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.

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?”

A toddler, his dad, and the unthinkable

Originally published on KevinMD

The toddler was a curious, rambunctious, talkative three-year-old who loved to explore.

Every week, he’d wait for Sunday to come, because Sunday was he and his dad’s special day. Mikey and his father adored each other.

Whether Mikey and his dad were doing “horseback rides,” playing basketball, or just sitting on the rocking chair for story time, whenever they were together there was fun, love and a forever bond.

Mom called them “the twins.”

One particular Sunday, “the twins” packed a picnic lunch with a bag full of breadcrumbs for the ducks. And Mikey couldn’t wait to feed those ducks! Dad loaded up the truck, and he and Mikey set off for their favorite park.

They sang their favorite song on the way: “This little light of mine … I’m gonna let it shine.”

When they arrive, it was a beautiful riot of spring: flowers reached for the sun, the air seemed to pierce through the fluffy clouds and the ducks waddled over and ate the bread crumbs Mikey had tossed to them.

Dad spread out a quilt on the grassy area under a tree where he and Mikey ate peanut butter and jelly sandwiches as they talked about the clouds and, of course, the ducks.

When lunch was over, Dad turned on the radio, and they listened to music. Tammy Wynette, Patsy Cline, Hank Williams, Johnny Cash and old gospel tunes — the good stuff.

Dad closed his eyes, but only for only a second. Mikey saw dad sleeping. Dad had such a beautiful smile, he thought.

Curious Mikey heard the ducks quacking and wanted to pet them. So he went down to the pond and got very close to the water. Then, one of his little feet slipped on a slick, wet rock.

At the hospital, things were quiet in the ER. The nurses were snacking on treats their families brought them after church. Sunday was always a good day for the nurses and staff. Church folk stopped by to visit loved ones and sometimes brought treats for the workers.

This particular day was eerily quiet, though. One of those “quiet days” that was almost unbearable. It was such a tranquil and peaceful Sunday that it almost “warned” us that something bad was going to happen. Amid the snacking and the chatting, there was a sense of doom.

A truck sped up to the Emergency Room doors. A frantic father carried his three-year-old son out of his truck and screamed, “My son, my son, help my son!”

Mikey was blue and lifeless as he lay on the ER stretcher. “Code Blue, Code Blue,” paged loudly and quickly throughout the hospital. Surgical nurses on their break ran out to the ER; respiratory therapists reported STAT to the ER. This small country hospital had only two MDs that day, and they dashed down the stairwell to the ground floor ER.

Mikey’s dad told the story gasping and hyperventilating.

“I fell asleep. I fell asleep … it was only seconds.”

Mikey had roamed off, and he slipped on a rock and fell into four inches of water. He couldn’t get up, and his mouth filled with pond water as he desperately gasped for air vomiting and aspirating until he was unconscious.

When Dad woke up, all he could hear was silence, but Mikey was never silent — until then.

We performed rapid CPR compressions between oxygenating him. Mikey was in pulseless electrical activity (PEA).

No pulse. No heart rate. No breathing.

Dad leaned over the ER sink, hung his head and began vomiting while he cried, “My son! My son!”

Despite our IV doses of epinephrine, rapid CPR, pleading with God and despite wanting to pretend this nightmare never happened — Mikey did not come back to life.

There he was blue and lifeless with vomit on his little T-shirt that read, “I love daddy.”

This was over twenty years ago, and the vision is ingrained forever in my brain.

Some things we cannot erase — ever.

This is what heroin addiction looks like

Originally published on KevinMD

What can I tell you? It started out innocently. College exams were over. And that meant one thing — party time! Bubbly, shots, beer, cocaine and Percocet. Everyone was happy. It was a celebration.

Pam came from a pretty strict religious family: no alcohol, no premarital sex and no crazy music in her house growing up. It was church every Wednesday and Sunday. And if you missed a Sunday, you were destined to hell.

So when Pam graduated from high school with top honors, she was set free and off to college. While there, she learned a lot about different cultures, different religions and different languages. She learned that not everyone was white, Christian and middle-class. This was a whole new world to her. And she loved it.

After several parties she learned some non-academic things one learns about in college. With her discovery of alcohol, pills and cocaine — she was ready to conquer anything. She had her wings and was ready to fly. And fly she did. Even with the partying through four years of college, she walked across the graduation dais with a diploma in her hand.

Then she found an amazing job in Manhattan far away from her provincial life. New York City: Bright lights, big promises and John.

John was Pam’s handsome, smart and, well, perfect manager at work.

Boy, did they have fun. There was dance, dinner and drugs … and even more drugs.

The fun went on for months, and then John proposed. Together they shared a taste for adventure, travel, exotic food, music and sex …

Eventually, they had a baby boy with blue eyes and blonde hair just like John. Pam’s family was complete, and Baby Jack was the apple of here eye. He was perfect in every way — except for his colic which made him cry and cry as Pam would rock him and rub his back. But what really calmed this baby down was warm baths — he loved them!

One day, John came home early. And he had a surprise for Pam. Although it was inexpensive, only around 80 bucks, it was precisely what the couple needed — a new high. The gift was black tar heroin and gave them the hit they were looking for after oxy and coke lost their lustre.

John tied his belt around Pam’s upper arm. The syringe was full, and he interested the needle into her vein and pushed. The rush was on. Pink clouds danced along side of puppies, kitties, unicorns and cotton candy. And life became painless.

Pam’s memories of her mother screaming, “Come home, you don’t know what you’re doing! You’re damned to hell,” her father’s rejection of her, the taunts, the damnation, the screams were all gone.

Pam was comfortably numb and free. It was pure euphoria.

Her head flopped down as she fell into the abyss.

She couldn’t wait to have more, she was rapacious and desperate for that feeling. But she knew she couldn’t keep doing this. Pam stopped eating and taking care of herself. Jack ran around in dirty diapers, and John came home later and later — Pam’s life was spinning out of control.

In a lucid moment, Pam knew she had to stop. Heroin took over her mind and body. So, she stopped using — cold turkey. She told herself that she could do it without help. 18 hours later, without the drug in her body, she started to sweat profusely, her body shook, her muscles ached, her legs were restless and the stomach cramps and vomiting were excruciating.

She wanted to feel good … to be normal. She just wanted the pain to go away. And her son just wanted to be held, to be fed. So he cried and cried.

Pam needed to fix this — to fix everything.

She knew she could calm Jack with a warm bath. So she put him in his baby seat, placed him in the bathtub, poured in bubbles, and turned the faucet on as she sat on the toilet seat and tightened up her belt. She injected deep into her vein and watched the bubbles rise … those beautiful bubbles.

John was out of town. He tried calling multiple times, and Pam wouldn’t answer.

When the police arrived, the door was locked, and they tore it down.

After two weeks, Pam roused but didn’t know where she was. She was in a strange bed in a strange place with a voice hoarse from an endotracheal tube.

She squeezed my hand and asked where she was.

I told her she was in the intensive care unit.

She didn’t remember a thing.

How do I tell her that she stopped breathing? How do I tell her that CPR was started on her? How do I tell her that she had a needle sticking out of her arm? How do I tell her that her bathtub water was overflowing onto the floor?

How do I tell her that her little boy is dead? How do I tell her that he drowned in the tub while his mommy shot up?

Words of wisdom for new nurses

Originally published on KevinMD

Welcome to the land of happiness, sadness, confusion, self-doubt, defeat and heroism. You have only just begun. This is not an easy job. And countless times you will say, “What was I thinking?” Or “Why did I do this?”

But it’s not really a job. It is a lifelong sentence. It can be insanely gratifying, or you can throw in the towel.

But be patient. It will consume you, and you will never be the person you once were prior to becoming a nurse.

My mother told me that I had to be a nurse. Back then, you did what mother said. I never wanted to be a nurse. I wanted to be a teacher or a journalist. But I did what mother said. I eventually grew into my nurse role. I went from psychiatry to ER to surgery/PACU, and finally landed in medical-surgical ICU. Almost 30 years of ICU.

1985 is when I graduated from nursing school. Computers were just becoming the new toy, and with the advancement of computers and technology, we still held onto archaic uniforms and traditions. Such as the nursing cap.

We were finally able to get rid of the dreadful nursing cap (thanks to women’s lib and sex-dress discrimination). I lost two years worth of salary increases because I was so against the nursing cap. The nursing cap that held onto thousands of microscopic germs. The nursing cap that got in the way with my patient care, the nursing cap that pronounced that I had to wear it because I did not have a penis. I finally threatened “sex-dress” discrimination, and I finally got my well-deserved raise, and never had to wear this appendage again.

I was absorbed in nursing. I loved the entire body and the vital organs malfunctioning and trying to figure out this puzzle of life. There were good times, and there were bad times.

These are my words of wisdom. My rules. Maybe this will help you absorb the rhyme and rhythm of nursing.

1. Stay alert, take a 30-minute break, take yourself to the bathroom, decompress. 12 hours is a very long day.

2. Be kind and gentle to all, from the janitor to the CEO to the poverty stricken homeless person. Treat everyone as an equal. There is no elite; there is no VIP unless everyone is a VIP.

3. Always keep your cup half-empty. I always thought the nurse that thought she knew everything was the most dangerous nurse. Medicine, cures, procedures, diagnosis and treatments are always changing. So keep your mind open.

4. Stay far away from the “bully trap.” The lateral violence. It’s not worth it, and you can be a part of ruining a person’s self-worth. Forever. Stay far away. Stand up to the bully, fight them off. Report them. Protect your fellow nurse and nursing staff.

5. Know your facts about your patient before you call an MD, PA or NP. Write down your problems.

6. Do not ever apologize to an MD for calling him or her about a patient that you need new orders for or you need to report a new condition in the patient. That is their job to assist you. You are the protector, the teacher, the nurse of your patients.

7. Chose your battles wisely. Managers can be wonderful, but they also can be a slippery slope. Chose your friends wisely also. Deception sadly comes in sheep clothing.

8. The worst shift can be the most wonderful shift if you engage, empower and help your fellow team. It is beyond any retirement gold watch you’ll ever receive when you have a good crew to work with and to depend on.

9. Watch out for burnout. That is the wonders of being a nurse. To go from psychiatry, ER, maternity nursing to newborn ICU, trauma ICU or neuro ICU to peace corps or travel nurse, to getting your BSN, or masters degree or doctorate to become an NP or an anesthetist: The world of nursing is wide open.

My bottom line to you all:

  • Keep your chin up, decompress, take a vacation, follow your heart.
  • Be kind to each other.
  • Respect one another. The old nurse and the new nurse.
  • No question is ever dumb.
  • Questions are good and much safer than not questioning and therefore potentially making a grave mistake.
  • Empower each other.

We’re all in this together. This circle of life. From birth to dying with dignity.

Focus, love, and empower.