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.

My battle against the nurse’s cap

Originally published on KevinMD

Florence Nightingale was among the first nurses who started wearing a nurse’s cap.

The cap was derived by nuns and represented those caring for the sick. Hair was neatly tightened into a bun and covered by the cap.
Back then becoming a nurse was typically seen as a female profession, but men were allowed to become nurses too. In 1930, only one percent of RNs nationwide were male.

Growing up in the 1950s and 60s I led a typical childhood that included watching my dad go off to work while my mom stayed at home, took care of the kids, did laundry, ironing, and preparing a culinary masterpiece of a meal every night.

It wasn’t until I got old that I realized my mother was “trapped.” A man’s world dictated her life. Though my dad was an IBM executive, we all knew that mom knew the math down to the cent. Had she had the chance to run the household finances, she would have been well off.

Daddy made the big bucks, and mom was only given an allowance.

Although the ‘60s and ‘70s erupted like a cultural volcano — women’s lib marches, bra burnings, and equal rights, opportunities and pay were all over the news. There was still a heavy sense of suppression in the air.

As females in our household, we would learn that when it was time for college and time for a career, we had few choices. Secretary, teacher, nurse, flight attendant, bank teller, waitress and wife, and mother. That was it. If you were a man, the door of opportunity was wide open: accountant, engineer, chemist, MD, pilot, lawyer.

I was not given a choice. My mother told me that I would be a nurse.

Never having been around sick people, I was scared to death. To get a job and finally leave my parent’s house, I finished the LPN program.

By 1985, I was completing college to graduate and become an RN, and that’s where this story takes off!!

In nursing school, I hated the nursing cap. I felt submissive and subservient with a cap on my head. It served no purpose except to remind me that I was in a man’s world.

Nursing school was harsh and difficult. Instructors were cruel and talked down to us. We were reminded that it was appropriate for instructors to talk down to us and belittle us, as this would be the way MDs would treat us once we graduated from nursing school.

We were to stand up when an MD came into a medical-surgical unit. We were to offer our chair to an MD. We were endlessly reminded that we were the low man on the totem pole.

When it came time to graduate from RN school, a fellow “militant” nursing school friend teamed up with me, and we decided to refuse to wear a nursing cap for our graduation. We were told by the chief of the nursing school that they would not graduate us if we did not wear a cap.

And so we did.

I was able to snag a job in the ICU. The year was 1986. It was a very large hospital. Nursing caps were mandatory. A class-action lawsuit was being introduced as female nurses could only wear dresses. This case was settled out of court, and we were able to wear scrub pants. So this was a major victory.

My first year as an RN, I decided to refuse to wear my nursing cap. It was a bacterial carrier from one patient room where the patient may have an open chest from surgery to another patient’s room that had serious infections. 
I found the cap meaningless and filled with nasty microorganisms.

Yearly evaluations came with a merit raise. And though I scored high on all procedures in ICU, I was denied my merit raise. The reason — I refused to wear my nursing cap.

Year two in ICU left me even more determined as I once again refused to wear a nursing cap. And once again, I was denied my merit raise.

When it came for our merit evaluations, I was denied again for the same reason.

And with that came my outburst.

“The only reason I am forced to wear a nursing cap is because I do not have a penis. If I had a penis, I would be free from this appendage that has no constructive value to it.

If you don’t give me my merit raise, I will get a lawyer and file against this institution for sex-dress discrimination.”

And with that, I received my merit raises and never wore that cap again.

Hats off to those people who influenced me: Ruth Bader Ginsburg, Martin Luther King Jr., President John Kennedy, women’s liberation, National Organization for Women (NOW), Malcolm X, Gloria Steinem, and the civil rights movement.

And because of these strong people, little girls across this great country of ours can dream of what they want to be when they grow up. They can now make their own decisions and make their dreams come true.

Power to the people.