So how did an aspiring artist and photographer end up working nights surrounded by medical equipment and sick people?
I blame my father. He’s not here to defend himself anymore, but take my word for it: there was no way he was going to let any of his daughters become starving artists.
So now I’m a semi-starving nurse. When I started nursing, my salary was $8.65 an hour. And although I do earn a bit more these days, believe me, Bernie Madoff never solicited me for investment opportunities.
Ultimately I set aside my artistic dreams for a more “practical” reality of mastering the science and art of critical care nursing. Part of me was fascinated by some of the “big” questions in medical care, like, “What do you do when all of the body’s organs start failing? How do you help people who are truly suffering, without resorting to Jack Kevorkian measures?” Solving analytical problems in a humane fashion seemed (and still seems) far more rewarding than photographing magnificent images—although I still find tremendous pleasure in stealing away and capturing the world through a viewfinder.
Oddly enough, my professional journey through medicine intersected with a personal medical condition—one that would remain undiagnosed and untreated for five years. At first, doctors said that my facial tics (hemifacial spasms) and strange pains were due to stress or some hysterical “woman’s disease.” Yes, this was in the 21st century.
Finally I found help at Mount Sinai in New York City and walked out with a few names and treatments for a disease that affected my head but was not “in my head”.
I started my nursing career with dysphonia, cervical dystonia and even general dystonia (too bad they didn’t give medals for ranks; I’d have been able to pin a few ribbons on my scrubs). Early treatments might have been much more fun if they had been given for cosmetic reasons, but my Botox, Myobloc and eventually Deep Brain Stimulation (DBS) treatments were prescribed to ease some less-than-glamorous symptoms.
How much trust would you put in a nurse who twitched and twisted? Not much, I’d imagine. So, at first, I worked while wearing a soft cervical collar that allowed me to perform sensory tricks to convince myself my body was aligned and not twitching and twisting.
After a while, however, that approach stopped working. While I thought I was doing a terrific acting job (perhaps even worthy of a Tony or an Oscar), my patients began asking me “What’s wrong with you? Are you in pain? Should I call a doctor? A nurse?” It was then that I knew the jig was up—at least in respect to sensory illusions.
So what was next for me? Retirement at age 30 was not an option, so I’ve figured out a way to continue doing what I love, despite my pain and my drugs and my brain surgery. Has it all been worth it? Yes. Am I an effective nurse? Ask my patients. Do I wish I could wake up and discover this has only been a long, bad dream? You bet.
How do I manage? I’ve got my own system figured out. Most people don’t want to work nights and weekends. I do. Not because the work is easier or quieter or better paying, but because working those hours makes me that much more valuable in a hospital.
Are you wondering what it’s like to work from 7:00 at night to at least 7:30 in the morning? Let me take you with me through a typical shift.
First, if you’re scheduled to start your shift at seven, you have to be at the hospital well before then. And if you live in New York City and happen to have dystonia, like I do, you should probably start even earlier. Find me a day without gridlock in this city and I’ll bet there’s either a national disaster or a holiday weekend.
Within the first half hour of our shift, we undergo the changing of the guard. During this time, the night team leader makes assignments and reports are exchanged. And then the real fun begins.
A TYPICAL SHIFT:
1930 hours – I have two patients. One is on a ventilator and will likely be bleeding all night since a drug she has been taking for migraines (methotrexate) has eliminated not only her headaches but also her blood’s ability to clot. Her mouth is also filled with packing material. My other patient weighs about 300 pounds, has pneumonia, and is in the second stage of lung cancer. How in the world am I going to turn her over?
Despite my (very tall) height, I weigh slightly more than 100 pounds. I also have wires in my neck that connect a pacemaker to my brain. These wires are not industrial grade and can snap under pressure. But I’ll deal with that issue later. I have work to do.
1945 hours – I review the computerized order checklists to learn what medications are due to my patients at 10 pm.
1950 hours – A patient’s family member asks for coffee. This would not be a big deal if not for the fact that walking with a steady, even gait is not my strong suit. With a rather interesting weave (not ever to be confused with that of a runway model), I deliver hot coffee. No spills, no burns, and no “thank you”.
2030 hours – I stop in to see patient #1. Her oral packing is bloody. The bed is bloody. It’s time to call the Ear, Nose and Throat (ENT) residents. The patient’s platelet count is only seven. Luckily, she is sedated (with IV Versed and IV Fentanyl) and her vital signs are holding steady.
2050 hours – I see patient #2 and hear gurgling. Since she’s not gargling, it doesn’t take a medical whiz to know that this is not a good sound. (Should you have a medical background, you might recognize the sound as a signal there is water in the patient’s lungs.) Since this patient has refrained from urinating for most of the day, I’m betting she’ll be much, much happier if I suction her. I do. I even hear a faint “Thank you.” I like this lady.
2100 hours – The ENT residents have ordered platelets for patient #1. Does that mean I’ll get them ASAP? No. It means I now have to call the blood bank and grovel. “I need them in a hurry.” Their reply of “Yeah, yeah” can be translated as, “You’ll get them when I get to you on my list of things-to-do, people-to-see and dinner-toorder.” Am I happy? No. Is this stressful? Yes. Does this make my straight hair curl and my dystonia symptoms go away? Guess.
2130 hours – I have got to work on my begging and pleading skills, as they do not teach this stuff in nursing school. The platelets have yet to be delivered and no one has called from the blood bank to say, “Come and get them” (or, even more unlikely, “We’re on our way.”) So I call them again. Were the platelets (a) delayed or (b) forgotten? My hunch is that the order is still sitting on the “to do” pile.
2200 hours – This is not good. My 300-pound patient needs to be turned over for a skin assessment. Science can send men to the moon—why can’t it build me an extra arm for multitasking? I add two bags of antibiotics to the patient’s IV. As I do this, it occurs to me that, although I’ve been on duty for hours, I haven’t had a chance to enter anything about my patients into the computer. I’ll do that now.
Wait, no I won’t. Alarm bells go off. My other patient’s blood pressure is dropping (“falling through the floor” would be a more accurate description). This is when all my years of training and experience pay off. I react automatically.
2210 hours – I run into the drug room (if you’ve ever seen someone with dystonia run, you know it’s not likely to rate many style points) and grab a bag of premixed intravenous Levophed. This medication is administered to raise blood pressure—it’s a drug I personally do not need at this point. My heart is pumping furiously, as if it might actually break the sound barrier. I dash back to my patient’s room, hook up the bag, and remain by the patient’s bedside for the next half-hour.
2245 hours – The bells are ringing, and all of them are for me. Has anyone done a study on how many things a single person can do at the same time? I need to clone myself (and preferably create a version without dystonia). Okay who gets priority, the bedpan-seeker or the hungry patient? No contest.
2300 hours – Here’s the good news: a knight in shining scrubs appears. His name is Stu, and he helps me turn my 300-pound patient. Here’s the bad news: the patient’s oxygen level is doing that downward slide. I’m hoping she doesn’t need to be intubated or put on a ventilator. I call the resident on duty and request a C X-ray order, praying that the patient isn’t retaining fluid.
I am retaining stress. This does not bode well for my next activity: writing status reports.
2320 hours – I start off with a bang but my hands have a mind of their own. I think, “write”. They think,“I’m cramping up, honey.” The hands win. Writing will have to come later.
2342 hours – Half a miracle: the C X-ray is done. The patient’s blood pressure has stabilized. But the blood bank remains a “no show,” and I really have to eat something and go to the bathroom. Can we get scrubs from NASA? Those spacesuits could work just fine.
2355 hours – I make an executive decision: I’m going to go to the blood bank and get my patient’s platelets. If we needed them before, we really need them now. This is not an order for pizza.
0010 hours – I’m still hungry. If I don’t sit down for five minutes I may fall over. I look up at the clock and realize now would be a good time to start all of my chart work. For most nurses, this part of the job would be slightly more relaxing than the dramas taking place at the bedsides. With dystonia, however, this part of my day is a pain in the neck. In fact, it’s more than that: it causes hand cramping and pain. Fortunately I’ve mastered the art of two-fingered-typing. No speed records will be broken tonight.
0015 hours – The formerly elusive platelets now find a home in Patient #1’s blood stream. Patient #2 doesn’t look good, however, and her breathing is labored. I think she needs more than suctioning. An order goes out for a diuretic to get rid of some that water. This time we go for something formidable: 40 mgs of IV Lasix.
0110 hours – Some of my charting is completed, the platelets have infused, and the Lasix seems to be working, but now it’s time to turn over both patients. And I still haven’t eaten. In the background, I hear a nurse argue with the resident-on-call about an emergency room admission. What’s new?
There are not enough nurses on duty tonight (are there ever?). We are so short-staffed, in fact, that I already know I won’t be coming off duty in the early morning. In nursing, the mantra is: “If it’s not documented, it’s not done.” Remember my typing skills? I won’t be leaving here for a while.
0130 hours – I notice bloody urine coming from Patient #1. Wondering if her liver is failing, I decide to draw her blood and send her lab work off early. She will need more platelets – she is not clotting well.
0140 hours – A patient is dying at the other end of the unit. He’s only 20 years old. His family is living by the bedside. No matter how many times I’ve seen this sort of drama unfold, it never gets any easier.
0210 hours – Now that all the labs and diagnostic tests are completed, Patient #2 (the 300-pound woman) raises my blood pressure to a nightly high. Her heart has gone into a lethal arrhythmia. I run into the room and pound her on the chest, hoping beyond hope to get a normal rhythm to return. My neck is killing me. The precordial thump works. EKG and complete labs are ordered. But her oxygen level has dropped again. Does she need even more Lasix?
0240 hours – As I’ve now become quite attuned to Patient #1’s platelet activity, I feel like celebrating as her number goes up from seven to…twenty-four! Just for good measure, the ENT guys order more platelets and some liver function tests. The patient’s blood pressure has remained stable. I finish my computerized charting entries. However, due to my dystonia, my arms hurt from hanging bags of platelets on a barely-reachable ceiling pole. What do shorter nurses do?
0300 hours – The few of us on the unit tonight have been running for what seems like forever. Forget ordering take-out dinners, forget eating the healthy snacks that some of us have packed. In between ringing bells and critical care nursing, we gulp down chips, soft drinks and the unhealthiest snacks imaginable. What if a dietitian happened to decide to spend the night here?
0310 hours – The 20 year-old patient dies. I feel sad. His parents are at the bedside. Morgue care is ordered.
0330 hours – My order of platelets is ready. I ask the unit clerk to pick it up, then I stop by the pharmacy for some newly-ordered antibiotics. The pharmacist, right here in this very large, very busy New York City hospital decides to let us know in no uncertain terms that the pharmacy doesn’t have the variety that we had ordered. Am I in a new episode of The Twilight Zone? What kind of pharmacy is this?
0400 hours – Meanwhile, back on the floor, patient turning commences. What could be worse than trying to perform this task alone? Finding the bed and its surroundings soaked with diarrhea. This is a job for the true angels of nursing: the housekeeping staff. I clean the patient, give her a back rub and a respiratory treatment. Before leaving the room, I do a platelet check.
0430 hours – Platelets are done. Will this shift ever end? Whatever could go wrong has already happened—or so I think.
Also, my feet hurt. Note to self (and to other would-be nurses with dystonia): clogs might as well be three-inch heels. A new emergency room admission arrives on the unit. The few staff who are left standing all help the patient settle in. We just want to sit down and go home.
0445 hours – Some of the routine things that nurses do are no longer easy for me to accomplish without help. Night nurses are responsible for exchanging old IV tubes for new ones. This used to be a non-event, but now I can’t open the packaging without using scissors or a clamp or a helping hand. It’s frustrating.
0510 hours – A minor miracle: my paperwork is up-todate and there are only two more hours left to this awful night.
0522 hours – A colleague has trouble inserting an IV. I offer to help. Even though I am unable to turn my head the “right way” anymore, I can do IVs by instinct. With dystonia, you learn to make accommodations and work around physical limitations. Here’s my secret: I usually rearrange the patient’s room so that everything is in my line of sight.
There’s another thing of which I need constantly to be aware since I went through DBS treatment: electromagnetic interference. All those security devices may be great for the hospital, but they cause havoc on a pacemaker— and mine goes to my brain rather than to my heart. This is, among other things, anxiety-producing so my neurosurgeon has me take a mild dose of Klonopin to reduce stress. Did I remember to take it this morning? No. I will pay for that oversight on the bumpy bus ride home.
0547 hours – An alcoholic in withdrawal wanders out of his room. His IVs are in disarray, he has a bloody gown, his EKG monitor is off and he announces to all of us he is ready to leave. Perhaps we should call the bellboy for his luggage and have the front desk prepare his bill. He resists our attempts to cajole him back into bed and then hits one of the nurses. We call security and the doctors. This guy ain’t listening to anyone.
0600 hours – Perfect timing. The head nurse walks down the hallway as the alcoholic makes his way to the nurse’s station. He’s spouting off four-letter words and making comments unsuitable for publication. Where is security? Are they in cahoots with the blood lab people? I really don’t want to be a punching bag, even if I’m beginning to feel like one. If my muscles get any tighter, I may explode.
0610 hours – Security arrives. Using less than spectacular intervention skills, they tackle the patient. Now what? We decide to ship him to the psychiatry ward, STAT!
0624 hours – I check Patient #2 and discover more diarrhea—the type of diarrhea that irritates skin and is induced by antibiotics. To make matters worse, the 300- pound lady can’t breathe when she’s in a prone position. Getting her out of her bed is impossible, especially since I only weigh 115 lbs. I call my knight in scrubs, Stu, and we clean the patient up once again. Now I do the “uh oh” check. Are my neck wires still intact? Yes. I can exhale.
0645 hours – I go back to the charts and enter final vital signs. I also need to compute data such as intake and outtake of fluids. Have you ever had to estimate the amount of diarrhea produced by a patient? I must have missed this lecture in nursing school.
0710 hours – Patient #1 needs extra IV potassium. I grab a bag from the drug room and hang it on the IV pole. The day shift staff begins arriving. I actually have a minute to swallow a dose of my medication, relieving my dystonia spasms.
0726 hours – Before giving a verbal report to the day shift, I review any last minute orders to make sure nothing was missed. Nothing was.
0745 hours – Shift over. I can relax. At least until tomorrow. Scalp pain erupts. Neck twisting and turning begins. I just want to sleep. But I wouldn’t trade my job for anything. Nursing with a movement disorder is exciting, rewarding and absolutely do-able!
by Beka Serdans, RN, MS, NP
Beka is an intensive care unit traveling nurse
for American Mobile Nurses