Remembering a physician, suddenly taken away

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.

Face down.

No pulse. No respirations.

Cold.

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.

His expertise.

Goodbye, Dr. J.

You were one of us.

You live forever in our hearts.

You were the best.

A love-hate relationship with nursing

Originally published on KevinMD

If you went to go to a museum in New York City and saw a live heart encased in glass, still pumping and pulsating — it would be my heart, shredded into a thousand pieces all in disarray. But it still would be pulsating. This describes my life as a nurse.

Nursing was a vacuum that sucked me dry and left me dangling with nothing more to give. Three years left until retirement, and I count the days.

I wanted to be a journalist for the New York Times or become a teacher. I was so excited to go away to college, but I should have known better.

Dad was an IBM executive but eventually drowned himself with alcohol. My mother was a true “Mommie dearest” who exhibited no warmth to us, her three kids. She neglected us, and we were essentially on our own.

Mom ruled with an iron fist. Was she miserable because dad drank and had many affairs? Or was it her newborn son who died three days later after he was born? She saw his stark black hair, but they didn’t let her cuddle her dead baby. He was buried in a massive grave along with several unnamed dead babies.

I had already seen JFK assassinated on our black-and-white TV. I was in second grade. Then came the other cruel realities in life: Nixon resigning after the big Watergate scandal. Martin Luther King Jr, Malcolm X, RFK, Medgar Evers — all gunned down in our America. When I graduated from Catholic school, I became aware that our bishop ran off with his secretary.

So I grew up knowing that life was not full of happiness. That it was full of sadness and hate and cruelty and darkness.

And beyond the dreams of escaping our large house to go away to college, I was stopped dead in my tracts. Mommie dearest said I would not go away to college, I would go to a local college and become a nurse. And from that moment, my life was dictated into the world of nursing.

I first became an LPN. I couldn’t concentrate in nursing school for my RN, and so I failed. I was always a failure — dumb and stupid and fat. Dad yelled at me when I dropped out and screamed: “You’re a failure, nothing but a failure.” I climbed through LPN school and graduated. Mom and dad took me out to eat for graduation. Mom announced that if I had become an RN, I would have been sent on a cruise. Instead, I got filet mignon. Years later, when I did get my RN, my parents were a “no show” for my graduation.

It seemed that my career in nursing was much like the life I had already led. My first job as an LPN was on psychiatry. And within two years, I saw how people did not get better with their mental illness. It was theirs to keep forever. My stories are forever, but the worst story on psychiatry was searching for a missing 50-year-old female patient on our unit. We searched everywhere until we found an isolated bathroom locked. The male techs plowed down the door, and there she was. Her jugular had been chiseled down and exposed. She was crying as blood dripped down her neck. Starring in the mirror, she couldn’t take the final cut. One more slice of her exposed jugular, and she would have been dead. I was 22 years old.

After several years, I began working on my RN. And I landed a job in a small southern town in the ED. I had lots of energy, and I loved the smorgasbord of the ED. Gunshot wounds, stab wounds, heart attacks, respiratory arrests, delivering babies.

But the worst: That 6-year-old girl brought into the ED. Eyes hollow and black as coal. Catatonic. She did not move. She had just been sexually assaulted by her momma’s boyfriend. To this day, I am still haunted by this little girl’s eyes. This little girl who had the magic of being young and happy, taken away from her forever.

I graduated to the ICU with my RN in hand. And that’s what became my true love. I loved the multi-system organ failure. I loved putting the puzzle pieces together. I loved being dynamic and energetic and attempting to save lives and problem solve and critically think. Thirty-plus years in ICUs and surgical trauma ICUs, and I considered myself a good nurse. I loved what I did.

But after 30 years in ICU, it became apparent that the general public had decided that their loved ones would live forever. With these ventilators and cardiac drugs and dialysis and balloon pumps and extracorporeal organ support (ECOS) and code cools and code blues and code strokes — everyone was going to live forever. Even the 92-year-old man who was in the ICU in a fetal position with brain stem damage was going to live forever as his daughter insisted on him being a full code.

And so we did. Full code, CPR, ribs crunching, daughter watching, doctors begging the family to let us stop And they refused. And we kept assaulting his body until his straight line on the EKG monitor announced for another 15 minutes that he was dead. Dead, despite compressions, despite code meds.

Assault. Disrespect. Denial.

And my heart grew tired and cold.

The bullies came to our unit. They were young and bright and “knew everything.” They didn’t have the experience or the wisdom that we had. But they carried disrespect for others. And their failure to pay attention and learn and critically think did not become a priority. And suddenly we thrust into: Where’s your hearing aid? Where’s your walker? You’re not retired yet?

I gave it my all until I couldn’t give anymore. Three years left, and I decided to go back to behavioral health. And I know I can’t heal them or cure them. I give meds to the psychotics and schizophrenics. And that’s OK with me.

Because at least now, I don’t have to pound on their chest while their body has decayed. At least I can respect them and not force to assault them. At least I have a management team to work with instead of vindictive or dishonest behavior.

You may think I’m not OK. But I am. I have weathered through a very complicating nursing life. As interesting as it has been, it has equally been sad and tragic. It has been a large portion of my life.

This nursing life.

I have loved you.

And I have hated you.

Nursing’s newest problem: The young eating the old

Originally published on KevinMD

In 1976, we couldn’t wait to be nurses. Our starched white dresses with the nurse caps and stripes symbolized our graduation status as we were called one by one to receive our diploma and a rose.

We took an oath to care for the sick, to be professional, to critically think, to respect doctors and to respect patients and family members.

And to respect each other.

It was the age before computers. We learned how to calculate IV fluids in drops per hour and drops per minute. We had large folders that contained algorithms for sepsis, or myocardial infarctions or code blues. We had a three-fold flow sheet that we would manually document on. Threefold front and back. Blood pressures every 15 minutes and the pressors to coincide with the blood pressure. Everything was manually written from labs to a patient’s chart to MDs handwriting new orders — and endless charting of everything that happened to the patient in the ICU or CCU. We knew everything we charted had to be precise as it was always a potential for legal matters.

The handheld calculator had just come out on the market. It was the newest invention: $85 for a handheld calculator. So we were thrilled that we could now plug in some numbers to get an accurate drip rate for IVs or calculate dosages in an instant.

We were associate-degree and diploma nurses. And only the “elite” would earn a BSN.

We didn’t have breaks; they didn’t exist. We just kept working until it was time to go.

You worked the shifts your manager told you to. There was no compromising. You just did what you were told to do. We were the new pioneers in this field of nursing, and we were quite proud of ourselves.

Some older nurses did not communicate well with younger nurses.

Sometimes it was bullying the young. Or harassing or degrading a younger nurse who was just learning.

And the newly coined phrase appeared:

“The old eating their young.”

And the phrase stuck. Unfortunately.

And there was nowhere to turn. The managers turned their heads away. Sometimes the hazing was so bad that nurses would resign and even find a new career.

The nurses we couldn’t wait to be were riddled with harassment and ridicule.

And instead of holding each other up, we slowly destroyed each other.

Fast forward to the year 2000.

We older nurses are counting the years we can say goodbye to this long, hard, relentless career. This career that afforded our family vacations and a house and car and nice clothes and college for the kids.

This career that challenged us in the gut as we watched people live longer or die faster. As we said our goodbyes to our patients, we grew to love, and we’d gulp buckets of tears when it was over. Our last goodbyes to patients we loved.

We slowly evolved painstakingly learning the computer. And the computer was foreign to us. We were “special” and slow and didn’t adapt as well as the younger nurses did. These younger ones started computers in their home, in kindergarten and throughout the rest of their young lives.

Though they sported lots of energy, they walked faster than us, and they now had medical protocols and procedures right at their fingertips — instant knowledge.

But what the young ones didn’t know was that we were pioneers. We’re the ones with years and years of knowledge and experience and wisdom. And thus, the cycle of bullying was reinvented.

I’ve been a manager of an emergency department, I’ve been first assist to the surgeon, I’ve been a staff nurse and a charge nurse in ICU. And I’ve endured over 30 years in nursing. I have to continue working three more years before I can financially retire.

My sadness comes in when I hear the young men and women in this nursing career start the harassment.

“Where’s your hearing aid?”

“Are you STILL working?”

“Where’s your walker with the tennis balls?”

And then there’s a laugh.

But it’s not funny.

It’s sad and degrading.

It compromises our integrity, worth and our camaraderie.
 And instead of working together — we tear each other apart.

This is the hardest part of nursing.

I know it’s not everywhere, but it does exist.

And so now the coin has flipped.

The young eating the old.

Are we strong enough to stop this?

Are we strong enough to encourage positive work ethics and behaviors and to learn from the new and learn from the old?

Can this profession be saved?

It’s up to us.

All of us.

Respect.

Educate.

Enrich.

Empower.

We came here for a reason. Let’s not destroy ourselves.

Nurses Week. Always and forever.

Originally published on KevinMD

I have to work tonight. It’s Saturday. And I don’t want to go in. It’s springtime, the skies are blue, birds chirping, and the flowers show off their magnificent colors.

But it’s Saturday. And along comes being a nurse. We have mandatory weekends, mandatory holidays like Christmas and Thanksgiving and Easter and Independence Day and Memorial Day.

Mandatory.

And even on my day off when I get a real nights sleep, I think about or dream about that emergent intubation, central line insertions, propofol drips, wrist restraints, code blues, and CPR. Chest compressions and O2 sats dropping because the patient has sputum plugs, catching that patient before he falls out of bed, medicating that one that is in active DTs, and the psychotics and the hallucinations.

If it’s a dream, I wake up exhausted.

The surgical trauma unit was my nightmare as I’d stare into that 18-year-old boy’s eyes who now was paralyzed from the neck down cause he did drugs and no seat belt and crossed over the line and killed that innocent driver on the other side.

Paralyzed from the neck down. Forever.

Or that beautiful young girl that jumped out of a building and came to us dead on arrival. And the exhaustion and anxiety of 12 to 13 long hours without a break, without a lunch.

This is a pledge I request to those not in the health care field:

Stop the insults.
Stop the innuendos.
Stop the disrespect.

Unless you have breathed our life, then stop announcing what you do not know nor have experienced.

A salute to you nurses. We have a special calling of saving your life. Of bringing in new life. Of sending you off softly into the night when it is your time.

I could never acknowledge all fields of nursing, but thank you.

Spread this:

Empower.
Enrich.
Respect.

Nurse’s Week. Always and forever.

A nurse’s downfall was telling the truth

Originally published on KevinMD

These events happened over 18 years ago. Some content has been changed to protect the innocent and the guilty. Searching for positive changes in the health care industry. We are not a number, and the patients are not a number.

I’m not good at lying. My eyes go to the left or look downward, and I start to stutter and pause. There is no eye contact, and I fall deep into the black tunnel of deception and fight to get out.

I grew up with lies and deception.

“Your father is taking ‘early’ retirement.”

My father, who I adored, who was an executive at IBM. He was fun loving and completely Irish — he also walked into walls at night after his gallon of wine. It was the family I couldn’t fix. And the daddy I loved so much … he was unfixable. We had the new large house on the right side of town, a lake house on two acres and the boat that matched. The nuns at my private Catholic school demanded respect.

Daddy was a “heavy drinker” as mom would say.

Daddy was an alcoholic.

And though I would have never wanted to be a nurse, the 1970s were full of dreams and women’s rights and burning bras, but my mother dictated our household. No matter what dreams you may have, you still would become a nurse, a teacher, a wife, a librarian. And I emotionally fought tooth and nail at my new role in life. The dreams of running away from that dark house that hid the truths and running towards fresh air and freedom were all extinguished — and my destiny was to be a nurse.

Mother said I was to be a nurse.

It was psychiatry then emergency nursing then surgery and PACU. I finally landed in ICU. And how I loved it. I enjoyed the intricate puzzle of multi-system failure organs. Heart lungs kidneys brain liver pancreas … they meshed well. This well-oiled machine fell apart piece by piece, organ by organ.

I was sold. Maybe mom was right. Perhaps I was supposed to be a crusader for the sick. CPR intubation drugs IVs, CAT scans and MRIs ventilators dialysis balloon pumps surgeries. Some made it through and smiled at you as they graduated from ICU to the step-down unit to out the front door. Some did not. Sometimes the thoughts and prayers from family members didn’t work at keeping their loved one alive. Sometimes Jesus decided it was time to go home. Sometimes Jesus would say “you don’t live forever” — nobody gets out of here alive.

I met nurses that had to be my sisters from another life. I met pure good and pure evil in the nursing profession.

I graduated to charge nurse in this 20-bed ICU. I loved directing the unit and problem solving and critical thinking in a flash of seconds.

But my downfall was telling the truth.

Political suicide. Sometimes upper management doesn’t want the truth. But I hated the untruths, the fabrications, and the lies. And so I loved my new position as a charge nurse, but I was a misfit from the beginning.

It wasn’t just one night that our acuities were dangerously high and nursing staff was low — it was a typical scene in the critical care unit. Do with what you have, don’t complain, an empty bed means availability for a new patient, but an empty bed didn’t mean a nurse to match.

In this environment, a particular night of doom started pleasantly enough — one nurse to two ICU patients. Fair enough, but there was chaos in the ER. Our ICU beds filled up. We weren’t a trauma ICU, but we would certainly become one in this night. A male 32 years old riddled with gunshot wounds, another male with multiple stab wounds. Our ICU filled up with critically ill patients, and our 2:1 assignments quickly went to 3:1 assignments. Code cools and code blues. Family members screaming from every corner of the ICU. The coronary care unit was handling CABGs and balloon pumps, and the neuro ICU had craniotomies coming to their unit. Any sanity you thought you had was out the window.

Our manager was the supervisor on-call for all of the critical care units that night. And I was told to call her. All three units were in crisis mode. And there were not enough nurses to take care of these patients. If you ever thought you could say “I’m going to lunch I’m hungry.” or “I need to go to the bathroom …” forget it because it wasn’t going to happen.

It was a war zone and looked like nobody would get out of here alive — not the patients and not the nurses. Upper management was nowhere to be found.

Some patients died that night. They didn’t have a chance. We were all short staffed that night because we were told over and over again like a broken record: budget, productivity, do everything, wave your magic wand to make the patients and the families happy. But what was behind the budget, the productivity?

Was it an end-of-year bonus check to the managers? Was it a salary increase to the CEO of $5 to $6 million per year not including the perks? Were the board members happily lining their pockets?

Nurses don’t go into nursing to get rich — ever.

That night seemed never to end. And management never returned my phones calls. Twelve hours of phone calls unanswered.

And the next morning the manager came in. No explanation, no apology. Total avoidance.

That’s when I knew the difference. That’s when I knew that you have to decide to be true to yourself or sell your soul. This manager chose to sell her soul.

A critical, urgent managerial meeting was called within a few days.

Mandatory. We were to discuss the critical shortage of ICU, CCU and neuro ICU nurses.

Problem solving.

All of the big wigs were there. Managers and directors and director of nursing and chief ICU physician. And then there was us — the little charge nurses who were the real heroes in the battlefield.

Every director and manager spoke up. The words came crashing in on me: “We’re here for you,” “We support you,” “Call us anytime night or day.” “We are here for you physically and mentally.” “Call us 24/7.”

They smiled and nodded their heads and patted themselves on their backs with an affirmation that they held some magic in their hands and some pretty simple solutions for such complicated and dangerous nursing practice.

Their words crashed into me like sharp stab wounds to my brain and every ounce of my genetic Irish-Italian blood spilled out all over that mahogany executive table.

I closed my eyes and let it all out.

Lies lies and more lies. And I had to put an end to this.

And I said to those managers and directors and physicians:

“Not true. None of this is true. Not only are you not available to us or our patients you are nowhere in sight.”

I went on. I was unstoppable.

“I called our manager on call that night 15 times. Fifteen times. Phone, cell, beeper … I left messages. And no reply ever. And I documented 15 times.”

I stared at our manager in the eyes as I spoke the truth. And the managers and directors and physicians, with their master’s degrees and their PHDs and their doctorate degrees, sat in silence, with their jaws on the ground. A pin dropping in that room would have been a loud noise.

One week later, I was called into the manager’s office. I was demoted to staff nurse. I was not to be the charge nurse again.

Was it political suicide? Was it the truth that no one wanted to deal with?

And those words. Those final words she said to me. A defining moment in my life and my career.

“You’re not one of us.”

And I knew that.

I wasn’t willing to sell my soul.

I was thankful that I was not one of them.