Behavioral health nurses sending out a sincere thank you to our Public Safety Officers (PSO’s)

By Debbie Moore-Black, RN

We are nurses in Behavioral Health and we want to thank our Public Safety Officers (PSO’s).
We are nurses. We work in highly dangerous and volatile units at hospitals.
We are not working in a prison.
We work in Behavioral health.
The Intensive Management unit, the adolescent unit, Dual-diagnosis unit and the Behavioral health Emergency Department. We are specially trained to protect ourselves and others with CPI. Which is a mandatory nonviolent crisis intervention training.

We have patients who are schizophrenic, bipolar, drug addicts, with assault charges, domestic violence and rapists.

Again, we are not a prison. Many of these patients come to us angry and hostile, bewildered, voices in their heads to kill, to kill themselves or others, to hurt those who have hurt them. They store irrational thoughts and they lash out randomly.

We have alarms in these units should we feel threatened. We easily can use a phone to call Public Safety stat. Sometimes it’s too late. Sometimes the patients are random.
Nurses and technicians easily can and are assaulted, injured, punched to the ground, beaten on the head.
We end up in the ER ourselves, CAT scans to the brain to show concussions, contusions on the head, dizziness and recurring PTSD of that fist coming at us. Random and unpredictable.

What we are thankful for are our Public Safety officers. Without them protecting us, it would be mayhem. We easily call them stat and they show up to our unit in multitudes.
They protect us from the unpredictable assaults. They are trained and professional. At any given moment, a patient will physically attack Public Safety Officers (PSO’s) with a vengeance.
We can not stand alone in this environment.
Without our PSO’s, we would be an unguarded prison.
A dangerous volatile unsafe workplace.

We came to work in this nursing profession to help the mentally ill. We did not come to work at a prison.
This is a hospital.
PSO’s are our lifeline. We are grateful for them.
Their courage. Their protection and their camaraderie.
Thank you PSO’s for all that you do.
Thank you for our small peace of mind.
This job cannot be done without you.

The end of life rally: terminal lucidity

By Debbie-Moore-Black, RN

Granny Rachel, my husband’s mother, was an old country soul. She was a simple lady who loved the Lord.

She accepted me with open arms, when my own parents turned their backs on me.
Granny Rachel made the best sweet tea. The best homemade vegetable soup with corn bread and gave unconditional love to all.

She totaled 2 of her cars twice. Her son would check on her and found multiple candles lit in her house. She left the tub on until it overflowed with water.

Rachel could no longer be independent.
We relocated her to an assisted living center. An almost 5 star-like hotel. Happy, friendly people, and Rachel found a new best friend, her roommate, Sally. They giggled and laughed together over silly things.

After 2 years at the Assisted living center, at the age of 89, Rachel started to deteriorate. Her CHF, her COPD from years of working in a mill in the south where there was pollution and no filters, destroyed her lungs. Brown lung disease.

Granny Rachel was dying. She let out agonal breaths. At any time, we thought, this was it.
It was the grande finale. My husband, and our son and myself gathered around her.
We held her hand and waited for
granny Rachel to let out her last breath.
My son opened up the Bible as he read: “Though I walk through the valley of the shadow of death…..
And then we heard a course whisper. From Granny as she recited: “I will fear no evil; for thou art with me; thy rod and thy staff: they comfort me”

Beyond disbelief, some type of chills ran through our bodies …. For one lucid minute, granny Rachel was with us. She was here to let us know she was traveling through the tunnel to eternity.

My mother. Colon cancer with mets to her lungs. Her brain. We did vigils at her house. Us daughters. We took turns watching her and caring for her with the assistance of hospice.
She would slip in and out of consciousness.
The time had come. Her breathing had slowed down. And then she opened her eyes.
She said to us: “I see angels. Beautiful angels.”
Just as clear as could be.
And then she said: “Joe, there’s our baby Terrence”. Joe was my dad. Terrence was the baby she lost at birth many, many years ago.

Sargent Sam (Sarge) A World War 2 veteran. A father of five and a wife of over 50 years.

When it’s time to transfer out of our ICU, like a promotion; that’s a good thing. But this was a transition to our comfort care suite.

Sarge did not want to be on a ventilator with his lung cancer. He knew it was time. He just wanted his family by his side. As the technicians wheeled Sarge on his stretcher out of the ICU, Sarge, who had an incredible sense of humor, shouted out to me: “I’m going to tell my wife you tried to flirt with me!!!” And with that, I blew him a kiss. Sadness filled my heart as I knew this was it. With his entire family by his side, Sarge died comfortably 2 days later.

How do we explain this end of life rally?
Maybe we can’t. Maybe it’s their way of saying goodbye as they enter the heavens.
They are on the brink of death and they wake up. Stable, lucid, they want to talk and eat and drink.

Rallying is a hallmark pre-death sign of improvement before death.
This can last for a few moments even days. They can sit up and talk.
This rallying is also called Terminal lucidity.

Try to cherish that last goodbye.
That one last opportunity to connect with your loved one while still earthly creatures.

They are saying their last goodbyes, with love in their hearts. With peace.
And they want you to know….
All is well.

(Photo cred: Google stock)

The Orphans of COVID: Who will care for them now?

By: Debbie Moore-Black, RN

The 911 call came too late. Her daughter was 32 years old and usually quite healthy. But she refused the COVID vaccinations. She said she took her vitamins and was healthy and that “God is my pilot” and “I don’t want toxins in my body.”

Her mother knew she was running a high fever. She knew she was short of breath frequently … until…

Her 10-year-old grandson couldn’t wake his momma up in bed. “Momma, wake up!” he screamed, shaking her body relentlessly.

Then Jamarr called out to his grandma, “Momma won’t wake up.”

And 911 was called.

The medics could barely get an O2 sat. Her BP was dangerously low. O2 sat 72 percent. Shallow intermittent breathing.

Oxygen mask applied. IV started, the medics turned their emergency lights on and sped to the nearest hospital.

No beds were available.

It is a frequent scene across America. She would have to stay in the ER.

But she didn’t make it to the ER. Medics performed CPR on Maria — rapid CPR to no avail. Asystole. No respirations. No pulse. Despite CPR and IV epinephrine.

The ER physician pronounced her death. Another. Toe tagged. Bodybag.

Body loaded on top of another body in the refrigerated trailer.

Jamarr was hysterical. Screaming. Crying. “I want my momma. Momma, don’t leave me. I want to go to heaven and be with momma now.”

Until he could cry no more.

And this became the most dangerous time.

Jamarr started to act out.

He poked a scissor at his heart, so his grandma could see. At school, he threatened to pierce his heart with a pointed pencil. He’d scribble during math class pictures of him by a tree, hanging from the tree from a noose. He drew pictures of knives and blood dripping down. And he would isolate himself from other students. Non-verbal —but those drawings.
Momma left him behind. He loved his momma.

If only.

Jamarr’s teacher notified the school nurse and principal. The drawings of hanging from a noose in a tree, the knives, the blood, the non-verbal gestures. His teacher and school nurse and his principal decided to call his grandmother to come and take Jamarr to a mental health facility.

Jamarr said he just wanted to die. He just wanted to be in heaven with his mamma.

The social worker accessed Jamarr. She was strong and stoic. But not this time. When her shift was over, she let out a gut-wrenching cry for Jamarr, for the orphaned children of COVID.

A newborn baby girl was delivered by C-section while her mother was on a ventilator in the ICU. The mom was deteriorating. After three weeks, the ICU physicians had determined that this patient was not going to live and that they must take the baby by c-section before the mother died.

The baby’s father had died a week before. He had COVID also. Both were unvaccinated.

This baby girl would grow up to never know her parents.

Five children surrounded their parent’s coffins. Now five orphaned children are grieving the death of their parents.

These parents feared the vaccine more than what might become of their children.

Orphanhood as a result of COVID is a hidden global pandemic in the U.S.

Adverse childhood experiences may be low self-esteem, increased risk of substance abuse, suicide, violence, sexual abuse and exploitation, mental health problems and shorter schooling.

Per the CDC, as of October 2021, it has been estimated that over 140,000 children up to the age of 17, have lost a parent, parents or secondary caregiver due to COVID.

The orphans of COVID — who will care for them now?

……

Originally published on KevinMD.com

**photo: Google stock

What really happens when the unvaccinated get sick with COVID

By: Debbie Moore-Black, RN

“My body, my rights.”

“My body is a temple.”

“I don’t want poison going into my body.”

” I’ve done my research.”

And they refuse to wear masks; they refuse to social distance. They refuse COVID vaccinations and the booster. Essentially, they spit in the face of the population that trusts in science and medical research.

The disrespect and disregard for scientists, medical doctors, RNs and respiratory therapists are astonishing.

Their support groups tout ivermectin, hydroxychloroquine and suggest that some drink iodine — any rationalization will do.

“It’s medical tyranny. Rally for freedom.”

“The masks build up my CO2.”

“They prevent me from breathing correctly.”

“They stifle my freedom.”

Let’s go through what really happens when someone gets COVID … someone who is unvaccinated and who gets severe symptoms.

What happens to the “tyranny” and stifling of one’s “freedom.” And not wanting this “toxin” to invade their body.

Sam is 42 years old. He’s done his “research” on social media. He’s in several groups.

He’s actually a leader of one of his groups online.

At one point, he wrote of the “great American hoax.” He frequently adds dangerous misinformation to the public. He’s loud and clear and a popular tribal leader.

So Sam starts experiencing shortness of breath.

He is unable to taste or smell. He gets a cough, cold, fever, nausea, vomiting, and diarrhea.

Sam is now gasping for air. His wife calls 911. His O2 sats are 84 percent.

He is rushed to his local hospital by medics. Sam deteriorates en route to the hospital, and although he had stated he didn’t want any “invasion” of a COVID vaccine, his wife says,

“Do everything.”

And the real invasion begins.

Sam is intubated emergently at the hospital. Several IVs are started. He is given IVP succinylcholine and etomidate … versed IVP.

The patient is intubated, bagged, and placed on a ventilator. His FiO2 is at 100 percent, PEEP of 12 to start. His wrists are restrained to prevent the patient from extubating himself.

An arterial line is placed into his radial artery, giving the nurses and doctors continuous BP readings and accessibility for ABGs and lab work. A central line is placed into his neck, to be exact: the tip of his SVC.

A Foley catheter is inserted into his urethra via his penis.

A rectal tube is also inserted into his rectum to catch the flow of his constant diarrhea.

His BP is dropping exponentially. His BP is 76/39. MAP is 51.

Fluid challenges have been initiated, but he doesn’t respond. So his ICU nurse is wearing goggles, gown, hair bonnet, shoe covers, N95 mask, gloves and has to “gown and glove” every time they enter the patient’s room.

The nurse now adds levophed and vasopressin drips. Remdesivir is also started. All FDA approved.

Day 2: Patient Sam is not progressing. In fact, he is deteriorating. So it will take six health care ICU nurses/CNAs/respiratory therapists to now prone the patient. The patient’s airway is of the utmost importance. We cannot lose the airway.

In synchronized rhythm, the patient is turned onto his stomach. This is supposed to help with better oxygenation, in theory. It is sometimes a last-ditch effort. For 16 to 18 hours, this position allows for better expansion of the dorsal lung regions.

Sam’s kidneys are crashing. His creatinine level is dangerously elevating. So now Sam has bought dialysis, which is another specialized nurse. The nephrologist now places a large bore vas catheter into the femoral venous/artery.

Many days have gone by in the ICU.

Sam is not responding to every possible ICU/COVID protocol and technique available.

Specialized ICU physicians, RNs and respiratory therapists are at the patient’s side in this 12-bed ICU. 24/7.

Sam has coded several times. Code Blue. Three code blues to be exact.

The majority of critically ill patients in the ICU are unvaccinated throughout our nation.

A conference is called for the wife by the ICU physician, ICU nurse, and chaplain. Frequent updates had been given to her.

But this is the grand finale.

Day 10: Sam has multi-system organ failure. Sam has thrown blood clots haphazardly to his brain. Sam is unresponsive. All organs are down.

Despite the endless life-saving events, Sam cannot be saved.

On the 10th day at 21:03, Sam is pronounced dead.

I don’t want these COVID vaccine toxins to invade my body.

My freedom.

My body. My rights.

…….

Originally Published on Kevinmd.com

From the prison of my job to freedom

By: Debbie Moore-Black, RN

It became a prison to me — impending doom.

I knew I had only three months left before I could retire. Three months isn’t long, but it is a lifetime away.

That long drive to work in that heavy highway traffic where there was always a collision. The anxiety of the drive knowing all along there was even more anxiety to come.

The patients that were involuntarily committed — forever schizophrenics and bipolar, usually non-compliant with their medications. That psychotic look in their eyes when we knew this was it. Another assault in the making.

You can feel the threat, the danger, the fear.

You can be surrounded by public safety officers, but it doesn’t matter. Everyone is fighting for their life.

The psychotic patient is fighting against his demons that he was never able to conquer, and the staff members that I work with were all holding onto their own universe of inner turmoil.

I long for my freedom. I’ve been a nurse since 1976. I yearn to breathe again with no agenda on my calendar. Only to wake up slowly each morning, give my dogs a kiss, have my two cups of coffee before Jack stands on my chest to let me know it’s time to take him for a walk, and before Lucy lets out her puppy growl. It’s a mandatory morning walk for these two.

But that’s OK.

I’ll visit my children, my manna from heaven.

I’ll give hugs to my granddaughters and pull out new books and toys for them, always feeling like their Mary Poppins.

I’ll watch movies; I’ll plan breakfasts and lunches with old nurse comrades.

What a journey.

From a shy redhead born into a house filled with stark black-haired siblings. A family filled with dysfunction. The underdog. The invisible one.

Wanting to be a journalist but was pushed out of the house to be a nurse.

The terror and fright of being a nurse to becoming totally entranced by ICU nursing with all of the intricacies of a body filled with multi-organ dysfunction. Watching each organ improve or deteriorate. Holding the hand of a newborn baby to holding the hand of a little lady gasping her last breath.

There is good and bad nursing management. The ones that cared about us as people versus the ones that treated us as a number as a threat to the “budget.”

I’ve worked in ER, surgery, ICU, surgical-trauma ICU, and behavioral health.

I’ve had three beautiful children in a sad, lonely, almost non-existent marriage.

There were years and years of trying to fix a marriage that was not fixable.

I’ve watched my husband ravaged by cancer until he let out his last breath.

I don’t know what’s in store for me on this last trot through life.

Many mistakes have been made.

But I can hold my head up high and say, “I tried!” — loud and clear.

Tomorrow may be lonely.

Tomorrow may be filled with quiet peace.

But I’ve earned my stripes to finally breathe again.

Originally published on KevinMD.com

That time my patient swallowed an entire bag of crack

By Debbie Moore-Black, RN

He was the middleman — the man that took the crack cocaine from the main guy, the drug dealer and then sold it to his “clients” and kept a percentage of the money for himself and the rest to the dealer.

It was a fine-tuned operation. You could make a lot of money. But you had to be precise, or else.


The patient was a tall, slim 20-something man. He had a fistful of crack cocaine rocks to sell. Before selling it, he decided he’d sample some of the crack. So he smoked it. And then he could feel his heart rate go rapidly. He got short of breath. Told his mom he didn’t feel well and that his heart was beating really fast. Mom called 911. He had sickle cell, which, apparently, doesn’t like samples of crack cocaine.

The medics hooked him up to their EKG monitor. Heart rate 180s. The medics sped to the ER, starting an IV and applying O2. He was in SVT.

Oxygen was applied, and adenosine was given, quickly, IVP.

He was transferred to the ICU step-down unit. After one night in the step-down unit, he was getting nervous. He had to get out of that hospital. He had a job to do. He had to sell this crack.

He cut his IV line with a razor blade. The nurses were suspicious, and they called the public safety officers (PSOs) to the patient’s room.

In his hospital room, PSO’s found razor blades and other drug paraphernalia, including crack cocaine pipes. The nurse and PSOs were quite suspicious. So the PSOs hung around as the nurse restarted his IV.

The PSOs did a visual check of his room, and he got scared. He was afraid they would find his crack. He had to leave that hospital soon, and he could not let them find the crack — that was money.

That was his money, his dealer’s money and product for his clients. He was a dead man if he didn’t get out of there soon. So making sure they wouldn’t take crack from him, he ingested a large clear lunch bag with crack cocaine rocks in front of the nurse and the PSOs.

What he swallowed was the size of a large round Christmas ornament.

And then I got the call. I was on call for ICU. Come in, stat. “You have a patient coming to you who just ingested a large bag of crack cocaine.”

This was a first.

Should the bag burst in the patient’s GI tract, he could have a sudden cardiac arrest., seizures or brain bleed. The crash cart was pulled up to the patient’s new room in the ICU.

I explained to the patient why he had to have an IV, why he had to be on an EKG monitor and why he had to have a crash cart in front of his room.

That what he just did was a recipe for disaster and sudden death.

Per poison control, I started a bicarbonate drip to potentially neutralize this lethal dose should it burst inside of him. We also gave the patient kayexalate, hoping that the crack cocaine would increase motility through this induced diarrhea and have crack come out while he excreted.

Everything we did, we explained extensively to him. We now had to attempt to save his life.

During this course of this regimen of care, we frequently had to change the patient’s bed sheets. Sometimes the patient would put his fingers up his rectum. Unsure of exactly what was happening, I sensed that the kayexalate was working its magic.

And there it was: A plastic baggy partially hanging out of his rectum.

“There it is,” a fellow nurse yelled. And with that, the patient jumped out of his ICU bed, tore off his gown, tore his IV out and ripped off his EKG electrodes. He was naked, and he took off running out of the ICU. I chased after him, along with another ICU nurse and a CNA to follow.

A “code gray” was repeatedly called overhead. Code gray is a call for all PSOs, stat.

The potential danger, assault, aggression is why we call a code gray.

Our ICU is on the same floor as the walkway to our orthopedic hospital. A clear glass walkway where cars could drive underneath this bridge/walkway. A large oversized banner proclaimed, “Excellence in care. Excellence in medicine,” right where all of the motorists could see.

The patient almost made it to that walkway. This tall, thin, naked man with a baggy of crack cocaine halfway hanging out of his rectum.

And the PSOs finally grabbed him and pulled him to the floor. He was a strong man. It took four PSOs to tackle him to the ground.
And there it was. A lunch-sized bag, intact and filled with light gray colored crack cocaine rocks.

With my latex gloves on, I pulled the bag of rocks out of the patient’s rectum and handed the bag to the PSOs.

The patient was wheeled back to his ICU room.

Two days later, during our busy visiting hours, the patient put his civilian clothes on and slipped out, looking like one of the many family member visitors.

He slipped out, and no one noticed he was gone. He slipped out somewhere into this large city, most likely hoping not to be found by his dealer or by his clients. We’ll never know his outcome, but we can’t imagine it was a good outcome.

Though this story is a decade old, it is repeated by nurses and doctors as if it were folklore.

But it is, most likely, a one-time-only true story.

Originally published at KevinMD.com

Image credit: Shutterstock.com

An executive father. Alcoholism. And the gallon of wine.


By: Debbie Moore-Black, RN

By: Debbie Moore-Black, RN

As I walked through the wine section at the grocery store, I spotted those gallon jugs of wine. I was searching for Christmas presents for my friends. But that brand glared at me.
Daddy.
My IBM executive daddy. We loved him so. But year by year, his demons took over. Every night, a gallon of wine. On weekends he’d alternate with a case of beer. But it was one or the other. No fail.

When I finally got my driver’s license at 17 years old, my job every weekend was to get dad his case of beer. I knew it was wrong. But I felt I didn’t have a choice. He was a loving father for a long time. And funny. His dad came straight from Ireland and my dad was proud of his heritage.

As kids, we only saw dad on the weekends. But he always brought us toys. He was engaging while we were young. He made us laugh. He was our world.

Dad moved up the corporate ladder. The big house was built on the “right” side of town. Private school for us 4 kids. A lake house with a matching boat. Mom wore designer clothes.

On the outside, we were this prosperous family.
On the inside was neglect and verbal abuse, and taunting. Our perfect family began to spiral out of control. I was the forgotten child. The invisible one. And I tried to stay invisible. Because, why would I want to go to proms or football games or basketball games when I was told repeatedly by my mom and dad, that I was fat, and stupid and ugly?

By the time I was in highschool, I watched my dad run into the walls, sometimes he’d fall to the ground. I’d hear my mother cry at night.

We all have our baggage, but by the time we became adults, I was certain it was guardian angels that raised us.

Dad lost his executive job. We were told he took “an early retirement”…. But that was just another lie.
He lost his lake house. The place I loved for its calm waters, gentle breeze through the trees and the quiet peacefulness.
Dad started working for another accounting company and shortly thereafter lost that job too.

As I got older, and finished college and became a nurse, my husband and I had our first child. My pride and joy. By the time we had our second child, I sank into a deep depression. I wasn’t sure if it was postpartum depression. But I felt frequent gloom and doom.
I diagnosed myself and felt it had to do with my parents … the depression and the suppressed thoughts I lived with for so long.
I started therapy sessions and I joined “Adult Children of alcoholics.”
There was one important message I learned from this: you can’t go through life blaming your parents. Eventually you have to deal with the past and grow from the cards that were dealt to you.

Some things can’t be forgotten.
Sometimes it’s that one thing that scrapes the cobwebs of your mind.
Like those gallons of wine at the grocery store.
Like those pretty dresses at the stores that were never attainable because we frequently wore the same clothes every day…. And were laughed at… while mommy wore designer clothes…

Mom died at the age of 63. Colon cancer. I felt no remorse. I cleaned her bowel movements in her bed along with the assistance of the hospice technician. I felt obligated, but I held no love.
I had sadness when my mother died. Sadness for the mother I never had.
Dad died at the age of 77. I ripe old age for an alcoholic. End stage liver disease. I saw him minutes before he died. Just a shell.
A sad life consumed in misery and alcohol.

I chose to remember dad’s sense of humor. The times he made me laugh. The time he brought me flowers when I graduated from Catholic school. The time he insisted on walking me down the aisle, though my mother warned him not to since my husband and I had “lived in sin” before we got married.

A controlled, sad life.
That gallon of wine.

Start with yourself: A reminder to give love and kindness

By: Debbie Moore-Black, RN

Were you neglected by your parents? Neglected of basics like clothes to wear or a tender hug or a simple “I love you?” from mom or dad, or both?
Were you shunned by your classmates because you wore the same clothes every day while your mom wore designer clothes and your dad was a business executive?
Were you called short and fat and ugly.
Did you have the lowest opinion of yourself and not even know that you were this beautiful shining bright star?
Did you crave the first drop of breadcrumbs from a man/or woman who was really just interested in themselves?
Did you marry that man/woman? Always craving for them to love you?
Did you religiously go to church and scream out your “Christianity” while all along you bashed the shy guy, the gay guy, the different guy.
Did you cast stones at others to make you feel better about yourself?
Did you embezzle, cheat on your wife or your husband….multiple infidelities?

You know what?
We all have cast the stones.
And now it’s Christmas time.
A time of cheer and hope.
A time of renewal.
A time to be that better person.
A time to shed your layers of coats. A time to look at yourself deeply in the mirror. Put down your addictions. Go to AA. Go to Narcotics Anonymous. Find and go to a licensed therapist. Seek a higher power.
Help out at soup kitchens, give to the poor, the destitute, the forgotten children.
Throw your troubles in your bucket.

And start anew.

#Kindness begins with yourself.

There is a light at the end of this tunnel.
There is a hope for a new tomorrow.
That door that closed on you, the window has just opened.
There is peace and harmony and love within yourself.
And it begins with yourself.
Reach out.
And send peace and kindness.
It could be that first step that you breathe a new breath.
Live and love.

#kindness begins with yourself.