we always wonder why?

The Bible says we don’t know the hour of our death.

Two days later her husband requested that I come check on his beloved wife. It was time to drain her pleural fluid again but she was sleeping.
I immediately came to their house.
She was unresponsive. Agonal breathing. Her family thought there was more time.
We always hope for more time.

Anxiety and pain eased up as she lifted her eyes to the heavens and then peacefully closed her eyes. With a slight smile on her face. A peaceful smile.

She had left this earth with a grieving tearful husband and daughter.
And we question why.
To only know that her reward in heaven is what she lived for all her life.

Rest peacefully my dear friend.
You are in the House of the Lord.

Pictures of happiness we never knew

By: Debbie Moore-Black, RN

I wish I could have known him.

That other side of him.

I look at his obituary pictures. 

Family, friends and colleagues sharing pictures of you smiling and laughing. Hugging each other. Smiling ear to ear. They were sincere smiles. Sincere happiness.

I wish I could have known him.

He was brilliant. One of our main ICU physicians. He could meticulously turn a critically ill patient around. With this Intensivist, there was hope for the patients.

But….

The side of him we knew.

Angry. Short tempered. Screaming at us. We were experienced nurses. We knew how to be great ICU nurses.

But we feared him.

His was a bulldozer who showed us no respect. He degraded us.

There was nothing we could do to gain his respect.

We were a failure in his eyes.

And every time he came into our ICU, we wanted to hide. 

Because the screaming would begin.

Relentless verbal abuse.

Management wasn’t there for us.

It was: “deal with it”

He finally left us and went into his own private practice.

We finally gained some type of peace while we re-collected our self esteem. 

We were there for the patients.

We were there to put these tattered multi-system organ failure patients back together again.

A new team of Intensivists came to us slowly. One by one. We were restored, as we began to create a new ICU unit filled with respect. With camaraderie. With sharing each other’s information and respecting our collective expertise.

I’m sad that as brilliant as he was he couldn’t find joy or happiness with us nurses.

Somewhere he had a demon that walked through our doors terrorizing us.

I’m glad you had some happiness elsewhere. Your pictures show us that other side that we never knew.

We wanted to respect you.

But you had too much anger in you.

Whatever you were facing, we may never know.

Rest peacefully.

I wish we could have known him.

By: Debbie Moore-Black, RN

PhD. Big man on the psych unit. Eighth floor. He puffed on his pipe as he sat behind that powerful mahogany desk separating him against them…as he listened to dialogue. One after the other.
The broken. The misfits. The psychotics and schizophrenics. Bipolar.
Beaten at birth, physically and emotionally.
He was the God in the land of serpents.
He’d select one by one. ECT. Electroconvulsive therapy.
Electrodes to their heads, mouthpiece in place. All clear. Surge of electricity to their brain as they went into a grand mal seizure.
They filed out. One by one. Zombie. Not remembering the present but knowing the past.
Eyes bulging. In a daze. And they’d stumble back into their room.
The psychiatric unit. 1970’s.
Murderers. rapists.pedophiles.domestic violence.Homeless. nameless
We got them all.

And after 2 years as I transitioned from LPN to RN I saw no cure.
Filing in and out, open door, revolving without a cure.

One pill makes you happy. One pill makes you small and the one the doctor gives you doesn’t do anything at all.

I ventured away and toward ICU nursing for 34 years and near retirement I thought I’d try psych again.

Nothing changed. FBI. Watching you. Poison in my juice. He’s watching me. I’m pregnant with Jesus. I am the Virgin Mary.
They had titles. A rapist a murderer a kidnapper. Violence.

I was assaulted twice. Randomly and unprovoked. Two CAT scans later and realized there was no cure. No pill that would alter them into the right direction. No algorithm.

ECT changed. Anesthesia now. With an anesthetist. Valium IVP. And a petite mal seizure.
Filed back to their unit by wheelchair after a recovery room period.
And they still didn’t remember the present but knew the past.

I left this time for good. Feeling no hope. For this population that may have had a chance at birth but were born defeated.

Behind his mahogany desk as he puffed on his pipe. He had all of the answers as he manipulated his existence on his throne.
Female nurses bowed down to him in adoration. Male techs walked by without eye contact.
He was feared. He was the god of the psychiatric unit.

With all of the answers.
But no answers at all.

…………….

(Google stock photo)

By: Debbie Moore-Black, RN

I was afraid to go to football games and basketball games.
I was afraid that they would look at me.

I was conditioned to believe I was short fat ugly and stupid. I’d sit in my bedroom, record playing, lights out…. Alone. On one of the biggest football nights. Over and over again.

I was short but I wasn’t fat or stupid or ugly. I had long red hair that curled naturally. I was a mixture of Irish and Italian but obviously carrying the recessive gene.

“You look like a monkey” as my mother looked at our Easter pictures …. Picture after picture of my mother’s distaste for me.
Deborah would you like more potatoes? Laughter, taunting, ridicule …daddy running into the walls after his case of beer. Losing his IBM director job, losing his accounting firm job, losing our lake house. My only solitude.

Watching my friends go off to college… and I was told I had to stay at home and go to a community college and become a nurse.

I never wanted to be a nurse.

In my dreams I was this journalist for the New York Times, with my one bedroom condo in Manhattan….
Instead I did what I was told and stumbled through Nursing school.

When I graduated, the ER at a small hospital in a small town urged me to come on board. And I eventually was promoted to manager.
Big fish in a small tank.
I wrote policies and procedures and bought defibrillators, held hands with Joint Commission and did staffing and taught BLS (CPR) and eventually had our staff get their ACLS certification… which was a big deal back then!

GSW’s, domestic abuse, cardiac arrests, respiratory arrest, delivering babies and catching the placentas and too many children with parents who were their abusers.
Child abuse wrecked me and I had to leave.

Adult ICU caught my eye and I joined the team. ICU was addicting. Ventilators and dialysis and central lines and PA Lines (Pulmonary Artery/Swan Ganz) and arterial lines and CRRT and CPR, multi system organ failure and a team of doctors and nurses and respiratory therapists that became my new family.

And along the way I met the one. I thought.
My magic man, my last hippie on earth who dazzled me and charmed me.
And though i was deemed as short fat ugly and stupid by my parents, this man lifted me up. I was on fire. Until I wasn’t.

He was not a good man. To me. A narcissist who never had enough. Women. I was so naive I didn’t know.
Not a good man but we created good children. So I kept on and on pretending it was a good marriage until his death.
And I was finally free.

I haven’t been on a date since. I’m too afraid of making that same mistake. So I don’t.

Retired from nursing, I sometimes miss it but not enough to clock back in again.

I may never know why parents create such beautiful children and turn them into frightened animals.
I guess there was not a lot of therapy back then. Obviously not enough self awareness.

You can be whatever you want
Especially when you lift that veil of
discouragement. Of negativity.

I am not sure of why I am here… maybe this is what I was supposed to do all along… was write about what everyone was trying to hide.

Write about the insecurities, the hate, the anger, the addictions, the abuse. Write about triumphs and tragedies of ICU nursing. Of peaceful dying and deaths and brutal dying of CPR and cracked ribs and ventilators and last hope treatments to patients who are futile but families insist on “everything.”

I finally opened up the curtains in that large dark house that kept all of the secrets.
But in the end, everyone knew the truth
We just didn’t speak it back then.

I’m here now loud and clear to open the curtains of lies and deceit and betrayal. The curtains are opened along with the windows.

Let the light in.

That’s the way it’s supposed to be.

By: Debbie Moore-Black, RN

TRIGGER Warnings: Near Suicide attempt, domestic abuse, Infidelities of husband, poor “marriage”, cancer, death. But with much therapy and raising wonderful children…. A thankful life filled with grace and thankful that I did not end my life.***

I sat in that dilapidated trailer. Alone. In the woods. Five acres of trees that crowded the blue sky.
My fist was filled with aminophylline pills. 60 pills to be exact. I was an asthmatic. I figured 60 pills would be enough to end it all. Maybe V tach and then death. No one would ever find me. Not in this forest.

We moved there to get away from the city. To be pretend hippies and live off the land.
We were young lovers. I truly thought I found my magic man. I was naive. I didn’t know. That his love, his gas lighting, his incredible charm was really a bunch of red flags.
When all of your life you’re told by your parents, your core, your safety net, you’re told, like a broken record, that you’re fat and ugly and stupid.

And he, the magic man, throws breadcrumbs of love. And I grabbed them. Because it’s all I ever had. Were his breadcrumbs.

For four years I thought we lived in bliss. He’d stare into my eyes and tell me how much he loved me. And I believed him.
I was in the middle of nursing school. Halfway through. I was almost there.

And he started to distance himself from me. Coming home late from work. Sleeping on the couch. Going on business trips with her…. But it was all “business.”
After four years of our new beginnings. Our first four years of marriage the truth was revealed.

My husband. My magic man. My everything was having an affair with a woman he was working with. Four years. Our marriage of four years. Just a farce.

The day I found out was the day he left me and ran off to Texas where his brother lived.
He packed his bags. He said he had to take care of himself. I said and finally realized that’s all he has ever done…is take care of himself.

Her husband was a deer hunter. Grabbed his gun and was going to come after my husband.
A country song couldn’t have done this justice.

Four years of marriage. Four years of my husband deceiving me and having an affair.
In the middle of nursing school.

I held the 60 pills in my hand.
I looked at the Bible. I prayed.
Pink Floyd was on the record player singing “Shine on you crazy diamond”

I stared at the pills. I felt crazy. But I knew I was a diamond. I chose not to ingest these pills.
I chose to finish nursing school.
An older nurse told me to wrap my troubles in a blanket and send them up to God.

He was a continuation of my parents.
I had poor survival skills.
Afraid to go out. But afraid to stay in.
But I chose not to take my life.

Eventually we tried to repair. Three children later brought me great joy. And I loved my life through them.
Because though my husband came back to me with a litany of forever apologies…. He never changed his ways.
He was unfaithful to the end.
And in the end
After his liver and pancreatic and lungs and lymph node cancer
We scattered his ashes into the winds on a mountaintop.

Though I’ve had a tormented soul, there had to be a guardian Angel watching over me.
And I look into my little granddaughters eyes. Their innocence but brilliance. Their magic. Their beauty. And there’s nothing more in life that I want or need.
But my children. My grandchildren and my puppies at my side.

Don’t give up.
Call for help.
Help is available.
Call #988
That little light inside of you shines through.

By: Debbie Moore-Black, RN

I finally found time after my retirement, to clean out my nurse book bag.
Stethoscope. Extra Playing cards for patients, highlighters, various pens, penlight, a notebook of important phone numbers throughout the system, tourniquets for IV’s. And a plastic whistle.

This is a $5+ Billion/year revenue at this healthcare system that sprawls throughout America…Let me explain.

This specific Behavioral Health unit carried the highest of acuities. Paranoid schizophrenia, bipolar, psychotic, delusional, paranoid, adding to this mix: a semi-vacation for some in prison. Prisoners who feigned suicidal ideations to gain entrance to our unit. A pillow case wrapped around their neck would get them into our unit. Speaking out loud to the “voices” and Worse case scenario, smearing their feces on the wall…. Would give these prisoners with these gestures a 2 week stay at our Behavioral Health. More like a hotel than their prison. These prisoners carried titles of murderers, rapists, kidnappers, domestic violence….and they all came to us.

We had a mandatory class to attend each year to protect ourselves. CPI. Crisis Prevention Institute. This training/exercise was to help the staff in deescalation skills and to help us manage patients through specific maneuvers also preventing potential assault from the patients. Although the exercise we practiced yearly, you pretty much had to be a pro at this to be ready and aware at any time especially during random acts of assault.

We registered our fears and our complaints to upper management asking frequently for security guards to be on our unit 24/7 for not only safety of staff but for the safety of patients also.

Instead, we were all handed a plastic whistle to carry in our pocket should we be attacked by a patient.
A plastic whistle.
Not an electronic gadget that you could press easily in your pocket, but a plastic whistle that you would have to pull out of your pocket and blow… hopefully before the patient attacked you.
The 24/7 Security guards were denied for us.
Not in the budget.

So we climbed the email hierarchy ladder and beyond an email to our manager and all ANM’s (Assistant Nurse Manager), we added our CEO. Not just requesting 24/7 Security guards to our unit.
But begging.

The CEO never replied.
Our manager verbally reprimanded those that added the CEO to the emails stating that he was not considered part of our chain of command.

And so instead, staff and patients alike were getting physically assaulted, spit upon, attempted strangulation, beaten over the head, a fist to the face…. The list is long.

I knew that it was time to exit when the truth was at any given time, a patient could snap my neck at one random gesture.

Since I had already been physically attacked twice on that unit, for my own safety I soon retired.

Because I knew management, and the CEO really didn’t care about our safety.
This $5+ billion/year revenue in this hospital system.

And I knew this plastic whistle would never save my life.

By Debbie Moore-Black, RN

I treat myself out to that same restaurant for breakfast like once or twice a month.
And there she is again. The same waitress. With those same sad eyes.
She knows my name but I don’t know hers.
Sometimes she has a bruise on her forehead or bruises up and down her arm. I can see through her makeup.

My heart bleeds. Because even though I don’t know her… I know her.

It’s pure speculation…. But The signs scream out.
The withdrawn downcast eyes that are filled with sadness. The partial smile that can barely do so. And the telltale bruises.
Usually physical abuse goes hand in hand with verbal abuse. That slow seeping of degrading, disrespectful gestures and words. That constant verbal abuse that tells you you’re worthless. You’re nothing without him.
I know the signs well.

When you feel so trapped. No way to climb out. Stuck. And you rationalize and pretend everything is fine.  And then you blame yourself for being an unworthy person.

The nurse in me wants to hug her tight.
I want to scream and shout: “Get out. Find safety. Find your self worth.”
Nobody ever deserves to be treated this way.
I finally got my freedom. But it takes years to shed the abuse. It comes back to you in flickers when you least expect it.

There is help out there. Now more than ever.
Get out is an easy term but carries so much baggage.
But it can be done.
Remember that song in kindergarten or Bible school? “This little light of mine… I’m gonna let it shine”
It’s there. That light. I promise.

I tip her well. Hoping for a minute of happiness for her. And I finally ask her what her name is.
Alina. She says.
I wish her a wonderful day and thank her.
I’ll keep her in my prayers. Prayers for safety and love and peace.
My eyes well up. As I get in my car, I look up her name.
Alina. Greek origin. That means “light.”

Please reach out.
There is help out there.

Call: 988
Call: National Domestic Violence Hotline 1-800-799-7233

By: Debbie Moore-Black, RN

We were not well versed. We nurses on Behavioral Health.
I finally left ICU nursing after 33 years. I was close to retirement and I thought Behavioral health would be so much easier than ICU.
But the old comparison of apples and oranges held true. There was no comparison of ICU to Behavioral Health.

We admitted a female patient 33 years old. She was angry. She had random outbursts along with hitting patients and staff members. No reason and no cause.
Her first day she let us know she was a female. Though she presented herself with a typical male attire, with very short cropped hair, she demanded we call her Lisa.
The next day she was a male. And Lisa became Tommy.
By the third day Lisa, then Tommy now became they/them.
It was confusing to the staff and to be safe we would call the patient by the last name.
The outburst continued. Random spitting and hitting of staff and fellow patients, that we were forced to put the patient in isolation. Basically to protect the other patients and the staff from Lisa or Tommy or They/them.

We had a mandatory zoom meeting from the social workers. They felt the staff needed to be educated. It almost felt as if it was a reprimand though. We were a busy unit. High acuities with varied diagnosis’ of schizophrenia, paranoid schizophrenics, bipolar, psychotics. These patients usually were non- compliant with their medications upon discharge. They did not go to therapy… our unit was a revolving door.

During the zoom meeting, the social workers insisted that we call the patients by their perceived pronouns. That we must respect their pronouns. But every day with Lisa was a challenge. There was no rhyme or reason to what the pronoun was for the day.

I interjected to the social workers, “but right now we have a patient insisting we call her “your majesty, the Queen of England”, another patient was Jesus, and a female patient was pregnant with the baby Jesus. So where do you acknowledge the patient with their pronouns or with their bizarre titles? Where do you draw the line?”
We added that the patients were expressing delusional thoughts such as being Jesus, the Queen of England, the FBI.
Where do you clearly tell the patient that this is a delusional thought? That this is not reality.

The social workers agreed that those titles were of delusional thinking …. But as other nurses piped in: where do you draw the line.
If a patient is one day a female, the next day a male and the next day a they/them is this also delusional ideations?
The social workers agreed that calling a patient Jesus or the Queen of England would encourage their delusional thoughts.
So it was decided that we would not acknowledge those delusional thoughts but we would acknowledge a patient’s pronouns even if it changed every day.

I would be the first to say I am not knowledgeable about gender pronouns and identity but would it possibly be fair to say that there is definitely gender identity confusion? And if so when did this start? Maybe during childhood? Maybe during some traumatic event?
It became clear that with all due respect we would only call the patient by their last names.
The reality was if we called them what they wanted us to call them for that day, the random outbursts, anger, screaming and physical assaults would continue.
And we had to somehow keep a level of calmness in this very volatile behavioral health unit.

Lesson learned: that although ICU patients were complex and challenging there was usually an algorithm to match their disease process.
In Behavioral Health there was no algorithm.
There was no finite answer.

(“FOLLOWERS” may comment appropriately.
Trolls/Scammers/hate comments will not be permitted)

*Google stock photo

By: Debbie Moore-Black, RN

We lived in the woods. 5 acres of trees. You could barely see the sky. We left the big city, for this piece of heaven. And by chance we met a couple that had a 5 year old daughter. Our son was 4 years old. They became best friends. They’d swing on the swing set, play in the sandbox and they’d splash each other in the little pool we had.
Kayla was this sweet tiny girl. Creative, artistic and smart. Her parents were like us. Pretending to be hippies and so called “living off the land.”
We had play dates, went out to eat together and we all became fast friends.

Kayla had long blonde hair. She was quiet. But she was a smart beauty.

A week passed and we hadn’t seen each other.
We called and called. And finally Kayla’s mother answered the phone. Barely able to speak, she was gasping in between breaths.

Kayla woke up in the middle of the night. Screaming. A blood curdling scream.
“My head hurts, my head hurts”.
Her parents rushed her to the hospital.
They figured an ambulance would never find them out here in the woods. This lost paradise.
Kayla’s brain was scanned.
Diagnosis: AVM. Cerebral arteriovenous malformation.
I was just starting nursing school and I knew very little of what an AVM was.
Arteriovenous malformation. An abnormal connection between the arteries and veins in the brain that usually forms before birth.
Many times it is undetected. With no symptoms. Until their is a rupture of one of the blood vessels in an AVM.

A stat MRI confirmed her AVM.
She was rushed off to surgery.
The neurosurgeon worked on her relentlessly. The risk was high. The prognosis was poor.
All of her long blonde hair shaved off.
All we could do is hope and pray.

But she remained in pediatric ICU.
On the ventilator.
Neurologically she never got better.
Her parents were zombie-like. Their precious Angel. No previous symptoms.
The light of their lives.

And she was pronounced dead after two days in ICU. There was no brain activity.

Somehow we all drifted apart.
We told our son that his little best friend is with the baby Jesus.
He was 4 years old and never quite understood what happened to his best friend.

As tragic as this was, Kayla’s parents chose to donate vital organs to other children.
They found out that little Kayla’s heart was a compatible match transplant to another little girl who had a severe heart defect and only had a few months to live.

We went to the funeral. The sadness was palpable. The little mahogany casket with bright daisy’s on top. Her favorite flowers.

The preacher talked about Kayla. Her love and sweetness. Her very short life.
But he also talked of how Kayla lives on. And her spirit is alive.

How do you lose a child, but choose the most unselfish act of giving life to another?

Sweet Kayla with her long flowing blond hair.
An Angel here on earth for just a short time.
But her spirit lives on.

The gift of life.

…..

Organdonor.gov
(Photo Google stock)

By Debbie Moore-Black, RN

I wasn’t suppose to hear this. But I did. It sealed the deal for me.
It was one of the reasons I had to finally leave my true love. My passion.
ICU nursing.

After 33 years as an ICU nurse, I sadly knew it was time to go.

I use to feel like I was purposeful. I use to think I was a dynamic part in saving lives in the ICU.
I lived and breathed ICU.
I was a charge nurse, a mentor, a preceptor. I attended the AACN meetings, I was the leader of the Shared Governance Committee, I was on the Rapid Response Team (RRT) and I obtained Level 4 RN which was the highest attribute you could earn as an ICU nurse.

But as the years passed, I watched patients with multi system organ failure come through our doors, usually the aged population, many with their own DNR/DNI papers and listen to the family members scream at us nurses and doctors: “Do everything.”

And unfortunately, the theory was that we had to honor the family members regardless of the legal DNR papers…. Because families can sue, dead people cannot.
And so we did.
We did “everything.”

The vigorous and fast CPR pounding on their brittle chest, hearing and feeling their ribs crack. The inhumanity and brutality I felt as we dishonored these poor souls.
But we were forced to do so.

The patients lay motionless on the ventilator, wrist restrained, turned and repositioned to prevent decubitus ulcers. Their vacant stare of what truly was their hell on earth.
Because this was not living.

This new manager had her masters degree. She had no ICU experience but apparently was a “good fit.”
She knew the “corporate commandments” and she knew them well.
She also rattled off reasons for why the budget was so important.
She slowly eliminated our care techs, secretaries and CNA’s, many times leaving us with skeletal staff.
And then came what I perceived as ageism.
Some of the older nurses with incredible experience were being put under the microscope, upper management second guessing us.

At first I didn’t comprehend what was going on until I overheard: “We can get two inexperienced young nurses for the price of one vintaged experienced nurse”.
It truly was a gasping moment for me.
Like how could any manager be ok with attempting to eliminate the experienced nurses?
But we soon learned that Corporate hospital America had sold their souls.
Not only are the nurses a “number” so are our patients.

Top CEO’s for “for- profit hospitals” can make yearly salaries into the millions even for non-profit hospitals. And their incentive pay and perks which add several millions.

My Grande finale was when we were told we would have a 3:1 assignment in ICU.
We were a high acuity ICU. 25 beds strong. Many patients were on ventilators and life saving IV drips like Nipride, Levophed, Vasopressin, add a central line and an arterial line, maybe a swan ganz line (PA or Pulmonary artery line), CT scans, and Code Cools and proning, ECMO, our duties were endless. And it would be 12-13 grueling hours non-stop without a break.

A 3:1 assignment was the end for me as I truly felt that if I did not protect my nursing license that I worked hard for… than nobody would protect it. Not even my ICU Nurse manager.

So I turned in my resignation.
I said good bye to my true love. ICU Nursing.
I could no longer bare to treat patients with haphazard nursing practice that was forced upon us by management.

I have those flashes of memories, the patients that were triumphs, the tragedies and sadness, the nurse camaraderie.
Memories to last me a lifetime.

The corporation. They may never know what we as nurses do relentlessly to save a life.
Would they ever look in the mirror and come to terms with greed becoming their god.
My prayer is to have a mandatory
safe nurse:patient ratio across our America.

Two for the price of one!!

(Photo: Getty Images Stock Photo)