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andhumanslovedstories · 1 year

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A while ago at work, I had a patient whose condition rapidly deteriorated during my shift, which I believed at the time was due to me not monitoring certain therapies closely enough. Essentially patient had parameters that their oxygen saturations should be between 88-92%. The patient was on supplemental oxygen via a nasal cannula, and was having oxygen saturations of 95% or more. The patient later became lethargic, confused, and hard to rouse. The patient was in hypercapnic respiratory failure, where they essentially were not exhaling enough CO2, the waste product of respirations. Patients who have oxygen parameters of 88-92% tend to be COPD patients, and I'd been taught where giving them too much oxygen can result in CO2 retention.

We ended up having to call a rapid response on that patient who needed to go on the bipap (non-invasive ventilator) to help them breathe effectively, and I went home from that shift feeling certain that I killed this person. That I had triggered a terminal decline that the patient would never recover from.

(Perhaps some context here: my grandfather went into hypercapnic respiratory failure and then died within a few days. Maybe he would have passed either way, I think probably he would have, but the respiratory failure was the moment his decline started accelerating. After he went hypercapnic, he was non-responsive from that point on.)

I called in sick to my next shift because I couldn't face going in. I spent the day thinking about what I'd done, what my moral obligations were, how do you atone for something when you cannot reverse the effects of the original error, and how paralyzed by shame I felt. What did I owe the patient? What did I owe the family? What did I owe myself? How many times had this happened before and I just didn't know because the decline happened after my shift ended?

It was a productive if unpleasant day of trying to sincerely examine myself and the things I'd done wrong without flagellating myself. It'd be almost easily to complete condemn myself and to stop nursing because I'm a Bad Nurse than it would have been to acknowledge the many steps that led to this patient outcome, only some of which I had a hand in. But this was my patient. They were my responsibility. What was the right reaction to have? What should I be feeling? In the course of doing my job, I caused harm to someone I swore to take care of. I still think that I am a thoughtful, hardworking, and compassionate nurse. I don't think the hospital would be better off if I quit. But I hurt someone.

I thought a lot about how this outcome happened, came up with steps to prevent it in the future, and found a new commitment within myself for continued learning. (If you've got a timeline of my particular fixations, this is about when my determination to go to grad school began.) I also thought about how much shame was making me sick. When my patient started declining and I realized the effects of my actions and inactions, one of my first thoughts was genuinely, "Everyone's going to know what I did." It was thought with absolute horror. I'd hurt someone and everyone was going to know it. They were going to know I was bad at my job and bad as a person.

And I was struck by what an unhelpful emotion that was. How much it made me, if only for a moment, tell NO ONE what was going on and what I believed to be the root cause. That it'd be better to let the decline continue rather than intervene because if I intervened that'd be admitting that I'd done something wrong. I didn't listen to that voice that told me to hide what I'd done, but I instantly understood the power of it.

There's this thing called the Compass of Shame which is about the different ways people handle their own feelings of shame--they avoid the shame, they withdraw from themselves and others, they attack others, they attack themselves. I know my own reactions to shame and try therefore not to go with my gut instincts, which are always to say I'm an irredeemably bad person and no one can know about this and if anyone does not about what I've done wrong, I deserve literally whatever punishment they could give me. I've had to learn I can both have failed to complete my responsibilities and still not deserve to lose my job or my flunk this class or give up on college or lose all my friends. But there is something appealing about masochistic shame. Like you can prevent others from judging and punishing you if you sufficiently judge and punish yourself. You'll still be a wretched monster, but no one else needs to know that.

That's actively dangerous for patients, who are the victims of healthcare errors, and it doesn't help prevent future mistakes if we are too ashamed to talk about what happened and why. We'll just keep fucking up in the exact same ways because no one else told us how they'd fucked up that way in the past and here's how we've changed the process because of that. I therefore have an ethical obligation to not internalize shame when I make mistakes at my job. I have tried to remember that while also trying my best to not make the same mistakes twice.

And then a week later, I was sent back to the same floor with the patient who'd declined on my watch. Because I'm a float RN and therefore don't have an assigned unit, I go to different floors every night (occasionally multiple floors on the same night). I see patients for 12 hours and then almost never see them again. Since I was back on the floor, I girded myself and went to go visit the patient, who to my surprise was alert and upright and about the same as I'd seen her at the beginning of my shift before they'd gotten bad. I said hi and asked how the patient was doing, and the answer was that patient was doing about the same as they'd been doing for the last month.

This was not good news for the patient, who was still medically complex, still dealing with an extremely difficult to address condition, but they were also not in the ICU, dying, or dead which is what I'd feared. And with the new knowledge that the patient was, if not okay, than at least stable as ever despite my actions, I could look back on that shift and see it differently, namely that this patient kept continuing to go into hypercapnic respiratory failure with or without oxygen. And then I looked into what I thought I'd been negligent about before and found that the scholarship on it was more complicated and divided than I'd thought. That the mechanism of action that I thought was driving the hypercapnic respiratory failure was in fact waaaaaaaaaaay more complicated than just over oxygenation, particularly in this patient who had a number of muscular abnormalities that made much more of an impact on ventilation than the oxygen would have. And while I still had to improve my practice, upon more reflection I could no longer say there was a direct one to one of my actions and the patient's decline.

I felt simultaneously forgiven, absolved, and humbled. I cannot describe to you the almost sheepish relief that rushed over me. Nothing that bad had happened. What did happen was only ambiguously my fault.

There's a power fantasy to shame sometimes, that you are uniquely bad and that your actions have monumental consequences. My actions on the job can have monumental consequences, but usually they are little things, little cares, little turns, little med doses, little therapies, little steps, little tasks, little jobs, little kindnesses or little cruelties that help a patient move forward or which hold a patient back. I'm there for 12 hours and never again. I can do a lot in that time, but I'm not gonna cure them and I'm probably not going to kill them. It's a relief, and it's a strange disappointment. We want to be important, even in bad ways.

While I can certainly fuck things up for patients, while I can certainly kill patients or traumatize them or withhold care or misuse my position, while I can do all those things, I don't actually have that much power over life and death. Everything that goes wrong isn't my fault. And sometimes something is your fault and nothing really happens except a few people have a bad night and you try not to do it again. I think that last bit is the most important part. I still should have titrated her oxygen down. I'm more careful about that now. I'm trying not to fuck up in the exact same way. I'll find exciting new ways to fuck up, and then I'll learn from those too.

#nursing tag #this is like waaaaaaaaaaaaaaay more detailed that i typically like to get with a post about my job #but i've been really thinking about it #this is the long post i said i'd reward myself with btw

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januaryrabbit · 1 year

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how seventeen would act around their s/o while drunk heheee

pairing: seventeen x gn reader, established relationship, fluff

word count: 1.8k

warnings: alcohol, cursing, mentions of sleeping over and physical affection w/ the boys but it’s meant in a fluffy context, not a suggestive/mature one!

other disclaimers: lowercase intended, probably typos, setting is hanging out with all the boys and with you!!!!!

a/n: i just realized in my wip post i said "crush" instead of "s/o"........WOOPS!!!!!!!!!!!!!!!! BUT ANYWAY hello everyone, i’m finally back with another post! i;m sorry for the very long hiatus, i p much always have something going on in my life lol @-@ but i have time now to actually write!!! i hope you enjoy this one hehe -mina

✩‧₊˚clingy drunks:

mingyu: this man will not leave you alone. he is in love with you. and he’s cheesy! in a sweet way :) will kiss your hand every few mins, lean on you, or put his arm around you so you lean on him hehe. i think he would also want you to reciprocate the clinginess too hehe,,,it makes him feel loved :3 i can see him moving your hand to his hair to ask you to play with it, and if you stopped, he would just take your hand and put it back in his hair LOl. he strikes me as someone who would take care of you (kinda like how he takes care of drunk hoshi hehe) and makes sure you're ok, even if he's drunk himself :]

seungcheol: omg omg HES GOING TO DOTE ON YOU SO MUCH!!! “jagi are you ok” “jagi do you need water” “jagi i’ll walk you to the bathroom, be careful”...he doesn’t realize that he himself is wobbling around and spilling water, LMAO. he just wants to help his baby!!! would def ask where you’re going if you get up, ask you to stay over with him, etcetc. would always have an arm around you and constantly LOL. would also go on a random rant about how protective he is of you HAHAHA!! like “Y/N . IF ANYONE MAKES YOU UNCOMFORTABLE. TELL ME RIGHT AWAY . I WILL DEFEND YOU TO THE ENDS OF THE EARTH EVEN IF IT’S MY OWN FRIENDS I DONT CARE WHO I HAVE TO BEAT UP (svt: BRO WTF?????) . GOD I LOVE U SOMUCH .” pls give him some water and a kiss!!!

junhui: i don’t think he’d necessarily be like talkative or doting, but i think he’s the type to just want to be around you and would sit really close to you :3 he almost gives me like Protective Bf vibes in the way that he’d just wanna be by your side to make sure you’re feeling ok too. plus, junnie just likes your company! i can picture him sending a lot of smiles toward you every few minutes because he’s so happy you;re his partner and he feels so comfy with you next to him :) also he likes leaning his head on your shoulder and he WILL show you cat pics the entire night…..pls comment on all of them or he’ll get sad. he also gives me the vibes of someone who has lazy days with his s/o after a night of drinking hehe…napping, hotpot and movies :)))

✩‧₊˚loud/emotional/(verbally) affectionate drunks:

soonyoung: MESSY U WILL HAVE TO CARE HIM !!!! did you see him on lee youngji’s show?? so cuteeee :( he would just shower you w/ affection heheh. im picturing him hugging you from behind like how he hugged the ice in the youngji ep and he would nestle his head into the crook of your neck and reach over to kiss your cheek :3c he would announce like every 20min how much he loves you to the whole room like "THIS IS MY PARTNER I LOVE THEM VERY MUCH THANKS!!!" and would post blurry pics of the two of you on his story with typos "i lvoe tehfm sonmchch" HAHA!! youll definitely have to sober up to take care of him hehe. would definitely start crying bc he loves you so much and YOU have to comfort him……you and mingyu get him to the car that night because he can’t walk by himself. the next morning hes like babe that was so fun round 2 of drinking tonight???????????? (horanghae pose)

seungkwan: BRUH KWAN GETS INTO (JOKE) ARGUMENTS WHILE HE’S DRUNK I HAVE NO DOUBTS!!! 90% of the time he’s trying to pick a fight with mingyu or chan i just know it I KNOW IT TO BE TRUE!! but with his s/o, i think he’s the type to be like HONEY THIS ONE IS FOR YOU and he starts belting a love ballad and singing directly to you HAHA!!! (vernon: why are u always trying to outsing everyone. no one else is singing.) seungkwan ignores vern’s comment and keeps going tho. he almost moves himself to tears by how much he loves you and how much love he’s pouring into his performance LOL. you tell him you love him too and that he doesnt have to sing VERY LOUDLY IN PUBLIC to profess his love !!! its not that serious pls sit down!!! and hes like MY LOVE FOR YOU IS SERIOUS . and that’s how you end up with a pouty and drunk kwan!!!!!!!!!

chan: oh my sweet chan,,he would just shower you with affection LMAO like “i love you. you’re amazing. you look so beautiful right now, you know that?” type of thing. he’s just the biggest simp hehe. i think hes also the type to just wanna have fun, he'd prob cheer you on if you took a shot like FUCK YEAH BABE GO OFF!!!! but i also think that he would be doing EVERYTHING for you. "i'll pour your shot!!!!! don't lift a finger SERIOUSLY!!!!!" asks you every 30min if youve had water. (you: yes. i had some 30min ago. when you GAVE ME SOME.) gets you snacks. if you needed to throw up he WILL hold your hair with a drink in the other hand (for him)!!!! he also helps you put your jacket on at the end of the night. it doesn't matter how drunk he is, he's firm on taking care of YOU!!! <3

✩‧₊˚(physically) affectionate drunks:

wonwoo: he’s all smiles for you hehe. clings onto your arm whenever you’re near him. he wouldn't be too loud or anything, but i think he'd shyly whisper compliments to you now and then about how you look nice or how much he loves you. i think he’d be one of the more chill people, he just feels happier than usual bc of the alcohol hehehhe. usually, wonu is pretty good at keeping himself composed when you show him affection. but when he’s drunk, i think he’d react a little more…he strikes me as someone who’s more verbally/physically affectionate when it’s just you two, but around friends/family he tones it down. but when he’s drunk i think he would be comfortable having you sit on his lap or having an arm around you <3

jihoon: i am convinced lee jihoon is a different man when he’s drunk!!!!!!!!! i have a hot-ish take when it comes to drunk uji…omg woozi would SOOOO open up physically and emotionally to you..and he’d be the type to always, Always have an arm around your waist and constantly hold your hand, looking at you with a smile that leads all the way up to his eyes. he’s someone who has dealt with a lot in his life, but in this moment, he’s so grateful to be here with his friends, and someone he loves that also loves him for who he is. the reason i think he’d be like this is juts because like. he doesn’t drink much, but when he does, feelings he’s been keeping to himself finally come up to the surface. also his face, neck and ears are constantly bright red because of the alcohol LOL. but ALSO they'd be red the next day when he realizes how he behaved in front of you hehe…. don't tease him too much about it or he'll die of embarrassment!

seokmin: dont ask me why bc idk but i think he would ruffle your hair constantly because youre so cute. then he would get distracted and talk to the bros for a bit, look at you again and remember how cute you are and ruffle it again sorry i dont make the rules!!!!!!! dk is definitely the loud/funny drunk hehe…hes the type to be giggly/try to make everyone laugh :) but i think he’d definitely try to make you laugh the most !! mostly in terms of physical affection though, i think he’d just dote on you a lot…like you know in the dingo video how he kept kissing woozi??? yeah he does that to you. along with the hair ruffles. and the attempts to get you to laugh. good luck. you’re going to drown in affection from this man LOL.

✩‧₊˚happy/chill drunks:

vernon: HE WILL CARE YOU this man is all vibes. he’s just here to have a good time lol. you’ll probably be the drunk one who needs to be taken care of :3 but if he was somehow convinced to get really drunk, i think he would still just be vibes. but happier vibes. i think he would just laugh at everything and keep a hand constantly on your knee heheh. also i think he would encourage seungkwan’s antics more when he’s drunk i’m just saying .

minghao: minghao is just relishing in the moment of enjoying his time with his friends and partner~ he doesn't strike me as someone who drinks much, kinda like vernon. he'd be more focused on having a good time with everyone! i think he's the type to have hangover remedies ready for you at home for the next day. i think he would also be the type of bf to know when to cut you off LMAO like “y/n’s had 4 shots….hyung STOP pouring them another one!!!!!!!!” he just seems like he'd be prepared to take care of his partner :) you're so lucky!! he’s also the type to observe you and take pictures/videos if you’re doing something funny while you’re drunk LMAO!!!!

joshua: josh is a giggly drunk i have no doubts. also in the dingo video that man was RED af!!! would probably be like “im fine im SO SOBER RIGHT NOW…BABE TELL THEM HOW SOBER I AM!!!” he is not sober. i also think he would be the type to compare hands with you LMAO. you’re just like ???? you know how big both our hands are???? you’re literally my bf???? and hes like I JUST WANTED TO CHECK OK!!! tbh he seems so fun to be around LMAO like he on the way to the hangout hes like “babe lets match each other if u drink i drink” and ur like HELLO SIR???????? WHO IS DRIVING US HOME?????? (jeonghan does and he sleeps over.) he just wants to have FUN and let loose with the homies and his partner!!!! consequences are for TOMORROW, y/n!!!!!! (he might start sulking if you don’t agree to match him but it’s fine you both know your limits hehe)

jeonghan: i see him as someone who doesn’t go too wild when drinking. kinda like vernon and minghao, i think he’s more there for vibes than getting fucked up lol. if anything, he’s doting on you because he finds you so cute, especially when you’re drunk hehehe. HE would be the one to ask you to do aegyo or something and when you do he just dies of cuteness lmao. i think he would also tease you in silly ways, like convincing you that he and s.coups are actually long lost brothers who found each other in college, or that seungkwan is a natural blonde. and of course you believe him which is the funniest shit ever to him!!!! LMAO!!!!! your shock and wonder at his blatant lies is the cutest thing to him. don’t worry tho he’ll tell you the next day nothing he said was true, except for when he said he loves you :)

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