Reflections of a critical care nurse [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“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.”

Debbie Moore-Black is a nurse who blogs at Do Not Resuscitate.

She shares her story and discusses her KevinMD article, “Go quiet into the night.”

Did you enjoy today’s episode?

Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!

Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Debbie Moore-Black. She’s a nurse and a longtime KevinMD contributor. She wrote the KevinMD article “Go quiet into the night.” Debbie, welcome to the show.

Debbie Moore-Black: Thank you for having me. I appreciate it.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Debbie Moore-Black: I was raised in a hardcore Catholic family. My dad was an IBM executive. He also became a non-functional alcoholic. My mother was very domineering, and the reason I’m telling you this is because my mother dictated that I become an RN. I wanted to be a journalist for the New York Times, you know, delusions of grandeur, but I was told to be an RN.

So I eventually became an RN and gravitated toward the ICU, where I had been for 33 years, and I recently left after 33 years to become a behavioral health nurse, as I have two years left before I can retire. I ended up in ICU and loved ICU, all of the intricate stories that we faced, and I wanted to share that not only with the camaraderie of other nurses throughout, you know, the universe, but also with lay people. I wanted to give them reality therapy about what’s really going on in the ICU. And so I started to write about it, and the easiest way for me to share my stories was obviously through Facebook, and that’s how I got started.

Kevin Pho: Now, you’re a wonderful storyteller, and a lot of your stories compared nursing back then to what it is now. What would you say were some of the biggest changes in nursing now compared to the past?

Debbie Moore-Black: We went electronic. You know, back in the day, charting was a four-page document, and you had to chart everything, because we were always told, “This is a legal document.” So the one big change was the invention of the computer, and that did make everything quite a bit easier. We had IV machines that now calculated drips for you. Back in the early ’80s, we were doing IV drips manually and counting drips with special vasopressor drips, and now everything is programmed.

And everything is at your fingertips now. You know, you can Google anything and get an answer, and back then you had to do major research and read books and documents and look things up. So I think the information is so much more readily available than it was back then.

Kevin Pho: You had mentioned earlier that one of the reasons why you were writing was so that patients or lay people can take a peek into the world of nursing. Now, what are some of the overarching messages that you want to share with them?

Debbie Moore-Black: One of the biggest things I found out in ICU was that we do not live forever. People started to, with modern technology and ventilators and chest tubes and dialysis: “We’re all going to live forever.” But the quality of life was totally going down the tubes, and people were rescinding DNRs on patients, and it became a moral issue for me that there is a peaceful way to die. You know, we don’t have to keep cracking ribs, and then they’re going to die anyway. That was one of my biggest issues.

But I also face things like the bullying in nursing, drug addiction, and alcoholism. There were so many things I wanted to share, and since I came from an alcoholic family and, you know, we were in a very large house on the right side of town, but everything was secretive, I wanted to explode and tell people, “Stop keeping secrets. Go get help. Go get therapy, and stop fooling yourself. Stop rationalizing, and go get help.” And, you know, look at yourself in the mirror and do something about what’s going on today, not only with you, but with your family and with the issues, you know, that are going on today in our universe.

Kevin Pho: And ever since you started writing on KevinMD and on Facebook, what has the response been?

Debbie Moore-Black: I’ve had a very good response from fellow nurses, you know, through Canada, Australia, Israel, I mean everywhere. It’s just been a really wonderful cyber effect. I don’t always have positive input from lay people, especially with COVID-19, because I’ve been a great encourager of wearing your mask, social distancing, and washing your hands, and I’ve had a good 100-some people who stopped following me. You know, I’m just trying to educate people. So I have over 63,000 followers right now. Hopefully one day I’ll write a book about the collection of my stories.

Kevin Pho: Let’s talk about one of your stories, “Go quiet into the night.” You wrote this back in early 2019. For those who haven’t read that article, can you walk my audience through it and share the story of why you decided to write it?

Debbie Moore-Black: Yes, I think I wrote this story. It’s about two different people in the ICU. One lady didn’t have a will or a DNR, and the family wanted her to basically live forever. She had a loving family, and she was a loving mother, grandmother, etc. But they had her on the ventilator, wrist restraints, vasopressor drips, a chest tube, and dialysis, and she ended up dying, you know, with her family surrounding her, but we had already done CPR on her and cracked her ribs, and that’s how she died, a very painful death.

And then the alternate story was a Grandpa Joe. They were not related, but it was the story of how he was in the ICU but decided he knew he was going to die. He had cancer ravaged throughout his body, but he wanted to be a DNR, a peaceful death, comfort care. And I told the loving story of him also, but he died with whispers of “I love you” in his ear, and he died peacefully.

And I did the contrast on purpose so people could see which way, you know, do you want to die? We’re all going to die anyway. So choose. What is the reason that you should want to supposedly live forever and then die a very painful, brutal, tragic death, versus a very peaceful death? And that was the beginning of my Do Not Resuscitate blog. Resuscitate, as we all know, means “bring back to life,” but I didn’t want to bring back to life people who should peacefully die. I didn’t want to bring back to life people who have drug addictions or alcoholism, or bullying in nursing. So do not resuscitate is really a metaphor for a lot of stories that I created. But this story just showed the contrast of two different ways that you can die.

Kevin Pho: During your time as a critical care nurse, what proportion of patients had advance directives and do-not-resuscitate orders?

Debbie Moore-Black: I would say probably 30 to 40 percent had DNR papers. We had a good 15 percent of family members who would rescind the DNR orders, and we had to follow the family. Even though the DNR is a legal document, we still had to follow the rescinding order by the family, because now the family was in control. The patient was now, you know, in a coma or semi-coma, and they took over. That was very disheartening, and that was another big reason that I wanted to educate people that not only do you need a DNR paper, you need someone trustworthy, whether it be a family member or a friend, someone that you can trust.

Kevin Pho: Now, if a family wants to rescind a DNR order, and the medical staff doesn’t think that’s in the best interest of the patient, what goes into that ensuing discussion with the family?

Debbie Moore-Black: I’ve been through many meetings with the intensivist and the family. The intensivist will be brutally honest with the family. The family chooses to rescind that DNR, and then we have to follow through. If a patient is in end-stage multisystem organ failure, there are times that we bring in an ethics committee, and there are times that there is a committee that shuts everything down, and the only way that the family can continue for us to do everything is that they would have to find another physician to take care. And usually, well, I would say 100 percent of the time, physicians do not want to take over that case. But this is when the case is totally futile, and I have seen that a few times. But usually we follow through to the very end, and it’s a very sad situation.

Kevin Pho: Now, there are a lot of physicians and other clinicians who listen to this podcast. During all your time as a critical care nurse, and currently as a behavioral health nurse, do you have any advice that you could share with the physicians who may be listening to this podcast?

Debbie Moore-Black: Absolutely. I have truly worked with some wonderful intensivists. The camaraderie was great, the honesty. So my recommendation: Be honest, keep yourself open, and especially listen to nurses with experience. We’re not trying to lead you astray. We’re trying to work together. And the best positive information I’ve had with intensivists were the ones who wanted to work with the ICU nurses and didn’t take over like a dictatorship. Those were the ones who paid attention to what we had to say, even if we had a feeling things were going downhill. Those were the ones that we were very receptive to, and it was successful whether the patient survived or not. It was always a good relationship clinically, for the nurses and for the patient and the family members, too.

So I’d say pay attention, listen to us, and don’t discount us. You know, obviously you all have had much more education, but we know what we’re talking about, also.

Kevin Pho: We’re talking to Debbie Moore-Black. She’s a nurse who wrote the KevinMD article “Go quiet into the night.” Debbie, what do you feel are some of the challenges facing the nursing profession today?

Debbie Moore-Black: Well, that’s a good question, and I’ll have to be brutally honest with you. I think nurses go into nursing because they want to. They want to help. They want to, you know, they’re clinicians. They’re medical professionals. I think one of the biggest problems in my 34 years of nursing was with management. Many times managers, they were RNs who become managers, and they truly sell their soul, and they forget what it was like to be one of us. And it becomes not what’s going on with us, with the patient ratio, but what’s going on with the budget.

And I think they need to look deeper and be more a part of the nurse-patient ratio, the nurse herself or himself, and be more tuned in, because I do see we become a number to management, and I have seen that over and over again. In 34 years, I can truly say I’ve had two really good managers. And that’s probably the best I can tell you: Pay attention to what we’re up to, and stop treating us like we’re a number.

Kevin Pho: And my final question, Debbie: Do you have a take-home message that you want to share with the KevinMD audience?

Debbie Moore-Black: I have two take-home messages. First of all, the biggest one, like I said, is that I talk about many problems. There’s bullying in nursing. There’s addiction. I talk about people who could be alcoholics, you know, dysfunctional families, domestic violence. I talk about a lot of those stories. And basically, the first message I would like to talk about is to look in the mirror, get some help, stop rationalizing with yourself, and get help. There’s plenty of help out there. If you’re a nurse in a hospital setting, there’s a free employee assistance program with certified counselors. So stop pretending and fooling yourself and others, and go get help. And that’s for the lay people, too. Stop, like I said, rationalizing your way out of what’s really going on.

The second message I have is very important, and it is about COVID-19. I am appalled at how people are dismissing this deadly virus. There are now 197,000 deaths in the U.S. from COVID. I’ve seen it. You know, the nurses are gowned and gloved and wear a face shield for 12 hours straight. It is grueling. And they’re dedicated, and already 900 health care professionals have died from COVID. Maybe because of a lack of PPE, not sure. That’s certainly one of the factors.

But I would plead with the public out there: Please respect this virus. Wear your mask, do your social distancing, and wash your hands, because it’s not going away anytime soon. And I’m quite upset over how people will disrespect medicine and science of this COVID virus and call it a hoax, and how it’s become political. It’s a virus, and if we’re not careful, we may end up in ICU too. You know, I know people who are right now dying in ICU and just struggling to even stay alive. And even if they survive, many people are still stuck with a poor lung disease, renal failure, strokes, and bleeds. It’s a deadly virus, and I just plead with everyone to please respect this deadly virus right now.

Kevin Pho: Well said. Debbie, thank you so much for your time and insight, and thanks again for being on the show.

Debbie Moore-Black: And thank you for having me. I appreciate it.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes