All Intensivists are not created equal
Originally published on KevinMD
She was new to this ICU. She was young, smart, funny, and considered one of the “cool” nurses.
Before we could really get to know her, she exposed her wonderful, fantastic, perfect life all over social media.
Their perfect two-story brick house, their two little, perfect angel daughters — the perfect life in the perfect town.
But what was most important was her perfect, handsome husband. He was bound to be a self-employed millionaire … you wait and see … Greg was now a real estate contractor. And he had the connections to build those semi-mansions that everyone craved.
Every night Crystal came into work, and she was all smiles, high energy. Although we all felt like underdogs to this nurse with her stellar life, we were happy for her.
But the facade started to slip through the cracks. Crystal would clock in late but have to leave early. Her phone calls while at work to her husband were pleading: “Please get out of bed and get the girls breakfast and ready for school.”
Greg was tired. Frequently tired. He really didn’t want to work at all. He knew his wife was a dedicated, hard worker. She easily put in 60 hours a week in the ICU.
Then the school system called. The girls weren’t showing up for school. A conference was called. And suddenly, one of the highest-ranking elementary schools in the district became the “worst” school. Crystal and Greg decided they would take their girls out of school and homeschool them. Greg would be their teacher while Crystal worked.
We found out that Crystal jumped from one job to the next. It seemed that when her fellow nurses caught on to her truth, Crystal would start a new job.
Crystal would come home from work after a night shift and find her girls still in bed sleeping. No breakfast, no grooming, no homeschooling.
One night she came into work. She was disheveled. She had difficulty focusing. And she had bruises all up and down her arms.
A nurse talked to management about possible domestic abuse. And management called Crystal in to offer her EAP (Employee Assistance Program). She could receive free therapy sessions from licensed therapists at her hospital — total confidentiality.
Crystal said nothing was wrong. Everything was fine. Her awesome husband had stopped “working,” the bills weren’t being paid, and Crystal had more and more excuses for why she had to call out sick.
But Greg was wonderful. He had connections. And this time they were going to pick up and move to sunny California. Lots of semi-mansions.
He’s going to be a millionaire one day.
And in a flash, they moved across the country.
Crystal “unfriended” and “blocked” many of her friends on social media that knew the truth.
They lost their house in foreclosure.
And some of us never heard from her again.
If you know the truth and you’re tired of the isolation, the demands, the aggression, the denial.
Stop lying to yourself — for your sake and for your children’s sake.
Reach out before it’s too late.
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
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
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.
Originally published on KevinMD
My anger rises when I see the TV “nurse” with her short white dress and her breasts spilling over her pronounced cleavage and her submissive voice speaking to this muscular male MD.
Her quick giggle and pretentious demeanor is a stereotype portrayed across the land. And the reality of what we really do goes unnoticed.
We have people shouting:
“Bring me a coke!”
“A blanket, hurry up!”
“The food is too cold … the food is too hot.”
“Hold my penis in the urinal because I can’t find it.”
“I’m allergic to everything but Dilaudid.”
Disrespect. Spitting. Yelling. Scratching. Hitting. Cussing.
And the waitress-like image comes across the screen and blends into reality — into our hospitals and emergency departments and intensive care units. And the degrading and harassment and the intimidation tactics and workplace violence scream at us.
And you want to end this incredible vicious cycle.
And you wonder why in the hell did you ever go into nursing?
And then there is that one person. That one patient. He’s old but not too old. And he’s just been given the death sentence.
And you want to hug him and hold his hand. Cancer ravaged his body, and he doesn’t have a chance. And he knows it, and you know it. But he’s thankful and appreciative and asks for forgiveness for “bothering” you.
And I want to give him a new lease on life — new body — because he is one in a million.
One in a million that makes you stop and think and cry
And say out loud:
“Oh, that’s why I became a nurse.”
Originally published on KevinMD
All of us nurses and physicians in the ED and ICU knew him well.
He was a young, 21-year-old. A smart, articulate guy who kept going from one hospital to the next. He had a system down … almost.
This young man was a drug seeker. He knew all about seizures and how an Ativan IV push felt during the “seizures” he allegedly was having.
Even though he had several identities and different names, we knew exactly who he was. He would wait for an ICU nurse to assess him at the beginning of the shift.
After the nurse assessed this seemingly charming man, she’d exit his room but wouldn’t get too far from the door when she’d hear shaking from “Randy’s” bed. When she’d turn around, she’d see Randy in a full grand mal seizure. A chaotic quiver, clenched teeth, followed by rigid body and blank stare.
Damn. He was good!
His physicians were fooled for quite some time. They’d give him the EEG, the CT scan, and then the Ativan IV push … and the old standbys Dilantin and phenobarb, too. But “Randy” preferred the combo of Ativan and attention the most.
Eventually, he was diagnosed with “pseudoseizures,” which are not the same as a seizure. There are only two types of seizures: epileptic and nonepileptic.
We knew him well.
Epileptic seizures occur when a sudden electrical disturbance in the nerve cells in the brain causes the person to lose control of their body.
Psychogenic nonepileptic seizures (PNES), are seizures that occur as a result of psychological causes such as severe mental stress.
Pseudoseizures may be caused by: anxiety, OCD, panic attack’s, ADHD, traumatic injuries, ongoing family conflict, substance abuse, PTSD or physical or sexual abuse.
How do we treat of pseudoseizures?
Cognitive-behavioral therapy (CBT).
There was a conference: Randy and the intensivist. The doctor explained to Randy that his seizures were not from a neurological disorder. But the seizures he had developed were after multiple or acute stressors that overwhelmed his coping ability.
Randy was angry. Though he had many stressors in life, homelessness, non-compliant with his antidepressant medications, no-shows with therapy, Randy refused to listen to the doctor.
And so he continued aimlessly jumping from one hospital to the next — a new name for each hospital. No family. No home. An aimless wanderer.
Police found a young man in a fetal position at a bus stop. A tourniquet wrapped tightly around his arm. An empty syringe in his hand. Heroin.
And with a pocketful of IDs:
Randy, Scott, Jeremy, Michael, Tim, Ryan.
We knew him well.
Originally published on KevinMD
An ICU physician once told me: Nurse managers have a life cycle of a mosquito.
Fast and furious.
And then gone.
Deleted until the next one shows up.
It was the perfect ICU.
Dynamic intensivists. Phenomenal.
And they respected us nurses and collaborated with us. We had perfect cerebral perfusion together.
Experienced ICU nurses who knew what to do like clockwork — teaching the younger new nurses. Teaching them the facts of ICU. The intricate signs of organ failures and how to have a second sense when things went wrong.
We taught them how to alert the doctors when a patient’s vital signs and lab work was showing signs of pending failure. We taught them to keep their cup half empty but to never fill their cup with overconfidence and arrogance. The nurse that “knows it all” becomes the most dangerous nurse.
We were a proud ICU. We earned our stripes.
We were the best.
Stephanie had three years of cardiac nursing under her belt. She glowed with knowledge, and she wanted everyone to know that she knew everything.
Her eyes were on the prize: management.
That’s all she ever wanted — to be the top dog. So she pushed her way to the top.
To the vintage nurses, she made us second guess ourselves. To the younger nurses, she increased their insecurities.
And to management … she was a dream.
She was their “yes girl,” and she played the part well.
No matter what she reported any situation that may have gone wrong to management, instead of confronting the nurse and the situation.
She was energetic and positive to management and anything they wanted or asked for she was right there to help.
She already had her BSN and was actively working on her MSN in administration/management.
Stephanie shadowed the manager while achieving her master’s degree.
She learned all of the “top secrets” of management and had them embedded in her brain. Her plan was to become the next manager. She was ready to implement all that she knew.
It wasn’t long after, that our manager of many years, Patty, had retired. And so with all of the bells and whistles, we sent her off with love and affection in our hearts.
She was our mama bear. She was the one that remembered our children’s birthdays, graduations and grandma’s funeral. She was the one that bonded us together and taught us how vital respect for one another was. She was the one that made this unit as our other family.
We worked hard, but we loved every minute.
Stephanie became the new manager, and we immediately saw a change.
During our daily huddle, she was frantic. We always did something wrong. Sometimes she appeared near hysteria. When the bullies joined our unit and degraded the older and new nurses, Stephanie closed her eyes to the truth. Mistrust and bickering and disrespect was a common everyday occurrence. And our ICU became like walking on eggshells.
We first saw the secretaries lose their jobs. The secretaries who watched non-stop 25 EKG monitors. They were given a two-week notice and were dismissed.
One by one, we saw the experienced nurses leave. And the unit was left with inexperienced nurses who were young and bright and jumped on being the new charge nurse and the new “rapid response nurse” (RRT. Code Blue nurse).
And they wore their name badges with pride. They were new and sparkly.
But they didn’t even know what they didn’t know.
And the awesome ICU that we once knew crumbled and lost its glow.
The air was thick and negative.
Our spirits were broken.
And we all moved on towards a more positive environment.
I miss that group of nurses and doctors.
We were family. It was as if we grew up together.
Memories. That’s what we have now.
We at least knew that no matter what, we were there for each other. We were there for the patient.
We could care less about how many degrees you had or didn’t have.
What we did care about was each other.
We knew we had each other.
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
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.