All Intensivists are not created equal
They scream and holler and march. First Amendment, it’s our right. Open up the USA.
This is Socialism. This is a hoax.
THIS, coronavirus, is deadly.
Invisible as the virus makes its trek across our USA. Across the Universe.
Nurses and doctors and respiratory therapists are being named hero’s. Signs and banners and free meals and cookies and doughnuts and loads of adoration come our way. But we don’t want to be named a hero. We are doing our job, our profession, our passion.
What the health care professionals want are safety, and protection, and experienced staff and PPE’s like N-95 masks, and gloves and gowns and face shields. And respect for this virus.
When you go out and march and protest without a mask, without social distancing, you are compromising fellow citizens, nurses and doctors and respiratory therapists. You are endangering us and your family and friends. This virus doesn’t care what you think. It searches for the next host to hook on to. Are you in your 30’s, or 40’s or 60’s… the virus doesn’t care.
Are you washing your hands with soap and water, sanitizer, keeping your distance? Do you walk freely through essential stores without a care; without a bother?
To you, it doesn’t matter.
Because you haven’t been affected yet.
We say our prayers going in. The hospitals test us before we clock in. They take our temperature and ask us questions. We are allowed to stay and work if we are afebrile, lack a dry cough, no loss of smell or taste, no shortness of breath, no congestion. And then we are allowed entrance to work in that ER or that ICU or any unit in that hospital. ICU’s and ER’s are now deemed as Hell.
There are no short breaks. It is 12 hours of relentless pain. Masks and shields and gowns and gloves and the very sickest Covid-19 enter our ICU’s. Pouring blood into these patients and oxygenating with emergent intubation, and vasopressins and lungs crashing and kidneys dying despite dialysis, despite our last ditch efforts of proning a patient, despite telling family members they can’t see their loved ones last breath on earth.
Despite hospitals allowing us ONE N-95 mask per 12 hour shift. Despite us knowing that this special mask should be used only once and then disposed of. Despite hospital units and surgeries closing down, despite nurses being furloughed or physicians being fired for speaking out against the lack of PPE’s, despite administrators receiving $250,000 bonus checks in this turmoil.
Frontline nurses and doctors have died from this virus helping you to survive.
Ministers and protesters, funeral sessions and greater than 10 social functions continue and you go on “blind faith.”
This coronavirus attacks our lungs our heart our kidneys and brain. It attaches and attacks until the patient goes into multi-system organ failure and then death.
To date the US has 58,947 deaths from coronavirus. This number continues to grow.
So please, help yourself to protesting, to screaming and shouting. You certainly don’t scare or intimidate this virus.
Wear your masks, keep your distance.
But if you keep your guard down, you may become the next fatal number.
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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.
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.
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.
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.
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.
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.
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.
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.”
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.
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.
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.
No pulse. No respirations.
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.
Goodbye, Dr. J.
You were one of us.
You live forever in our hearts.
You were the best.
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.