DAY 33

265. That’s the maximum number of questions on the NCLEX licensing exam, with a limit of six hours to write it. If you get something right, you’ll get a harder question. If you get it wrong, you might get an easier question, or the exam will shut off because you’ve answered enough wrong and have already failed. It is a scary and grueling exam to write. It is not altogether unlike a nursing shift.

265. That might be approximately the number of things we have to get right in a day, from counting out the right number of pills, to making the correct diagnosis, to landmarking the right spot for an injection. Is that a hole in the eardrum behind all the drainage, or is that a scar from an old perforation? Did I miss any of their allergies? There are hundreds of bulls-eyes we have to land each day, but it’s the single mistake that will cost us and haunt us.

A few weeks ago, I had a young man who came in for an allergic reaction, with a history of anaphylaxis. He’d taken a benadryl with slight improvement initially, and I sat on the fence briefly about whether to treat him as a full anaphylaxis. But when he told me the swelling in the back of his throat seemed to be worsening, I hurriedly poked him with a shot of epinephrine and then called the doctor for more orders.

The doctor gave me orders for the usual cocktail of IV medications, but pointed out that I had doubled the dose of epinephrine. I almost smacked myself in the head. Epi comes in 1 mg vials, but we give 0.5 mg at a time. I give this all the time at home – this is a dosage I should know. But somewhere between putting an IV in and checking his vitals, and skimming the book to check if I had advance directives to give epi, I had skimmed the instructions to read “1 mg/mL vial” and stopped reading the part two lines later that said to give only 0.5 mg.

It made the patient a little jittery, but at least it cleared all of his symptoms quickly. He refused to stay for the four hour long post-medication monitoring. “I feel great! I have to go pick up my mail. I’ll call you if it gets worse again, but it never does.” He cheerily hopped off the stretcher and stuck out his arm so I could pull out his IV. No harm done, at least.

Do no harm – that’s one of the first principles they teach you in nursing school. It seems so basic, but sometimes we walk dangerously close to this line, without even considering the complexity of how this plays into end-of-life care. (That is a whole other can of worms.) We are only human, and often exhausted, frustrated, and stressed ones at that. We make mistakes. But the weight of misplacing a decimal on a medication calculation is very different than that of misplacing it on someone’s dinner receipt.

Yet it has never been enough to just do no harm. How many times have we failed to be more patient, to listen better, to not brush off people’s small concerns?

I remember Sara sitting in my office several weeks back, talking about the challenges of being patient with people. Living in the same community meant seeing all sides of people sometimes – the good, the bad, and the ugly. It could be so difficult not to let this colour our perceptions and treatment of them, or not to feel drained when they seemed to ask too much of us.

I know this feeling all too well. How many times have I been yelled at for long wait times, for people in pain needing medication, for elderly patients sitting in the waiting room overnight because they’ve been admitted to the hospital when there are no beds? How many times have I had to apologize for things things beyond my control, or bite my tongue from telling people that as excruciating as it is, the pain will not kill them. It is easy to think of these people as rude, abrasive, and self-centered. It is much harder to remember that they are scared and overwhelmed. It may be equally hard for them to remember that we are trying our best.

Sara brought up one of the other casual nurses I hadn’t had a chance to meet, who had tattooed the word “benevolence” on her arm as a reminder to herself. Do not forget to treat these people as human beings. Do not forget to be patient with them. Do not become jaded. I’m reminded of one of my favourite quotes: When given the choice between being right and being kind, choose kind.

Benevolence. It’s something we should all be reminded to extend to others, especially on the days when it’s hard. And maybe, to extend that kindness to forgive ourselves when we fall short.


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