Memoirs of a Critical Care Nurse
Categories: Family Health
AOL Health: In the book, you talk about managing your multiple sclerosis while continuing to work, which sometimes meant taking time off.
Culkin: It's a vast continuum, really. I've been lucky. I'm really on the mild side. I think that the drugs [I take] are helpful, and I've been on those since early 2002. I think that has helped me stay stable -- that and exercise. I did take two years off from work, which is kind of a big thing and hard for me to do. But I do think it helped me. I was so tired -- MS fatigue is terrible -- I was having a lot of flares. I was just in bad shape going into that and not having to work for two years set me up -- I really did improve quite a lot and was able to go back to work.
Fatigue is a huge thing, and the way I deal with that is I work part time. If I worked fulltime I would not do as well, frankly. Enough sleep helps. I know it sounds so basic, but we're chronically sleep-deprived in our culture, and I was, too, prior to having to deal with this. I do get really tired. It is a long day. Exercise and fitness helps me cope with it. I think if I were de-conditioned I probably couldn't do it. In spite of multiple sclerosis to maintain fitness has really made a difference for me.
AOL Health: When did you receive your initial diagnosis?
Culkin: 2001. But I had symptoms as long ago as 1988. I think my particular trajectory of MS was slow because it was 13 years from the time I first noticed symptoms that came and went until I actually got a diagnosis.
[Initial symptoms were] dizziness, numbness and tingling. Dizziness was really big. I would get this almost incapacitating fatigue. Memory loss. That was another thing in my 30s I was thinking, "Am I destined for Alzheimer's?" It was striking. I'd always had a good memory with quick information processing. All of a sudden I was noticing gaps in that, and that was frightening. I would say these things, and they would check my thyroid levels and those were fine, so it went on for awhile. Things would come and go. It's easy for you to say to yourself, "that was in my imagination."
AOL Health: Even as a nurse, you had no idea something was wrong?
Culkin: You would think I'd key in, but I was a pediatrics nurse and you don't see a lot of MS in the peds population. It was outside my area of expertise to clue into it. Also, there's very little MS in critical care. Things tend to happen slowly.
The thing that really triggered it was I developed blind spots in my left eye. It's optic neuritis, and it's a big red flag of MS. Forty percent of people with optic neuritis go on to develop MS.
AOL Health: As much as you can try to balance the disease, your job is both physically and emotionally demanding. Are there ever days where you just don't have the strength to go to work?
Culkin: If I have a flare-up and my symptoms are severe enough that it requires steroids I absolutely cannot work. What I get is three days of high-dose IV steroids, and I cannot work for about two weeks after that. I'm really dizzy. Some people don't have that much trouble with it, but I definitely cannot work in the wake of that. If I get a cold it can hit me a bit harder; it can bring out more of the neurologic symptoms.
AOL Health: What made you want to become an emergency flight and critical nurse?
Culkin: I was an emergency flight nurse for five years and currently back in critical care. I was always interested in medicine, and I was always drawn to the higher tech, sicker patients. That's what attracted me to it in the first place, and now it's been 30 years. I think what is perhaps a little unusual about me is that I've worked in all the critical care specialties. I was a pediatric and neonatal nurse for 20 years and a flight nurse for five years.
AOL Health: Caring for sick children in neonatal and pediatric seems like one of the more difficult specialties to cope with emotionally. What made you want to go into it and how did you handle the children and their families?
Culkin: Basically, you're there to do what you can to improve the situation. I loved working with kids and families. Kids are so resilient. They're very courageous in a lot of ways.
I like working in depth. I like the level of detail and the degree of understanding you have to have of complex issues when you work in critical care. I've enjoyed all the areas. With kids it was hard at times, but also when they improve they really improve. They can go on to live a long life, and that's very satisfying.
AOL Health: You've lost patients and friends, and you write about many of those experiences in your book. What are some of the moments that have stayed with you over the years?
Culkin: There are quite a few. It's interesting because in the process of writing the book, I rediscovered some. You know, you take care of so many people -- I've estimated it's between 5,000 and 10,000 people now -- and it's interesting what little details will trigger memories.
When you lose kids that stays with you. I don't know the end of the story of a lot of the people I've take care of. When they leave the critical care unit I don't know whether they did well or didn't do well, so that's a hard thing.
One of the stories in the book is about the first baby I ever took care of that died. She had a congenital anomaly that was incompatible with long-term life. It was just being new at it, being new in the environment and taking care of her. I really bonded to her [along] the way, so she has stuck with me all those years.
When you go out in the field and [patients have] had a cardiac arrest from trauma, they're very unlikely to survive even if we transport. And so you go out and you pick up these people, and you know it's a little bit of a fruitless exercise. That's kind of hard. There have been quite a bit of those over the years.
Now in my current environment I'm on the other end of the lifespan with adults, very, very many elderly adults. It is really great when an elderly adult comes in and you can get them back to their baseline so that they can get to go home and have another while to enjoy their lives.
AOL Health: Both of your parents have passed away, and in the book you talk about caring for them as they got older. As a nurse, you knew exactly what was going on with them medically. Was it difficult balancing being a daughter and a nurse?
Culkin: It puts you in an interesting position because you're usually the interface between the healthcare system and the parent for your family. That was kind of rocky in my parents' case, especially in my dad's case because he rejected a lot of the possible help he could get from the healthcare system. I had to work it out between him and me how much of that kind of help he wanted and at what point to back off. He has self determination. So that was very poignant and difficult, and at the same time I think we all did the best we could. It's a scramble for any family in that situation.
It was really trying to decide how much information and intervention my dad wanted or didn't want. It was particularly hard for me because had he been willing to go through more, I think he could possibly have had more good time, but he decided against it and you're the boss of your own ship in that way. He passed away in 2003.
My mom had been sick a long time, and for her it was [an issue] of [little] guidance from her. She was queasy about medical details. She was an example of someone who didn't want to know. I would try to have that discussion with her. How much intervention do you want? What constitutes quality of life to you? And she just wouldn't play ball. Then I found myself in the position of having to decide for her how much was enough. She passed away in June 2002.
Continued: Day-to-Day Life as an Emergency Flight Nurse
Previous: Memoirs of a Critical Care Nurse
Culkin: It's a vast continuum, really. I've been lucky. I'm really on the mild side. I think that the drugs [I take] are helpful, and I've been on those since early 2002. I think that has helped me stay stable -- that and exercise. I did take two years off from work, which is kind of a big thing and hard for me to do. But I do think it helped me. I was so tired -- MS fatigue is terrible -- I was having a lot of flares. I was just in bad shape going into that and not having to work for two years set me up -- I really did improve quite a lot and was able to go back to work.
Fatigue is a huge thing, and the way I deal with that is I work part time. If I worked fulltime I would not do as well, frankly. Enough sleep helps. I know it sounds so basic, but we're chronically sleep-deprived in our culture, and I was, too, prior to having to deal with this. I do get really tired. It is a long day. Exercise and fitness helps me cope with it. I think if I were de-conditioned I probably couldn't do it. In spite of multiple sclerosis to maintain fitness has really made a difference for me.
AOL Health: When did you receive your initial diagnosis?
Culkin: 2001. But I had symptoms as long ago as 1988. I think my particular trajectory of MS was slow because it was 13 years from the time I first noticed symptoms that came and went until I actually got a diagnosis.
[Initial symptoms were] dizziness, numbness and tingling. Dizziness was really big. I would get this almost incapacitating fatigue. Memory loss. That was another thing in my 30s I was thinking, "Am I destined for Alzheimer's?" It was striking. I'd always had a good memory with quick information processing. All of a sudden I was noticing gaps in that, and that was frightening. I would say these things, and they would check my thyroid levels and those were fine, so it went on for awhile. Things would come and go. It's easy for you to say to yourself, "that was in my imagination."
AOL Health: Even as a nurse, you had no idea something was wrong?
Culkin: You would think I'd key in, but I was a pediatrics nurse and you don't see a lot of MS in the peds population. It was outside my area of expertise to clue into it. Also, there's very little MS in critical care. Things tend to happen slowly.
The thing that really triggered it was I developed blind spots in my left eye. It's optic neuritis, and it's a big red flag of MS. Forty percent of people with optic neuritis go on to develop MS.
AOL Health: As much as you can try to balance the disease, your job is both physically and emotionally demanding. Are there ever days where you just don't have the strength to go to work?
Culkin: If I have a flare-up and my symptoms are severe enough that it requires steroids I absolutely cannot work. What I get is three days of high-dose IV steroids, and I cannot work for about two weeks after that. I'm really dizzy. Some people don't have that much trouble with it, but I definitely cannot work in the wake of that. If I get a cold it can hit me a bit harder; it can bring out more of the neurologic symptoms.
AOL Health: What made you want to become an emergency flight and critical nurse?
Culkin: I was an emergency flight nurse for five years and currently back in critical care. I was always interested in medicine, and I was always drawn to the higher tech, sicker patients. That's what attracted me to it in the first place, and now it's been 30 years. I think what is perhaps a little unusual about me is that I've worked in all the critical care specialties. I was a pediatric and neonatal nurse for 20 years and a flight nurse for five years.
AOL Health: Caring for sick children in neonatal and pediatric seems like one of the more difficult specialties to cope with emotionally. What made you want to go into it and how did you handle the children and their families?
Culkin: Basically, you're there to do what you can to improve the situation. I loved working with kids and families. Kids are so resilient. They're very courageous in a lot of ways.
I like working in depth. I like the level of detail and the degree of understanding you have to have of complex issues when you work in critical care. I've enjoyed all the areas. With kids it was hard at times, but also when they improve they really improve. They can go on to live a long life, and that's very satisfying.
AOL Health: You've lost patients and friends, and you write about many of those experiences in your book. What are some of the moments that have stayed with you over the years?
Culkin: There are quite a few. It's interesting because in the process of writing the book, I rediscovered some. You know, you take care of so many people -- I've estimated it's between 5,000 and 10,000 people now -- and it's interesting what little details will trigger memories.
When you lose kids that stays with you. I don't know the end of the story of a lot of the people I've take care of. When they leave the critical care unit I don't know whether they did well or didn't do well, so that's a hard thing.
One of the stories in the book is about the first baby I ever took care of that died. She had a congenital anomaly that was incompatible with long-term life. It was just being new at it, being new in the environment and taking care of her. I really bonded to her [along] the way, so she has stuck with me all those years.
When you go out in the field and [patients have] had a cardiac arrest from trauma, they're very unlikely to survive even if we transport. And so you go out and you pick up these people, and you know it's a little bit of a fruitless exercise. That's kind of hard. There have been quite a bit of those over the years.
Now in my current environment I'm on the other end of the lifespan with adults, very, very many elderly adults. It is really great when an elderly adult comes in and you can get them back to their baseline so that they can get to go home and have another while to enjoy their lives.
AOL Health: Both of your parents have passed away, and in the book you talk about caring for them as they got older. As a nurse, you knew exactly what was going on with them medically. Was it difficult balancing being a daughter and a nurse?
Culkin: It puts you in an interesting position because you're usually the interface between the healthcare system and the parent for your family. That was kind of rocky in my parents' case, especially in my dad's case because he rejected a lot of the possible help he could get from the healthcare system. I had to work it out between him and me how much of that kind of help he wanted and at what point to back off. He has self determination. So that was very poignant and difficult, and at the same time I think we all did the best we could. It's a scramble for any family in that situation.
It was really trying to decide how much information and intervention my dad wanted or didn't want. It was particularly hard for me because had he been willing to go through more, I think he could possibly have had more good time, but he decided against it and you're the boss of your own ship in that way. He passed away in 2003.
My mom had been sick a long time, and for her it was [an issue] of [little] guidance from her. She was queasy about medical details. She was an example of someone who didn't want to know. I would try to have that discussion with her. How much intervention do you want? What constitutes quality of life to you? And she just wouldn't play ball. Then I found myself in the position of having to decide for her how much was enough. She passed away in June 2002.
Continued: Day-to-Day Life as an Emergency Flight Nurse
Previous: Memoirs of a Critical Care Nurse
