I’ve read a couple of other blog posts about what it’s like to be a Labor & Delivery Nurse, a NICU (neonatal intensive care unit) Nurse, a Geriatric (elderly) Nurse, etc. But I haven’t come across one that has been written about working with patients who have suffered a stroke or have a neurological disorder. It’s taken me some time to write this post but it’s finally completed and ready for posting!
A stroke is brain tissue death from either a clot or a bleed. Depending on which side of the brain it is on and where it’s located it can affect different areas of the body. Telemetry is heart electrical monitoring. Every person who has a stroke or has a history of heart problems is on a heart monitor to watch for irregular rhythms. The neurological aspect comes in when we have a patient with multiple sclerosis, seizures, or alcohol withdrawals, for example.
One thing I think any nurse could say is that every day is different. A new experience with every shift (for the most part). You can never foresee what is going to happen until it’s already happening.
I recently switched to working the night shift from the afternoon shift. In doing this it means my wake up time went from 1pm to 5pm and I go to bed around 8:30am instead of 3am. I’m a nocturnal person by nature anyways so it doesn’t feel too different for me but it’s not the same schedule the rest of the world is on. I have to get up earlier than usual if I need to run errands before businesses close but fortunately they’re also open on my days off.
Here’s how my work days go.
Upon arriving I usually grab a bite to eat in the cafeteria then head on up to my unit where I chat with my co-workers in the break room. We tell each other the crazy stories about what happened over the weekend and catch each other up on the gossip of what’s going on with who. This is our time to be light-hearted and laugh. Once you step out on the floor your serious face comes on and it’s time to work.
You can usually tell what kind of night it’s going to be based on the bed exit alarms going off or the frazzled looks the nurses and aides have when you walk down the hall. Most nights it’s hectic and everyone is stressed but occasionally (rarely) there are some nights where everyone is as chill as a cucumber and the patients are not climbing over the side rails.
Being a nurse is no joke. It is a hard job that is demanding physically, emotionally, and mentally. We have to help lift patients in bed, bend over them as we change and clean them, tolerate truly terrible odors while keeping a straight face, and walk on our feet for 8-12+ hours a day. We have to stay strong as family members and/or patients get angry and yell, cry out in sadness or pain, strike out at us when they’re confused and scared. We have to separate ourselves from the depressing situations and remember to not take harsh words personally. We work holidays, weekends, all hours of the day, and take care of other people’s families while away from ours. Most importantly though, we have to try and not take our work home with us.
With every year that I’m a nurse my skin gets thicker, my confiendence stronger, and my shoes more new and more comfortable than the last pair. I gain a wider range of skills and broader knowledge in various areas, some of which I can apply to my life outside the hospital.
Not a lot of other nurses like to get pulled to our floor because they find the patient population to be more challenging to deal with than other units. A lot of the patients that come to us require total care because one side of their body doesn’t work or they’re in the throws of detoxing from alcohol and are anxious and impulsive. Because they’re not certified to perform the stroke scale they do not get stroke patients.
Stroke patients are a special kind of patient. If it was a small stroke and they don’t have debilitating symptoms they wonder why we’re keeping them at all and want to do everything themselves like they did before. I’ve had patients who had a bunch of little strokes throughout one side of their brain and the only symptoms they exhibit are numbness in their ring finger and pinky or just the bottom part of their lip and I’ve also had patients who are essentially not there anymore.
These cases are the hardest because it’s difficult on the families as well as the staff. They can not always communicate their needs and are in pain from not being able to move one side of their body. They require turning every two hours and elevating their feet on pillows to prevent bed sores, oral care with lemon or mint flavored mouth swabs, help eating pureed food or given liquid supplements through a stomach tube. They need someone to hold their hand when their family goes home because they’re afraid to be alone. Many of these patients don’t live very long because having a stroke is very taxing on the body.
I recently had a gentleman who had a severe stroke who became very depressed about his current state and contemplated suicide. His stroke affect a large portion of the left frontal area in his brain which left him with trouble communicating his thoughts, difficulty swallowing non-pureed foods or thin liquids, the right side of his face, arm, and leg had no sensation and were completely flaccid. He felt that he had no quality of life left and did not want to live this way. Psychiatry consulted on him and deemed him not a suicide risk at that point but it really brought into reality the horrors of being locked in your own body, not able to communicate or move or eat and rely on others for your basic needs.
Those that come in with neurological disorders can be challenging in their own way. I once had a young male patient who had a seizure at home. His parents brought him in and he was postichtal (the state of mind and body after a seizure in which they can be confused, combative, drowsy, or impulsive). I remember that at one point we had to restrain his hands to prevent him from hurting himself and us as he was coming back to his baseline mentation.
There was another case that hit me really hard a few months back. This woman came into the ER because she lost consciousness one morning and began gasping for air. She was only in her 70s and was very healthy, even was set to run a triathalon in a month. Her family was at her bedside the entire time. It was difficult to watch this woman have her episodes because it involved the jerking of her head, neck, and shoulders. She was seizing and during these she would gasp and sound like she was struggling to breathe. I was giving her Ativan constantly it seemed like and it wasn’t doing anything. We sent her down for tests and the neurologist diagnosed her with Status Epilepticus.
Status Epilepticus is classified by the National Institutes of Health as a medical emergency and defined as “a continuous seizure lasting more than 30 min, or two or more seizures without full recovery of consciousness between any of them” (source). She fell under the latter part of the definition and was literally having them every 2-5 minutes.
They were trying to see if they could find a way to stop them safely without her dying because she was a full code at this point (if her heart or breathing stopped we would have to try and bring her back). I was off for a day and when I came back they still had no solution. Nothing worked. She wasn’t eating, wasn’t drinking, wasn’t awake, and still seizing every few minutes. The family had decided to place her on comfort measures earlier that morning and her gasping sounded worse than ever. I remember trying to reposition her so her airway was open more but it didn’t help, rubbing chapstick on her dry lips because that’s what I would want someone to do for me, and kept her sheets dry and wrinkle free. She was placed on an Ativan drip which finally stopped her seizures and died an hour later.
The entire situation was traumatizing to me because she had been the first patient I had with true seizures and for her to be constantly having them, knowing what it was doing to her body and brain, it made me heartbroken for her and her family. I try to reserve myself in front of patients and their families, to not get emotional, but when her son, who had flown in from California that morning, started crying I lost it and cried with them. It was difficult and I’ll never forget it for the rest of my life.
I’ve learned a lot in my year and a half on the Stroke and Neuro floor and I’m very grateful for the experience and knowledge gained. My job is hard. It challenges me and makes me a better person by giving me the tools to strive for a more stable life for myself and Andrew, to be more confident in my knowledge and abilities, and to continue pursuing a higher education. I’m pretty happy here and expect that I’ll stay a while still and maybe some day I’ll branch out a try new things. But for now I’m comfortable where I am.