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.

Comfort in my final hours

Originally published on KevinMD

My name is Lucy.

I have stage IV liver cancer. I wanted everything done — even though the doctors told me this disease is terminal. My family, my church and my friends were praying for “the cure.”

Though I believed in God and the hereafter, I wasn’t ready to go. 74-years-old with beautiful children, grandchildren, and a great-granddaughter.

I woke up confused. In the background — wherever I was — I could hear music: “How great thou art.” One of my favorites.

I had a tube in my mouth, and I couldn’t talk. My wrists were restrained, and I couldn’t move. They had me tied down. Everything was blurry. My chest hurt like someone had pounded on it. People in white coats and scrubs surrounded me. I became aware that I was in a room with doctors and nurses and respiratory therapists.

A man introduced himself. He said he was a respiratory therapist, and he was going to pull the “tube” out of my mouth. The endotracheal tube. I gasped and took a deep breath, and I could barely talk.

The team explained to me that I was in the ICU. And because I wanted everything done to me, I had been emergently intubated, restrained, pain and sedation meds given through my veins continuously. My heart decided to stop, and “the team” did CPR on my fragile body. Because by now, I didn’t want to eat. I had lost over 25 pounds from the liver cancer.

I was told that some of my ribs cracked during CPR. I had pneumonia.

A palliative nurse came to talk to me within a few days. I wasn’t out of the jungle yet.

The palliative nurse talked to me about comfort, about acceptance, about peace and being pain-free and being with my family and friends surrounding me.

Comfort care. DNR, DNI.

New words for me.

I was so sick, so tired, so much in pain. I led a wonderful life.

Now, it was time for acceptance.

I remember those words from my doctors: terminal, no cure, palliative chemo … extending your life.

But at what cost?

Was it worth staying in an ICU in a comatose state? Was it worth having your chest beaten on with CPR and cracked ribs and pneumonia set in? Was it worth being tied down?

I knew the answers.

I was always stubborn. But maybe it was time for acceptance.

Maybe the prayers being sent my way were meant for a peaceful death. A peaceful entrance into the heavens.

I called my family in with my physician, my nurse, and the palliative care nurse.

I begged my family to please not put me on a ventilator again.

Please let me be comfortable.

Please make me comfort care.

DNR and do not intubate and do not treat.

I slept quietly going in and out of consciousness. My sons and daughters gathered around. They laughed and cried and told many fun stories of when they were young! My grandchildren and great-granddaughter held hands as they sang “Yes, Jesus Loves Me.”

Another favorite of mine.

And their tiny voices uplifted me and my soul.

I was surrounded by love.

This time — I was ready.

Texting and driving: what happens every day in America

Originally published on KevinMD

Jenna had it all: She was smart, pretty, inquisitive and popular, with just one more year until she graduated from high school.

She was at the top of her class and couldn’t wait until high school was over, and she could become a pediatrician just like her dad. One day, Jenna would be an MD.

“One day at a time,” her parents always told her, even though she wanted to rush to the next stage of her life.

At the end of her senior year, the big day came: prom. Jenna had so many things to do, like get her hair done, pick a dress, and all of those things every girl going to the prom needs to do. The day before, Jenna had to put these things on the back burner since her mom cooked a mouthwatering meal for her and some important guests — her grandparents, only the sweetest and kindest people in the whole world, by the way.

Mom sent Jenna a text:

“Hey Jenna, where are you? U OK? It’s almost time for dinner. Grandma and grandpa are waiting.”

As Jenna drove home in a hurry, she knew not to look at her phone. But the text was from her mom, and Jenn knew she’d be safe as she traveled along the narrow winding road … maybe a little too fast.

She went to text back.

Forty-five minutes past since her mom texted Jenna who said she’d be home in 15 minutes. Jeff and Patty Davis now were concerned. Jeff Davis, MD, decided to look for his daughter.

He jumped into the car and took the usual route that Jenna would probably have taken home.

Instinctively, Dr. Jeff knew something was wrong. Jenna always followed through. She was always on time.

He traveled around that narrow road. What he saw left him breathless. There was a stabbing feeling in his heart as he saw ambulances, police, fire trucks and other people standing by watching. There were EMTs and paramedics standing over a crushed up body. And there was that cute yellow car Jenna got for her 17th birthday.

That car was wrapped around a tree on the opposite side of the road she was supposed to be driving on.

Jenna. His pride and joy. Pulseless, disfigured. Snapped at the neck. Lifeless.

The paramedic found Jenna’s cell phone on the floor of the car.

Jenna had texted her mom back:

“Mom CALM down. I’ll be home in 15 minu …”

This story is a composite of what happens every day in America.

My husband was dying. I was being ignored.

Originally published on KevinMD

It was a long December.

A few years ago, my husband of 37 years got his death sentence: recurrence of liver cancer with mets to his lungs and lymph nodes.

He had a “Whipple” — a surgical procedure for pancreatic cancer — on Dec 24, 2015, and the surgeon discovered liver cancer too. So it was a 16-hour surgery. We were told he might die on the table.

His eyes haunted me as I kissed him good luck for surgery. I didn’t know if this was our last moment together.

The surgery was successful, and chemo and radiation followed along with two heart attacks.

95 percent LAD and 90 percent circumflex the next year.

Each time I told him that he was having a heart attack, he would let me know that I was just causing trouble.

I never professed to be a cardiac nurse, but I knew my cardiology 101 quite well! But he maintained his arrogance and maybe his denial as he chomped away on his sublingual nitroglycerin like it was candy.

For the last six months before his new diagnosis of recurrence of liver cancer, he stayed in bed almost 80 percent of each day. There was excruciating pain in his abdomen. Narcotics would only help a little.

I instinctively knew his cancer was back, but nothing could prove it: The CAT scans were negative, MRIs were negative. But then, his liver function tests jumped up — he became extremely jaundiced.

A simple ultrasound — one of the least expensive and simpler scans — finally proved what I thought: recurrence of liver cancer.

Two drains under interventional radiology to his liver would follow. And finally, a stent placed to his liver.

He didn’t eat, and he lost over 25 pounds. The stent stayed in place, but the cancer grew larger as it spread frantically throughout his body. This left him in a skeletal state, jaundiced, barely able to talk or to walk.

And this man who was the best father to our three children, who loved his granddaughter and our daughter-in-law, who faithfully took care of his mother until her death, who was an advocate for the underprivileged, who was a leader in the under-privileged community, who worked diligently at the health department as an educator and producer and director of health films and co-founder of a health care film festival throughout the U.S and became a partner to assisting in establishing the same in England, who joyfully took our children’s friends into our house and treated them as if they were his own and took them on vacations of cruises and fun parks and beaches and volunteered with our church youth group teenagers in white water rafting events and seeing these young people off on a mission trip to Ireland to promote peace and love and encouraged education to the most underprivileged …

This man who I deemed as the last hippie on earth lay in a hospice bed restless receiving morphine and Ativan.

And I wish his suffering would end because this is not a life.

It’s been a harsh two years. Many miles of driving back and forth to many doctors: oncologists, psychiatrist, surgeon, interventional radiology, CT scans, MRIs, palliative pain MDs, healing hands, internal medicine — and I’d begged for a DNR. I’d beg for hospice. I was told I had no say so as long as my husband said he was waiting for a cure. He wanted everything done. And I frantically explained: “Your ribs will crack with CPR, your body is too fragile, you’ll end up on a ventilator and your wrists will be tied down and restrained, and then you will die anyway.” Nobody listened.

His surgeon told him “We’ll do palliative chemo, and it’ll wipe this cancer out that has come back to your liver and lymph nodes and lungs. You’ll live another three to five years.”

And his oncologist said, “We will do palliative chemotherapy, you can handle it.”

And they demanded that he ate well and take 20 meds twice a day and take insulin on his frail body that he refused to nourish.

It was those false promises I resent from the medical profession. I told the MDs what they promised was not true. Why are we doing this?

And I was shunned and disregarded. But I knew the truth.

And here he lies in a hospice bed waiting for death with a quickly deteriorating body and mind that doesn’t know our names or his name. And we scrambled to adjust and prepare … because the truth is only five percent of people with liver cancer diagnosis survive this deadly cancer within five years.

There are no miracles.

I beg the medical community to be honest and upright and stop the fairy tales and false assumptions that everything will be fine.
False promises lead to more heartache.

I’m asking for truth.

I just wanted truth.

My husband passed away peacefully at 2:20 p.m. on December, 11 2017.

He fought the good fight, and as always we all wished we had more time left.

I’ll never forget the eyes of a 6-year-old sexual assault victim

Originally published on KevinMD

Patsy loved playing bingo every Wednesday night. Her boyfriend of three years loved watching her daughter Jenna who was a tiny and pretty six-year-old her momma called “princess.”

Even though they weren’t related, Jenna called Patsy’s boyfriend “Uncle Billy” at her mother’s behest.

And Uncle Billy made Jenna shyer and quieter than she usually was. He’d walk in on those Wednesday nights and demand a big hug and kiss on the cheek from Jenna — she would always obey.

Bingo usually kept Pasty away for two hours. And one night when she came home, she knew that something was wrong.

Those coal-black, empty eyes were void of any emotion.

Billy was sitting in the dark with a half-empty glass of whiskey and an ashtray full of cigarettes. She went to make sure her princess was tucked in and to give her a goodnight kiss. But there was blood on Jenna’s sheets with her dolls and teddy bears strewn about on the floor. That beautiful blonde hair was in disarray. Patsy shook Jenna, but there wasn’t movement.

A frantic 911 call ensued.

Billy sat silently as Patsy screamed at him. He just took a drag of his tenth cigarette.

Sirens blared and the radio dispatched “code 600.”

We cleared the small ED room for security and privacy. A police officer and sheriff showed up with a social worker. That’s how we knew this was sexual assault. Was it another teenager, a girlfriend or wife?

But we not prepared for the sight of a beautiful little girl laying out on a stretcher. She was almost catatonic and wouldn’t speak and barely moved.

I took her temperature, brushed through her hair for any evidence, and I saw the bruises on her arms and thighs. Her vaginal area was red and bruised. I was horrified and angry. I noticed something else — her eyes. Black as coal.

It was as if someone had sucked the life out of her or reached in and grabbed her soul. Those coal-black, empty eyes were void of any emotion.

A social worker was present and privately asked the mother questions. Billy had already been questioned.

The physician and I did fingernail scrapings, the MD did a vaginal exam, searching for evidence, searching for sperm. We completed the rape kit, secured the evidence and handed it over to the sheriff.

Little Jenna was taken away by the social service lady to an undisclosed foster care home for her protection.

Months later, the physician and I were served deposition papers. We had to go to court and testify that the evidence never left our hands — that it went from me to MD to sheriff. Chain of command. Chain of evidence.

I was nervous, but I wanted this man locked up forever.

Billy ended up in jail for eight months. He got out of jail for “good behavior.”

I never saw Jenna again. I always wondered what happened to her. Did she get therapy? Did she get love and protection? Did she lead a stable life?

I’ll never know.

That was in 1983, and I am still haunted by those hollow black eyes that lost a twinkle that all little six-year-old girls should have.

What man’s best friend taught me during a patient’s death

Originally published on KevinMD

Years ago in a 15-bed acute medical-surgical ICU, the nursing supervisor contacted me about a special assignment. Once I knew what it was, I said, “Absolutely.”

We were about to admit a patient in his 40s with end-stage AIDS/HIV. He asked to be a DNR, but his MD wanted to admit him to the ICU for close monitoring. But the patient had a special request. Even with IV antibiotics and pain medication running through his veins, Mr. Sam Smith just wanted one thing — his Yorkshire Terrier named Charlie. This dog that was found in a dumpster behind a grocery store was Mr. Smith’s best friend. They were always together, Charlie a few steps behind his human companion.

After Sam was admitted to ICU, I made sure he was comfortable, relaxed and pain-free. Friends came to visit, and one brought Charlie who wagged his tail and proceeded to lick Sam’s face. What a grand reunion.

I introduced myself to Sam and Charlie and watched the both of them throughout the night always making sure Sam had a blanket and his buddy was tucked in right next to him. Charlie cuddled up to his owner and slept peacefully through the night.

At 0300, I had to draw labs, and Charlie looked up at me as if to say, “Hey! Don’t hurt my master.” I explained to the dog, as if he were human, that I had to collect blood from his friend so I could get some information on his care. Charlie calmed down a little, but he was still staring at me.

Then I realized that this dog was probably thirsty. I filled up a styrofoam cup with water and gave it to him. He lapped it up and then turned to me and licked my forearm. I knew then that he was aware I was there to help both of them through this strange, sad passage of life.

Sam’s other friends would come in and out to take Charlie for walks outside where Charlie would sniff the flowers, do his “duty” on a few bushes, bark at the birds, then come back to the ICU to resume watch for his very favorite friend, rescuer, and caregiver.

Within two days, Sam became progressively lethargic, somnolent and nonverbal. His breathing became slower and slower. His family and friends were now at his bedside telling stories of Sam and Charlie. They laughed, and they cried as they told story after story of the wonderful, amazing adventures of Sam and Charlie.

Carlie was fully aware that Sam was dying. As they told stories, Charlie remained snuggled up to Sam. He licked his master on the cheek and resumed his position … right beside Sam’s heart.

After four slow, irregular breaths, Sam let out his last breath.

To say that our entire ICU staff and physicians alike were crying buckets would be an understatement.

But to say that Sam had a tragic ending would be wrong. He chose to die with his family, friends and best friend Charlie right by his side.

That night, I learned that there are words with special meanings, like compassion, friendship, and dedication.

And a small dog named Charlie taught me what unconditional love means and that death is a continuation of life.

We don’t live forever, but our memories do.

Keep love in your heart, and you will live forever.

Charlie went home with his other caregiver — Sam’s partner.

A nurse shares who she really is

Originally published on KevinMD

How do I tell you who I am in a couple of paragraphs?

Well, I was born in 1955, so that makes me 61 years old. My namesake is probably movie star and America’s sweetheart Debbie Reynolds.

My maternal grandfather was straight from Italy; my paternal grandfather was straight from Ireland. Both crossed the Atlantic and landed on Ellis Island in New York Harbor. It was the promised land.

So, that means I was raised in a half-Irish and half-Italian hotbed of culture and temperate.

There are four kids in this family, well five kids — one died at birth and was buried in the ground with all of the other unnamed dead babies. That’s how they did it back then.

Mom was a domineering lady who “ruled the roost,” while dad climbed the IBM corporate ladder. Once we moved from New Jersey to the South, we thought we had “arrived.”

We had a big house on the “right” side of town. Private Catholic school for eight long years. Confession every Friday so we could sin all over again. Church every Sunday. And if you didn’t go to church, it would be a mortal sin marked on your soul, and you would be destined for hell … eventually. If you weren’t Catholic, we would pray for you because you also would land in hell.

I watched the assassinations of JFK, of Martin Luther King Jr, Medgar Evers, Robert Kennedy and Malcolm X on our black-and-white TV. I paid attention to the Civil Rights movement, discrimination, separate schools and separate water fountains and lynchings — hangings because white skin was “better” than black skin.

I watched Richard Nixon bid farewell as his Watergate break-in unraveled after he told us that he was not a crook.

I watched Wall Street greed and fraud as they manipulated all of us.

I watched the bishop that graduated us from Catholic school bid us farewell as he left the church, running away with his secretary.

I listened to my mother cry in her bedroom behind closed doors as daddy climbed the corporate ladder with IBM — more infidelities, more money, more alcohol. I lived the dysfunction. Watched dad run into the walls at night, watched him lose job after job, watched us lose our lake house and my place of serenity.

Civil rights, the hippie movement, the “dogs run free why can’t we,” and I strummed my guitar to Carole King, Pink Floyd, Led Zeppelin and the Doors.

I strummed through the dysfunction, through the repeated messages in my head that mom and dad taught me, that I was fat and dumb and stupid. And by the time I could go to college, I envisioned myself far, far away. Maybe I’d be a teacher or a journalist and write for The New York Times. Or maybe I would stay at home and become a nurse because that’s what mom said I had to be. A nurse.

And so I did.

Nursing school was brutal. My first job was in the psychiatric unit. I knew the dysfunction well. The schizophrenic side was more interesting than the neurotic side. And in the late 1970s, there he was. The last hippie on earth working as a “poetry therapist,” and I had to have him!

Years later, we had three beautiful and smart children. How I loved being a mom. They were my manna from heaven.

I went through the hoops of nursing: Psychiatry, surgery, PACU, emergency nursing, surgical-trauma nursing and then my true love — ICU.

I loved putting the multi-system failure organs together and figuring out this endless puzzle. Years and years of CPR, code blues, code cools, code grays, STEMIs and missed Thanksgivings and Christmases with my family.

Good managers and terrible managers, good nurses and dedicated nurses and “I don’t give a shit nurses,” abusive MDs and ones that really cared about the patients and about us.

My mom died of colon cancer with mets to the liver. I cried at her funeral. Crying for the mother I never had. The mother that made herself vacant after her baby had died years ago. Dad lived to be 77.

An old age for an alcoholic. End-stage liver disease. A predictable death for him.

And here I am — still clocking in. I love it. But some things I don’t love. I don’t love the CPR and crushing of ribs on tiny little ladies and men that should have died peacefully. I don’t love the families that demand to rescind DNRs on their parents who are at the end stage of life.

Our society has got it all wrong. They think we will live forever. The “machines” will keep us alive indefinitely no matter what. No matter if they are on a ventilator and restrained, and they have no quality of life. No matter that they have a large-bore vas cath in their neck for dialysis and are on very strong IV pressers. No matter that the family is either feeling guilt or are in strong denial as their loved one lies hopeless and helpless as their body sloughs away.

I can see it in their eyes. The surrender. The “please, let me go peacefully” look.

We don’t live forever.

No one gets out of here alive.

If there were one wish I could have with my millions of years dedicated to nursing, it would be to beg you to let your loved one go peacefully into the night.

A mom, a mother-in-law, a grandma, a lover of two dogs, a wife, a nurse. A dreamer of dreams who hopes and prays for a better world of loving one another until our last breath.

And that’s who I am.

A nurse returns from vacation. And she’s thankful to the ICU she came back to

Originally published on KevinMD

I’m in the ICU and was just back from an incredible tropical vacation. Nine days of vegging out on the beach. The glistening ocean was just steps away from the five-star hotel I was staying in, where doormen greeted me with fruity daiquiris and a staff that couldn’t wait to serve my every whim.

I was in paradise, and far, far away from the reality of my day-to-day existence as an ICU nurse.

I was nowhere near the code blues, the sputum plugs, nor the bowel movements that dripped onto the floor. I was also far away from demanding family members, management, and that plastic smile I was forced to don in situations with them.

Vacation was over, and I was back. Although this was my profession and I was highly skilled, I secretly wished I never came back.

But here I was. Day one. My assignment? Another old person. An 82-year-old lady with stage 4 lung cancer. Another little old lady gasping for air with her old friends praying over her as if she were already dead. They would visit and sometimes sing gospel music from days gone by as they all swayed.

One day, the patient, Gerde (short for Gertrude), asked me to her lipstick on. And I did.

She asked me to fluff up her soft white hair.

And I did.

She asked me if I wanted to learn to crochet.

And I said yes.

And in between her ABG’s, adding IV antibiotics, giving her nebulizers and putting her on high-flo oxygen, she taught me to crochet.

She taught me even though she knew she was going to die. She knew it was time to go.

And in the dread I felt from leaving that tropical vacation and having to face this assigment, how did I find the most precious lady on earth who could not wait to reunite with her husband.

Within three days, she taught me to crochet a scarf as beautiful as any scarf available in an upscale department store.

She asked me to hold her hand as her final request. She was ready. I sat beside her and held her small, cold hand as she drifted off to the hereafter.

Her face glowed as she left this earth with a smile. No one blinked when she died, nor when they saw me crouched down with my head low in front of the computer with tears rolling down my cheek.

I was no longer sad I left my vacation. I was thankful that I left that tropical island to come back home to a little old lady who gave me bountiful blessings is just three days.

A nurse was attacked in the emergency department. This is her story.

Originally published on KevinMD

Victim: Female nurse, age 25

Time: circa 1980

Place: A hospital in a sleepy Southern town with fifty beds, six emergency department beds, one nurse, one doctor and one secretary.

It was an unusually quiet Friday night in this small emergency department.

We all knew Friday was “party day”: pay day, play day, alcohol, pills, drugs, loud music and lots of really bad decisions.

Not only did we cover the entire city, but we also covered many surrounding small towns and all of the conditions these locations imply.

When women came to the ED with “abdominal pain,” we had to break it to them that they were pregnant and ready to deliver. There were gunshot wounds, heart attacks, respiratory arrests, stab wounds, and many a church goers’ “done fall-outs.”

Overdoses, alcoholics, and drug seekers were migrated to the ED equally with snot-nosed kids with colds.

Fridays were the worst nights. But this Friday was different — it was completely quiet.

Then, the radio transmitter called in:

Rescue squad: 19-year-old male, attempted to put his mother’s house on fire. Superficial razor marks to his right inner forearm. Use of PCP — angel dust, Ketamine, horse tranquilizer, hallucinogenic.

The rescue squad came bursting through the ED doors in their normal fashion. He’s young and naked under the sheet. His razor marks … I’ve seen worse. They’re just superficial. His voice is soft and polite pepper with “yes, ma’am” and “no, ma’am.”

An MD suggests to put betadine on his razor marks and send him home. No stitches required.

As I apply the betadine, he sits up on the stretcher, stares me in the eye and loudly yells, “I’m gonna f**k you, b***h!” Before I knew it, he grabs my scrub top and tears open the snaps on the front. My bra is in full view, and he gropes my breasts with both of his hands and clutches my vagina.

I was violated.

His incessant squeezing of my breasts and vagina and his repulsive chanting about how he wanted to molest me made me feel as if I was in the darkest side of hell.

I screamed for help, “Call the police!” There isn’t an alarm or a security guard.

The MD kicks the patient’s ankle saying, “Stop that boy,” and the patient continues to “dance” with me across the ED. The secretary notifies the local police to come to our hospital stat.

I was assaulted over and over again until I was backed into a corner. My world stopped. It was me in the corner. And this naked man with his enlarged appendage was starring at me.

This was it.

I did not know any self-defense or survival skills. I knew my nursing pledge to “do no harm,” but I also knew that that “thing” was not going to go inside of me.

I had one hand free and grabbed his naked scrotum. I squeezed as hard as I possibly could and twisted them until I could twist no more.

His eyes rolled upwards, he went limp and fell to the floor. He fainted. I shut him down. I sat on his back, the MD sat on his legs, and finally, a fat-bellied policeman walks in.

“Y’all need some help?”

They carted him off to jail. I was obviously traumatized and started to cry. Dr. X said, “I’m so sorry, I’m just not used to this situation.”

It was Christmas time. It was the season to be jolly.

The hospital gave me three days off and workmen’s comp.

I felt violated and dirty — the nearest thing to being raped.

I was distrustful, angry and I even had a difficult time sleeping with my husband. I thought don’t touch me. Don’t anyone touch me.

But in the midst of all of this, I grew stronger — almost fearless — to where I could stare a man in the eyes and say, “Don’t even try. I will destroy you.” I felt like Superman.

When my attacker fell to the floor, I saw stars and stripes — victory.

But it doesn’t always turn out this way. Blame it on mental illness, alcohol, the wrong people with guns, the epidemic use of opiates or the mere frustration of waiting to be seen in the ED and waiting more than 15 minutes is 15 minutes too long.

The fuse is short in the ED.

Emergency departments across the nation are a haven for violence and abuse. The ENA (Emergency Nurses Association) reported that 80 percent of ED nurses and health care personnel were physically/verbally attacked in the ED 2014-2016. MDs reported being attacked in the ED by 75 percent.

I’m not sure what it will take for our protection.

I do know that a hospital CEO typically makes $3-14 million per year.

Priorities. Go figure.

Who is alive: man or machine?

Originally published on KevinMD

He had cardiomyopathy and CHF for over 20 years. At the time, doctors told him he could die at any time. That was 20 years ago. His EF was 10 percent — barely livable.

Two decades later, this admit kept him on a see-saw with respiratory distress, a bad heart, bad lungs, atrial fibrillation with RVR and heart rate in the 140s all day long. He progressed from nasal cannula to Optiflow to 100-percent BiPAP. A Cardizem drip was added to no avail. His next step would be intubation.

I pulled his wife outside of her husband’s room. And I told her that he wasn’t doing well and we may have to progress to a ventilator, and not to let him drink anymore — aspiration and aspiration pneumonia.

I could see the years of suffering on their faces. The dedication and love they had for each other.

His wife agreed. But 20-minutes later, she came to talk to me.

“We don’t want a ventilator. We’ve dealt with this for over 20 years. He doesn’t want a ventilator,” she said.

I grabbed our intensivist and gave her the heads up. She talked with the wife and the patient who both requested a DNI.

The patient stated he would go through one round of CPR … just one round. A strange request, I thought.

The MD added DNI to the patient’s chart.

An hour later, his wife came to talk to me again, “This doesn’t make any sense to not put him on a ventilator but to do CPR and crush his ribs and hurt him when we know he has a bad heart and lungs. I think it would be cruel! He’s ready to die. He told me so. We don’t want to see him suffer anymore. He just wants to be pain-free. No more pain and suffering.”

I could see the years of suffering on their faces. The dedication and love they had for each other.

Back in the day, we had a universal policy: All or nothing. Either a full code with CPR, intubation or nothing at all. Now patients and families can choose. There are different variables: no intubation but do CPR. Or give ACLS meds but no CPR. Many of these variables/ protocols make no sense to me, but the families and patients get to choose.

I agreed with Mrs. Smith and explained to her as we were surrounded by three respiratory therapists that by not intubating but doing CPR one time was like giving him a car but telling him he couldn’t have any gas.

The respiratory therapists agreed.

I introduced the thought of morphine in small amounts. A 2 mg IV push helps with breathing and anxiety and air hunger.

She agreed. And Mr. Smith was made a DNR/DNI.

The man’s family came from near and far. His sons, daughters, sisters, brothers, his buddy from elementary school, his favorite chaplain and his wife. They all sat by his side and kept vigil. They shared stories of Mr. Smith as they laughed and cried.

As Mr. Smith nodded in and out of consciousness, they held hands and hugged one another as a tear rolled down Mr. Smith’s cheeks.

We made Mr. Smith “comfort care.” And that’s what it means: providing comfort at end stage lung, kidney, heart, liver diseases, terminal cancers and multi-system organ failure.

Morphine was given as needed for comfort.

And we watched Mr. Smith drift away from our universe — the inevitable.

I cry as I write this. But I rejoice in knowing that we did not torment this man with CPR, cracked ribs, ventilator, wrist restraints, central lines and dialysis.

I remember something my husband once said to me,”Who is alive: man or machine?”