Giving up a medical ambition to become a nurse

Lim Chi Ching, Class of 2010

Advanced Practice Nurse (APN) Lim Chi Ching’s childhood ambition was to be a doctor and help save lives.

She is saving lives today but not as a doctor.

Ms Lim changed her mind at 18 after learning how a nurse had conscientiously cared for her late grandmother before she passed away from pneumonia.

Ms Lim’s parents worked when she was a child growing up in Malaysia so she was brought up by her maternal grandmother and the two became close. Wanting a better education for their daughter, Ms Lim’s parents sent her to Singapore to do her A-levels. Just before her exams, her grandmother passed away. Her parents kept the news of her grandmother’s death from Ms Lim because they didn’t want her to be distracted from the A-levels.

Understandably, Ms Lim was upset when she found out that her grandmother had passed on. To comfort her, her mother shared with Ms Lim the meticulous care her late grandmother received before she passed away.

“For instance, when the very thin skin on the back of her hands peeled off, the nurse would carefully bandage them, ensuring there was no pain or infection,” recounts Ms Lim.

Knowing her grandmother was well cared for in the last leg of her life made Ms Lim realise that the work done by nurses in relieving a patient’s pain and promoting her dignity was as important as a doctor’s job in treating the disease.

As someone who had always marched to the beat of her own drum, she decided to give up her medical ambition despite achieving good A-level grades that would have qualified her to apply for medical school.

Instead, she chose to accept the National Healthcare Group’s Nursing Scholarship and enrolled in the undergraduate nursing programme at the Alice Lee Centre for Nursing Studies (NUS Nursing) in 2006 as its pioneer batch of students.

An attachment to the cancer department of the National University Hospital (NUH) subsequently made up her mind to be an oncology nurse. Seeing the nurses there care for end-stage cancer patients gave her an overwhelming sense of déjà vu and left a deep impression on her. “The nurses didn’t have a cure for these patients but they were able to help ease their pain and make their last days more meaningful and dignified-similar to what that nurse did for my grandmother,” Ms Lim explains.

Advanced Practice Nurse Lim Chi Ching, who manages a Myeloma Clinic and a Telehealth Clinic at NCIS, understands the importance of providing emotional support for her patients.

Oncology nursing is unique in that the impact of a cancer diagnosis on a patient cannot be compared to that of other diseases, says Ms Lim. Besides administering timely treatment procedures prescribed by doctors, such as chemotherapy, antibiotics, blood transfusion and immunotherapy, oncology nurses also need to be a source of emotional support for their patients.

Understanding the needs of patients and offering them the right encouragement and comfort was something Ms Lim found difficult to do when she first started her practice; but with experience, she has come to learn that sometimes, all her patients needed were a pair of warm hands holding theirs and a listening ear.

“I feel that oncology nursing has become more and more challenging as cancer treatment is now very advanced and new therapies are introduced regularly. As the treatment provider, nurses must be able to judge and give initial treatment before the doctor arrives,” adds Ms Lim.

To improve her ability to diagnose and administer treatment, Ms Lim underwent two years of Master’s training at NUS Nursing and a one-year internship before passing the Singapore Nursing Board’s examination to become an APN.

There are five APNs at the National University Cancer Institute, Singapore (NCIS) where Ms Lim works. They take turns carrying out diagnoses, giving initial treatment and recommending medical plans for individual patients to the attending doctor. They also order tests and X-rays, interpret the results and assist patients according to the reports. These are services offered by NCIS’ Urgent Care Clinic to patients presented with symptoms requiring review prior to chemotherapy.

Ms Lim helms a Myeloma Clinic and a Telehealth Clinic for patients with myeloproliferative disorders. Her training is in multiple myeloma, a cancer that forms in a type of white blood cell, called plasma cell, which helps fight infections by making antibodies to recognise and attack germs. Multiple myeloma causes cancer cells to accumulate in the bone marrow where they crowd out healthy blood cells. Instead of producing helpful antibodies, the cancer cells produce abnormal proteins that can cause complications.

“Many affected are the elderly and all we can do is keep the cancer under control with oral medication. Unlike previous intensive treatments that sometimes resulted in complications, the oral medication can help patients adapt and return to their lifestyle,” says Ms Lim.

I’m happy to be able to fight alongside my patients…I don’t think I would ever want to lose that special bond that nurses have with patients.

Some of her classmates have left nursing for other professions in healthcare, but Ms Lim finds satisfaction in oncology nursing. “I’m happy to be able to fight alongside my patients. I vividly remember one who was in a wheelchair. Every time we met, he would try to stand and ask me to be his cheering section to help motivate him. I almost cried,” she recounts.

“I don’t think I would ever want to lose that special bond that nurses have with patients.”