Full text of DOI:10.1177/1055329002238028

Clinical Care Column
10.1177/1055329002238028
J
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AC Ving ol. 13, No. 6, November/December 2002
orism
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The Terrorism of Caring
Richard S. Ferri, PhD, ANP, ACRN, FAAN
M
y left lung collapsed on December 6, 2001. It just
Twelve hours later, I hear a hissing noise in my
room. I suddenly feel my left lung deflate like a bal-
loon set free. My chest tube is half way out! I grab it
and place pressure on my chest and scream for a nurse.
I quickly tell her what is wrong and she urgently pages
a surgeon. I tell her, as I do my best Smurf imitation,
that I want someone older this time. Experience does
count.
When I saw a man my age run into the room, I actu-
ally felt relief. He promised me his chest tube would
not fall out. The pain was incredible. I had to begin
begging for pain medicine. As the second surgeon
sliced my chest, I thought . . . this is insane! Why do I
have to beg and scream? Does anyone really think I am
trying to con drugs by having chest tubes inserted?
dropped. I developed crushing chest pain and intensive
shortness of breath. The chest pain went away and my
pulse was steady so I allowed my ever-present coping
mechanism of denial to take over. I did nothing about it
for 2 days.
Then I went to see my primary care nurse practitio-
ner. I told her she was going to earn her money at this
visit. Breath sounds could not be heard on my left side.
The X-rayconfirmed myworsefears: pneumothorax.
So I am whisked off to the emergency room where
boredom and potential are the sisters that haunt the
dwelling. After much fanfare, I am placed on a
stretcher and the poking begins. Blood gases. Big bore
IV. Foley catheter. The nurses performed these with
remarkable skill and ease. Then walks in the surgeon.
Let’s call him Dr. Skippy. If I were a bartender I would
have carded him. He was cute, goofy, and young.
I finally asked him had he ever put in a chest tube
before. “Yup,” he giggled as a reply. I looked over at
my nurse and searched her eyes for an answer. “I won’t
leave you for a moment,” she said as she slipped some
morphine in my IV. The pain relief was joyous.
She then asked Dr. Skippy how much Versed he
wanted me to have. I picked up my head and informed
them—once again—that I was on Sustiva and Versed
was contraindicated. I was trying to formulate the
words to explain induction of the CYP3A4 pathway as
the Versed was pushed into my line. So the end result is
I remember everything about the chest tube insertion
since the Versed effect was reduced in the presence of
Sustiva.
Okay, alliscalmand I am back homeon CapeCod. I
am getting back to my regular routine and feeling
pretty good. The phone rings and my sister tells me my
mother is on life support in the ICU. She is dying. My
family and I were anticipating a quiet at-home death
for my mother due to breast and lung cancer. All the
paperwork and the DNRs were in order. However,
some overzealous EMT has intubated my mother and
she is hooked up to a ventilator. By the time I can rush
home, I find her in four-point restraints and bucking
her ventilator.
As I walk into her cubical, my father, brothers, and
sister are all there and fear has gripped their faces. It
Richard S. Ferri, PhD, ANP, ACRN, FAAN, is an HIV/AIDS
nurse practitioner and consultant in Provincetown, Massa-
chusetts. Correspondence should be sent to Richard S.
Ferri, PhD, ANP, ACRN, FAAN, 261 Bradford Street,
Provincetown, MA 02657; e-mail: rferri@aol.com.
This was my first encounter with the fact that few
clinicians really listen to us dumb patients. I felt like I
was there to satisfy their adrenaline needs.
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Vol. 13, No. 6, November/December 2002, 73-75
DOI: 10.1177/1055329002238028
Copyright © 2002 Association of Nurses in AIDS Care

74 JANAC Vol. 13, No. 6, November/December 2002
was not supposed to be like this! The physician turns
around and smiles when he sees me.
“Don’t worry,” he says. “We are going to take care
of your mother’s high blood pressure and rapid heart
rate with a Cardizem drip.”
ventricular ectopy. I began to do my EKG 101 lecture just
to distract myself. Never let a teachable moment pass.
Another ER, another chest tube insertion, and
another nightmare. Once I was stable in the ICU, I
finally got some pain relief and I started to cry. Every-
thing just came crashing down on me. The deaths of
my mother and aunt, the chest tubes, the fear, and just
the whole damn thing.
A nurse walked in and looked at me crying and
called me a wimp. Look at you and all your muscles
and you cryin’ like that?
It is one of the few times in my life that I ever wanted
to hit someone. I told her to get out and leave me alone.
I was angry that a nurse could even mouth those words.
I felt violated by my own profession.
“No, you are not,” I calmly reply.
I explain that she needs pain and anxiety relief. She
is a “no code” and we do not want any interventions
except for comfort measures.
“I don’t know if I candothat,”hestammered back.
“I want the administrator on call in here now,” I
countered.
Magically, 10 minutes later a nurse walks in with a
morphine drip and syringe full of Valium. The drugs
do what they are supposed to do, and my mother calms
down and looks peaceful. I spend the night suctioning
out her mouth, cleaning her, and turning her. I was so
grateful to be a nurse and to be able to care for her.
In the morning, with the help of a nursing supervi-
sor, I petition the hospital’s ethic committee to have
my mother extubated. It was a surreal meeting. Let my
mother die, please.
Three days later, I am back at home once again and
go for a follow-up X-ray. I was feeling fine. My breath-
ing was great. I planned to go out to lunch after the X-
ray, with friends. As the doctor threw the film up on the
light box my eyes widened in horror. My left lung was
nowhere to be seen. He gently turned to me. I started to
cry. He hugged me, and rescue was called.
This time I got a helicopter ride to a big-time hospi-
tal in Boston. I was rushed to the airport and greeted by
police and firefighters. “Why all this?” I asked out
loud.
Nine hours later with her family at her bedside, my
mother moved into eternity.
Six days later, the other woman who raised us died.
My aunt just could not go on without her sister. So I am
back home and knocking on the funeral director’s door
once again. He is stunned. I have come to the conclu-
sion you know you are really having a bad time when
you make a funeral director cry.
It was a really windy day, and they feared the chop-
per might crash I was told. Oh, this is just great. I
secretly began to hope I could get upgraded to first-
class and get a stiff drink before takeoff.
Two weeks after my aunt’s funeral, I distinctly
heard my left lung pop again and felt my chest turn into
a clot of pain. I got to experience my first ambulance
ride from the patient’s point of view. Needles and tubes
got stuck in me, and I was stripped naked. So far, no
one had mentioned anything for pain, so I decided to
bring it up.
“You bet as soon as we get to a town where the cell
phones work.”
I did not even bother to quibble. Technology had
sabotaged me once again. Oh well.
The younger of the EMTs is still in training. He
announces—again, like I am not in the same van—that
he does not like the way I look. Well, I thought to
myself, I have had my better moments. He thought I
was having some runs of PVCs. I quickly scanned the
EKG and informed him that it was artifact, and not
In the chopper, a medic and nurse stripped me naked
with the sophisticated skills of a highly experienced
streetwalker. The frenzied dance of tubes began once
again. There must be a rule that once an orifice is found
a tube must go in. Marionettes had less strings than I
did by the time we took off.
Then they debated paralyzing and intubating me in
midflight as the medic jammed an 18-gauge needle
between my ribs. It felt like my foley was being used to
play jump rope. I mentioned that I was still alive and in
the same chopper with them. The ride became very
bumpy, and all they could do was hang on. For the first
time in my life I thanked God for turbulence.
We landed with a great thud and with painful rapid-
ity I was once again jabbed, poked, and tussled without
regard. Okay, this was my fourth chest tube, and I am a
pro. Still, no one listened.

Ferri / The Terrorism of Caring 75
Shipped up to the ICU, I asked for pain medicine
and the physician told me he did not “believe” in pain
medicine. I informed him that pain management does
not require a belief system like a religion. It is clinical
medicine.
So here is what I have learned from all of this—
something has to be done. No more lip service.
The stress on both the staff and the patients in an
ICU is beyond anyone’s measure. It needs to be identi-
fied and dealt with immediately. It is a time bomb
exploding on a regular basis.
Experience and certification do matter in quality of
care. I can honestly state that any time I had a certified
nurse take care of me—AIDS, critical care, you name
it—I received much better care. This only makes
sense. Certification in your specialty requires profes-
sionalism, extra study, and extra commitment. Believe
me, it showed at the bedside.
Pain and symptom management are afterthoughts.
Do not get me wrong. People ask you all the time about
your pain because the Joint Commission mandates it.
The only thing is, most did nothing about it, except
chart. I can only assume my chart was doing a lot better
than I was.
I think if I heard one more cheesy, “So Doctor Ferri,
on a scale of 1 to 10, how would you rate your pain?” I
would scream. It did not matter what number I gave,
since almost nothing changed unless I demanded it.
Pain and symptom management need to be in every
nursing program in the country. Nurses have to reclaim
their leadership role in this area. Every nursing dean
needs to make sure pain and symptom management is
in their curricula.
He asked me if I would like a Tylenol. No, I wanted
his boss.
The surgeon who placed the chest tube walked in,
and I explained the situation to her. I got what I needed,
and she told me that she had some real concerns about
this guy. Of course, this doctor in question would still
be my doctor. I did not feel good about this. I remained
hypervigilant my entire time in ICU monitoring every-
thing. I rarely slept out of sheer fear. Forget about eat-
ing live bugs on national television. If you want to
understand real fear, all you have to do is lay in a criti-
cal care unit with tubes flowing out of you and ques-
tionable clinicians.
Now it is time for me to have a thoracotomy and still
more chest tubes. I woke up from surgery as I felt the
nurse anesthetist extubate me. She was gentle and
wonderful. And, oh, I was alive.
My post-op pain was horrible, and a little “ICU psy-
chosis” settled in. No one thinks that a patient in a bed
with tubes is a real person. They yak and yank at you
without any regard. I decided to kick the next person
who tugged at my foley. Respect for sleep is not even
on the radar screen. Because I was one of the sickest
patients, I was near the nurse’s station, and I was
embarrassed to have heard what I did. One nurse spent
hours on the phone, and I knew everything about her
from her sex life to the house she wanted to buy. She
chatted, and I laid across the hall in pain. A drink of
water would have been nice.
As AIDS nurses, we have a tremendous gift to give
to our profession and the health care community. We
are the leaders in pain and symptom management. It is
time for us to lead others down the path we once had to
trod. It is time for a revolution in health care. Pain and
suffering need to be dealt with appropriately. I think it
is going to be up to us.