I don't know it all but I thought I should

I do not know everything about my job as an ICU nurse. I know that I am not expected to. When I don't have the answers and can not find them instantly (impatience: adhd trait) I feel that I am not meeting expectations. These expectations I know are self imposed and unrealistic yet I still disappoint myself when I "fall short".

I had a really good weekend, I went back to work well rested after vacation and ready to spend time with those who seem to truly appreciate me and laugh at all of my jokes. All of my patients were fairly stable without any unexpected complications. Until night four:

On night three a patient had been admitted as a telemetry unit overflow patient, this patient had a significant medical history, the admitting diagnosis was SOB/CP. She was not my patient but I answered her call several times for the nurse who was caring for her. This patient seemed to be displaying typical drug/attention seeking types of behavior which included crying out, moaning loudly, speaking as if she were breathless (O2 sats were in the high 90's) demanding specific pain medications. She refused alternate meds due to ineffectiveness and made repeated demands that her doctor be called for orders for her pain med stating very loudly at 5:45 am "Call Dr. ... he knows that I need my...". We had already called and the very grouchy physician would not give an order for the med. At 7:00 am her husband rolls in the door and she very loudly and tearfully explains that "they are doing nothing to help me". Five nurses (including me) had taken turns trying to calm and assist her and 4 of the 5 sighed "I'm glad she was not my patient" (including me).

Night four: Hi ho Hi ho it's back to work I go. Oh NO! She's my patient, this nights gonna blow.

She was now intubated though. Late in the morning while the night shift were tucked in our beds, visions of vacation in our heads...her O2 sats dropped to the 50's and had to have rapid sequence intubation...needless to say she was very quiet during my shift. This is where the guilt begins, "Gee, I was in her room this morning, I looked at her and decided that she was a drug seeking drama queen". I did not make the statement out loud but the chant remained in my head during the entire night. I found myself trying figure out what I should have seen during my few encounters so that her decline could be anticipated.

I have a friend that lets me know when I am being too hard on myself. That night my friend threatened to take away the stick that I was beating myself up with. Last night Dr. Cox told JD that, "If you start blaming yourself for every patient that dies it is a slippery slope that you can not come back from" (or at least that is the way I remember hearing it). My very wonderful and wise friend and Dr. Cox are right. I must learn to accept that I do the best that I can with the tools that I have and sometimes even the best education, doctors, resources, equipment and prayers can not give you the outcomes that you want or expect.

I have decided to put the stick away.

I wonder if my patients and colleagues would still look at me with undying admiration, affection and awe (or at least that is the way it is in my happy place) if they knew the secret to my success is late night reruns of Scrubs.