Don’t Wake Me Up Again

By: Debbie Moore-Black, RN

After 33 years as an ICU RN, I had finally decided I couldn’t do this anymore.

It was my last nightshift. The last shift that convinced me I had made the right decision.

The CNA and I went door to door to turn each ICU patient that was not capable of turning themselves.

ICU-06

Mrs. Thelma was 86 years old.

She laid in her bed slightly restless. Restrained. On a ventilator. NG tube for tube feedings. Levophed drip for a low blood pressure.

Mrs. Thelma was not able to turn herself.

The CNA and I knocked on the patient’s door. Her son was asleep on the side bed provided for families.

Her son woke up. “What do you want”? Why you waking me up”?

We explained that we had to turn his mother.

His poor gray haired mother. Attempting to extubate herself. Attempting to pull out her NG tube. Too weak to turn herself. Restrained to prevent her from extubating herself and pulling her NG tube out.

The family wanted everything done.

We turned and repositioned Mrs Thelma. We cleaned up the bowel movement in the bed and changed her sheets. I gave her a small amount of morphine ivp for comfort.

I held her hand and silently apologized to her.

I was sorry her family was not rational.

I was sorry her family thought she’d live forever

I was sorry that they were the reason she suffered so.

There was a family conference. The ICU MD explained she was going through multi system organ failure. She’s 86 years old.

That they could allow her to die peacefully.

But they wanted everything done.

And so we did. Painful day after painful day.

Every 2 hours we had to turn and reposition her or decubitus ulcers would set in. Suction her mouth and ETT, rub her back. Clean her body.

Her eyes were hazy. A living hell.

We left the room after we tucked her in.

The son announced: “don’t wake me up again”

I prayed for a peaceful death for Mrs Thelma…. but not this way.

My last night, clocking out to people who refuse to allow their loved ones to die peacefully.

I tried. I educated.

Many refused.

I could no longer deal with the torment that lies in the ICU.

To family members: We do the best we can.

We are not your servants. We are not your waitress/waiter.

We are caregivers. Professionally educated to treat your sick loved ones.

Please work with us.

We are strong…. but we are tired.

Respect and Empower.

The Prison: Covid ICU

By Debbie Moore-Black, RN

By: Debbie Moore-Black, RN

I enter the hospital to work again. I must work as I have 3 small children and a husband presently out of work d/t Covid. He is “non-essential.”
There’s a violinist playing at the employee entrance. I know they do this to lift our spirits. But it’s a slow sad string that reminds me of the titanic. And yes every day I clock in, I feel as if it’s a sinking ship.

By now we should have plenty of N-95’s, plenty of face shields and gloves and disposable gowns to enter that covid room, that Covid patient that never goes away. That continues to multiply.
It’s a painful job. I thought I would be saving lives as a nurse, but instead we are prolonging death.
This ICU is 24 beds. All Covid patients. 24 strong. I gown and glove and put my N95 mask on and face shield to enter that patient’s room. That patient with Covid… he’s 40 something, and he refused to wear a mask anywhere. Said it was a hoax. Said it wouldn’t happen to him. Spread his infection to his mom and grandmother and anyone else that potentially came in contact.
He had come gasping for air to the ED. It didn’t help that he was an everyday 2 pack of cigarettes smoker. That everyday he downed several cheeseburgers with fries and a milkshake. That every night he drank many cans of beer.
He said it was against his rights of freedom to wear a mask. He said it was a muzzle. He said he wasn’t going to be one of those sheep that follow a ridiculous rule of social distancing, washing hands and wearing a mask.

The muzzle he said suppressed his right to speak.
And now he contacted Covid. His O2 sats were in the low 80’s, he had co-morbidities like being over weight, high cholesterol, cigarette smoker and now his lungs were failing him. As Covid easily attached and infected his lungs.
It was only a matter of time for Johnny to earn dialysis, multi-system organ failure crept in. Kidneys failing, blood clots to his brain. And no matter what we did with those miraculous drugs of remdesivir and steroids, it wasn’t working. His breathing became asynchronous with the ventilator. We called it “guppy” breathing. Like a fish without water. He couldn’t follow commands. Family held tight for hope. For a miracle.
The MRI showed no activity to his brain. Anoxic injury with blood clots.
Covid rapidly ate through his body.
I pulled my work phone out, heavily encased in a protective plastic, so I could face time his family.
No holding hands. No final kiss on the cheek.
Just a final vision of Johnny.
We pronounced him dead at 0515. Notified the family. The morgue was notified. Make room for one more dead person to be stacked on top of another like multiple bunk beds.

Gave him his final bath. Toe tied him for his identity. Wrapped him up in his morgue plastic zip up bag. And we sent him off.

Clocking out we all face local police and administrators and firemen and medics cheering us on. Congratulating us. Calling us heroes.
Free pizza and ice cream for us.
And we bow our heads low.
Because we don’t want the cheering and balloons and the violinist and the pizza and ice cream and clapping hands.
We don’t want to be called heroes.

What we want is respect for each other.
What we want is for you to wear a simple mask.
What we want is for you to social distance and wash your hands.
What we want is for you to allow us to clock out and go home to our families safely without feeling that we potentially could infect our loved ones because of you being so incredibly careless.
Pay attention to science and medicine or else you may be the next careless victim.
Wear your mask.
Deal with the truth and get over your ego.

All Intensivists Are Not Created Equal

All Intensivists are not created equal.

By: Debbie Moore-Black, RN

I’d like to preface this story with saying that the majority of the Intensivists I have worked with have been exceptional, caring, and professional. We had all established a good camaraderie and we had mutual respect for each other. We worked well together.

But there always seemed to be one that was the exception.

And as I drive some long miles on a recent “get away” to the mountains…, the flashback came back to me.

Joellen was 64 years old. She smoked all her life. 2 packs of cigarettes a day. She started smoking at the age of 16. Hollywood made smoking sexy and romantic.

By the time she was in her late 50’s she developed severe shortness of breath without exertion. She had difficulty breathing. She wouldn’t put her cigarettes down.

Her physician told her: “If you don’t stop smoking for good, you’re going to die.”

In and out of the hospital she progressed to a diagnosis of CHF and COPD. Her physician told her at the age of 64 she was now considered “end stage” COPD. There was no regimen of care for her as her lungs were destroyed by her incessant smoking.

She agreed to sign a Do Not Resuscitate as she entered the ICU one last time. She did not want to be intubated. But she agreed to be medically treated.

It was now my shift. Night shift. And Joellen had a very bad day. Her breathing was shallow, her lips were cyanotic, her O2 sats were in the 80’s.

It would have been an optimum time to place her on “Comfort Care”, but the patient said she wasn’t ready to die.

Throughout the night, I watched Joellen breathe with great painful effort. She sat straight up in bed, shallow forceful breathing.

She suffered so.

I notified the “Virtual MD” to request morphine for Joellen. She had nothing ordered to ease her breathing. Even a small amount Morphine IVP could help relax and slow her breathing down without as much struggle.

The virtual MD said “no” he would not order morphine for her. I explained how she was awake and alert and suffering terribly… but he said “no, I don’t want her to get addicted to the morphine.”

I then Notified the Intensivists on call.

That was our chain of command.

Before I could explain myself to the Intensivist on call, he said to me “Do you realize you woke me up from my bed at 0300”?

I told this physician how Joellen was having shallow breathing, diaphragmatic breathing, low O2 sats and she was suffering greatly and all I wanted was some Morphine to give to this poor lady to ease her breathing and her suffering.

He let me know he would get back to me after he talked to the Virtual MD.

One hour later, I received a call back from the MD on call. Lasix 20 mg IVP stat. That will take some fluid off of her and it will help her breathing.

We don’t want her to become addicted to morphine”

And that was his answer.

And here I was faced with a dying woman. Lasix didn’t touch her. Her breathing became more shallow. Her lungs filling with fluid, barely able to auscultate. Her O2 sats slowly dropping to the 70’s and 60’s.

I sat next to Joellen and held her hand. Wanting to breathe for her. Wanting to comfort her…wanting to provide her with just a small amount of morphine…. but unable to.

I was given the most inappropriate order ever from 2 MD’s who claimed a dying woman would potentially become addicted to morphine.

Poor Joellen. As I held her hand, her breathing slowed to a minimum. She had worked so hard. Her eyes rolled back, and she let out her last breath.

I felt defeated. That a simple order from an MD could not be obtained.

Joellen died a painful death.

Eventually I found out that there was a review of this “case”.

I’m sure there was a “mild reprimand”

I drive up to the mountains. The leaves changing into their vibrant colors…

And I still see those haunting eyes of Joellen.

This nurse was hiding the truth behind social media

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.

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.”

Don’t want to wear a helmet? Sign up as an organ donor.

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.

Maybe.

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.

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.

That’s why I became a nurse

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.”

The patient with a pocketful of IDs

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.

Dead.

And with a pocketful of IDs:

Randy, Scott, Jeremy, Michael, Tim, Ryan.

We knew him well.

Perfect nurse. Perfect manager. Perfect puppet.

Originally published on KevinMD

Perfect nurse.

Perfect manager.

Perfect puppet.

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.

Twenty-five beds.

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.