Inside Stories of Nursing Told in Book of Reflections  

Alumni nurses on the challenges of their nursing career pre- and during COVID-19, as journaled in a book launched to herald the efforts of Alexandra Hospital nurses.

I Have Learnt Never to Take Things for Granted

Reflection by Ms Doreen Heng

When COVID-19 hit Singapore, Alexandra Nursing pivoted to a state of constant planning and adaptation. In the book Missy Reflections, Ms Doreen Heng, the Hospital’s Clinical and Education Assistant Director of Nursing, offers a glimpse of what this entailed. Ms Heng, who oversees the ICU, had to continuously plan ahead of unexpected requests and demands – such as catering for a surge in ICU bed capacity, preparing “infrastructure-ready environments”, and working with colleagues to identify nurses for deployment to the ICU. Ms Heng and her ICU Nurse Educator pioneered Zoom-based split-team training for nurses before they were deployed to the ICU. They also developed crash courses on ICU nursing to train nurses who were transferred to the ICU from the Operating Theatre, Day Surgery, Endoscopy Centre and the clinics. The SARS veteran who was involved in opening a new isolation ward 17 years ago writes that incorporating mental toughness in the training was crucial.

Little did she know that as she busied herself with pandemic response, her mental fortitude would be put to the test when a medical condition, which she did not name, hit her. Even though she felt compelled to fight COVID-19 alongside her colleagues, Ms Heng shares that she had to “drop everything” to deal with her illness. Despite feeling “overwhelmed by uncertainty, fear and guilt”, she knew that she had to remain composed and “focus on the next right thing”. This meant delegating job coverage and preparing her team to function optimally without her presence. “This event taught me the importance of expecting the unexpected,” she reflects. 

As a patient during COVID-19, Ms Heng journals that she understood what her patients went through when their loved ones could not be with them while they were recuperating. Without her nursing colleagues supporting her through her ordeal, she believes that her experience would have been much more frightening and lonelier.

“I learnt never to take things for granted… My experience highlighted the importance of staying composed when managing emergent situations, and that it is more important to focus on the process rather than the outcome,” she reflects.

Meeting People from All Walks of Life

Reflection by Ms Wendy Yue

In her reflections, Ms Wendy Yue presents a personal slice of life as a nurse. When she passed out of the School of Nursing, she wanted to join the Hospital’s medical ward but was posted to the surgical ward instead. She eventually grew to love the fast pace of general surgery nursing practice, providing pre-operative education and post-operative care to patients, and the sense of accomplishment she got when her patients were healed and could be discharged.

One of the teachable moments of her nursing career came when she had to care for a Japanese tourist who could not speak English. She recalls communicating with him through gestures and drawings, which brought amusement to the patient’s stay. Upon his return to Japan, he sent Ms Yue a postcard that she still keeps today. “I can never forget this learning episode,” she writes. “It taught me that (in nursing) it is about how you make others feel… it is about using both your heart and brain.” 

Ms Yue explains that during the early years of her nursing career, she loved the perks of shift work: “I could sleep more, wake up later for work, and leave work earlier than office workers.” Working on weekends and public holidays was the biggest perk: “On the weekends, there were fewer procedures and shorter ward rounds, so the nurses could take their time with patient care.” Ms Yue even requested to work every Chinese New Year as she hated visitations and would tell her family members that she had to work so that her Malaysian co-workers could go home for the Lunar New Year.

The SARS veteran worked in the Intensive Care Unit during the outbreak. Post-SARS, she was transferred to lead the general ward, during which she was promoted to the role of Nurse Manager. While she found patient care easier than managing people, a major takeaway for her was that “a leader is only effective when the team is”.

Today, Ms Yue works in Rehab care. She enjoys what she does even more, she writes. She finds meaning in restoring each patient to the role they hold in life sans illness. She derives the most satisfaction from seeing patients return to visit the nurses, showing that they are coping and living well with their loved ones.

My Way

Reflection by Mr Darren Goh

Etched deep in Mr Darren Goh’s heart is a male patient named “M”. In his twenties and married, M was admitted for HIV-related lung complications that required non-invasive ventilation support. The team caring for him proposed initiating urgent anti-viral treatment and rushed to make arrangements to ensure he received the care he needed. However, to everyone’s surprise, M rejected the proposed treatment plans. Mr Goh spent a long time talking to M to try to understand and convince him otherwise. Yet M remained adamant.

“As the day went by, M (lay) in bed… breathless like someone who (was running) a marathon… every breath (could have been) his last… His meal was set beside him… but he barely touched anything. His energy was channelled (to the effort of) breathing,” Mr Goh writes. In mere hours, Mr Goh saw that M became weaker and began to lose consciousness. M’s mother and wife sat beside him, holding on to him with cries that Mr Goh remembers as some of the most heart-wrenching he had ever heard. Mr Goh says he knelt beside M and asked him if this was what he wanted. In spite of his drowsy state, M responded to his question with a resounding “yes”. Mr Goh explained to M what was to come to prepare him and told him to be brave. 

Mr Goh recalls kneeling by M’s bedside with his inconsolable mother and wife during his final moments. Although his heart was heavy, he softly comforted M’s relatives, telling them that M was able to choose how he wanted his life to end. And then M’s heart stopped, no longer was there a beat or a breath. The cries went on, silently.

This experience left a deep impression on Mr Goh. He had encountered many deaths since, but he had never nursed someone who was coherent, and insisted on his choice despite the reversibility of his condition.

When Mr Goh reflects on M, Frank Sinatra’s “My Way” always comes to his mind.

Becoming a Palliative Nurse

Reflection by Ms Marie Tsen

Ms Marie Tsen, a palliative care nurse who has walked many final journeys with her dying patients, chronicles the first time she had to perform the last offices for a deceased patient. During that fateful afternoon shift, Ms Tsen, who was then a third-year Nursing student from Nanyang Polytechnic, was looking forward to the last day of her clinical posting before the Christmas holidays.

After returning from her break at 6 pm, Ms Tsen’s Staff Nurse-in-Charge instructed her to prepare a last offices trolley as the patient under their care had passed on a few minutes ago. She swiftly prepared the trolley and joined her preceptor for the procedure. Shortly after cleansing the deceased body, her preceptor was called away and left the room, leaving Ms Tsen alone with the dead.

Ms Tsen felt uneasy being alone with a dead body. This was her very first experience with a cold and stiff body. She broke out in a cold sweat, not daring to look straight at the face of the deceased. The 15 minutes that she spent alone felt like 15 hours, she writes. “My body was as stiff as the dead after the last office was completed,” Ms Tsen journals.

On hindsight, the experience strengthened her, writes Ms Tsen. She went home resolved to take death as part and parcel of life as a nurse. Little did she know, 20 years after that experience, she developed a special interest in caring for the dying and walking this final journey with them by becoming a Palliative Nurse.

Embrace New Experiences and Challenges

Reflection by Ms Ong Chia Yee

In December 2017, after years of procrastination, Ms Ong Chia Yee signed up for a medical mission trip with her church to experience a journey beyond her comfort zone. Together with a team of about 8 healthcare workers and 100 church members, she flew to the Kampong Cham Province in Cambodia for a week to minister to the locals and offer medical aid to them.

It was her first time visiting a remote village and rendering medical aid in a foreign country. Coming from an urban environment, the poor living conditions of the Khmer locals, such as the lack of proper sanitation and access to clean water, opened her eyes to the reality of poverty.

During medical aid, the villagers’ concept of a medical facility to offer healthcare defied her usual expectations. There were no tables in the set-up – only wooden plank beds borrowed from the locals. The facility was located in a cattle’s hut and the medical aid team had to brave scorching weather to tend to an unending queue of locals requesting to be seen by a physician for their health problems. The language barrier made administering aid more complex and time-consuming.

The level of poverty and malnutrition was a shock to Ms Ong and challenged her traditional concept of healthcare delivery, requiring her to exercise flexibility and adaptability. She also realised how privileged she was to have grown up with a comfortable roof over her head, food on the table and access to a good education.

“Going for medical missions with my church will not stop with this one experience, and it has spurred me to be open to embrace new experiences and challenges.”

For Ms Ong, this meaningful medical mission trip was the experience of a lifetime that could not have been learnt through textbooks or years of academic education. Although her trip didn’t end up transforming the lives of the villages, she took comfort from a quote from Mother Theresa, who said, “If you can’t feed a hundred people, then feed just one.” “As long as I choose to offer and give whatever I have, it can have value and significance,” she concludes.

To read the full reflection, grab a copy of “Missy Reflections”, a compilation of over 60 reflections about human strength, hope and courage. Now available free on request in softback hard copies. Email: Yu_Ting_Soh@nuhs.edu.sg