Remembering a physician, suddenly taken away

Originally published on KevinMD

Our 20-bed ICU finally captured 10 intensivists — all board-certified in critical care medicine. We were fortunate enough to have one of these doctors in our ICU 24-7.

Of course, they all practiced professionally with expertise.

But I remembered this one the most: Dr. Jason McKenzie (name changed for privacy).

He easily became our friend and “go-to” person.

Clocking in at night and finding out that Dr. J was our doc, would give me great joy.

He was fun-loving and our safety net.

One minute, I’d rap a part of an Eminem tune to him, and he’d automatically complete it. Or I’d switch to a Led Zeppelin tune, and he’d stay right on track.

If we needed a central line, he would be there to insert one. During Code Blues, he’d rattle off what meds were required next.

He wasn’t just a clock-in doctor. He was here for the patients and their family, but he was also here for us nurses too.

He respected and acknowledged us, and we knew we could go to him for anything.

We’d laugh with him, hear one of his stories or jokes, and within an instant, switch gears and run a code.

One of the most important values for a nurse is to know that doctors listen to them and respect them. Dr. J was the whole package.

He talked about his wife and their two adorable children. He had love in his eyes when he spoke of them. We knew they were one lucky family!

After several years, he moved to a different city in a different state and flourished. He became the director of ICU at a large teaching hospital.

He mentored and taught many residents and interns and nurses alike. They all loved him too.

And then we got the news — news that couldn’t be true.

He was a “no-show” at the hospital for morning rounds. This wasn’t his norm.

Some of his buddies went to his house, knocked on his door … no answer.

They called the police to let them in.

And there he was.

Face down.

No pulse. No respirations.

Cold.

At the age of 47, our dear Dr. J was dead.

We found out later that he was scheduled for a stress test two months after he died.

LAD: 100 percent occluded. The widow-maker.

ICU nurses, doctors, respiratory therapists crowded the funeral parlor.

His two small children touched his casket. His wife with her head bowed, dressed in black. It was too early, too soon to be dressed in black.

Disbelief and not a dry eye.

I cried uncontrollably. I just lost my friend. My buddy. My fellow rapper.

We all lost him.

But I’ll never forget his kindness. His wit.

His expertise.

Goodbye, Dr. J.

You were one of us.

You live forever in our hearts.

You were the best.

A love-hate relationship with nursing

Originally published on KevinMD

If you went to go to a museum in New York City and saw a live heart encased in glass, still pumping and pulsating — it would be my heart, shredded into a thousand pieces all in disarray. But it still would be pulsating. This describes my life as a nurse.

Nursing was a vacuum that sucked me dry and left me dangling with nothing more to give. Three years left until retirement, and I count the days.

I wanted to be a journalist for the New York Times or become a teacher. I was so excited to go away to college, but I should have known better.

Dad was an IBM executive but eventually drowned himself with alcohol. My mother was a true “Mommie dearest” who exhibited no warmth to us, her three kids. She neglected us, and we were essentially on our own.

Mom ruled with an iron fist. Was she miserable because dad drank and had many affairs? Or was it her newborn son who died three days later after he was born? She saw his stark black hair, but they didn’t let her cuddle her dead baby. He was buried in a massive grave along with several unnamed dead babies.

I had already seen JFK assassinated on our black-and-white TV. I was in second grade. Then came the other cruel realities in life: Nixon resigning after the big Watergate scandal. Martin Luther King Jr, Malcolm X, RFK, Medgar Evers — all gunned down in our America. When I graduated from Catholic school, I became aware that our bishop ran off with his secretary.

So I grew up knowing that life was not full of happiness. That it was full of sadness and hate and cruelty and darkness.

And beyond the dreams of escaping our large house to go away to college, I was stopped dead in my tracts. Mommie dearest said I would not go away to college, I would go to a local college and become a nurse. And from that moment, my life was dictated into the world of nursing.

I first became an LPN. I couldn’t concentrate in nursing school for my RN, and so I failed. I was always a failure — dumb and stupid and fat. Dad yelled at me when I dropped out and screamed: “You’re a failure, nothing but a failure.” I climbed through LPN school and graduated. Mom and dad took me out to eat for graduation. Mom announced that if I had become an RN, I would have been sent on a cruise. Instead, I got filet mignon. Years later, when I did get my RN, my parents were a “no show” for my graduation.

It seemed that my career in nursing was much like the life I had already led. My first job as an LPN was on psychiatry. And within two years, I saw how people did not get better with their mental illness. It was theirs to keep forever. My stories are forever, but the worst story on psychiatry was searching for a missing 50-year-old female patient on our unit. We searched everywhere until we found an isolated bathroom locked. The male techs plowed down the door, and there she was. Her jugular had been chiseled down and exposed. She was crying as blood dripped down her neck. Starring in the mirror, she couldn’t take the final cut. One more slice of her exposed jugular, and she would have been dead. I was 22 years old.

After several years, I began working on my RN. And I landed a job in a small southern town in the ED. I had lots of energy, and I loved the smorgasbord of the ED. Gunshot wounds, stab wounds, heart attacks, respiratory arrests, delivering babies.

But the worst: That 6-year-old girl brought into the ED. Eyes hollow and black as coal. Catatonic. She did not move. She had just been sexually assaulted by her momma’s boyfriend. To this day, I am still haunted by this little girl’s eyes. This little girl who had the magic of being young and happy, taken away from her forever.

I graduated to the ICU with my RN in hand. And that’s what became my true love. I loved the multi-system organ failure. I loved putting the puzzle pieces together. I loved being dynamic and energetic and attempting to save lives and problem solve and critically think. Thirty-plus years in ICUs and surgical trauma ICUs, and I considered myself a good nurse. I loved what I did.

But after 30 years in ICU, it became apparent that the general public had decided that their loved ones would live forever. With these ventilators and cardiac drugs and dialysis and balloon pumps and extracorporeal organ support (ECOS) and code cools and code blues and code strokes — everyone was going to live forever. Even the 92-year-old man who was in the ICU in a fetal position with brain stem damage was going to live forever as his daughter insisted on him being a full code.

And so we did. Full code, CPR, ribs crunching, daughter watching, doctors begging the family to let us stop And they refused. And we kept assaulting his body until his straight line on the EKG monitor announced for another 15 minutes that he was dead. Dead, despite compressions, despite code meds.

Assault. Disrespect. Denial.

And my heart grew tired and cold.

The bullies came to our unit. They were young and bright and “knew everything.” They didn’t have the experience or the wisdom that we had. But they carried disrespect for others. And their failure to pay attention and learn and critically think did not become a priority. And suddenly we thrust into: Where’s your hearing aid? Where’s your walker? You’re not retired yet?

I gave it my all until I couldn’t give anymore. Three years left, and I decided to go back to behavioral health. And I know I can’t heal them or cure them. I give meds to the psychotics and schizophrenics. And that’s OK with me.

Because at least now, I don’t have to pound on their chest while their body has decayed. At least I can respect them and not force to assault them. At least I have a management team to work with instead of vindictive or dishonest behavior.

You may think I’m not OK. But I am. I have weathered through a very complicating nursing life. As interesting as it has been, it has equally been sad and tragic. It has been a large portion of my life.

This nursing life.

I have loved you.

And I have hated you.

Nursing’s newest problem: The young eating the old

Originally published on KevinMD

In 1976, we couldn’t wait to be nurses. Our starched white dresses with the nurse caps and stripes symbolized our graduation status as we were called one by one to receive our diploma and a rose.

We took an oath to care for the sick, to be professional, to critically think, to respect doctors and to respect patients and family members.

And to respect each other.

It was the age before computers. We learned how to calculate IV fluids in drops per hour and drops per minute. We had large folders that contained algorithms for sepsis, or myocardial infarctions or code blues. We had a three-fold flow sheet that we would manually document on. Threefold front and back. Blood pressures every 15 minutes and the pressors to coincide with the blood pressure. Everything was manually written from labs to a patient’s chart to MDs handwriting new orders — and endless charting of everything that happened to the patient in the ICU or CCU. We knew everything we charted had to be precise as it was always a potential for legal matters.

The handheld calculator had just come out on the market. It was the newest invention: $85 for a handheld calculator. So we were thrilled that we could now plug in some numbers to get an accurate drip rate for IVs or calculate dosages in an instant.

We were associate-degree and diploma nurses. And only the “elite” would earn a BSN.

We didn’t have breaks; they didn’t exist. We just kept working until it was time to go.

You worked the shifts your manager told you to. There was no compromising. You just did what you were told to do. We were the new pioneers in this field of nursing, and we were quite proud of ourselves.

Some older nurses did not communicate well with younger nurses.

Sometimes it was bullying the young. Or harassing or degrading a younger nurse who was just learning.

And the newly coined phrase appeared:

“The old eating their young.”

And the phrase stuck. Unfortunately.

And there was nowhere to turn. The managers turned their heads away. Sometimes the hazing was so bad that nurses would resign and even find a new career.

The nurses we couldn’t wait to be were riddled with harassment and ridicule.

And instead of holding each other up, we slowly destroyed each other.

Fast forward to the year 2000.

We older nurses are counting the years we can say goodbye to this long, hard, relentless career. This career that afforded our family vacations and a house and car and nice clothes and college for the kids.

This career that challenged us in the gut as we watched people live longer or die faster. As we said our goodbyes to our patients, we grew to love, and we’d gulp buckets of tears when it was over. Our last goodbyes to patients we loved.

We slowly evolved painstakingly learning the computer. And the computer was foreign to us. We were “special” and slow and didn’t adapt as well as the younger nurses did. These younger ones started computers in their home, in kindergarten and throughout the rest of their young lives.

Though they sported lots of energy, they walked faster than us, and they now had medical protocols and procedures right at their fingertips — instant knowledge.

But what the young ones didn’t know was that we were pioneers. We’re the ones with years and years of knowledge and experience and wisdom. And thus, the cycle of bullying was reinvented.

I’ve been a manager of an emergency department, I’ve been first assist to the surgeon, I’ve been a staff nurse and a charge nurse in ICU. And I’ve endured over 30 years in nursing. I have to continue working three more years before I can financially retire.

My sadness comes in when I hear the young men and women in this nursing career start the harassment.

“Where’s your hearing aid?”

“Are you STILL working?”

“Where’s your walker with the tennis balls?”

And then there’s a laugh.

But it’s not funny.

It’s sad and degrading.

It compromises our integrity, worth and our camaraderie.
 And instead of working together — we tear each other apart.

This is the hardest part of nursing.

I know it’s not everywhere, but it does exist.

And so now the coin has flipped.

The young eating the old.

Are we strong enough to stop this?

Are we strong enough to encourage positive work ethics and behaviors and to learn from the new and learn from the old?

Can this profession be saved?

It’s up to us.

All of us.

Respect.

Educate.

Enrich.

Empower.

We came here for a reason. Let’s not destroy ourselves.

Nurses Week. Always and forever.

Originally published on KevinMD

I have to work tonight. It’s Saturday. And I don’t want to go in. It’s springtime, the skies are blue, birds chirping, and the flowers show off their magnificent colors.

But it’s Saturday. And along comes being a nurse. We have mandatory weekends, mandatory holidays like Christmas and Thanksgiving and Easter and Independence Day and Memorial Day.

Mandatory.

And even on my day off when I get a real nights sleep, I think about or dream about that emergent intubation, central line insertions, propofol drips, wrist restraints, code blues, and CPR. Chest compressions and O2 sats dropping because the patient has sputum plugs, catching that patient before he falls out of bed, medicating that one that is in active DTs, and the psychotics and the hallucinations.

If it’s a dream, I wake up exhausted.

The surgical trauma unit was my nightmare as I’d stare into that 18-year-old boy’s eyes who now was paralyzed from the neck down cause he did drugs and no seat belt and crossed over the line and killed that innocent driver on the other side.

Paralyzed from the neck down. Forever.

Or that beautiful young girl that jumped out of a building and came to us dead on arrival. And the exhaustion and anxiety of 12 to 13 long hours without a break, without a lunch.

This is a pledge I request to those not in the health care field:

Stop the insults.
Stop the innuendos.
Stop the disrespect.

Unless you have breathed our life, then stop announcing what you do not know nor have experienced.

A salute to you nurses. We have a special calling of saving your life. Of bringing in new life. Of sending you off softly into the night when it is your time.

I could never acknowledge all fields of nursing, but thank you.

Spread this:

Empower.
Enrich.
Respect.

Nurse’s Week. Always and forever.

A nurse willing to forgive others. And to forgive herself.

Originally published on KevinMD

I was 5 years old on a busy New York City street with my mom, dad, and two sisters. A large man in shabby clothes holding a garbage bag in his hand stood on the corner waiting for the light to change.

My dad reached into his wallet and handed the stranger a $20 bill, patted him on the shoulder, and said, “Have a good day, my man.”

Dad knew everybody — even strangers, it seemed.

Back then, I didn’t know what poor was, but I did know he was a stranger and dressed oddly. And I knew that $20 was a lot of money.

No one explained anything to me, and we just kept walking.

Now, I was raised in the Catholic church where only Catholics go to heaven. We prayed for the “public” children and their parents because they weren’t Catholic. They were going to hell.

If you missed a Sunday mass, a very large, dark spot appeared on your soul — you’d be going to hell too.

I became defiant as I got older. I met the man of my dreams — or at least thought I did. He was this pseudo-intellectual hippie with Afro-eque hair and a long, unruly beard. His eyes were beedy and blue complementing his thin frame in a way. And he would always smoke those cigarettes. He was my magic man. We played music together, wrote poetry, too. I inhaled and exhaled his every word.

We bought a trailer on five acres, and we were going to live off of the land. I dumped my Catholic religion. As my parents said, we were “living in sin.”

But I was naive and young and came from a dysfunctional family with a mommie dearest and alcoholic dad. Daddy would drink a gallon of wine a night and bump into walls. Here he was Mr. IBM man who sent us to private Catholic school and owned the big brick house on the good side of town with a cute lake cottage and boat. The big, dark house disguised the sadness, the dysfunction, the negligent parents. The screams of emotional and verbal abuse. The message like a tape recorder over and over again:

“You’re dumb and stupid and not pretty.”

I thought I broke through — I became that nurse Mom told me I had to be!

We married and had three beautiful children. Before baby three, there was no future vision from my husband. Are we to stay in this two-bedroom trailer?

There was no movement from him. And so I got a second job as a nurse and saved money for a down payment to move out of that trailer and never look back.

It was a sad and tormented marriage. He had many lovers. Many infidelities. And though I put my heart into raising our children with the greatest joy, I always felt degraded and disrespected — and sad.

My husband, Ted, led a life of being a computer guru, public health servant, awesome father, and friend to others in the neighborhood, even a surrogate father to some.

Ted carried a glow to his universe.

I’d work 60 hours a week as a nurse to make ends meet. I worked until I was exhausted.

But I carried on.

Thirty-seven years of marriage. And then my life came to a halt.

Tormented years of marriage, of the infidelities, of the emotional abuse…. sadness and loneliness and always wishing for that happy marriage that never happened.

And in a blink of an eye, the only man I really ever knew, was gone. Liver and pancreatic cancer with mets to his lungs.

And today I wake up alone except for my pups; they stay by my side. I’ve been through therapies to lessen the pain, the anger, the sadness, and the loneliness.

And it was recent that I woke up one morning, as the sun squeezed through my blinds. I had tears in my eyes.

I had rejected Jesus for a very long time.

But today I felt Him.

The five-year-old in me remembered my dad handing a poor man $20.

And there he was. Jesus.

The Jesus in all of us.

Kindness and love and forgiveness.

I felt that glow that I had lost long ago.

An old poem that I had cross-stitched many years ago came out of my top drawer.

Maybe an anonymous author:

He spun a thousand webs to capture me
One was faith, and one was simple grace,
A strand broken out into the wind …
I look today at all the tattered ends
And wove a web of prayer back up to Him.

Tonight I walked the dogs. And I looked up and saw the Big Dipper. I hadn’t looked up in a long time.

The beauty of this universe, the stars, the flowers, the oceans, that newborn baby. The mountains.

I stand stripped and humble.

And willing to forgive others.

And to forgive myself.

A nurse’s downfall was telling the truth

Originally published on KevinMD

These events happened over 18 years ago. Some content has been changed to protect the innocent and the guilty. Searching for positive changes in the health care industry. We are not a number, and the patients are not a number.

I’m not good at lying. My eyes go to the left or look downward, and I start to stutter and pause. There is no eye contact, and I fall deep into the black tunnel of deception and fight to get out.

I grew up with lies and deception.

“Your father is taking ‘early’ retirement.”

My father, who I adored, who was an executive at IBM. He was fun loving and completely Irish — he also walked into walls at night after his gallon of wine. It was the family I couldn’t fix. And the daddy I loved so much … he was unfixable. We had the new large house on the right side of town, a lake house on two acres and the boat that matched. The nuns at my private Catholic school demanded respect.

Daddy was a “heavy drinker” as mom would say.

Daddy was an alcoholic.

And though I would have never wanted to be a nurse, the 1970s were full of dreams and women’s rights and burning bras, but my mother dictated our household. No matter what dreams you may have, you still would become a nurse, a teacher, a wife, a librarian. And I emotionally fought tooth and nail at my new role in life. The dreams of running away from that dark house that hid the truths and running towards fresh air and freedom were all extinguished — and my destiny was to be a nurse.

Mother said I was to be a nurse.

It was psychiatry then emergency nursing then surgery and PACU. I finally landed in ICU. And how I loved it. I enjoyed the intricate puzzle of multi-system failure organs. Heart lungs kidneys brain liver pancreas … they meshed well. This well-oiled machine fell apart piece by piece, organ by organ.

I was sold. Maybe mom was right. Perhaps I was supposed to be a crusader for the sick. CPR intubation drugs IVs, CAT scans and MRIs ventilators dialysis balloon pumps surgeries. Some made it through and smiled at you as they graduated from ICU to the step-down unit to out the front door. Some did not. Sometimes the thoughts and prayers from family members didn’t work at keeping their loved one alive. Sometimes Jesus decided it was time to go home. Sometimes Jesus would say “you don’t live forever” — nobody gets out of here alive.

I met nurses that had to be my sisters from another life. I met pure good and pure evil in the nursing profession.

I graduated to charge nurse in this 20-bed ICU. I loved directing the unit and problem solving and critical thinking in a flash of seconds.

But my downfall was telling the truth.

Political suicide. Sometimes upper management doesn’t want the truth. But I hated the untruths, the fabrications, and the lies. And so I loved my new position as a charge nurse, but I was a misfit from the beginning.

It wasn’t just one night that our acuities were dangerously high and nursing staff was low — it was a typical scene in the critical care unit. Do with what you have, don’t complain, an empty bed means availability for a new patient, but an empty bed didn’t mean a nurse to match.

In this environment, a particular night of doom started pleasantly enough — one nurse to two ICU patients. Fair enough, but there was chaos in the ER. Our ICU beds filled up. We weren’t a trauma ICU, but we would certainly become one in this night. A male 32 years old riddled with gunshot wounds, another male with multiple stab wounds. Our ICU filled up with critically ill patients, and our 2:1 assignments quickly went to 3:1 assignments. Code cools and code blues. Family members screaming from every corner of the ICU. The coronary care unit was handling CABGs and balloon pumps, and the neuro ICU had craniotomies coming to their unit. Any sanity you thought you had was out the window.

Our manager was the supervisor on-call for all of the critical care units that night. And I was told to call her. All three units were in crisis mode. And there were not enough nurses to take care of these patients. If you ever thought you could say “I’m going to lunch I’m hungry.” or “I need to go to the bathroom …” forget it because it wasn’t going to happen.

It was a war zone and looked like nobody would get out of here alive — not the patients and not the nurses. Upper management was nowhere to be found.

Some patients died that night. They didn’t have a chance. We were all short staffed that night because we were told over and over again like a broken record: budget, productivity, do everything, wave your magic wand to make the patients and the families happy. But what was behind the budget, the productivity?

Was it an end-of-year bonus check to the managers? Was it a salary increase to the CEO of $5 to $6 million per year not including the perks? Were the board members happily lining their pockets?

Nurses don’t go into nursing to get rich — ever.

That night seemed never to end. And management never returned my phones calls. Twelve hours of phone calls unanswered.

And the next morning the manager came in. No explanation, no apology. Total avoidance.

That’s when I knew the difference. That’s when I knew that you have to decide to be true to yourself or sell your soul. This manager chose to sell her soul.

A critical, urgent managerial meeting was called within a few days.

Mandatory. We were to discuss the critical shortage of ICU, CCU and neuro ICU nurses.

Problem solving.

All of the big wigs were there. Managers and directors and director of nursing and chief ICU physician. And then there was us — the little charge nurses who were the real heroes in the battlefield.

Every director and manager spoke up. The words came crashing in on me: “We’re here for you,” “We support you,” “Call us anytime night or day.” “We are here for you physically and mentally.” “Call us 24/7.”

They smiled and nodded their heads and patted themselves on their backs with an affirmation that they held some magic in their hands and some pretty simple solutions for such complicated and dangerous nursing practice.

Their words crashed into me like sharp stab wounds to my brain and every ounce of my genetic Irish-Italian blood spilled out all over that mahogany executive table.

I closed my eyes and let it all out.

Lies lies and more lies. And I had to put an end to this.

And I said to those managers and directors and physicians:

“Not true. None of this is true. Not only are you not available to us or our patients you are nowhere in sight.”

I went on. I was unstoppable.

“I called our manager on call that night 15 times. Fifteen times. Phone, cell, beeper … I left messages. And no reply ever. And I documented 15 times.”

I stared at our manager in the eyes as I spoke the truth. And the managers and directors and physicians, with their master’s degrees and their PHDs and their doctorate degrees, sat in silence, with their jaws on the ground. A pin dropping in that room would have been a loud noise.

One week later, I was called into the manager’s office. I was demoted to staff nurse. I was not to be the charge nurse again.

Was it political suicide? Was it the truth that no one wanted to deal with?

And those words. Those final words she said to me. A defining moment in my life and my career.

“You’re not one of us.”

And I knew that.

I wasn’t willing to sell my soul.

I was thankful that I was not one of them.

My battle against the nurse’s cap

Originally published on KevinMD

Florence Nightingale was among the first nurses who started wearing a nurse’s cap.

The cap was derived by nuns and represented those caring for the sick. Hair was neatly tightened into a bun and covered by the cap.
Back then becoming a nurse was typically seen as a female profession, but men were allowed to become nurses too. In 1930, only one percent of RNs nationwide were male.

Growing up in the 1950s and 60s I led a typical childhood that included watching my dad go off to work while my mom stayed at home, took care of the kids, did laundry, ironing, and preparing a culinary masterpiece of a meal every night.

It wasn’t until I got old that I realized my mother was “trapped.” A man’s world dictated her life. Though my dad was an IBM executive, we all knew that mom knew the math down to the cent. Had she had the chance to run the household finances, she would have been well off.

Daddy made the big bucks, and mom was only given an allowance.

Although the ‘60s and ‘70s erupted like a cultural volcano — women’s lib marches, bra burnings, and equal rights, opportunities and pay were all over the news. There was still a heavy sense of suppression in the air.

As females in our household, we would learn that when it was time for college and time for a career, we had few choices. Secretary, teacher, nurse, flight attendant, bank teller, waitress and wife, and mother. That was it. If you were a man, the door of opportunity was wide open: accountant, engineer, chemist, MD, pilot, lawyer.

I was not given a choice. My mother told me that I would be a nurse.

Never having been around sick people, I was scared to death. To get a job and finally leave my parent’s house, I finished the LPN program.

By 1985, I was completing college to graduate and become an RN, and that’s where this story takes off!!

In nursing school, I hated the nursing cap. I felt submissive and subservient with a cap on my head. It served no purpose except to remind me that I was in a man’s world.

Nursing school was harsh and difficult. Instructors were cruel and talked down to us. We were reminded that it was appropriate for instructors to talk down to us and belittle us, as this would be the way MDs would treat us once we graduated from nursing school.

We were to stand up when an MD came into a medical-surgical unit. We were to offer our chair to an MD. We were endlessly reminded that we were the low man on the totem pole.

When it came time to graduate from RN school, a fellow “militant” nursing school friend teamed up with me, and we decided to refuse to wear a nursing cap for our graduation. We were told by the chief of the nursing school that they would not graduate us if we did not wear a cap.

And so we did.

I was able to snag a job in the ICU. The year was 1986. It was a very large hospital. Nursing caps were mandatory. A class-action lawsuit was being introduced as female nurses could only wear dresses. This case was settled out of court, and we were able to wear scrub pants. So this was a major victory.

My first year as an RN, I decided to refuse to wear my nursing cap. It was a bacterial carrier from one patient room where the patient may have an open chest from surgery to another patient’s room that had serious infections. 
I found the cap meaningless and filled with nasty microorganisms.

Yearly evaluations came with a merit raise. And though I scored high on all procedures in ICU, I was denied my merit raise. The reason — I refused to wear my nursing cap.

Year two in ICU left me even more determined as I once again refused to wear a nursing cap. And once again, I was denied my merit raise.

When it came for our merit evaluations, I was denied again for the same reason.

And with that came my outburst.

“The only reason I am forced to wear a nursing cap is because I do not have a penis. If I had a penis, I would be free from this appendage that has no constructive value to it.

If you don’t give me my merit raise, I will get a lawyer and file against this institution for sex-dress discrimination.”

And with that, I received my merit raises and never wore that cap again.

Hats off to those people who influenced me: Ruth Bader Ginsburg, Martin Luther King Jr., President John Kennedy, women’s liberation, National Organization for Women (NOW), Malcolm X, Gloria Steinem, and the civil rights movement.

And because of these strong people, little girls across this great country of ours can dream of what they want to be when they grow up. They can now make their own decisions and make their dreams come true.

Power to the people.

A lesson in never giving up

Originally published on KevinMD

Jim Henson, creator of the Muppets and Sesame Street, died at the age of 53. His diagnosis was toxic shock syndrome/streptococcus pneumonia — a deadly bacterial infection.

We were on vacation when we heard the news: The genius who opened the imaginations and hearts of our children … maybe you too … was gone. We were devastated and saddened that the magic Muppet man had died.

One year later, our ICU admitted a 32-year-old female named Sarah. She was beautiful with long blonde hair and a loving, devoted husband by her side. Her diagnosis: Streptococcus pneumonia — the same thing as Jim Henson.

Sarah was rushed past the patients lining the ER walls waiting to see an MD or RN. She had shallow, gasping respirations. The ER MDs, nurses and respiratory therapists ran to her, and she was emergently intubated.

A central line placed, pressers flowed through her veins … normal saline bolus after bolus. Temperature of 103.2 degrees. Blood pressure 72/36 with a heartbeat slow and thready.

As she entered our ICU, we were prepared: cooling blanket, the strongest antibiotics, 24/7 EKG monitoring, and BPs every 15 minutes.

After a week, Sarah was not better. She was spiraling out of control, and her organs were shutting down. We had to add a vas cath for dialysis.

The intensivists updated Sarah’s husband; it was grim. But every day we stood quietly by her side without fail to do everything possible for her survival.

Finally, the physicians approached Sarah’s husband telling him we did everything possible, but she wasn’t getting better. A DNR was recommended. And her devastated husband, Pete, agreed.

We continued our regime of care, and nothing was discontinued — but we accepted that Sarah was not going to survive this deadly disease.

Every day, Pete pulled up a chair and read her poetry out loud.

Every day, Pete held his wife’s hand and told her he loved her.

Every day, Pete would comb her hair and read poetry to her.

Every day.

Slowly, her blood pressure improved and we were able to take her off IV pressors. Her temperature dropped to normal. Her heart rate went into a normal sinus rhythm.

And as he held his frail, sick wife’s hand — she squeezed back.

Overwhelmed he screamed for the ICU nurses to come see what just happened. He asked the doctors to come to her room. And he requested that the DNR be rescinded.
Within another week the endotracheal tube was removed. Sarah gasped her first breath without a ventilator.

Physical therapy came to work with her every day. Her strength grew.

And finally, she graduated out of the ICU and to a step-down unit. Pete at her side.

Pete never gave up.

We didn’t either.

One year later, we received a postcard from Sarah and Pete.

Sarah was standing on a mountain top, and the words she wrote on the postcard read: “Thank you all for believing in me.”

Go quiet into the night

Originally published on KevinMD

I know what you’re thinking: She’s cold-hearted, cruel, and unkind.

But am I? Or are you?

Grandma Lilly is 87-years-old and in the ICU. She’s on a ventilator with her wrists restrained to the side of the bed. Grandma can barely see because her eyes are puffy: scleral edema. And her heart races: 140 beats per minute. Her blood pressure is low and Levophed and vasopressin drips are ordered.

Her family can’t talk to her as she phases in and out of existence. For her, end-stage renal disease means dialysis. And respiratory failure equals ventilator. She’s a brittle diabetic with uncontrolled fluctuating blood sugars.

Grandma Lilly can’t eat, and we feed her by a tube that goes into her nose and to her stomach. Tomorrow, she gets a PEG tube surgically inserted to feed her. She’s been on the ventilator too long.

Next comes the ICU package: ventilator, dialysis, pressers, restraints, trach, PEG tube.

Any second of clarity or awareness is pure brutality. There’s no pretty ending to this torture except through death.

Poor Grandma Lilly.

Oh, the memories! When we were kids, we’d chant for Grandma Lilly. She’d snuggle us up in that rocking chair and read books to us. Let us splash our feet in the puddles after a misty rain, built sandcastles at the beach, and gave us candy when momma said no.

She was our heart and soul, and we wanted her to live forever. But we don’t live forever.

There’s cruelty in putting an 87-year-old with multi-system organ failure on a ventilator; restrained, medicated, disoriented, and wishing for the tunnel to the hereafter.

“The choice can be yours”

Your memories will live forever.

The ventilator. Churning inspiratory and expiratory breaths … day after day as Grandma Lilly wishes for death.

Grandpa Joe is two doors away from Grandma Lilly.

He’s going to die too from cancer. But he’s led a good life. And he’s cognitive enough to say he wants to die peacefully with his family and his dog Rufus by his side.

Grandpa Joe is a DNR/DNI and has requested to be “comfort care.”

He is given a morphine drip that flows slowly through his vein for his excruciating pain from cancer.

He breathes slowly. But he’s happy and pain-free and surrounded by love. His room is dimly lit. Music seeps out and fills the ICU hallways. Frank Sinatra, Nat King Cole, Ella Fitzgerald and Billie Holiday.

A Boy Scout and an Eagle Scout, he was the only one in his family who got a college degree. We loved his campfires, the stories he told, the wisdom and gentle guidance. And here, his family sat around him. Good old Grandpa Joe. What a life filled with love. They held his hand as they told their loving stories of Grandpa Joe. They laughed and silently wept. Tears of love and happiness and letting go but knowing the pain and suffering of his cancer would be over with soon.

After several rounds of CPR and cracked ribs, little Grandma Lilly died.

Grandma Lilly left this earth tied down like a captured animal.

Grandpa Joe left this earth with quiet whispers of, “I love you.”

The choice can be yours.

Go quiet into the night.

This is our last dance.

The secret life of a nurse

Originally published on KevinMD

This is based on a true story. The name and some details of the events have been changed. 

She was the smarter nurse who floated to ICU, to CVRU, to CCU. She could handle any crisis: balloon pumps, CRRT, open-heart patients, respiratory distress, code blues — anything.

Sandy was quiet. She didn’t really have any nurse friends. She was a loner.

But we could depend on her to take the most difficult assignments.

She was our brightest star.

We delivered our babies two weeks apart from each other. I remember when we both got back from maternity leave, she proudly showed all of us 8 x 10 pictures of her family and of her new baby. I felt inferior. Like I was the bad mom because I had no pictures.

Both of our babies went to the hospital daycare. And every day that we worked together, the daycare would call Sandy on the phone. Her baby was frantic and having tremors. Something was wrong. And Sandy would have to leave our ICU and walk to the nursery and hold and rock her baby and breastfeed her. Her baby would eventually sleep into a beautiful toxic slumber.

Before the age of computers, narcotics were counted by a day shift nurse and a night shift nurse. Narcotic papers were signed and eventually sent to the pharmacy.

Sometimes the numbers didn’t add up. Sometimes a morphine ampule would have a crystallized gel wrapped around the scoring of the ampule — it was just clear nail polish.

Sometimes her patients would have unusually high blood pressure or high heart rates as if they were in pain. But they couldn’t be in pain. Sandy’s notes were meticulous, and her narcotics were well documented.

How did we miss this? Where was that cry for help?

What we didn’t know was that Sandy was being watched by management and by the pharmacy. The pharmacists were aware of the discrepancies, the missing ampules of morphine and the uneven levels of medicine in the Valium vials or the crystallized solution gluing the top of the ampule to its body.

They moved Sandy around a lot. One day she’d be in the progressive care unit, the next day in CVRU, to ICU and CCU. And she never complained.

She was confident that she had this act of deception down to an art.
But she left a trail. The obsession, the perfection of covering her tracts became sloppy, and that’s how pharmacy picked up a trend.

Calls from the daycare, her baby screaming, her patients in excruciating pain but could only express themselves hemodynamically, as they couldn’t talk since they were on ventilators, restrained, balloon pumps and CRRT.

She’d fade in and out from unit to unit. And there was never any eye contact.

We watched in disbelief as two security guards escorted her out of our ICU. A syringe and tourniquet found in her scrub pocket.

She sobbed and denied ever doing drugs.

She denied ever failing to medicate her patients.

She denied the fact that her baby was addicted to the morphine that flowed through her breast milk.

She tested positive for fentanyl. But she still denied.

We were all devastated. How did we miss this? Where was that cry for help?

The state board of nursing offered rehabilitation. They offered her help. She refused. Eventually, her nursing license was terminated.

DSS removed her children.

And we never saw Sandy again.

The perfect nurse.

The perfect mother.

Hidden by a mask that she wore each day that she clocked in.