Schizophrenia: They are on an island of their own

By: Debbie Moore-Black, RN

I knocked on his door. It was 8:30 pm. Medication time. Jerome slowly opened his door. He was easily over 6 feet tall.

Towering over my 4ft 11,5 “ self. Naked. Eye to eye with his penis.

He chanted “you ain’t a bitch. You ain’t a ho….. you my wife”

Ok Jerome, take your medicine.
I’ve entered a new dimension of nursing.

After 30 plus years as an ICU nurse, I thought I’d ride out Behavioral Health until my retirement in one year. I thought it would be easy.

What I didn’t realize was that we have a most complicated mind. All of us.

I smiled during my interview. Told them what they wanted to hear. And I was in.
Day after day. This was the psychotic unit. Psychotic, schizophrenic, bipolar…. all of the above. Medication was sometimes our only hope.

It’s cold outside. Winter time. The homeless know what to say. On the streets, our hospital, our behavioral health unit is like the “Hilton”.

New scrubs, private rooms, breakfast lunch dinner and snacks. A shower. And medications to calm you down, to help you sleep to make those voices in your head disappear for a moment.

The voices that say kill… kill… kill. The voices that tell you you’re no good. Cut yourself deeper faster. Jump off the bridge, run into traffic…. anything to make the voices go away.

Marlene is 52. She likes methamphetamine. She has multiple husbands and she’s pregnant with the baby Jesus. And screams a bloody chilling scream in the middle of the night.

We rush to her side. She bangs her head repeatedly against the wall. It’s hard to deescalate a psychotic. Medication is your only friend. Haldol, zyprexa, Ativan, Thorazine. Take your pick.

Our heroes are Public Safety. We push a button, or call the number stat, and they are there. All of them 4 and 5 of them rush to our side to protect us.

This is not a prison. This is a Behavioral health unit. And each day we say a prayer that there won’t be violence. That there won’t be an assault. That we won’t have to put someone in seclusion. That we aren’t forced to use 4-point restraints.

These are the misfits. The homeless. The non-compliants They know when it’s cold outside. They can no longer cope. We are their friend. Their protector.

Schizophrenia. A strange and exotic disease. They are on an island of their own.
What have I gotten myself into?

Originally published at

During the pandemic, many health care workers won’t be home for Christmas

By Debbie Moore-Black, RN

He was a healthy 36-year-old paramedic with a loving wife and an adorable little boy.

Jim loved his job. The rush, the adrenaline, the blaring lights through downtown hurrying to get to the major hospital. Cardiac arrests, gunshot wounds, tragic auto accidents, respiratory arrests, CPR, compressions, starting IVs. Speaking to the ER physician en route to the hospital to give stat meds for V-tach, SVT, delivering a baby. Anything and everything. Jim was there and ready for the next life-saving event.

COVID was rapidly spreading throughout the country. Standards and compliance with wearing masks were not always a priority. PPEs were also not readily available to health care workers. Jim was aware of the risks involved. But he was young and healthy. And in a hurry.

It couldn’t happen to him.

Jim developed a cough. A dry, persistent cough. And then he lost his sense of taste and smell. His energetic self became weak and lethargic. His temperature rose to 101.6. His manager said he must be tested for COVID. His test was done and processed urgently.

Jim tested positive.

Jim had to be quarantined from work from his squad. At home, Jim stayed in a separate room. Away from his little son and wife.

Within one week of testing positive, Jim continued with his cough, but he became short of breath. His wife found him gasping for air in his bed, and she immediately called 911. His fellow paramedic partners picked him up. Put him on a stretcher, added oxygen, started an IV. His O2 sats were 82 percent. Jim was pale, gasping, and barely able to talk. He was rushed across town to the ER.

His O2 sats continued to drop. His wife held his hand. We love you. She said.

Jim was brave. And he replied: I’ll be home for Christmas. As he squeezed his wife’s hand.

Stat ABGs showed the need for emergent intubation. O2 sats now 76 percent.

Jim was intubated, a central line inserted. Nimbex (a paralytic) started along with a propofol drip. He was transferred to the ICU. IV steroids started along with his first dose of remdesivir. His blood pressure dropped dangerously. Levophed drip was started.

November slid into December.

Week after week went by. Jim’s kidneys shut down, and now dialysis was started. The ICU nurses and physicians worked endlessly. There were no breaks—12 to 13-hour shifts. Jim’s nurses enter his room. Day after day. Shift after shift. Isolation Gown, gloves, N95, face shields, shoe covers. Grueling and hot and suffocating.

His wife, Mary, calls up. Needing a report of her husband. Her voice quivers. The nurse allows FaceTime with Jim’s wife and four-year-old Timmy. We love you. She says. And all she sees is Jim on the ventilator with a distant stare of no comprehension. She leaves pictures Timmy drew for his dad at the hospital’s front entrance. Jim’s ICU room walls are covered with pictures of Christmas trees and Timmy’s handprints and hurry home, daddy.

The intensivist calls for a conference with Jim’s wife. We’re sorry. We are not making headway. He’s deteriorating. COVID has destroyed his kidneys, his lungs. MRI shows minimal brain activity. Despite everything we have done.

His wife bows her head. A tear stings her cheek as she remembered his grasp of her hand: I’ll be home for Christmas.

Internationally, 7,000 health care workers have died from COVID. Physicians, nurses, EMTs, paramedics, housekeepers, technicians, plant engineers have perished as they heroically face this silent killer.

Originally published at: Kevin MD

Don’t Wake Me Up Again

By: Debbie Moore-Black, RN

After 33 years as an ICU RN, I had finally decided I couldn’t do this anymore.

It was my last nightshift. The last shift that convinced me I had made the right decision.

The CNA and I went door to door to turn each ICU patient that was not capable of turning themselves.


Mrs. Thelma was 86 years old.

She laid in her bed slightly restless. Restrained. On a ventilator. NG tube for tube feedings. Levophed drip for a low blood pressure.

Mrs. Thelma was not able to turn herself.

The CNA and I knocked on the patient’s door. Her son was asleep on the side bed provided for families.

Her son woke up. “What do you want”? Why you waking me up”?

We explained that we had to turn his mother.

His poor gray haired mother. Attempting to extubate herself. Attempting to pull out her NG tube. Too weak to turn herself. Restrained to prevent her from extubating herself and pulling her NG tube out.

The family wanted everything done.

We turned and repositioned Mrs Thelma. We cleaned up the bowel movement in the bed and changed her sheets. I gave her a small amount of morphine ivp for comfort.

I held her hand and silently apologized to her.

I was sorry her family was not rational.

I was sorry her family thought she’d live forever

I was sorry that they were the reason she suffered so.

There was a family conference. The ICU MD explained she was going through multi system organ failure. She’s 86 years old.

That they could allow her to die peacefully.

But they wanted everything done.

And so we did. Painful day after painful day.

Every 2 hours we had to turn and reposition her or decubitus ulcers would set in. Suction her mouth and ETT, rub her back. Clean her body.

Her eyes were hazy. A living hell.

We left the room after we tucked her in.

The son announced: “don’t wake me up again”

I prayed for a peaceful death for Mrs Thelma…. but not this way.

My last night, clocking out to people who refuse to allow their loved ones to die peacefully.

I tried. I educated.

Many refused.

I could no longer deal with the torment that lies in the ICU.

To family members: We do the best we can.

We are not your servants. We are not your waitress/waiter.

We are caregivers. Professionally educated to treat your sick loved ones.

Please work with us.

We are strong…. but we are tired.

Respect and Empower.