Tuesday:

I go to work after a long weekend and find that someone screwed up the scheduling and the person who usually supervises me is working the other wing and I have to work with a different supervisor. This is a big deal because I am still orienting and kind of don't know my butt from a hole in the ground. So this new supervisor has given me seven patients, where I normally have four or five. I made a big mistake and didn't see that I had one patient, so I find this out an hour after he was supposed to have his morning meds (MISTAKE #1). I am rushing around getting his meds and the family of this other patient comes in to take him out for the day. I tell them that there is something else going on at that moment and they will have to wait 15 minutes. They seem agreeable and I take care of that neglected patient. (very very nice man in his 50's with a horrible case of cancer that has invaded his butt. I mean big time invaded. bad.) Once that is done I go about getting paperwork completed to get the patient leaving prepared and legal. As I am taking his medications out of the drug machine my supervisor comes up and asks me what I am doing. Apparently, before patients leave, we are supposed to inform the pharmacy and THEY are to get the medications ready. I didn't know this, so I didn't do it (MISTAKE #2). I then tell the pharmacy about the patient, and go in to tell the patient and his family about the delay. They freak out and start yelling at me in front of everyone. I take full responsibility because it was my fault, and that just seems to fuel the fire. They are near a state of panic about getting caught in traffic and start telling me ridiculous stuff about how my license is going to be revoked and they are going to write up a formal complaint against me. While I know that I really have done nothing that would come close to requiring such severe punishment, I can't even defend myself because the man didn't even stop to breathe. I feel myself start to cry so I run off to the pharmacy to try to expedite the whole mess. At the pharmacy I break down and cry and cry and they pharmacists were really very nice.

In the end the guy didn't do a formal write up, in fact apparently as soon as I left he cooled down and offered to make a donation to my place of work and he even laughed about how he just felt he needed to teach me a lesson. What a bastard. I hate it when anyone calls me a young lady, but when people think they can't treat me with respect I just lose my shit. I am the sort who cries when very angry, and this made me very very angry. So angry I just cried for another 45 minutes and was totally delicate for the rest of the day. It was awful.

So I finally recovered from that yesterday, when my supervisor had me back on her wing and everything was good again. I had four patients and I did very well. So today when I was back again I felt pretty confident that things would go well, and they started out that way.

There are five nurses working on my wing, and only two drug machines. This makes it difficult to get out all the medications on time, considering that every patient has at least four or five meds all due at nine in the morning. So we try to get started pulling drugs at 7:00, when the shift starts. All the meds go in labeled cups in a drawer until 9:00, when they are distributed.

Somehow, I was pulling out drugs and I put the wrong medications in the wrong drug cups. So when I gave the nice old musician man his meds and he asked why he had only received half of the number of pills (of course, this was AFTER he swallowed them) my stomach SANK. like a stone.

I left the room to confirm my suspicions, and sure enough I had given this patient his neighbor's meds. This is a major mistake, requiring a formal error record to be completed, among other things. But really, the problem was that I gave this wonderful gentleman three times his normal amount of morphine. This is the part where you say "oh, shit."

Which is what I said. As the blood was draining from my face, I reported the error to my supervisor. She told me to stop panicking and report the mistake to the physician, to see what we might need to do.

The good thing is that the patient had been taking a lot of morphine already, so he wasn't going to die from this dose. The bad thing was that he was supposed to go play music at his old haunt that afternoon with all his friends. With that amount of medication on board, there was a decent chance he would be completely somnolent, the kind of somnolent where you fall asleep in your mashed potatoes. Try as we did, we couldn't convince the man to stay in that day and he insisted on going to see his buddies. It was horrible. But then at the end of the day the guy returned smiling bigger than he was when he left. He'd had a great day, and was competely pain free for once. As it turns out, we'd been undermedicating him for his pain, which was forcing him to suffer needlessly. My mistake had given him one good day. Not bad for a man who has few days left in life. I will admit I am terribly lucky that most patients at my work get the same medications, so he mostly ended up getting slightly different doses of the same drugs.

At least with my regular supervisor she reassured me that everyone makes mistakes and that it was a learning experience and I would live to see another day.