All Intensivists are not created equal
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.
Originally published on KevinMD
What can I tell you? It started out innocently. College exams were over. And that meant one thing — party time! Bubbly, shots, beer, cocaine and Percocet. Everyone was happy. It was a celebration.
Pam came from a pretty strict religious family: no alcohol, no premarital sex and no crazy music in her house growing up. It was church every Wednesday and Sunday. And if you missed a Sunday, you were destined to hell.
So when Pam graduated from high school with top honors, she was set free and off to college. While there, she learned a lot about different cultures, different religions and different languages. She learned that not everyone was white, Christian and middle-class. This was a whole new world to her. And she loved it.
After several parties she learned some non-academic things one learns about in college. With her discovery of alcohol, pills and cocaine — she was ready to conquer anything. She had her wings and was ready to fly. And fly she did. Even with the partying through four years of college, she walked across the graduation dais with a diploma in her hand.
Then she found an amazing job in Manhattan far away from her provincial life. New York City: Bright lights, big promises and John.
John was Pam’s handsome, smart and, well, perfect manager at work.
Boy, did they have fun. There was dance, dinner and drugs … and even more drugs.
The fun went on for months, and then John proposed. Together they shared a taste for adventure, travel, exotic food, music and sex …
Eventually, they had a baby boy with blue eyes and blonde hair just like John. Pam’s family was complete, and Baby Jack was the apple of here eye. He was perfect in every way — except for his colic which made him cry and cry as Pam would rock him and rub his back. But what really calmed this baby down was warm baths — he loved them!
One day, John came home early. And he had a surprise for Pam. Although it was inexpensive, only around 80 bucks, it was precisely what the couple needed — a new high. The gift was black tar heroin and gave them the hit they were looking for after oxy and coke lost their lustre.
John tied his belt around Pam’s upper arm. The syringe was full, and he interested the needle into her vein and pushed. The rush was on. Pink clouds danced along side of puppies, kitties, unicorns and cotton candy. And life became painless.
Pam’s memories of her mother screaming, “Come home, you don’t know what you’re doing! You’re damned to hell,” her father’s rejection of her, the taunts, the damnation, the screams were all gone.
Pam was comfortably numb and free. It was pure euphoria.
Her head flopped down as she fell into the abyss.
She couldn’t wait to have more, she was rapacious and desperate for that feeling. But she knew she couldn’t keep doing this. Pam stopped eating and taking care of herself. Jack ran around in dirty diapers, and John came home later and later — Pam’s life was spinning out of control.
In a lucid moment, Pam knew she had to stop. Heroin took over her mind and body. So, she stopped using — cold turkey. She told herself that she could do it without help. 18 hours later, without the drug in her body, she started to sweat profusely, her body shook, her muscles ached, her legs were restless and the stomach cramps and vomiting were excruciating.
She wanted to feel good … to be normal. She just wanted the pain to go away. And her son just wanted to be held, to be fed. So he cried and cried.
Pam needed to fix this — to fix everything.
She knew she could calm Jack with a warm bath. So she put him in his baby seat, placed him in the bathtub, poured in bubbles, and turned the faucet on as she sat on the toilet seat and tightened up her belt. She injected deep into her vein and watched the bubbles rise … those beautiful bubbles.
John was out of town. He tried calling multiple times, and Pam wouldn’t answer.
When the police arrived, the door was locked, and they tore it down.
After two weeks, Pam roused but didn’t know where she was. She was in a strange bed in a strange place with a voice hoarse from an endotracheal tube.
She squeezed my hand and asked where she was.
I told her she was in the intensive care unit.
She didn’t remember a thing.
How do I tell her that she stopped breathing? How do I tell her that CPR was started on her? How do I tell her that she had a needle sticking out of her arm? How do I tell her that her bathtub water was overflowing onto the floor?
How do I tell her that her little boy is dead? How do I tell her that he drowned in the tub while his mommy shot up?