pt. was 90, total care with dysphagia and recently admitted after recovering from aspirational pnuemonia. i took care of him yesterday with no problem. today, i was told we had to make sure we brushed his teeth after breakfast. i had a brief tutorial on brushing teeth and other aspects of basic pt. care in ns, but i had only done denture care in clinicals up to that point...but i figured it couldn't be too hard, i'd seen the cna's do it on other pt's before so i gave it a shot. i dipped the brush in a little bit of water and put a tiny dab of toothpaste on and brushed...when it came time to spit, i gave the pt. the emesis basin and instructed him to do so. he spit out a tiny amount but there was still a lot in his mouth and i could tell he was having difficulty spitting it out because it was a thick consistancy and sticking to his mouth. he started to swallow some of it...and i started to freak out thinking "oh god he's going to swallow a big chunk of that and it will become lodged in his airway", so i took the cup of water which had a tiny amount left in it (literally about a centimeter) and gave it to him and told him to swish and spit. as soon as i did it, i realized what a monumental mistake i had just made...he’s an aspiration risk on thickened liquids. ****. i leaned him forward and helped him to spit it out, which he did but he started coughing like crazy and struggling for air (which is a pretty common occurrence with him but it is always scary when it happens) i had my partner go get the rn while i tried to help him get all of it out. she came in and made sure his airway was clear, and he ended up being fine, thank god. she asked me what happened and i was honest...i got lectured for it (i knew i would) but she was pretty understanding since this is our first clinical rotation.
my instructor was a different story...she took me into the post-conference room and proceeded to ream me out, telling me that i wasn't taking this seriously and that i needed to remember that i was dealing with a human life, that this man could be my grandfather and i was acting without empathy
then, she called a special class meeting…she didn’t name me by name or state exactly what happened, but i’m sure everyone knew she was talking about me because i was the only one crying. she launched into a lecture, again, about the fact that these are human beings and that people can die from our mistakes, and how maybe some of us (meaning me, i'm sure) are just not meant to be nurses, and are “in it for the money” and really didn’t care about being a good nurse or caring for their patients. part of me felt like crawling under a rock and dying, and part of me wanted to scream at her. i know that it is her license on the line, and i know she has to address concerns with patient safety…but she has no idea what she is talking about when it comes to my empathy or how serious i take this. i was up until 1am last night researching this man’s medical conditions and learning how to ask him questions in his native language just so i could communicate with him better-why would i bother doing that if i didn’t care? if i didn’t take this seriously, why did i get the nurse right away? why would i tell her what i did? like i mentioned the coughing spells aren’t unusual for him so i could have easily gotten away with it, but i didn’t even think twice about it. it was a mistake-a bad one, yes, but it was not made because i didn't have empathy or just didn't give a crap about this man's well being...it wasn't even that i didn't know aspiration precautions, i was just so afraid of him choking that i momentarily forgot.
the truth is no matter how bad she made me feel, it's nothing compared to the butt-kicking i did to myself. i held it together the best i could but as soon as i got into the car i broke down crying and had to pull over because i couldn't drive. i watched my grandfather succumb to aspirational pneumonia, i remember vividly what it was like to watch him struggle to breathe and the look of terror on his face when he couldn't. the idea that a stupid mistake like that could potentially cause someone to go through that pain is really heartbreaking and makes me wonder if i can really handle this career
. i leaned him forward and helped him to spit it out, which he did but he started coughing like crazy and struggling for air (which is a pretty common occurrence with him but it is always scary when it happens) i had my partner go get the rn while i tried to help him get all of it out. she came in and made sure his airway was clear, and he ended up being fine, thank god. she asked me what happened and i was honest...i got lectured for it (i knew i would) but she was pretty understanding since this is our first clinical rotation. 
