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)

By Debbie Moore-Black, RN

I always knew my work schedule.
But this time I got it wrong…. Or maybe I got it right.
I clocked in, and reported to ICU for my nightshift to start.
But I wasn’t on the schedule. And strangely enough, they had enough nurses that night.

The nursing supervisor asked me if I would be willing to go to the neonatal ICU (NICU) and rock a baby.
Except for nursing school, I knew nothing about neonatal nursing much less NICU.
But this should be easy. So I said yes.

I entered the NICU and the charge nurse asked me if I could rock this little 5.5 lb premature baby girl.
She was irritable with a frantic shrill cry. Her body trembled.
I immediately thought: “what have I gotten myself into?”
Her tiny self had a nasal cannula attached to her nostrils.
Little Greta was going through withdrawal symptoms.
Her mom did drugs. Opioids.

My heart wept.
Little Greta would tremble. An uncontrollable body tremor.
But I held her close in my arms as I slowly rocked her.
She was perfect. Her tiny fingers wrapped around one of my fingers. We looked into each other’s eyes. Those small brown eyes. And I slowly rocked her, slow and rhythmic. I put her close to my heart. So she could feel my warmth. Feel my heart beating.
Feel my love.

I was told the mother was already discharged. That she was undergoing drug rehabilitation which included methadone treatment.

Social services would make visits to see the progress of Greta and visits to the mom also.
The goal was to eventually return Greta back to her mother, when she was physically able to go home.
DSS would eventually make well visits to the mom and baby Greta when she was returned to her mom.

Within 2 hours of rocking Greta, her breathing slowed to a restful state. Her little eyes closed as she slept peacefully in my arms.
I could have rocked her forever.

I said a prayer for Greta that she would have a happy life. I said a prayer that her mom would be rehabilitated and would never go back to drugs.

This perfect creation. Sleeping quietly in my arms.
And I wished her the best that life and love could give her.

I could only pray a positive prayer.
I did not want to begin to think the dark thoughts that circled my mind.

After two hours of rocking baby Greta, I handed her over to her nurse, I slowly walked out of the hospital. My “assignment” was over with.

Tears slowly fell to my cheeks. Tears I couldn’t hold back.
Tears for baby Greta. Her perfect self, and that peaceful snuggle against my chest as she held her tiny hand tightly wrapped around my finger.

…..

SAMHSA National Helpline
Substance Abuse and Mental Health Services Administration.
Confidential free help from public health agencies to find substance use treatment and information.
1-800-662-4357
(Photo: google images)

By Debbie Moore-Black, RN

None of us are perfect nor do we live in a perfect world. We all carry some degree of baggage.
But something is wrong.
Terribly wrong.

One of my past jobs was Mental Health/Behavioral Health and I think I’ve seen it all.
From the young to the old.
Deviant behavior, cutters, schizophrenia, psychotics, bipolar, homeless, drug addictions, alcoholism, depression, catatonics, rapists, murderers, kidnappers, mental, physical and sexual abusers and the mentally, physically and sexually abused.
But the ones that tear me apart, the ones that break me down
are the children… and that’s when I begin to wonder.
Is this where the mental illness begins? Our formative years?
What is missing?
In our world of cell phones and social media comes bullying and violence and self-harm and isolation.

She was 14 years old.
She was disheveled, hair in her face… rocking back and forth in her assigned hospital bed.
She was hiding. Hiding from herself. Hiding from her mother and step-father.
Hiding from the world.
Her arms and thighs revealed the sadness.
Multiple superficial cuts down her arms and thighs.
My heart wept.
She was awaiting placement to an adolescent group home. She couldn’t live at home anymore.
Step-dad raped her on multiple occasions. Her screams were disregarded. Disregarded by her mom and muffled by her step-dad.
Neglected, physically, mentally and sexually abused at 14 years old.
Her mom wanted her out of the house.
Momma wanted her out of her life.
Momma didn’t want competition in the house.
So Haley had to go.
The husband, the step-father won over Haley. Or did he?
How do we tell Haley she’s valuable and smart and precious and wanted?
How do we regain her self-confidence, her love for herself?
Or does she end up in society as a deviant, a sociopath, an abuser, a drug abuser?
I sat by her hospital bed and listened to her as she rocked herself.
Her tiny voice barely could be heard.

But I wanted to scream. Moms, dads, parents: your kids need love, consistency, boundaries, respect, shelter, guidance.

Please don’t toss them away.

Check yourself out. Stare yourself in the mirror.
Go to their football and soccer games. Attend their school plays and chorus and ballet.
Cheer them on.
Tell them they are smart and beautiful and kind and good.
Teach them responsibility, teach them to clean up after themselves, please and thank you, respect for themselves and for each other, protect them and guide them.
And love them.

Haley was placed in a group home. She had friends her age that became her “sisters.”
She learned love and guidance and she felt safe and protected.
She excelled in school. I knew she would.
But despite all of her new positive life, deep down there was that tiny black hole in her heart.
That missing basic love from her mom.
That painful tragic raping from her step-father.
Hopefully she will be able to grow and turn her pain into creativity.
We discovered Haley was an artist.
We hope you paint the walls and paint the town and paint your life into a new beginning.

Haley, I send you my love.
You’ve only just begun ….to live.
Paint the world baby love. 💖

📞 988 📞 #Suicide and Crisis Lifeline 24/7

By Debbie Moore-Black, RN

She was 82 years old. Sweet, frail, and maybe 4ft 8 inches tall.
She had tons of grandchildren,
a few great-grand children and her beloved children.

They all grew up knowing that family was their core. Their base, their home where love resided.
It was only a few days before Christmas and Mrs. Mary entered our ICU.
COPD. She lived with this for a long time…but this time it crippled her.
O2 nasal cannula, small amounts of morphine IVP for comfort to help her breathe, and to help her relax.

The family gathered around and while in ICU they decided on a group session. Which included her ICU physician, a nurse (me), and the respiratory therapist.
We discussed DNR, DNI and Comfort Care measures.

And behind the tears that welled up in Mrs Mary’s eyes, she spoke to all of us:
“I have lived a wonderful and fruitful life. My beloved husband passed away 10 years ago. I still love him and I still miss him.
I will miss you here on earth, but please know that my spirit will always be with you. I’m ready to go be at peace with my Maker and with my husband. I will be your guardian Angel and look after all of you.”

We all had tears in our eyes.
It was a defining moment.
This 82 year old dear soul, totally cognizant , totally alert and oriented, and she made her decision. No CPR. No crushing of her ribs. No ventilator. Just her wish to be with her family and die in peace.

Her little 5 year old granddaughter…. Walked up to her “memaw” and presented her with a Christmas present that she picked out herself!!
Little Amelia had a music box with an Angel on top. As Mrs. Mary wound up the music box, Out softly came the music: The first Noel the angels did say….🎶

They hugged each other and promised to be with her the next Christmas morning.

That next day, Christmas morning, a light snow filled the hospital canvas. It was a quiet day. A peaceful day.
Her children, grandchildren and great grandchildren had just arrived to wish their “Memaw” a Merry Christmas.
As they walked into her room, they noticed Mrs Mary had her eyes closed. Agonal breathing.

Mrs. Mary let out her last breath.
She died with a peaceful smile.
And in her lap, between her hands, she held to the final moment the Angel music box.
We all held hands, hugged each other in this tender moment.

It was Mrs Mary’s first Noel in heaven.
“The first Noel the angels did say….”
And her family realized that she was the Angel. Their forever Angel.
Easily singing with her husband now and surrounded by many other angels.

By Debbie Moore-Black, RN

I know every word to every Broadway musical play from back in the 1950’s through the 1960’s and beyond. Daddy would buy the vinyl records of the latest musicals.

Our sad lives filled with anguish, anger and neglect from our mother would diminish for another shining moment with daddy and his music.

It was our moment of infused happiness with my two sisters as the music would play as dad would put another vinyl record on his record player.

The Music Man was special. We’d run around in our pajamas as we sang “Shipoopi”…. We thought this may be a naughty word but we were allowed to sing it.

We’d hold hands and dance in circles with endless giggles to the music.
We became the imaginary orchestral band with pretend trombones….. “76 trombones led the big parade.”🎶

It was those magical moments I remembered as I watched recently “The Music Man” in NYC.

I found myself tearing up with each song.
Each song that brought back those sweet memories of our innocent youth.

Eventually, dad moved up the corporate ladder with IBM and we transferred from New Jersey to the Carolinas. Away from his mom and dad who came straight from Ireland.
Far away from my mom’s parents who had landed in America from Italy.

Dad was a computer director expert. When with the birth of computers they stood as tall as a washing machine or refrigerator. With each promotion, came the bigger house on the right side of town, the private school we went to, the lake house with the matching boat. The infidelities, the gambling, and then the endless drinking.

As a teenager I watched my dad walk into the walls from too much drinking. Our so called fairy tale life had come to an end and came crashing down on us.

We were called to the kitchen table for a “family meeting”. Dad had taken an “early retirement” at 45 years old. It was just another fabrication. Because my parents lived off of lies. Dad was terminated from his big corporate job. That was the truth. Alcoholism. But that was hush hush.
The large house was just a facade as the inside told the truth. Curtains closed dark inside… and that became our life as we painfully grew up into awareness.

Every song I teared up, some tears trickled down as I remembered that once whimsical time in our lives as youngsters.

I’m not angry. I’m not really even sad anymore.
Because I’m thankful that my dad was able to give us a magical time in our youth.

For one brief shining moment…. We were in that band with 76 trombones. We were in that parade with shiny uniforms on and drums and cymbals and clarinets ….

Metaphorically…. Daddy was our music man…who left his mark of joy and spirit for us three children to last us a lifetime!!!

Photo: “The Music Man”
“The Music Man” written by: Meredith Wilson

By: Debbie Moore-Black, RN

I retired from nursing this June of 2022.
I was so happy and relieved that I no longer had to do this.
But even at my age of 66…. I’m still trying to find myself.

The house that once seemed very small with me and my husband and our three children and many neighborhood children laughing and playing and dancing and singing … and climbing into my van to go to the next adventure… the amusement park, roller skating, swimming, a few cruises and Disneyland and the Bahamas and Mexico ….and teaching our children right from wrong. Good from bad.
How to study, how to learn how to be serious and how to have fun and how to be sincere.
And now that house that once seemed so small and so filled with family and friends, is very large to me.
Just me and my 2 dogs.
My husband died 5 years ago. Our children are grown, all college educated with careers and spouses and then some grandchildren.

It’s such a vacuum.

I wanted our children to have the best.
I wanted my children to have fun and enjoy their childhood.
I worked many hours a week. Many times 60 hours a week. So they could have nice clothes. So they wouldn’t be laughed at.

I wanted them to have everything I didn’t have.

We encouraged curiosity and education and music and sports.
Their home plate was love.

And now the quiet still.
I’m not sure if I accomplished enough.
Did I stay on the right path.
Where do I go from here?
Do I die in my sleep?
Do I finally become that author that I’ve always wanted.
Do I hope that I’ll infiltrate my granddaughters with my genetic love?

It’s a vacuum.

It’s a reflection and retracing my steps backwards of what I should have done. What I could have done. And knowing that I broke the cycle of my parents alcoholism, of their negativity, of their ultimate repeated taunts of failure towards myself.

I’m hoping that if there is one more second left in my life…. I will be given the nod of approval.
That I did the best I could to break the cycle I was raised with. To break the cycle of a bad and unfaithful marriage from my husband.

That I can hold my head up and know that I have passed on to generations to come of strong, happy, insightful people.
To pass the torch for the betterment of mankind.

It’s a simple thought but also a sky full of galaxies thought.
I pray I’ve made a mark.
A profound mark…. One day at a time.