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.
ICU-06
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.
Do Not Resuscitate 
You are an amazing woman & I want to thank you for all these years you have given the people in your area love and respect. My daughter is in the process of becoming a nurse & I can only hope she finds someone just like you to show her the way into this scary , sometimes sad profession. Thanks again for all the years you gave to the patients!
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I have tears in my eyes this morning. I have been a nurse since 84. Retired now, but your blog brings it all back
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You are great Debby, you did a good job, but people don’t know about reality, involving elderly. I am myself one: 80 years old, former M. D. In Romania and RN case manager here ( after passing through R. N schooling) .In Romania I was the President of first . Palliative Care association. Soon after our start up, another one came aboard, at initiative of an English man with money and outside help:. It was a hospice care type . They stopped our initiative in which we saw palliative care as a part of education in any medical or nursing specialties, as a a mean to reduce suffering, when our medical/ technical abilities fail in terminal state of cancer, respiratory, renal, or cardiac insufficiency,neurological severe situation. Terminal state starts not in the last day, but weeks or monthsi n advance. My decision to immigrate in U. S at age 61 was done by hearing the First Palliative Care Congress in Gerontology in New York 20 years ago!
Though, here, as in my country, this field was transferred to Oncologists, pain doctors and Anesthesiologists forgetting that Morphine drops orally in very small doses has many uses and does not induce any dependency.
My dear, Debbie, you and doctors with high position need to get up till higher places and speak up urgently and change ! Nor the tragedy of Covid19 made our society smarter. We all are mortal and if you want immortality, go to study the old book: Bible Let tell it louder as long we still can tell it. Many things should be changed: training,, specialty status, money allocation, double medical care ( adding primary care)., a whole range of medications and procedures. In fact, all these will be less expensive. Palliative Care is not assisted suicide, nor patient abandonment with only nursing assistant care and live support.
P. S. I was myself victim of ignorance many times, one very shocking :Two years ago, I had been hospitalized for 31 day with postop severe condition when i requested to do my advance directive in hospital with request for Palliative Care if deteriorated . . Nurses reported that I am suicidal and I was placed on permanent sitter for 3 days till Psychiatric evaluation! (I live in TX.)
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