Monthly Archives: August 2016

The Dark Side of Travel Nursing

So, I have been doing travel nursing again for essentially the past year. It has been mostly awesome. I spent 9 months in Houston, Texas, and most recently have come to St. Louis, MO. I have loved it. I have loved the freedom of working a contract and being able to take time off if needed, I have loved exploring new cities and meeting new people. It has been overall a wonderful experience!

Most recently (as in last week) though, the dark side of travel nursing reared it’s ugly head. Insecurity. Lack of benefits. No safety net. I had a “health incident”, which landed me in the hospital, on the other side of the rail so to speak. My shift started out as they usually do, getting report and developing my plan for the night. Midway through my shift though, I was having really bad chest pain. I had been feeling badly most of the week, increased heart palpitations, massive fluid retention, heartburn and fatigue. I had been chalking it up to overworking as I had been fairly consistently putting in 60+ hours per week for a while. As I stood there talking to the NP about my patient, I kept rubbing my chest unconsciously. She noticed and asked me about it, and proceeded to march me into an empty room. I took my blood pressure which prompted and “Oh my god Sarah, is that your pressure!?”. Needless to say it was a bit high. The long and short of it was, without me even being aware of it, she orchestrated someone to come in and take my patients and send me to the ER. I was furiously charting trying to catch up and they even snapped a photo of me with oxygen on refusing to get in the wheelchair until my assessment was completed.

I went to the ER, and went through the whole shebang. Because I have lupus, and I have been off my meds for 3 months, everyone started jumping up and down that I need to be admitted. Needless to say I was non-plussed. The first thing I thought of was “I can’t miss any work”. See, the dark side of travel nursing is, if you don’t work you don’t get paid. Additionally, if you opt for their housing, you can face penalties for missing your hours to supplement their expenses at maintaining your apartment. It is a very scary prospect to be a patient in the hospital, and even more so when you are facing financial issues to boot. After much foot dragging and arguing, I agreed to be admitted (have I mentioned I am a HORRIBLE patient?). My cardiac enzymes were negative, but based on my symptoms and my lupus, the doctors felt strongly that I needed a dobutamine stress echo. I will spare you the gory details, but suffice it to say, that was one of the worst experiences of my life. Nobody should ever have their heart go from 56 beats per minute to 176 beats per minute in the span of 2 minutes. I thought I was going to die. I cried.  A lot. And almost vomited on the tech, poor thing. By the time I got back up to my room, my blood pressure was so dangerously low I almost fainted in the wheelchair. Scared the poor CNA to death, but somehow managed to levitate my ass to the bed before collapsing. My blood pressure never came up to normal, and continued to be very abnormally low. I requested enzymes with my PM labs, because I truly felt like I had been having a heart attack during the stress test.

Needless to say, my stress echo was “abnormal”, much to the surprise of everyone. The cardiologists honestly thought they were just going through the paces and I would go home that day. I did not go home. They scheduled me for cardiac cath the following day, which absolutely terrified me. See, the problem with being a nurse, is you know too much. On one of my travel assignments , I sent a lovely lady to cath lab, and she never came back. I get report and transfer of all the patients with “complications” post cath. Scares the bejesus out of me. Later that night, about 1am, doctors came tiptoing in (always right when I need to go to the bathroom, like toddlers or cats), and went “ah well, tell us more about what happened during your stress test”. Suddenly everyone was interested to hear what I had tried to tell them before. Turned out I had a small MI during the test. By this point,  I felt like they were trying to kill me, to be honest. My enzymes had been negative up to that point, but their test suddenly has everyone going “um don’t get out of bed and here is a heparin drip”.  Through all of this though, my amazing friends and coworkers really saved the day. From listening to me freak out, visiting me at night when I couldn’t sleep, to making sure I was with the best interventional cardiologist for my cath, these nurses saved me. See, they didn’t see “a traveler”. They saw a fellow nurse, scared to death, and took care of me. Even my boss, went to cath lab to make sure everyone knew I worked there, came to see me, and hugged me when I was losing my shit before going to cath lab. All I wanted to do was go home….but these people kept me sane.

The next day I went for my cath. I asked for a radial approach, to have faster healing time. The cardiologist didn’t want to do it because of my Reynaud’s, but he did anyways (I begged). Turned out he was right and I should have listened to him, it hurt like a son of a bitch and still does. The long and the short of it was I apparently had a 68% blockage midway down my LAD. the put a stent in, and now I am on plavix and aspirin, with the lovely diagnosis of Coronary Artery Disease and Non Stemi Myocardial Infarction. There are no other lesions anywhere, and most likely the pain I have been having for a long, long time has been vasospasms. See, I never paid attention to my “chest pain” because it wasn’t like what I thought of as chest pain. I could point to where it hurt. Apparently that spotI could point to was halfway down my LAD. The doctor said it was a little hidden, but that I was extremely lucky considering this was in the main artery of my heart.

All of this has been overwhelming to say the least. I can’t wrap my head around the idea that at 44, with no family history, normal blood pressure, perfect cholesterol that I am a cardiac patient. Yes I am fat- have always been so. But being fat in and of itself doesn’t clog your arteries. Turns out, the pesky Lupus does. For some unknown reasons, the near constant inflammation I experience from my Lupus is worse on my arteries then having bad cholesterol. This coupled with chronic arterial vasospasms led to me needing a stent. It is possible the “benign” heart arrhythmia I have had all these years was in fact this lesion developing. Being off the meds that reduce inflammation levels in my blood exacerbated all of this. Luckily, statins also help with inflammation, also for unknown reasons. So if I take my meds like a good girl I should be fine. Mind you, I stopped them because they were making me fat. Because we live in a society where it is better to be dead than fat. That is a blog post for another day, however.

They say that experiencing a profound health crisis changes you. I don’t know that it has changed me per se, but it is definitely giving me pause to rethink things. While I love travel nursing, it is a bit like playing Russian Roulette. Unless you are smart and have 6 months of salary saved up (and face it, who among us does?), you run the risk of losing everything if you can’t work. There is no safety, no backup, no net. None of us are immune, no matter how indestructible we think we are. This experience has taught me that it is ok to be a little selfish. To think about my needs first before others. I need to get back to classes and finish school (I am going for my RN to MSN, then NP). I need to have a less stressful job. I need to make more money so I can work smarter instead of harder. The days of “well I will just pick up an extra shift” as the answer to all the financial woes must stop. I cannot be this workhorse anymore. I need some safety and security in my life, as much as is possible in this crazy world to have.

I also realized I have been afraid to share what has been going on, because of the stigma associated with CAD. I know, that people assume by looking at me that I “ate myself” into a heart attack. I also know that the people who love and care for me know that is not true. I probably have better eating habits than most of the people I know. I avoid meat, fat, eat lots of veggies etc. I loathe cheeseburgers and mayo, and usually get chased after to eat something. Obesity is a complicated thing, and not easy to deal with. I had been losing weight fairly consistently after getting off the steroids, until the new Lupus meds- then over 9 months I gained 45 pounds back.  No matter what I did, how I restricted my diet, what exercise I did, I gained. According to my fitbit  I would hit my 10K steps in the first 4 hours of work.  I gained in weird places, not normal to me. So I went off my meds. In my mind, I could be ouchy and fat, or ouchy with Lupus, what was the difference? What I didn’t stop to think about was the hidden effect the Lupus was having on my body. The insidious inflammation and destruction of the unseen parts of my body. Sure, I started to lose weight again, slowly, but at what price?

So now, I am going back to work tonight. Nervous, only with a week recovery. Could I use more time off? Sure! Who couldn’t? But the sad truth is I can’t afford it. One week without pay was all I could do. While I adore travel nursing, and part of me wants to continue jetting around the world to exciting locals, meeting new people and seeing new places- I realize that I need to slow down and reconsider. The sad truth is I can’t “afford” to do travel nursing anymore. I need to seriously investigate a permanent position until I am finished with school. I need to get back on that bandwagon ASAP so I can finally have some viable financial options that offer nursing away from the bedside, but not in administration which I loathe with all my soul. Luckily, I love it here in St. Louis. I adore the people I work with, the unit, my boss, the hospital, the city. I am lucky I have support here and the backup to take a perm position. Hopefully that will work itself out by the end of this contract. I am still waiting to hear from HR, apparently they move glacially slow. But hopefully this will turn into something even better for me then I have had before. Meanwhile, it’s back to the grind, albeit at a little slower pace.

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Filed under random musings, Travel Experience