That patient/situation that haunts you still

[Cricket183, BSN, RN]

In the thread "Every nurse has that one patient they'll remember forever" meanmaryjean shared a story of a patient Lisa who delivered a premature infant and was critically ill in ICU and did not get to see her baby before she died. Meanmaryjean expressed that "it still haunted her to this day".

I think most of us have that one patient/situation that haunts us. What is yours?

I'll share mine. I worked oncology my entire career. I'm very much a type A personality. Meticulous. Organized. Complicated chemo regimes appeal to me. We had a patient, early 20's, who was diagnosed with choriocarcinoma, a rare form of cancer and one I had never dealt with before. She was on a complicated chemo regime including some chemo agents I had never administered before. I looked up the proper administration of the agents I wasn't familiar with but failed to look up the standard dose.

When chemo was received from pharmacy it had to be verified by the pharm tech and a chemo certified RN, then it had to be verified by a second RN prior to administration. (I was both chemo certified by the hospital & ONS, as well as an OCN.) When we checked it I calculated a different dose for one of the chemo agents than what was prepared by pharmacy. (It was Hal f the dose it should have been). The tech insisted I was wrong and showed me her calculation. After recalculating it, I felt just as strongly I was right and refused to sign for the chemo. She was furious and went and got the pharmD, who also was not very happy. We had a dedicated chemo pharmacy on our unit and usually worked well together. He showed me his calculation and he came up with the same dose as the tech. I showed him my calculation. (By the way, it was a complicated conversion due to the way the order was written compared to the way the drug was supplied. And we all used different ways to calculate the answer. I used dimensional analysis. Not sure what the tech & pharmD used.) Anyway, my unit manager was brought in. She too came up with the same dose as the tech & pharmD. So I relented, wondering if I needed a refresher course in dose calculations. I administered the chemo.

Fast forward a few months to the patient's admission for her third round of chemo. Our oncology coordinator was doing a routine chart audit (she had been on vacation the day the patient was originally admitted therefore wasn't available as a resource). She noticed the chemo dose was incorrect. It was indeed half of what it should have been. The patient had received 1/2 the dose that was ordered on three different occasions. Twice administered by me. 6 RNs, 2 pharm techs, and 1 pharmD had calculated, verified, and/or administered the wrong dose of chemo.

I don't know the patient's final outcome. It wasn't long after this that I went on disability due to my own health issues. Choriocarcinoma has a high cure rate. At the time the error was discovered the patient's beta-hcg level had been dropping significantly which is a positive indication. She continued to receive chemo every four weeks (the correct dose) and I pray she did well. I feel if she would have had a negative outcome than I would have heard further about it.

Some good did come of it. There were some huge system errors involved that were fixed. We standardized our chemo orders (eliminating the need for the complex calculations) and instituted a policy that new chemo orders had to be written for each admission (we often used photo copies of previous orders from pharmacy). But it still haunts me. Yes there were others involved, but ultimately it was my responsibility. Why I didn't trust myself or look up the standard dose or even stop and clarify the order with the oncologist--I don't know. I don't have a good answer.

[crashcartqueen, BSN, RN]

I have not been a nurse for very long, but I have already faced a few impressionable experiences in my time in the ER. I still often think about my first code I was a part of earlier this year. The patient was brought in unresponsive and had been so without a pulse for 20 minutes. The patient was very young but had likely experienced a massive heart attack. I remember doing CPR on her lifeless body in a very disconnected way - I am usually not a "task oriented" type but I was in that moment. Even though the odds were against us from the beginning I was very bothered by the outcome - the patient was unable to be revived. I kept having the thoughts, could we have done more, what if I had done that, what if I had insisted we try longer, yada yada. Doing post-mortem care was also in a sense a spiritual experience. A large group of her family could be heard wailing from the waiting room and because of age she was a coroner case so there wasn't much we could do to clean her up. We tried the best we could - and the whole time I was thinking of what a privilege it is as a nurse to be able to see human life come into this world and to see it leave.