A nurse’s downfall was telling the truth

Originally published on KevinMD

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

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

I grew up with lies and deception.

“Your father is taking ‘early’ retirement.”

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

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

Daddy was an alcoholic.

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

Mother said I was to be a nurse.

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

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

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

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

But my downfall was telling the truth.

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

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

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

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

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

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

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

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

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

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

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

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

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

Problem solving.

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

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

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

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

I closed my eyes and let it all out.

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

And I said to those managers and directors and physicians:

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

I went on. I was unstoppable.

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

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

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

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

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

“You’re not one of us.”

And I knew that.

I wasn’t willing to sell my soul.

I was thankful that I was not one of them.

A lesson in never giving up

Originally published on KevinMD

Jim Henson, creator of the Muppets and Sesame Street, died at the age of 53. His diagnosis was toxic shock syndrome/streptococcus pneumonia — a deadly bacterial infection.

We were on vacation when we heard the news: The genius who opened the imaginations and hearts of our children … maybe you too … was gone. We were devastated and saddened that the magic Muppet man had died.

One year later, our ICU admitted a 32-year-old female named Sarah. She was beautiful with long blonde hair and a loving, devoted husband by her side. Her diagnosis: Streptococcus pneumonia — the same thing as Jim Henson.

Sarah was rushed past the patients lining the ER walls waiting to see an MD or RN. She had shallow, gasping respirations. The ER MDs, nurses and respiratory therapists ran to her, and she was emergently intubated.

A central line placed, pressers flowed through her veins … normal saline bolus after bolus. Temperature of 103.2 degrees. Blood pressure 72/36 with a heartbeat slow and thready.

As she entered our ICU, we were prepared: cooling blanket, the strongest antibiotics, 24/7 EKG monitoring, and BPs every 15 minutes.

After a week, Sarah was not better. She was spiraling out of control, and her organs were shutting down. We had to add a vas cath for dialysis.

The intensivists updated Sarah’s husband; it was grim. But every day we stood quietly by her side without fail to do everything possible for her survival.

Finally, the physicians approached Sarah’s husband telling him we did everything possible, but she wasn’t getting better. A DNR was recommended. And her devastated husband, Pete, agreed.

We continued our regime of care, and nothing was discontinued — but we accepted that Sarah was not going to survive this deadly disease.

Every day, Pete pulled up a chair and read her poetry out loud.

Every day, Pete held his wife’s hand and told her he loved her.

Every day, Pete would comb her hair and read poetry to her.

Every day.

Slowly, her blood pressure improved and we were able to take her off IV pressors. Her temperature dropped to normal. Her heart rate went into a normal sinus rhythm.

And as he held his frail, sick wife’s hand — she squeezed back.

Overwhelmed he screamed for the ICU nurses to come see what just happened. He asked the doctors to come to her room. And he requested that the DNR be rescinded.
Within another week the endotracheal tube was removed. Sarah gasped her first breath without a ventilator.

Physical therapy came to work with her every day. Her strength grew.

And finally, she graduated out of the ICU and to a step-down unit. Pete at her side.

Pete never gave up.

We didn’t either.

One year later, we received a postcard from Sarah and Pete.

Sarah was standing on a mountain top, and the words she wrote on the postcard read: “Thank you all for believing in me.”

Go quiet into the night

Originally published on KevinMD

I know what you’re thinking: She’s cold-hearted, cruel, and unkind.

But am I? Or are you?

Grandma Lilly is 87-years-old and in the ICU. She’s on a ventilator with her wrists restrained to the side of the bed. Grandma can barely see because her eyes are puffy: scleral edema. And her heart races: 140 beats per minute. Her blood pressure is low and Levophed and vasopressin drips are ordered.

Her family can’t talk to her as she phases in and out of existence. For her, end-stage renal disease means dialysis. And respiratory failure equals ventilator. She’s a brittle diabetic with uncontrolled fluctuating blood sugars.

Grandma Lilly can’t eat, and we feed her by a tube that goes into her nose and to her stomach. Tomorrow, she gets a PEG tube surgically inserted to feed her. She’s been on the ventilator too long.

Next comes the ICU package: ventilator, dialysis, pressers, restraints, trach, PEG tube.

Any second of clarity or awareness is pure brutality. There’s no pretty ending to this torture except through death.

Poor Grandma Lilly.

Oh, the memories! When we were kids, we’d chant for Grandma Lilly. She’d snuggle us up in that rocking chair and read books to us. Let us splash our feet in the puddles after a misty rain, built sandcastles at the beach, and gave us candy when momma said no.

She was our heart and soul, and we wanted her to live forever. But we don’t live forever.

There’s cruelty in putting an 87-year-old with multi-system organ failure on a ventilator; restrained, medicated, disoriented, and wishing for the tunnel to the hereafter.

“The choice can be yours”

Your memories will live forever.

The ventilator. Churning inspiratory and expiratory breaths … day after day as Grandma Lilly wishes for death.

Grandpa Joe is two doors away from Grandma Lilly.

He’s going to die too from cancer. But he’s led a good life. And he’s cognitive enough to say he wants to die peacefully with his family and his dog Rufus by his side.

Grandpa Joe is a DNR/DNI and has requested to be “comfort care.”

He is given a morphine drip that flows slowly through his vein for his excruciating pain from cancer.

He breathes slowly. But he’s happy and pain-free and surrounded by love. His room is dimly lit. Music seeps out and fills the ICU hallways. Frank Sinatra, Nat King Cole, Ella Fitzgerald and Billie Holiday.

A Boy Scout and an Eagle Scout, he was the only one in his family who got a college degree. We loved his campfires, the stories he told, the wisdom and gentle guidance. And here, his family sat around him. Good old Grandpa Joe. What a life filled with love. They held his hand as they told their loving stories of Grandpa Joe. They laughed and silently wept. Tears of love and happiness and letting go but knowing the pain and suffering of his cancer would be over with soon.

After several rounds of CPR and cracked ribs, little Grandma Lilly died.

Grandma Lilly left this earth tied down like a captured animal.

Grandpa Joe left this earth with quiet whispers of, “I love you.”

The choice can be yours.

Go quiet into the night.

This is our last dance.

The secret life of a nurse

Originally published on KevinMD

This is based on a true story. The name and some details of the events have been changed. 

She was the smarter nurse who floated to ICU, to CVRU, to CCU. She could handle any crisis: balloon pumps, CRRT, open-heart patients, respiratory distress, code blues — anything.

Sandy was quiet. She didn’t really have any nurse friends. She was a loner.

But we could depend on her to take the most difficult assignments.

She was our brightest star.

We delivered our babies two weeks apart from each other. I remember when we both got back from maternity leave, she proudly showed all of us 8 x 10 pictures of her family and of her new baby. I felt inferior. Like I was the bad mom because I had no pictures.

Both of our babies went to the hospital daycare. And every day that we worked together, the daycare would call Sandy on the phone. Her baby was frantic and having tremors. Something was wrong. And Sandy would have to leave our ICU and walk to the nursery and hold and rock her baby and breastfeed her. Her baby would eventually sleep into a beautiful toxic slumber.

Before the age of computers, narcotics were counted by a day shift nurse and a night shift nurse. Narcotic papers were signed and eventually sent to the pharmacy.

Sometimes the numbers didn’t add up. Sometimes a morphine ampule would have a crystallized gel wrapped around the scoring of the ampule — it was just clear nail polish.

Sometimes her patients would have unusually high blood pressure or high heart rates as if they were in pain. But they couldn’t be in pain. Sandy’s notes were meticulous, and her narcotics were well documented.

How did we miss this? Where was that cry for help?

What we didn’t know was that Sandy was being watched by management and by the pharmacy. The pharmacists were aware of the discrepancies, the missing ampules of morphine and the uneven levels of medicine in the Valium vials or the crystallized solution gluing the top of the ampule to its body.

They moved Sandy around a lot. One day she’d be in the progressive care unit, the next day in CVRU, to ICU and CCU. And she never complained.

She was confident that she had this act of deception down to an art.
But she left a trail. The obsession, the perfection of covering her tracts became sloppy, and that’s how pharmacy picked up a trend.

Calls from the daycare, her baby screaming, her patients in excruciating pain but could only express themselves hemodynamically, as they couldn’t talk since they were on ventilators, restrained, balloon pumps and CRRT.

She’d fade in and out from unit to unit. And there was never any eye contact.

We watched in disbelief as two security guards escorted her out of our ICU. A syringe and tourniquet found in her scrub pocket.

She sobbed and denied ever doing drugs.

She denied ever failing to medicate her patients.

She denied the fact that her baby was addicted to the morphine that flowed through her breast milk.

She tested positive for fentanyl. But she still denied.

We were all devastated. How did we miss this? Where was that cry for help?

The state board of nursing offered rehabilitation. They offered her help. She refused. Eventually, her nursing license was terminated.

DSS removed her children.

And we never saw Sandy again.

The perfect nurse.

The perfect mother.

Hidden by a mask that she wore each day that she clocked in.

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.

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.

A nurse returns from vacation. And she’s thankful to the ICU she came back to

Originally published on KevinMD

I’m in the ICU and was just back from an incredible tropical vacation. Nine days of vegging out on the beach. The glistening ocean was just steps away from the five-star hotel I was staying in, where doormen greeted me with fruity daiquiris and a staff that couldn’t wait to serve my every whim.

I was in paradise, and far, far away from the reality of my day-to-day existence as an ICU nurse.

I was nowhere near the code blues, the sputum plugs, nor the bowel movements that dripped onto the floor. I was also far away from demanding family members, management, and that plastic smile I was forced to don in situations with them.

Vacation was over, and I was back. Although this was my profession and I was highly skilled, I secretly wished I never came back.

But here I was. Day one. My assignment? Another old person. An 82-year-old lady with stage 4 lung cancer. Another little old lady gasping for air with her old friends praying over her as if she were already dead. They would visit and sometimes sing gospel music from days gone by as they all swayed.

One day, the patient, Gerde (short for Gertrude), asked me to her lipstick on. And I did.

She asked me to fluff up her soft white hair.

And I did.

She asked me if I wanted to learn to crochet.

And I said yes.

And in between her ABG’s, adding IV antibiotics, giving her nebulizers and putting her on high-flo oxygen, she taught me to crochet.

She taught me even though she knew she was going to die. She knew it was time to go.

And in the dread I felt from leaving that tropical vacation and having to face this assigment, how did I find the most precious lady on earth who could not wait to reunite with her husband.

Within three days, she taught me to crochet a scarf as beautiful as any scarf available in an upscale department store.

She asked me to hold her hand as her final request. She was ready. I sat beside her and held her small, cold hand as she drifted off to the hereafter.

Her face glowed as she left this earth with a smile. No one blinked when she died, nor when they saw me crouched down with my head low in front of the computer with tears rolling down my cheek.

I was no longer sad I left my vacation. I was thankful that I left that tropical island to come back home to a little old lady who gave me bountiful blessings is just three days.

A nurse was attacked in the emergency department. This is her story.

Originally published on KevinMD

Victim: Female nurse, age 25

Time: circa 1980

Place: A hospital in a sleepy Southern town with fifty beds, six emergency department beds, one nurse, one doctor and one secretary.

It was an unusually quiet Friday night in this small emergency department.

We all knew Friday was “party day”: pay day, play day, alcohol, pills, drugs, loud music and lots of really bad decisions.

Not only did we cover the entire city, but we also covered many surrounding small towns and all of the conditions these locations imply.

When women came to the ED with “abdominal pain,” we had to break it to them that they were pregnant and ready to deliver. There were gunshot wounds, heart attacks, respiratory arrests, stab wounds, and many a church goers’ “done fall-outs.”

Overdoses, alcoholics, and drug seekers were migrated to the ED equally with snot-nosed kids with colds.

Fridays were the worst nights. But this Friday was different — it was completely quiet.

Then, the radio transmitter called in:

Rescue squad: 19-year-old male, attempted to put his mother’s house on fire. Superficial razor marks to his right inner forearm. Use of PCP — angel dust, Ketamine, horse tranquilizer, hallucinogenic.

The rescue squad came bursting through the ED doors in their normal fashion. He’s young and naked under the sheet. His razor marks … I’ve seen worse. They’re just superficial. His voice is soft and polite pepper with “yes, ma’am” and “no, ma’am.”

An MD suggests to put betadine on his razor marks and send him home. No stitches required.

As I apply the betadine, he sits up on the stretcher, stares me in the eye and loudly yells, “I’m gonna f**k you, b***h!” Before I knew it, he grabs my scrub top and tears open the snaps on the front. My bra is in full view, and he gropes my breasts with both of his hands and clutches my vagina.

I was violated.

His incessant squeezing of my breasts and vagina and his repulsive chanting about how he wanted to molest me made me feel as if I was in the darkest side of hell.

I screamed for help, “Call the police!” There isn’t an alarm or a security guard.

The MD kicks the patient’s ankle saying, “Stop that boy,” and the patient continues to “dance” with me across the ED. The secretary notifies the local police to come to our hospital stat.

I was assaulted over and over again until I was backed into a corner. My world stopped. It was me in the corner. And this naked man with his enlarged appendage was starring at me.

This was it.

I did not know any self-defense or survival skills. I knew my nursing pledge to “do no harm,” but I also knew that that “thing” was not going to go inside of me.

I had one hand free and grabbed his naked scrotum. I squeezed as hard as I possibly could and twisted them until I could twist no more.

His eyes rolled upwards, he went limp and fell to the floor. He fainted. I shut him down. I sat on his back, the MD sat on his legs, and finally, a fat-bellied policeman walks in.

“Y’all need some help?”

They carted him off to jail. I was obviously traumatized and started to cry. Dr. X said, “I’m so sorry, I’m just not used to this situation.”

It was Christmas time. It was the season to be jolly.

The hospital gave me three days off and workmen’s comp.

I felt violated and dirty — the nearest thing to being raped.

I was distrustful, angry and I even had a difficult time sleeping with my husband. I thought don’t touch me. Don’t anyone touch me.

But in the midst of all of this, I grew stronger — almost fearless — to where I could stare a man in the eyes and say, “Don’t even try. I will destroy you.” I felt like Superman.

When my attacker fell to the floor, I saw stars and stripes — victory.

But it doesn’t always turn out this way. Blame it on mental illness, alcohol, the wrong people with guns, the epidemic use of opiates or the mere frustration of waiting to be seen in the ED and waiting more than 15 minutes is 15 minutes too long.

The fuse is short in the ED.

Emergency departments across the nation are a haven for violence and abuse. The ENA (Emergency Nurses Association) reported that 80 percent of ED nurses and health care personnel were physically/verbally attacked in the ED 2014-2016. MDs reported being attacked in the ED by 75 percent.

I’m not sure what it will take for our protection.

I do know that a hospital CEO typically makes $3-14 million per year.

Priorities. Go figure.