How to be an RN with a Movement Disorder ? PART 1

I get this question asked almost constantly when I am a work in the ICU. First, a bit of basic information about me. I truly never wanted to be a nurse,but due to the convincing powers of my father; I landed in Nursing school right out of high school. Art school was something that I had strived for while dodging high school biology and physics courses. But, my father would not have "one of his 3 girls demoted to the status of a starving artist". That status would belong to my youngest sister after she completed a degree in photography at FIT in NYC before heading out to sunny California. The 2 year degree was completed by the lackluster age of 21, beginning my career in nursing at a salary of $ 8.65 an hour. URGG..I was expected to save human lives at a salary not too far from today's minimum wage. Somewhat of a disgrace today and at the time.
I entered critical care nursing right away,being fascinated by analytical problem solving, complex health conditions such as Multi-system organ failure etc., death and dying along with a good ounce of basic human suffering, which at the time was being adressed by the pathologist Jack Kevorkian on a monthly basis. At the time I began nursing, I already was exhibiting signs of dystonia especially dysphonia and cervical dystonia along with facial tics, otherwise known as hemifacial spasms. But, for 5 years I was told by multiple doctors that it "was all stress related" " I had a womans disease" and " it all was in my head". I was sent from physician to physician without a clear-cut diagnosis until I hit the doors of Mount Sinai in NYC on my own two feet- dysphonia, cervical dystonia, and generalized dystonia. Finally confirmation and validation of symptoms. A clear-cut diagnosis.
Early on, I would work with a soft cervical collar in order to prevent my hands from using those famous sensory ticks, that trick the mind into believing that your body is aligned in perfect alignement and reduces twitching, distortion, twisting etc.
As symptoms became more visible, patients would ask " what was wrong with me ?" " was I in pain?" You BET, I was..
Gradually Symptoms became more difficult so over time I developed my own system or paradigm of nursing using famlies and patients to help me.I actually began contemplating on retiring from nursing
Now - what is a typical day like for me, you may ask ? Well, first I have always worked the night shift, meaning from 7pm to 730 am ( bear in mind that Nurses never leave on time...); there is always something to do, needs to be met along with mounds of paperwork. I generally arrive at work about an hour early, blame it in NYC traffic and gridlock. Assignments are given out by the team leader of the night, report is exchanged, all done within the first 30 minutes of the shift.
A Typical Day
1930 - I have two patients, one who has packing in their mouth and no clotting factors at all due to the use of methotrexate. She's on a ventilator and likely will bleed all night. My other patient weights about 300 pounds and I wonder how am I going to even turn her with pneumonia and stage 2 lung cancer.
1945- I begin going thru our computerized Order Checklists to just to make sure what meds are due at 10 pm.
1950- A family member asks for coffee. I got and get them some coffee.
2030- I see my fiirst patient. The oral packing is bloody. Time to call the ENT Residents to come and check her.Her platelet count is 7. The bed is covered with blood. Urggh..Luckily she is sedated with IV Versed and IV Fentanyl. Her vital signs are holding right now.
2050- I see my other patient and I hear gurgling sounds coming from her throat. She sounds " wet ", water in the lungs. She has not peed that much all day either. I suction her and she sounds better. I hear a verbal "Thank You" from her.
2100- The ENT Residents have ordered platelet infusions. I call the blood bank saying that "I need them in a hurry." Their reply " yeah, yeah" in a Jamacain accent. Ya-di-dah...
2130- Still no platelets or calls from the blood bank that they are ready. Another call to the Blood Bank. They were delayed. FORGOT.
2200- I hang two antibiotics on my 300 pound patient, and ask for help to turn her. To do a skin assessment. I haven't charted a thing on paper or in the computer on either patient. Alarm bells go off. My other patient has dropped their blood pressure. Oh Hell- what am I going to do now ?
2210- I run into the drug room and grab a bag of premixed intravenous Levophed, used to raise the BP. I remain by the bedside for the next 30 minutes.
2245- A call bell goes off, a patient wants a bed pan. Another patient wants some food. RING, RING.
2300- Stu helps me turn my 300 pound patient, as we turn her she drops her sats- meaning her oxygenation. I hope that she will not need to be intubated or placed on a vetilator. I call the Residents and ask for an CXray order on her. I hope she is not retaining fluid.
2320- I begin rapidly writing,but hands are cramping up already. The writing will have to wait for each patient.
2342- CXray done. BP has stabilized. The Blood bank still has not called. I have not eaten a thing or run to the bathroom yet.
2355- I decide to run to the Blood bank for my patient's platelets myself. I could be waiting all night for them.
0010- I sit down for 5 minutes. Gosh - am I tired already as I look at the clock. I begin charting.
0015- Platelets are hung after being checked by 2 nurses. My other patient is "wet ". She needs a diuretic, a water pill given in intravenous form- Lasix 40mgs IV is ordered. She doesn't look that good. Her breathing seems labored.
0110- Some of my charting is completed, the platelets have infused, the Lasix seems to be working. I have to turn both patients now. I still haven't eaten. One of the nurses is arguing with the resident-on-call- about an ER admission. There are not enough of us, RNs , on tonight. We are working short-staffed. I already know that getting out on time will not occur for me in the morning. We have a philosophy in nursing - NOT documented, NOT done.
0130- I notice bloody urine from the packed oral lady. I decide to draw her Labs early. She will need more platelets - she is not clotting well. Wonder if she has some liver failure ?
0140- A patient is dying at the other end of the unit. The family is living by the bedside. He is only 20 years old. Drats...
0210- Labs are done, CXR are done on eveyone. My 300 pound patient decided to go into a lethal arrythmia. This is no time to laugh. I run into the room and hit her on the chest to get her out of the abnormal rhythm. My neck is killing me. The precodial thump works. EKG ordered. Complete Labs are ordered on her. Her oxygen level has dropped again. More Lasix ??
0240- My platelets are up to 24 from 7. WOO HOO. I feel like celebrating. The ENT guys order more platelets and some liver function tests. Her BP has been stable. I finish my computerized charting entries. PHEW. MY arms hurt from hanging platelets on a unreachable pole from the ceiling.
0300- All of us have been running all night. We eat at the desk - chips, coke and other munchies...No healthy food tonight. Forget take-out at this time of the nite.
0310- The 20 year old patient down the hallway has died. I feel sad. His parents were at the bedside. Morgue care.
0330- My platelets are ready. I have the Unit Clerk go and pick them as well as stop by the pharmacy for some newly ordered antibiotics. The pharmacy gives us grief that they don't have the variety ordered. What kinda of pharmacy is this ?
0400- Turning is in order. Find a bed soaked with diarrhea, dripping to the floor. Ohh , Geezz...What next...? I clean the patient up ,giving her a back run along the way as well as a respiratory treatment. Platelet check.
0430- Platelets are done. I can't wait for the shift to end. What could go wrong , HAS tonight. My feet are hurting me. Clogs are not optimal shoes if you have dystonia. A new ER admission arrives. I help settle the pateint in with my colleagues. No one has had the time to think about upcoming Nurses Week in early May. We just want to get out and go home.
0445- New IV tubings need to be changed, a responsibility of the nite crew.
0510- My paperwork is up to date. 2 more hours to go.
0522- A colleague can't place an IV in. I place an IV in just by instinct. I can't turn my head the right way anymore. I rearrange the patient's room so that all is in my line of sight. Got it- the IV is in. But forgot to take my Klonopin dose. Shucks. The bus ride home should be a nice horror for me, bumps and all.
0547- A patient, an alcoholic in withdrawal, wanders out of his room. His IV s are in disarray, he has a bloody gown, his EKG monitor is off;he says that he is ready to leave, walk out AMA. He resists our cajoiling him back to bed and hits one of the nurses. We call security and the docs. He ain't listening to anyone. Just what we need at 0600 when our Head Nurse is coming down the hallway. He begins shouting profanity at her. Where is security ? I don't want to be hit. I already feel punched up, all my muscles are tightening up.
0610- Security arrives AND tackle the fellow to the floor. We decide to ship him to the Psych Ward.FAST.
0624- Diarrhea City again. The type of diarrhea that is irritating to the skin and induced by antibiotics. My 300 pound lady can't breathe when she is an a flat postion. Getting her out of bed would be impossible. I only weigh about 115 lbs. No protective cream available. I and Stu clean her up one again.
0645- More charting to do - final vital signs , adding up of numbers - what was taken in, and what was peed out. I have to estimate the amount of diarrhea. Lucky Guess for me.
0710- My other patient with the oral packing needs extra IV potassium, which I grab from the drug room and hang. The day shift staff begins arriving. I swallow my dose of klonopin, late anyway...
0726- Last minute Order checks to make sure that I did not miss anything. I didn't. Verbal report given to the day shift
0745- What a long shift...
That is nursing for you. Scalp pain erupts.