This Old Man

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

We clock out and walk to the cafeteria in our

semi-comatose state. We are starving.

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

He wears a gold wedding ring.

We respect his quiet space.

He’s been there for awhile.

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

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

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

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

She was the love of his life.

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

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

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

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

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

We knew the truth and so did he.

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

She died 3 weeks ago.

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

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

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

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

V.I.P. Status

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

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

His decubitus ulcers were raging with infection.

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

He was VIP status.

I always had a problem with VIP status.

Either everyone was a VIP, or no one was.

Every patient should be treated with mutual respect and care.

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

Who was alive? Man or machine?

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

IV pressors started.

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

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

The oldest of the boys.

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

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

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

During this time, textiles and cotton farming ruled.

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

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

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

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

It was summertime and 80 degrees outside.

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

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

She wanted everything done to Preston.

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

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

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

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

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

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

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

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

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

Love versus greed.

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

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

Originally published on KevinMD

The brother I never knew.

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

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

She was a vacant, negligent mother.

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

That was a lot like my mother.

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

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

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

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

The golden son.

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

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

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

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

But this was her redemption.

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

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

Within one hour of delivery, he was dead.

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

A dead baby.

A disgrace.

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

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

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

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

My sisters and I somehow raised ourselves. We survived.

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

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

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

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

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

She housed herself in until her death.

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

I cried at my mother’s funeral.

I cried for the mother I never had.

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

Denial and rationalization will not save you from a heart attack

Originally published on KevinMD

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

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

But the damage was done.

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

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

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

And he knew “everything.”

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

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

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

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

I was hushed and silenced by my husband.

I knew nothing. He knew everything.

As he ate his nitroglycerin like candy.

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

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

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

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

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

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

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

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

Denial and rationalization are your enemies.

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

It will catch up with you.

But it’s your choice.

Classic symptoms of a heart attack are:

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

Call 911!

Denial and rationalization will not save you.

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

His ashes were spread over a mountain top.

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

He was 68 years old.

It’s your decision.

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.

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.

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.

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.