Hope in the killing fields

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Our 23 bed ICU has been converted to Covid-19 patients.

All of them.

I want to tell myself this is science fiction, but it’s not. It’s real. And we are scared.
As I enter the unit to start my night shift, we have a huddle of the off-going and oncoming nurses.

We are committed to fight this invisible monster.

After a brief update of all of our patients, we bow our heads and say a prayer. A prayer to protect all healthcare and essential workers across our nation. And our Universe. A prayer for safety and strength. A prayer for the patients stricken with this potentially lethal virus. A prayer for the families that are not allowed in to see their loved ones. Not allowed in to say hello, or to say I love you or to say their goodbyes.

ICU has always been my favorite job. The dynamic and strong work here. Fearless and endless, we never stop.

But this is different.

We receive our assignments. If we are lucky, we only receive 2 patients. Both on ventilators. We have a clean nurse to assist with adding our PPE’s. We also pray that we have the right protective equipment. N-95 masks, isolation gown, gloves, foot covers, and face shield. I am the “dirty nurse”.

I have to be prepared to have everything ready to go into that patient’s room.
IV antibiotics, IV drips like vasopressin and Levophed for those dangerously low blood pressures. Lab vials for the continuous need of lab work taken from the patients arterial line. Tube feedings for their nutrition. Morphine IV drips for their pain and discomfort, propofol for sedation.

Beyond all of the technical and mandatory medical needs of this patient, I have to remember there is a person on that ventilator. A person who is all alone. There is no family member with them. It’s me and the patient. And that steady beep of the EKG monitor and the pumping of the ventilator. The noises that provide no comfort.

This virus does not discriminate.

I have 30 year old male who was perfectly healthy and I have 64 year old lady. This virus is an equal opportunity employer.

In my 30 plus years as an ICU nurse, never have I seen this incredible death threat.
I check the ventilator along with the respiratory therapists at my side. Check the settings, suction the patient. Though the patient is in a semi-chemical daze from the pain meds and sedation medications, I squeeze this young man’s hand, I let him know we are here for him. That we are going to do everything possible to make him strong again. To let him walk out of this place and see his wife again and hug his little kids again. And pet his dog again. I tell him to hang in there. That we are doing everything possible to fight this monster.

His breathing is shallow. His lungs have taken a beaten. But I can see his pulse and I can feel his pulse.

I hold his hand. And tell him to be strong. I say a pray for him. For us.

I want to shatter inside myself but I know I can’t . We must stay strong.
He turns his head towards me.

And squeezes my hand back.

Hope.

This is dedicated to all of the nurses, physicians, respiratory therapists who dedicate their lives every day in the face of danger. Thank you for all that you do.

Coronavirus

We are the land of plenty.

But not now

We stand naked.

Our America is not prepared.

With the surge of coronavirus invading our nation, nurses, physicians, respiratory therapists and medics remember our oath, our dedication and our persistence of always putting sick people first.

Everything is urgent, and emergent and downright scary.

We all worry if we’ll be infected. Will we carry this virus home to our family?

Isolation and quarantined.

The front lines are Emergency Departments and ICU’s and not only are there not enough beds, or ventilators, there are not enough experienced nurses, or respiratory therapists or physicians to spread out. Some physicians are dead. A nurse has died.

We are being told by management to use the same mask day in and day out.

Our PPE’s are inadequate and not bountiful.

An experienced nurse has been suspended because she refused to take care of a coronavirus positive patient in ICU, as she was not given a mask or gown to protect herself. Because the hospital was out of supplies.

Suspended.

Nurses are told if they test positive they must report to work anyway.

This devastating list and problems are extensive.

And there is no way out.

We are the killing fields with minimal or no protection.

I say make noise and document.
Report to the state board of nursing.
To the health department.
Report to OSHA.
This is not a hoax.
This is not a science project.
This is the real thing.

A virus spreading wildly with no vaccine.

And when the nurses and physicians and respiratory therapists and medics start tumbling down like a domino effect, in sickness or in death….

It’ll be lights out for those in need.
Game over.

This Old Man

Finally it’s time to clock out of this ICU. No break for 12 hours, we beg to go to the bathroom just for a nano-second, in between not skipping a beat to hang life-saving IV drips, assisting with central line insertions and arterial lines, and intubations of the sickest. We pretty much just go door to door literally saving lives. Code blues, and chest compressions and emergent intubations and rapid response team screams out overhead, as we are responsible for that too, and by the time it’s 0815… not 0715…. we are exhausted and haggard and starving.

We clock out and walk to the cafeteria in our

semi-comatose state. We are starving.

And there he is. Again. That old man at a table in the corner of the cafeteria. He always has a sweater on, eating breakfast and looking at the morning newspaper.
We know who he is and we’ve tried to say “hi” or “good morning” but he never looks up.

He wears a gold wedding ring.

We respect his quiet space.

He’s been there for awhile.

He is that man that lost his wife in ICU. The love of his life.
He’d slowly shuffle into ICU, with that sweater and sometimes a bow tie. He would come every day and hold his wife’s hand. And read a verse from the Bible to her. She was non-responsive. She was 82 years old. He is older. She never moves. On the ventilator, inspiratory, expiratory, the EKG monitor shows a slowing rhythm. His dear wife Ethel, is slowing down. Per his wish, he begged us and the physicians to give them both more time.

When we saw him coming, the tissues came out. It was heartbreaking.

When he did talk to us, he told us they were high school sweethearts. They met at the

Valentine school dance. Her long brunette hair. Her rosy cheeks and her eyes that sparkled.

She was the love of his life.

He went off to war to fight for his America. World War II. When he came home, he twirled her around and around and said he’d never let her go. On one knee he asked her to marry him. To live with him forever. For Ethel to be his forever. With the little money he had, he was able to buy her a small diamond. She showed it off like it was 5 carats, it was barely a 1/2 carat. But she was happy and proud and in love.

They bought their first home and proceeded with five children. All sent to college. All had jobs. She was the best wife. The best mother. And the best grand-mother.

Their children knew what they had to do growing up: Boy Scouts, Girl Scouts, church, Sunday school, homework, cheerleading and football and proms and first dates and beach trips and marriages and grand babies.

They led a good life. They had celebrated many anniversaries and their love grew and grew.

Ethel developed abdominal pain. She had been quite healthy… but with CT scans and PET scans and ultrasounds, pancreatic cancer was discovered. The prognosis was poor. The doctors advised Mr. Bill to let his wife die peacefully. But he couldn’t. And day in and day out, every day without fail, he’d shuffle in to our ICU.

We knew the truth and so did he.

And on that fateful day, it all came to a halt. He watched the erratic rhythm on the EKG monitor. He watched us do compressions, fast and hard. He insisted on her being a full code because she couldn’t die on him.

She died 3 weeks ago.

And every early morning we walk down to the cafeteria, and there he is. Sitting in the corner with his newspaper and breakfast…. without looking up.

Maybe he’s not ready to say goodbye to his wife.

We want to hug him, hold his hand, talk to him, but we respectfully keep our distance.
He’ll know when it’s time to say goodbye.

Until then, he’ll shuffle in and out of that cafeteria. Waiting.

V.I.P. Status

We were told to wear masks before entering this patient’s ICU room. Entering his room, you could smell his rotting flesh. He was 92 years old.

His skin would slough off if you dared to bathe him.

His decubitus ulcers were raging with infection.

As long as I’ve been an ICU nurse, this was the worst — the smell, the neglect, the disrespect for this man.

He was VIP status.

I always had a problem with VIP status.

Either everyone was a VIP, or no one was.

Every patient should be treated with mutual respect and care.

He laid there motionless. Pupils fixed. No movement except for a deep sternal rub we would do to check any responsiveness. He laid on that bed on a ventilator churning inspiratory, expiratory.

Who was alive? Man or machine?

Because of his sepsis, multiple-system organ failure, and his dangerously low blood pressure, we had to place a central line in him.

IV pressors started.

And we waited and hoped and prayed that his suffering would soon be over.

He came from old southern money. His daddy started up textile mills in the south. And his daddy passed his legacy to him. Preston “The Second.”

The oldest of the boys.

He would continue to spread his textile mills to Georgia, Alabama, and Mississippi.

But Preston was the king of the mills. And the king of the families that worked for him.

Sitting in his great, 9,000-square-feet Victorian house on a mountain top as his employees lived in the valley of the mill village. There were only identical two-bedroom, one-bath houses. The families that lived and breathed the mill life lived there.

During this time, textiles and cotton farming ruled.

Preston was a good man, though. He was a philanthropist. He loved the arts, and botanical gardens, operas, and Broadway plays. He loved his wife, his high school sweetheart, and his son and two daughters. And they led a good, bountiful life.

Preston financially helped his employees if they were sick or having money problems. He was their king, and they loved him.

By the time he was 70, his dear wife passed away. He was sad and lonely, and a new woman came into his life. She was full of energy. Loved the social life and gave Preston continuous love and affection. To his children, though, she was distant and superficial. His adult children caught on right away. She had her “eye on the prize.”

Preston married her. Anna had a taste for the finer things in life: antiques, clothes, dining, travel to exotic lands. Whatever she wanted, it was always the best that money could buy.

It was summertime and 80 degrees outside.

We were all working continuously in ICU without a break or quiet moment. We knew visiting hours were soon. The ICU doors opened.

In walks Preston’s wife Anna with a full mink coat, silk-lined. Really.

She wanted everything done to Preston.

And so we had to do the impossible. We had to torment this patient who desperately wanted to die.

His children wanted him off the ventilator. His children wanted their dad to rest peacefully without all of the medicines or the intrusive ventilator.

Dad wasn’t even responsive. But their step-mother insisted. Everything was to be done.

We were told by the children that his wife wanted him alive because when he died, her flow of money ended. She would only be given an allowance.

You see, Preston eventually realized what his wife was all about.

So we carried on. Turning his body. Cleaning up his feces in bed as he had no control. Washing him as his skin sloughed off.

The rotting smell of a man who should have been dead. It became unbearable.

Several days later, he finally died — his children on one side of his bed.

His wife, in her mink coat, on the other side of the bed.

Love versus greed.

We were grateful and thankful that this great man that everyone loved was finally able to rest in peace.

This nurse was hiding the truth behind social media

Originally published on KevinMD

She was new to this ICU. She was young, smart, funny, and considered one of the “cool” nurses.

Before we could really get to know her, she exposed her wonderful, fantastic, perfect life all over social media.

Their perfect two-story brick house, their two little, perfect angel daughters — the perfect life in the perfect town.

But what was most important was her perfect, handsome husband. He was bound to be a self-employed millionaire … you wait and see … Greg was now a real estate contractor. And he had the connections to build those semi-mansions that everyone craved.

Every night Crystal came into work, and she was all smiles, high energy. Although we all felt like underdogs to this nurse with her stellar life, we were happy for her.

But the facade started to slip through the cracks. Crystal would clock in late but have to leave early. Her phone calls while at work to her husband were pleading: “Please get out of bed and get the girls breakfast and ready for school.”

Greg was tired. Frequently tired. He really didn’t want to work at all. He knew his wife was a dedicated, hard worker. She easily put in 60 hours a week in the ICU.

Then the school system called. The girls weren’t showing up for school. A conference was called. And suddenly, one of the highest-ranking elementary schools in the district became the “worst” school. Crystal and Greg decided they would take their girls out of school and homeschool them. Greg would be their teacher while Crystal worked.

We found out that Crystal jumped from one job to the next. It seemed that when her fellow nurses caught on to her truth, Crystal would start a new job.

Crystal would come home from work after a night shift and find her girls still in bed sleeping. No breakfast, no grooming, no homeschooling.

One night she came into work. She was disheveled. She had difficulty focusing. And she had bruises all up and down her arms.

A nurse talked to management about possible domestic abuse. And management called Crystal in to offer her EAP (Employee Assistance Program). She could receive free therapy sessions from licensed therapists at her hospital — total confidentiality.

Crystal said nothing was wrong. Everything was fine. Her awesome husband had stopped “working,” the bills weren’t being paid, and Crystal had more and more excuses for why she had to call out sick.

But Greg was wonderful. He had connections. And this time they were going to pick up and move to sunny California. Lots of semi-mansions.

He’s going to be a millionaire one day.

And in a flash, they moved across the country.

Crystal “unfriended” and “blocked” many of her friends on social media that knew the truth.

They lost their house in foreclosure.

And some of us never heard from her again.

If you know the truth and you’re tired of the isolation, the demands, the aggression, the denial.

Stop lying to yourself — for your sake and for your children’s sake.

Reach out before it’s too late.

The brother I never knew. The mother I never had.

Originally published on KevinMD

The brother I never knew.

He was buried in an unmarked grave with other dead babies. 1960.

I am now the age my mother died. She was 64 years old: colon cancer.

She was a vacant, negligent mother.

During one of my psychology classes in nursing school, we learned about the baby monkey experiment (the Harlow experiment), where a baby monkey was laid against a mother made of wires. It was an inanimate object void of heart and warmth and touch and love.

That was a lot like my mother.

It’s interesting how I seem to have flashbacks of when I was five years old. It was 1960.

It wasn’t “nap time,” but I noticed my mother spent a lot of time in bed. I knew she was sad, and that made me sad. How I loved my mother! I snuggled up next to her to give her comfort and love. The only thing I knew was how to be next to her and maybe take away some of her sadness.

Mom came from a strong Italian family. Her father was from Italy and crossed over to America, landing on Ellis Island. America: the promised land. And to have a son in the family was the ultimate blessing.

Mom was hoping this time for a son. After having twin daughters with stark black hair and then me with vibrant red hair (dad was Irish!), this third pregnancy had to be a boy.

The golden son.

Before the age of ultrasounds or NICUs (newborn ICUs) or surfactant, modern medicine in newborns had not yet developed at the time.

After eight months of pregnancy, mom started to have contractions and vaginal bleeding — all of the wrong signs for a healthy baby. Eight months gestation was too premature.

Dad rushed her to the hospital. And after several hours of labor, mom delivered a baby boy. The Italian “prize.”

They heavily sedated mothers back then during labor. She remembers being drowsy and weak with blurry visioned. She remembers seeing the back of Terrence’s head — the name given to him. His grandfather from Ireland’s name.

But this was her redemption.

Finally, she could please her parents! A boy with olive-colored skin and black hair.

And he was whisked away. My mother would never hold and bond and kiss the baby boy.

Within one hour of delivery, he was dead.

It was called “hyaline membrane disease” — now known as Infant respiratory distress syndrome or neonatal respiratory distress syndrome. It is more common in premature infants born six weeks or more before the due date. This is a condition in newborn babies in which the lungs are deficient in surfactant, preventing their proper expansion and causing the formation of hyaline material in the lung spaces.
And my mother came home to us three girls without that bundle of joy.

A dead baby.

A disgrace.

There was no therapy sessions or grieving. Everything came to an abrupt halt.

Baby Terrence was buried in a cemetery along with other dead babies in a large unmarked grave with multiple crosses everywhere.

One hour on this earth left my mother in total devastation for her lifetime.

And she withdrew from the joys her daughters eagerly wanted to give her.

My sisters and I somehow raised ourselves. We survived.

Dad climbed the corporate ladder with IBM. Dad bought the big house, the lake house, and the matching boat. He had several infidelities, and his drinking eventually surpassed “social drinking.”

What made mom miserable and vacant was all of the above.

But grieving the death of a baby or child is considered the ultimate tragedy.

There was no “hotline.” There was no bereavement support group. Psychotherapy was looked down upon.

And so she existed day after day, year after year, mentally bypassing our growth and development, our proms, our high school graduations, and college graduations and marriages and grandbabies.

She housed herself in until her death.

On my mother’s death bed as she was dying some of her last words to my father were, “Joe, do you have the baby? Where’s the baby?”

I cried at my mother’s funeral.

I cried for the mother I never had.

As John Lennon once sang: “Mother, you had me, but I never had you.”

Don’t want to wear a helmet? Sign up as an organ donor.

Originally published on KevinMD

I walk out my front door today to do my obligatory walk around the block with my pups.

Two police cars with blue lights flashing, lead a caravan of over 100 motorcyclists to a funeral for one of their fallen brothers. They revved up their motors in the procession, I guess, as a sign of love, of brotherhood, of kindred spirits in the motorcycle world.

I choked up. I was ready to cry. It reminded me of that 23-year-old male I once had while I worked surgical-trauma ICU.

A young man riding his motorcycle with no helmet, no protection, flying freely down the highway. Superman. “I’m going to live forever.” Not a care in the world with angel dust (PCP) in his system. Feelings of freedom and forgetting any troubles.

No troubles — until it happened. He crossed the line. Killed an innocent man in a car — a deadly collision.

He came to us from the emergency department. He was paralyzed from the neck down and on the ventilator with chest tubes, fractures to legs, ribs, arms — eyes wide open. But he couldn’t blink. He couldn’t track, his pupils were irregular.

His poor mother called me every morning at 6 a.m. with a crackle in her voice.

A motherly voice of sad surrender.

“Is he any better?” she would ask.

And sadly, I would have to tell her no. He wasn’t better; he was worse.

Eventually, a conference was called with the intensive care trauma team physicians and the mother. We would withdraw life support.

And that was it.

Maybe he would have been saved had he not done drugs. Maybe he would have been saved if he had a helmet on.

Maybe.

An emergency department physician once gave us ED and ICU trauma nurses a seminar. I’ll never forget.

Don’t wear your helmet — then make sure you register as an organ donor.

In the U.S. 19 states do not require a motorcycle helmet.

Motorcycle helmets reduce the rate of head injuries by 69 percent and reduce the risk of death by 42 percent.

According to the CDC, close to 2000 lives were saved due to helmet wearing in 2016.

The blue lights passed by me. His buddies of over 100 in single file, revving their motors … and not one with a helmet.

Denial and rationalization will not save you from a heart attack

Originally published on KevinMD

Smoking was cool. And he started smoking at the age of 15. Two packs a day — every day.

When he was 32 years old, we had our first-born son. And he decided to quit cold turkey.

But the damage was done.

Somehow, someway, it would catch up with him in devastating ways.

By the time my husband was 66 years old, he developed shortness of breath and chest pain. With exertion and without exertion.

Greg, my husband, was a health educator. A computer guru. A real “cerebral.”

And he knew “everything.”

Sometimes it’s not good to think you know everything.

Even when I — his wife, an ICU nurse of over 30 years — said to him, “You’re having a heart attack,” his response to me was not to cause trouble, and he would handle this.

He called his internal medicine doctor and was put on nitroglycerin. And the medical office said: “See you next Wednesday.”

I mentioned to him that no medical office tells you to come to their office the next week when you are actively having symptoms of a heart attack.

I was hushed and silenced by my husband.

I knew nothing. He knew everything.

As he ate his nitroglycerin like candy.

After a few days, he decided he couldn’t stand the pain any longer.

The medics picked him up in the middle of the night. His 12 lead EKG was perfect, but his troponin blood level was sky-high.

The cath lab team was called in, and my husband received his diagnosis: 95% LAD, the “widowmaker” it’s called.

The cardiac surgeon stated that a 15-minute delay from when he got to the hospital — he would have been dead.

Another heart attack would follow: circumflex 90 percent, RCA next in line and more stents were placed.

His final diagnosis came: liver and pancreatic cancer eventually with mets to his lymph nodes and lungs.

Was it the two-pack-a-day cigarette smoking or the large three glasses of wine a day that led to heart attacks and cancer? Did his cells form irregular cells and mitosis occurred? Maybe.

When you are haphazard in your lifestyle, and you think you are infallible and you will live forever; you slide down that slippery slope.

Denial and rationalization are your enemies.

Look in the mirror at yourself when you smoke those cigarettes or vape those oils into your lungs or drink that bottle of wine or case of beer per day.

It will catch up with you.

But it’s your choice.

Classic symptoms of a heart attack are:

1. Chest discomfort, pain, tightness in the chest
2. Nausea, indigestion, heartburn, stomach pain, may even vomit
3. Pain that spreads to the arms usually the left arm but can be both
4. Feel dizzy or lightheaded
5. Throat or jaw pain
6. Easily exhausted
7. Snoring loud, gasping, choking-sleep apnea
8. Sweating — cold sweat for no obvious reason
9. Cough that won’t quit
10. Your legs, feet, and ankles are swollen
11. Irregular heartbeat

Call 911!

Denial and rationalization will not save you.

My husband died on September 11, 2017, due to liver and pancreatic cancer with mets to lymph nodes and lungs.

His ashes were spread over a mountain top.

He was a father, a husband, a brother, a son, an uncle, a grandfather.

He was 68 years old.

It’s your decision.

That’s why I became a nurse

Originally published on KevinMD

My anger rises when I see the TV “nurse” with her short white dress and her breasts spilling over her pronounced cleavage and her submissive voice speaking to this muscular male MD.

Her quick giggle and pretentious demeanor is a stereotype portrayed across the land. And the reality of what we really do goes unnoticed.

We have people shouting:

“Bring me a coke!”

“A blanket, hurry up!”

“The food is too cold … the food is too hot.”

“Hold my penis in the urinal because I can’t find it.”

“I’m allergic to everything but Dilaudid.”

Disrespect. Spitting. Yelling. Scratching. Hitting. Cussing.

And the waitress-like image comes across the screen and blends into reality — into our hospitals and emergency departments and intensive care units. And the degrading and harassment and the intimidation tactics and workplace violence scream at us.

And you want to end this incredible vicious cycle.

And you wonder why in the hell did you ever go into nursing?

And then there is that one person. That one patient. He’s old but not too old. And he’s just been given the death sentence.

And you want to hug him and hold his hand. Cancer ravaged his body, and he doesn’t have a chance. And he knows it, and you know it. But he’s thankful and appreciative and asks for forgiveness for “bothering” you.

And I want to give him a new lease on life — new body — because he is one in a million.

One in a million that makes you stop and think and cry

And say out loud:

“Oh, that’s why I became a nurse.”

The patient with a pocketful of IDs

Originally published on KevinMD

All of us nurses and physicians in the ED and ICU knew him well.

He was a young, 21-year-old. A smart, articulate guy who kept going from one hospital to the next. He had a system down … almost.

This young man was a drug seeker. He knew all about seizures and how an Ativan IV push felt during the “seizures” he allegedly was having.

Even though he had several identities and different names, we knew exactly who he was. He would wait for an ICU nurse to assess him at the beginning of the shift.

After the nurse assessed this seemingly charming man, she’d exit his room but wouldn’t get too far from the door when she’d hear shaking from “Randy’s” bed. When she’d turn around, she’d see Randy in a full grand mal seizure. A chaotic quiver, clenched teeth, followed by rigid body and blank stare.

Damn. He was good!

His physicians were fooled for quite some time. They’d give him the EEG, the CT scan, and then the Ativan IV push … and the old standbys Dilantin and phenobarb, too. But “Randy” preferred the combo of Ativan and attention the most.

Eventually, he was diagnosed with “pseudoseizures,” which are not the same as a seizure. There are only two types of seizures: epileptic and nonepileptic.

We knew him well.

Epileptic seizures occur when a sudden electrical disturbance in the nerve cells in the brain causes the person to lose control of their body.
Psychogenic nonepileptic seizures (PNES), are seizures that occur as a result of psychological causes such as severe mental stress.

Pseudoseizures may be caused by: anxiety, OCD, panic attack’s, ADHD, traumatic injuries, ongoing family conflict, substance abuse, PTSD or physical or sexual abuse.

How do we treat of pseudoseizures?

Cognitive-behavioral therapy (CBT).

There was a conference: Randy and the intensivist. The doctor explained to Randy that his seizures were not from a neurological disorder. But the seizures he had developed were after multiple or acute stressors that overwhelmed his coping ability.

Randy was angry. Though he had many stressors in life, homelessness, non-compliant with his antidepressant medications, no-shows with therapy, Randy refused to listen to the doctor.

And so he continued aimlessly jumping from one hospital to the next — a new name for each hospital. No family. No home. An aimless wanderer.

Police found a young man in a fetal position at a bus stop. A tourniquet wrapped tightly around his arm. An empty syringe in his hand. Heroin.

Dead.

And with a pocketful of IDs:

Randy, Scott, Jeremy, Michael, Tim, Ryan.

We knew him well.