April 2019 – Do Not Resuscitate

Originally published on KevinMD

I was 5 years old on a busy New York City street with my mom, dad, and two sisters. A large man in shabby clothes holding a garbage bag in his hand stood on the corner waiting for the light to change.

My dad reached into his wallet and handed the stranger a $20 bill, patted him on the shoulder, and said, “Have a good day, my man.”

Dad knew everybody — even strangers, it seemed.

Back then, I didn’t know what poor was, but I did know he was a stranger and dressed oddly. And I knew that $20 was a lot of money.

No one explained anything to me, and we just kept walking.

Now, I was raised in the Catholic church where only Catholics go to heaven. We prayed for the “public” children and their parents because they weren’t Catholic. They were going to hell.

If you missed a Sunday mass, a very large, dark spot appeared on your soul — you’d be going to hell too.

I became defiant as I got older. I met the man of my dreams — or at least thought I did. He was this pseudo-intellectual hippie with Afro-eque hair and a long, unruly beard. His eyes were beedy and blue complementing his thin frame in a way. And he would always smoke those cigarettes. He was my magic man. We played music together, wrote poetry, too. I inhaled and exhaled his every word.

We bought a trailer on five acres, and we were going to live off of the land. I dumped my Catholic religion. As my parents said, we were “living in sin.”

But I was naive and young and came from a dysfunctional family with a mommie dearest and alcoholic dad. Daddy would drink a gallon of wine a night and bump into walls. Here he was Mr. IBM man who sent us to private Catholic school and owned the big brick house on the good side of town with a cute lake cottage and boat. The big, dark house disguised the sadness, the dysfunction, the negligent parents. The screams of emotional and verbal abuse. The message like a tape recorder over and over again:

“You’re dumb and stupid and not pretty.”

I thought I broke through — I became that nurse Mom told me I had to be!

We married and had three beautiful children. Before baby three, there was no future vision from my husband. Are we to stay in this two-bedroom trailer?

There was no movement from him. And so I got a second job as a nurse and saved money for a down payment to move out of that trailer and never look back.

It was a sad and tormented marriage. He had many lovers. Many infidelities. And though I put my heart into raising our children with the greatest joy, I always felt degraded and disrespected — and sad.

My husband, Ted, led a life of being a computer guru, public health servant, awesome father, and friend to others in the neighborhood, even a surrogate father to some.

Ted carried a glow to his universe.

I’d work 60 hours a week as a nurse to make ends meet. I worked until I was exhausted.

But I carried on.

Thirty-seven years of marriage. And then my life came to a halt.

Tormented years of marriage, of the infidelities, of the emotional abuse…. sadness and loneliness and always wishing for that happy marriage that never happened.

And in a blink of an eye, the only man I really ever knew, was gone. Liver and pancreatic cancer with mets to his lungs.

And today I wake up alone except for my pups; they stay by my side. I’ve been through therapies to lessen the pain, the anger, the sadness, and the loneliness.

And it was recent that I woke up one morning, as the sun squeezed through my blinds. I had tears in my eyes.

I had rejected Jesus for a very long time.

But today I felt Him.

The five-year-old in me remembered my dad handing a poor man $20.

And there he was. Jesus.

The Jesus in all of us.

Kindness and love and forgiveness.

I felt that glow that I had lost long ago.

An old poem that I had cross-stitched many years ago came out of my top drawer.

Maybe an anonymous author:

He spun a thousand webs to capture me
One was faith, and one was simple grace,
A strand broken out into the wind …
I look today at all the tattered ends
And wove a web of prayer back up to Him.

Tonight I walked the dogs. And I looked up and saw the Big Dipper. I hadn’t looked up in a long time.

The beauty of this universe, the stars, the flowers, the oceans, that newborn baby. The mountains.

I stand stripped and humble.

And willing to forgive others.

And to forgive myself.

Originally published on KevinMD

These events happened over 18 years ago. Some content has been changed to protect the innocent and the guilty. Searching for positive changes in the health care industry. We are not a number, and the patients are not a number.

I’m not good at lying. My eyes go to the left or look downward, and I start to stutter and pause. There is no eye contact, and I fall deep into the black tunnel of deception and fight to get out.

I grew up with lies and deception.

“Your father is taking ‘early’ retirement.”

My father, who I adored, who was an executive at IBM. He was fun loving and completely Irish — he also walked into walls at night after his gallon of wine. It was the family I couldn’t fix. And the daddy I loved so much … he was unfixable. We had the new large house on the right side of town, a lake house on two acres and the boat that matched. The nuns at my private Catholic school demanded respect.

Daddy was a “heavy drinker” as mom would say.

Daddy was an alcoholic.

And though I would have never wanted to be a nurse, the 1970s were full of dreams and women’s rights and burning bras, but my mother dictated our household. No matter what dreams you may have, you still would become a nurse, a teacher, a wife, a librarian. And I emotionally fought tooth and nail at my new role in life. The dreams of running away from that dark house that hid the truths and running towards fresh air and freedom were all extinguished — and my destiny was to be a nurse.

Mother said I was to be a nurse.

It was psychiatry then emergency nursing then surgery and PACU. I finally landed in ICU. And how I loved it. I enjoyed the intricate puzzle of multi-system failure organs. Heart lungs kidneys brain liver pancreas … they meshed well. This well-oiled machine fell apart piece by piece, organ by organ.

I was sold. Maybe mom was right. Perhaps I was supposed to be a crusader for the sick. CPR intubation drugs IVs, CAT scans and MRIs ventilators dialysis balloon pumps surgeries. Some made it through and smiled at you as they graduated from ICU to the step-down unit to out the front door. Some did not. Sometimes the thoughts and prayers from family members didn’t work at keeping their loved one alive. Sometimes Jesus decided it was time to go home. Sometimes Jesus would say “you don’t live forever” — nobody gets out of here alive.

I met nurses that had to be my sisters from another life. I met pure good and pure evil in the nursing profession.

I graduated to charge nurse in this 20-bed ICU. I loved directing the unit and problem solving and critical thinking in a flash of seconds.

But my downfall was telling the truth.

Political suicide. Sometimes upper management doesn’t want the truth. But I hated the untruths, the fabrications, and the lies. And so I loved my new position as a charge nurse, but I was a misfit from the beginning.

It wasn’t just one night that our acuities were dangerously high and nursing staff was low — it was a typical scene in the critical care unit. Do with what you have, don’t complain, an empty bed means availability for a new patient, but an empty bed didn’t mean a nurse to match.

In this environment, a particular night of doom started pleasantly enough — one nurse to two ICU patients. Fair enough, but there was chaos in the ER. Our ICU beds filled up. We weren’t a trauma ICU, but we would certainly become one in this night. A male 32 years old riddled with gunshot wounds, another male with multiple stab wounds. Our ICU filled up with critically ill patients, and our 2:1 assignments quickly went to 3:1 assignments. Code cools and code blues. Family members screaming from every corner of the ICU. The coronary care unit was handling CABGs and balloon pumps, and the neuro ICU had craniotomies coming to their unit. Any sanity you thought you had was out the window.

Our manager was the supervisor on-call for all of the critical care units that night. And I was told to call her. All three units were in crisis mode. And there were not enough nurses to take care of these patients. If you ever thought you could say “I’m going to lunch I’m hungry.” or “I need to go to the bathroom …” forget it because it wasn’t going to happen.

It was a war zone and looked like nobody would get out of here alive — not the patients and not the nurses. Upper management was nowhere to be found.

Some patients died that night. They didn’t have a chance. We were all short staffed that night because we were told over and over again like a broken record: budget, productivity, do everything, wave your magic wand to make the patients and the families happy. But what was behind the budget, the productivity?

Was it an end-of-year bonus check to the managers? Was it a salary increase to the CEO of $5 to $6 million per year not including the perks? Were the board members happily lining their pockets?

Nurses don’t go into nursing to get rich — ever.

That night seemed never to end. And management never returned my phones calls. Twelve hours of phone calls unanswered.

And the next morning the manager came in. No explanation, no apology. Total avoidance.

That’s when I knew the difference. That’s when I knew that you have to decide to be true to yourself or sell your soul. This manager chose to sell her soul.

A critical, urgent managerial meeting was called within a few days.

Mandatory. We were to discuss the critical shortage of ICU, CCU and neuro ICU nurses.

Problem solving.

All of the big wigs were there. Managers and directors and director of nursing and chief ICU physician. And then there was us — the little charge nurses who were the real heroes in the battlefield.

Every director and manager spoke up. The words came crashing in on me: “We’re here for you,” “We support you,” “Call us anytime night or day.” “We are here for you physically and mentally.” “Call us 24/7.”

They smiled and nodded their heads and patted themselves on their backs with an affirmation that they held some magic in their hands and some pretty simple solutions for such complicated and dangerous nursing practice.

Their words crashed into me like sharp stab wounds to my brain and every ounce of my genetic Irish-Italian blood spilled out all over that mahogany executive table.

I closed my eyes and let it all out.

Lies lies and more lies. And I had to put an end to this.

And I said to those managers and directors and physicians:

“Not true. None of this is true. Not only are you not available to us or our patients you are nowhere in sight.”

I went on. I was unstoppable.

“I called our manager on call that night 15 times. Fifteen times. Phone, cell, beeper … I left messages. And no reply ever. And I documented 15 times.”

I stared at our manager in the eyes as I spoke the truth. And the managers and directors and physicians, with their master’s degrees and their PHDs and their doctorate degrees, sat in silence, with their jaws on the ground. A pin dropping in that room would have been a loud noise.

One week later, I was called into the manager’s office. I was demoted to staff nurse. I was not to be the charge nurse again.

Was it political suicide? Was it the truth that no one wanted to deal with?

And those words. Those final words she said to me. A defining moment in my life and my career.

“You’re not one of us.”

And I knew that.

I wasn’t willing to sell my soul.

I was thankful that I was not one of them.

Month: April 2019

A nurse willing to forgive others. And to forgive herself.

A nurse’s downfall was telling the truth