A Late Bloomer: Nursing with Rheumatoid Arthritis and Bipolar Disorder by Cary Jo Cook, RN, CMSRN
My path to nursing was long and circuitous. I graduated from nursing school as a registered nurse when I was 36 years old. Since becoming a nurse, I have worked in skilled care, behavioral health, med-surg, neuroscience and ICU step-down. I currently work in an orthopedic spine surgeons clinic as a nurse clinician.
I experienced my first joint problems in junior high school: bursitis in a heel and bilateral knee chondromalacia with patellofemoral syndrome, both of which continued into high school and limited my participation in gym class. As a young adult, the knee pain continued. I had swelling and generalized joint pain and intermittent redness.
Finally it got bad enough that I had to start seeing doctors. At times, I was symptom free. But at times I could be a 25-year-old healthy, fit woman who could barely walk up a step due to severe knee pain. I saw a few internists and orthopedists over a period of around 10 years. None could give me a diagnosis or help with the pain. A year or so after I became an RN, I had a severe episode; the swelling was so bad that I could not open medication bottles or insert an IV. I was certain I had rheumatoid arthritis (RA). I referred myself to our hospitals most popular rheumatologist.
This rheumatologist diagnosed me with RA as well, and soon I started a regimen of multiple medications. They helped a little, but not enough. But within a short period of time, I began taking Remicade infusions.
This was the beginning of the end of my hospital career. I improved dramatically on the Remicade and did pretty well for about a year. I struggled with fatigue constantly, so I eventually had to cut down to one full-time job up until that point I had been working beyond full-time while raising a teen-aged boy as a single parent.
I transferred to a newly opened neuroscience unit at a sister hospital and had critical care classes and training along with extensive neuroscience training. This last year in hospital nursing, I moved up from staff nurse to clinician. I worked as a day charge and worked on the step-down unit. I loved neuroscience nursing, and I didnt want to leave it.
However, a combination of upper management difficulties at the hospital and my ever-worsening RA made it clear that I could not continue spending 12 hours or more on my feet every shift, lifting patients who were often twice my size. The fatigue and the hand, wrist and foot pain and swelling was just too much. I never wanted to be known as one of those nurses who just sits in the station and doesnt take care of her patients, let alone help others with theirs. I decided to leave the hospital and find a job that was less physically challenging.
I took what seemed like a great job in a 13-surgeon orthopedic practice. I became the spine surgeons nurse, which seemed to dovetail nicely with my neuroscience knowledge, experience and enthusiasm. There are also general orthopedic patients with fractures and strains. This has required that I learn how to cast. The problem here is the cast saw. I did not anticipate the cast saw. Its a heavy, awkward, vibrating device used to remove casts. It causes me great pain in the hands and wrists. I am very lucky that the doctor and PA with whom I work are very kind about doing cast removal for me when I ask. Neither of them acts like they are annoyed or resentful. I am grateful, because like most nurses, I dont like to ask for help. RA causes chronic tendonitis as well as the obvious joint deformities, so often I just dont have the strength or control to work this machine. I think the patients would be alarmed if I appeared to have a difficult time handling the saw on their extremities.