I could easily have given up that day.
I reviewed the chart the night before—40 units of NPH insulin subcutaneous before breakfast—then went home to practice the technique: a tiny needle and a small volume of medication. I used an orange to simulate the skin and gain confidence about how to puncture the skin and push the plunger injecting the medication. As I entered the ward with my fellow classmates the next morning, I felt prepared to give my very first injection.
I removed the insulin from the refrigerator and began to warm the vial between my fingers. I carefully selected the 100-unit insulin syringe. As I slowly drew up the dose, nervously flicking the air bubble out of the top of the syringe, my clinical instructor watched from the side.
LISTEN to WVTF/NPR featuring prof. Kelly: Gladly Giving Hundreds of Shots a Week
Before we went into the room, I checked the record for site rotation: right side of belly. I swallowed hard. We knocked and entered, introducing ourselves and our plans for his morning insulin. Lying in bed, the older man nodded approvingly. I pulled up his gown and searched his right side. I began to have doubts.
I hadn’t practiced an injection in the belly before, and the man’s skin was dry and wrinkled, nothing like the smooth skin of the orange I used the night before. I swabbed the area with the alcohol pad and then took the syringe in my hand. I looked up at my instructor who smiled and nodded supportively. I felt a drop of sweat run down the back of my neck. I felt a bit nauseated.
Positioning the syringe at the 45-degree angle for a subcutaneous injection, I looked back at my instructor again. She moved closer to me for support. I pushed the needle into the skin, but it didn’t go. The sweat dampened my temples. I tried again but the needle bounced off. I looked at my instructor frantically. Quietly she whispered, “It’s okay. Try it again.” I looked at the older gentleman who seemed unaware of my anxiety. Again, I pushed the needle into the skin, but at the last minute retreated. I doubted my skills. I couldn’t do it. As tears started to fill my eyes, the instructor came behind me. She took my hand with the syringe still locked in position and together we advanced the needle into the man’s belly.
“Push the plunger,” she instructed. I did. “Now remove the needle.” I did. The gentleman looked at me and smiled. The instructor beamed. I had done it! I had given my first injection. I’d needed help, and it was not easy, but I‘d done it. I was going to be a nurse.
I have never forgotten the support and belief the instructor provided to me almost 40 years ago. As a fragile student, I could have easily given up that day. But she urged me to continue. It has been worth the effort. My nursing career has been rich and devoted ever since. I went on to give many injections in many places and in many parts of the world.
In a hospital in Cambodia, I started IVs on children with malaria. As an advanced practice nurse, I perfected my skills doing spinal taps and bone marrow aspirations in cancer clinics. In West Africa, I placed intraosseous needles into the tibia of children dehydrated with Ebola. And in the pediatric ICU, I advanced PIC lines into infants suffering from sepsis.
Recently I signed up to volunteer to inoculate health care providers with Covid-19 vaccine. As a nursing professor, I was no longer on the frontlines, and so would wait my turn while paying it forward by vaccinating. In mid-December, my shift started at 6:30 a.m., and the line of ER nurses and ICU physicians was long. Many had worked all night. I scanned the room and found my station. By now, it was old hat.
And, at the same time, different. I proficiently drew up the dose, swabbed the nurse’s upper arm, and swiftly injected the vaccine. After I withdrew the syringe and placed a band-aid, we smiled at each other and locked eyes. I saw the tears of all she’d endured over the last several months, the fatigue of a battle that seemed endless, and the joy she felt at receiving the vaccine. I took her hand, as years ago the instructor took mine, and beamed with pride.
Kelly, coordinator of the pediatric nurse practitioner program, has delivered thousands of vaccines to children and adults around the world over the last 40 years. She continues to work regular shifts as a volunteer vaccinator with UVA Health and the Virginia Department of Health. Her essay was first published in the American Journal of Nursing's "Off the Charts" feature, in early February 2021.