Ni hao ma

So, it’s been a while since my last entry. Today is October 29 in the year of our Lord 2020.

It is my third day of immersion at NCCU or the Neuro Critical Care Unit. If you are not aware, I am a Float Pool Nurse, so I am rotated to various units because I don’t have a permanent unit. I was assigned with Ma’am Joanna Mae on my first day, and with Ma’am Denisse on the next succeeding days as my buddy nurse. I’ve handled a level 4 patient.

I am thankful that my manager already assigned me to have my duty at the critical care unit… Does she trust me already? I don’t know. I hope so.

I have learned so many things today. My patient today, Mr. W is a foreigner. He doesn’t understand English. He has a Glasgow Coma Scale of 7. It means that for the eye opening (2: to pain), verbal response (1: none), and motor (4: withdraws from pain). The patient is from time to time having abnormal extension of his upper extremities, whenever he feels stimulated. My patient, Mr. W was asleep. I tried introducing myself with the google translate.. I typed “My name is Jae. I’m your nurse for today from 6am until 2pm” in his own language. Although, he is asleep.

Does the ears still function when a person is asleep? Hmm. Something to think about.

Glasgow Coma Scale Perfect Score is 15 (Eye Opening: 4, Verbal Response: 5. and Motor response: 6)

So, the things that I am grateful for today despite, my patient’s intravenous lines were removed. I inserted three intravenous lines which were all patent and intact for my first try (Right arm : two gauge 22) and (Left arm : one gauge 24), with the use of the vein viewer. I am really improving when it comes to inserting lines. So, yay! On the other hand, I have learned today that I should secure my patient’s lines with the use of a wrist splint or secure it with a transpore.

My patient has ongoing D5W at 60 cc/hour, with Precedex and Midazolam at doctor’s desired dose. My patient got febrile awhile ago as well, so he perspired a lot and soaked what he was wearing. I changed his gown twice. The nasogastric tube was also fixed because it was already seen protruding at the patient’s mouth. So, NCCU nurses does the NGT insertions. So I assisted Ma’am Denisse. Stat ECG was done. (ECG has 6 color leads for the chest area and 4 leads at the upper and lower extremities).

Chest leads (Red, Yellow, Green, Brown, Black and Violet)
Arm Leads (RL – Red, RL Black & LA – Yellow, LL – Green)
So, for me to remember the color placements in the arm leads : 
(Color placement in the way I see the patient frontal view)
Right Arm - Marcos (Red)
Right Leg - Dead (Black)
Left Arm - Cory Aquino (Yellow) 
**due to Laban sign
Left Leg - (Green) Since Cory Aquino provided CARP or the Comprehensive Agrarian Reform Program
Right – Marcos (Red, black) & Left – Cory (Yellow, Green)

STAT Chest (AP) XRay was done (**Make sure you are at a distance from the Xray technician especially when you are a girl or a woman). Urinalysis specimen collection was done as well from the Foley catheter. (But be careful not to puncture the balloon, so the FC will still be secured).

My patient was toxic today, but I learned a lot, so I’m very thankful.

I prepared Norepinephrine (4:1) Levophed of 16 mg was given as well, since the patient had hypotension, just to increase the blood pressure to maintain Systolic BP of not less than 110 mmHg.

I monitored his intake and output hourly, and I accomplished it.

I had a challenging day today as well with my coworkers. I remember a Nursing Aid, asked me if what was my duty just before my shift ended in the pantry.. I told him, “morning”, then he said, “buti na lang hindi kita ka-duty, may narinig kasi ako na toxic ka”. Maybe he jokingly said that to me, but I am a new person at the unit. I am still adjusting, and I’m really sensitive. hehe

I pray that God will give me a supernatural patience and the ability to communicate well with the people around me, because they tend to misunderstand me most of the time because I am quite the serious and rigid type at work. I have an authoritarian attitude sometimes. So, I pray for P-A-T-I-E-N-C-E, and the will not to give up, dear God.

Thank you. Til next time, I pray for a good night sleep.

My First RRT

September 3, 2020

Hi! I am nurse Jaea.

I was the incoming nurse for morning shift awhile ago at COvid unit G west of the hospital where I work at. It is my second day of immersion at a progressive care unit usually intended for cardio patients. However, due to the pandemic, it became a progressive unit for Covid positive patients.

I have never had any code blue nor RRT as the bedside nurse within my entire nursing career. But then, I was assigned and immersed at G west, where I can most of the time hear code blues and RRT announcements.

I was donning on my bunny suit, preparing for duty when the announcer said, “RRT G West”. I was anxious. My stomach felt uneased as I approached the station.

I don’t know what to do. Since I told Maam Val, the nursing unit manager of the area that I have not had any code blues and RRT before, I felt like the charge nurse will assign me to the patient, so that I would be able to observe. The good thing was that I am still a buddy nurse to my preceptor, Maam Ivy Jasmin. I am so amazed with my preceptor awhile ago. I witnessed how she talked to the patient and calmed the patient by ‘whistling breaths’ and how the equipment needed were prepared. I tried to help. But I was frozen. I don’t know how should the process go. The other nurses were helping us too. Thank God.

While preparing, there is the presence of the respiratory therapist too who maneuvered the machine (I forgot the term), where the patient was hooked to breathe oxygen. There was a plastic drape on top of the patient from the Operating Room or delivery room? Not sure. I witnessed how the Anesthesiology consultant injected via slow IV push Propofol (if I am not mistaken) into the heplock of the patient. The Anesthesiology doctor intubated the patient with a guide machine. Mind you, I was really anxious even though it was just an RRT and not code blue. My anxiety somehow lessened when the Anesthesiology consultant talked to me and when he handed me the posi flush for flushing before he injected propofol.

When I am anxious, sometimes I cannot hear clearly what the person beside me is saying. Do you feel the same? Then, I got back to my senses. I needed to learn about this. So that I would be able to know when it happens again in the future.

I have a different level of anxiety in stressful situations, but then I am learning how to keep myself calm, which was the advice given to me by sir Jay, the Assistant Nursing Unit Manager of the area. “Stay calm” that’s what he texted to me before the day transpired. I am glad and grateful with the presence of my preceptor Ma’am Ivy awhile ago. I know that I still have a lot to learn.

After the patient was intubated, the patient was inserted with nasogastric tube (by MROD). He was inserted with indwelling foley catheter and was hooked with fluids such as Precedex 400 mg (2 vial) in 100 ml NSS and Fentanyl in 50 ml D5W by ma’am Ivy.

The patient was breathing with the use of the machine.

I just observed the RRT, then I was assigned to my other elderly patient that is quite stable enough, I was a buddy to ma’am Val afterwards. She is amazing and assertive. I am amazed that she is already a nursing unit manager at a young age.


While I was with my elderly patient, I told him my name. I said that my name is “Jaea”. His hearing is not quite well, so he validated if my name is “Julia”, because that’s what he heard. Then, I told him again, “No sir, I am Jaea po”. Then he said, “Julia?” Hahaha. Simple joys of being a nurse. I inserted an IV line to him on his left hand and administered a “to start” medication. I am glad that he can eat independently. Then, I asked my patient if he would allow me to pray for him. Then he let me prayed for him before my shift ended. I was worried if he could hear my prayer. I held his right hand and spoke the words, as the spirit led me. After that he said, “Di tayo papabayaan ng Panginoon” (God won’t abandon us). I was touched when he said that to me. I learn from my patients too, you know. Sometimes, I question myself why am I a nurse in the hospital, when it is so difficult..

Just like with my case, I was diagnosed with depressive disorder by the doctor since 2013. Right now, I am stable with low dose medication compared from years ago. Don’t worry, I am cleared by my doctor that I am fit to work. Sometimes, I still feel lonely, especially now that I am living independently in Manila. I needed to realign my thoughts every day, to battle the negativity in my mind. I would read the bible in the morning and in the evening before I sleep, just to be reminded of God’s promises to me. God is faithful forever and ever. I believe. You know, the good thing about being a nurse is that it somehow distracts me from my negativity whenever I enter my patient’s room.

I have not reached the level of an expert nurse yet, but I am hoping and praying to be a nurse who has already mastered the skills that a safe nurse should possess. Every time I commit a mistake, I pray to God to help me accept it all with humility, even when it hurts. If I will evaluate myself, I feel like I have already improved from before. Little by little everyday. Thank you God.

I am learning everyday. It never stops. Battling the unseen war, the unseen enemy. I believe God is with me in this journey. He knows everything: the past, the present and the future.

Good night.

Nahum 1:7 ” The Lord is good, a strong refuge when trouble comes. He is close to those who trust in him”

Oxygen Administration

Materials:
- Oxygen source (Wall outlet: White [CI-G], Green, [...], oxygen tank or cylinder, portable oxygen tank
- Oxygen gauge with Flow meter
- Appropriate oxygen delivery system (nasal cannula, simple oxygen mask or non rebreather mask)
- stethoscope
- pulse oximeter and probe (if necessary)
- oxygen guard (if oxygen tank is used)

What to do:

  1. Verify the practitioner’s order for oxygen therapy
  2. Confirm the patient’s identity (Name and birthday)
  3. Explain the procedure to the patient, and let him know why he needs oxygen
  4. Do hand hygiene
  5. Gather the needed equipment
  6. Select the most appropriate oxygen delivery device based on the order and the patient’s status.
  7. Assess the patient’s condition, baseline vital signs, and breath sounds, and ensure a patent airway.
  8. Check the patient’s room to ensure safety for administration
  9. Place and Oxygen Precaution sign above the patient’s head and on the door.
  10. Put on personal protective equipment, as needed.
  11. Place the oxygen delivery device securely on the patient, ensuring proper fit.
  12. Adjust the oxygen flow rate as ordered.
  13. Monitor the patient’s response using a pulse oximetry.
  14. if the practitioner has ordered an ABG analysis, check values after allowing sufficient time for the patient’s oxygenation to return to a steady state.
  15. Assess the patient frequently for signs of hypoxia.
  16. Observe skin integrity
  17. Remove and discard your PPE if worn
  18. Do hand hygiene
  19. Clean and disinfect your stethoscope using a disinfectant pad
  20. Do hand hygiene.
  21. Document the procedure.

Enteral Feeding

Materials:

  • Stethoscope
  • Feeding solution
  • Sterile Water
  • Towel
  • Tray
  • Calibrated glass (for flushing solution)
  • Toomey syringe (See image) / Asepto syringe

What to do:

  1. Charge nurse/ Bedside nurse/ Ward Clerk encodes the doctor’s ordered tube feeding solution via Diet Data Entry (include the type of feeding solution, caloric requirement per day, volume per day and concentration)
  2. Charge nurse verifies the feeding bottle/ solution’s label delivered by formula man against doctor’s order sheet, tube feeding card and Kardex and shall check for the following: Type of feeding solution, caloric requirement/ day, concentration (calories/cc)
Nota Bene:
Computation for volume per day and per feeding:
(Caloric requirement per day – 2000 kcal/day)
(Concentration – 2 cal: 1 cc in 6 equal feeding per day. Compute for the volume to be given per feeding)
Formula:
Total caloric requirement per day/ Concentration (calorie/cc)/ # of feeding per day.

Example:
Volume per feeding = 2000kcal/ 2 cal x 1cc
  1. Gather and prepare the necessary equipment and the enteral feeding formula.
  2. Do hand hygiene.
  3. Assess the patient to determine the risk of aspiration and for presence of abdominal distention.
  4. Position the patient to prevent regurgitation/ aspiration of feeding solution according to the following:
Position:
Conscious: Semi Fowler’s (30-45 degree) as tolerated by patient or upright position.
Asleep : Gently wake up the patient and assist in Semi – Fowler’s position
Unconscious: Semi- Fowler’s position
  1. Assess for feeding tube placement before administering the tube feeding and at 4-hour intervals.
Steps for checking tube placement:
* Kink and remove cover of NGT
* Attach the syringe (Toomey) to the NGT
* Place diaphragm of stethoscope at the epigastric area
* Inject 5 ml of air into the NGT
* Listen with your stethoscope for presence of “whooshing” sound
* Aspirate the equivalent amount of air introduced
  1. Place towel over the patient’s neck and chest area
  2. Check for residuals by attaching a Toomey syringe into the port, gently pull back the plunger to aspirate for stomach content. Stop if resistance is felt. Do not use too much force or the tube may collapse.
  3. Re-check for correct NGT placement
Nota Bene:
* If residual formula is > 50 ml. Place in kidney basin, withhold due feeding and refer immediately to the MD.
* If <50 ml., measure gastric content and allow to flow back by gravity. Deduct the volume of the residual from the volume of the feeding solution to be given.
  1. If coffee ground aspirate is noted, hold feeding and refer to the doctor immediately
  2. Document in the I & O under drain column and nurse’s progress notes for quality/ quantity and characteristics (volume) and management done if any.
  3. If no residual is noted, proceed with feeding.
  4. Remove and discard your gloves. Do hand hygiene. Put on new gloves.
  5. Flush the feeding tube with ordered fluid, volume and frequency.
  6. Kink NGT and detach the syringe (Toomey)
  7. Connect the feeding tube bag containing the feeding solution to NGT securely.
  8. Make sure that the feeding bag is installed properly into its enteral pump, with proper data entered. (Volume to be infused and flow rate)
  9. In the absence of an enteral pump, use a feeding bag with a regulator and compute for the desired rate accordingly (drops per minute). Regulate the flow of feeding solution according to doctor’s order.
Formula:
Volume to be infused (volume per feeding) x drop factor/ # of hours x 60 minutes
  1. Hang the feeding bottle to IV stand at the height of not less than 12 -18 inches above the tube’s point of insertion.
  2. Assess for GI intolerance to tube feedings at 4-hour interval. Monitor patient for any signs of aspiration.
  3. After feeding solution has been infuse, remove cover of feeding bottle and flush it with the ordered fluid and volume. Kink and cover the NGT (for intermittent feeding)
  4. For continuous feeding, monitor the patient as often as every hour for complications of feeding.
  5. Instruct the patient/ relative to maintain semi-flower’s position/ upright position for 1 hour to prevent regurgitation.
  6. Wash with soap and water and dry (Toomey Syringe and rinsing glass). Put in a kidney basin/ wrap in ziplock plastic and place inside the bedside table.
  7. Re -assess patient for signs of aspiration/ feeding complications.
  8. Remove your gloves and do hand washing.
  9. Document.
Document:
* Feeding (Nurse’s notes and I/O sheet
* Type of feeding solution
* Caloric requirement/ day
* Residual feeding
* Assessment of patient (Nurse’s Notes)
* Condition of patient before, during and after procedure
* Signs of aspiration and other feeding complications (if any).
* Others (Nurse’s Notes)
* Doctor’s name, time, and response to the referral.
* Feeding time, dose, volume of feeding given.

Capillary Blood Glucose Monitoring

Materials:

  • Novastat CBG Machine
  • Test strip
  • Single use lancet
  • Alcohol swab
  • Cotton ball
  • Diabetic Record (MAR)
  • Operator ID

What to do:

  1. Gather and prepare the appropriate materials
  2. Do hand hygiene. Wear clean gloves.
  3. Confirm patient’s identity. (Name and birthday)
  4. Assess patient’s condition. Ask for patient’s last meal. Make sure the patient had 2 hours fasting for a pre-meals CBG. If the instruction is post-prandial, allow 2 hours gastric emptying time.
  5. Explain the procedure to the patient.
  6. Provide privacy.
  7. Select the puncture site. (Adults: finger, Infant: toe)
  8. Have the patient wash with soap and water and dry them.
  9. Using the machine from the Home Screen, press LOG IN.
  10. Scan the operator ID and press accept.
  11. From Patient Test Screen press ACCEPT.
  12. Scan Strip Lot #, then ACCEPT.
  13. Insert test strip to the bottom of blood glucose meter.
  14. Massage finger/ toe towards the chosen site of puncture. Do not touch the patient’s puncture site.
  15. Clean the intended puncture site with an alcohol pad and let it dry completely.
  16. Using a single-use lancet, placing the lancet perpendicularly to the surface.
  17. Inform that the patient he will feel a pricking pain then push the button to puncture site.
  18. Wipe away the first drop of blood using a gauze pad.
  19. Massage the finger to allow the blood to pool. Touch a drop of blood to the test area on the strip.
  20. Apply pressure to the puncture site using a dry cotton ball, if possible, instruct the patient to maintain pressure.
  21. Results appear in 6 seconds. Record the results in the diabetic record, refer the results if needed. (Refer to Medical Resident on duty or to an Endo Fellow On Duty)
  22. Discard the lancet in a sharps collector. Dispose the test strip in the infectious waste bin.
  23. Remove and discard gloves.
  24. Do hand hygiene
  25. Clean and disinfect the blood glucose meter.
  26. Do hand hygiene.
  27. Administer the appropriate medication or ask the patient to eat if needed.
Blood Glucose Level Chart

Measuring Intake and Output

Materials:

  • Appropriate devices for measuring input (measuring cup, syringe, medication cup, kidney basin or water pitcher)
  • Appropriate measuring container for each type of output being measured, marked in ml.
  • Fluid balance sheet
  • Bedside intake and output worksheet
  • Clean gloves

What to do:

  1. Gather necessary equipment and label with patient’s name
  2. Place the intake and output record (labelled with sources of fluid I&O) and am IV flow sheet, if used in the patient’s medical record.
  3. Perform hand washing.
  4. Confirm Patient’s identity (Name and Birthday)
  5. Explain the process of measuring I&O to the patient and his family.
  6. Alert staff of the need to measure I&O.

Fluid Intake:

  1. Note the time, amount, and type of IV solution or tube feeding on the I&O sheet and on the other appropriate flowsheet.
  2. Measure and record amount of oral fluids ingested, type and amount of instillations and how administered, the amount of medication in liquid, amount of medications and normal saline flushes, amount of medications and water flushes through GI tube.

Fluid Output:

  1. Do hand hygiene.
  2. Wear clean gloves.
  3. Measure urine in graduated container and record
  4. If the patient has an indwelling urinary catheter, open the clamp on the drainage bag, allow urine to flow into the container without touching the drain to the sides of the container and record amount. Close and secure clamp.
  5. Nota Bene* Record: Color, clarity, and odor of urine.

I have few pointers to note as well. It is important to know if the urine of the patient is adequate in comparison with the patient’s fluid intake. Make sure to relay alarming signs to the doctor on duty.

Note: In general for adults, Urine output is adequate if it is 0.5 cc/ kg/ hr. (Dr. Infante, 2020)

Progressive Pulmonary Care Unit Immersion

Hi! I am nurse Jea (Jea is the nick name I am using at work, because Jaea is difficult to spell and to pronounce for my patients). I am a Patient Care Services – Float Pool Nurse. I have no permanent unit, so I have been rotating to different units in the hospital.

I will be sharing my experience with Pulmonary Care Unit – Progressive Care for this last month’s immersion. I have started my immersion from June 22 up to August 2, 2020.

From June 22 up to July 1, I was assigned to Sir Luigi as my preceptor. He was nice, but there were times that he reprimanded me because of some things that I forgot and failed to do: such as late referral to the MROD for the hourly urine output measurement, poor time management, being stiffly book-based, but I’m thankful for it.

CLABSI Notes (Central line-associated bloodstream infection)

With Sir Luigi, I learned how to do PICC line flushing of pre and post medication, once daily usually if not used (with 0.2 ml Heparin and with 50 cc of NSS), to use 3 or 5 cc.

  • First, use clinell wipes (green for device and blue for skin) on the port for 30 seconds.
  • Flush Heparin 5 cc
  • Flush medication
  • posi flush of 10 cc NSS
  • Then, Heparin 5cc again.

On the other hand, upon cleaning a central line, I should be wearing clean gloves; then put cutasept, then wear sterile gloves.

  • Use clinell wipes (green for device and blue for skin)
  • put biopatch. (blue – face the sky)
  • then clean with clinell, always away from the center
  • then, place tegaderm
  • dress unused ports of the central line with curos. (hang unused curos to the pole)

CAUTI Notes (Catheter-associated urinary tract infection)

  • It is very important to do perineal washing every shift even when the patient did not poop
  • Lower foley catheter below the bed
  • hang the foley catheter to the bed not the side rails

VAP Notes (Ventilator Associated Pneumonia)

  • It is important to suction
  • tracheostomy care must be done per shift
  • silent ventilator
  • clean inner cannula, by removing inner cannula to disinfecting solution in hydrogen peroxide plus NSS in a kidney basin), but replace the inner cannula with fenestrated cannula
  • Put back to mechanical ventilator
  • hyperoxygenate the patient
  • Then, remove the non woven gauze dressing surrounding the tracheostomy, disinfect with hydrogen peroxide using a cotton applicator then put gauze

Code Blue Notes:

If I am the bedside nurse of the patient who is pulseless, immediately flat the bed.

  • Never leave the patient. Patient may have his/ her sensorium decreased.
  • Call bell if the patient is deteriorating. Tell the Vital signs of the patient. Remember the time called for code blue which is 3221.
  • Usually, upon arrival of the other health care team, one is assigned for the oxygenation of the patient and the suctioning (O2 @10L ambubag, pump every 8 seconds. Disconnect MV then do ambubagging), then the other is assigned in the Ecart and one does the compression (the bedside nurse, 1st set is 120 CPR)
  • Usually, all the drips of the patient are stopped! Then, fast drip of 900 cc NSS is done but make sure to check patency of the line first.
  • The Ecart person, must remember the time the 1st Epi was given. It must be timed for every 3 minutes.
  • In a code blue, the MROD is there, the AROD intubates, there’s xray as well post intubation, the HM oversees and the Patient Experience is the social worker who explains the process to the relatives.

RRT Notes:

  • Note the O2 saturation of the patient.
  • must be placed in high back rest
  • hook O2 or hyperoxygenate
  • refer to MROD
  • Don’t stop inotropes such as (Levophed, Dopamine, Dobutamine, Epinephrine and Phenylephrine)

Even when I have been a floater for so many months now, I still feel like I have so many things to learn. I am thankful for the learnings Sir Looj taught me.

Also, I have been reproached by some of my senior nurses and charge nurses in the area. I understand why I was scolded and I appreciate it, however, I wish they did not say it in a loud manner, because it is humiliating, especially for an introvert like me, but I just took it all in. I made mistakes and I humbly accept them.

Also, it is important to remember to transfer a patient having an O2 with a nursing aid or a porter but most importantly with MROD overseeing the transfer of bed to another room (such as when the patient is for hemodialysis, or for CT scan for progressive care patients). Also, the Neuro Resident is the one overseeing for patient’s transfer for MRI.

On the other hand, upon giving medications, always let a senior nurse check the medications prior to administration. Upon going to the patient’s room, I should make sure that the EMAR is with me. I must ask for the patient’s identifiers (name and birthday), then double check the dose of the medication in the EMAR with the medication at hand.

I also learned how to do bed bath, how to change linens and on how to change the diapers of the patient.

Note to self: I must be a safe nurse all the time. I must render safe nursing care, and must avoid errors.

I am thankful to God for this experience. I am thankful for Maam Gretchen, the Nursing Unit Manager of the 6 Main A and Sir Neil, the Assistant Nursing Unit Manager and Sir Mike, the Clinical Unit Based Educator of the unit, Sir Luigi, my preceptor and my senior nurses (Maam Aya, Maam Tama, Maam Andrea, Sir Dom, Sir Rein, Sir Kiko, Sir Coco, Sir Ja, Maam Kim, Maam Barbie, Maam Felice, Sir Thoi, Sir AJ, Maam Van, Maam Ven, Maam El, Sir Alvin, Maam Mers and Maam Arlene, Sir Clive and Maam KC, Maam Faye, Sir Earl, and Maam Lyka) and fellow floaters Sir Ric and Maam Lanie. I am thankful for all of them, but these are just the names that I remembered.

See you again sometime soon, 6 Main A! Thank you God for all the learnings.

Prioritization of needs

As a nurse, you have the full responsibility and authority with the bedside care to be given to your patients. Be firm but still be kind as you talk to them. We don’t have the luxury of time to spend on one patient not unless very sick and dying.

You can say, “Sorry, It’s not a priority at the moment, is there anything else you want me to do before I leave?”

Do I make any sense?

Whom shall I fear?

I know the Lord is always with me. I will not be shaken, for he is right beside me. Psalms 16:8 NLT

You’re an angel

The first time I have been called an angel by my patient.

Last Sunday, I was assigned as a bedside nurse in 2 West. I had elderly patients assigned to me. On that night, I met Sister Alphonse, 81 years old. She was a nun.

On that night, she had chest pains and she was catching up her breath. I notified the MROD on duty. Stat X Ray was done. Then I monitored her oxygen saturation, placed her on high back rest from a flat on bed position. Took her vital signs, increased the level of her oxygen via nasal cannula as ordered, decreased her IV hydration as ordered. I was a little apprehensive of what could happen, but thank God there were no casualties.

I talked to her, asked her to pray with me and I prayed for her. On that night, It was the first time I sang songs for my patient. I sang Amazing Grace, Still and Above all, with Jen the caregiver of my patient. I tried the best that I can to calm her down because she complained of difficulty sleeping. I also tried to give her back tapping and a little reflexology I learned back in college. I am glad that her anxiety lessened. Before she slept, she told me something I won’t forget. “You’re an angel”, she said. I was touched. My eyes almost got teary. Then I continuously hummed her to sleep. She said that I am blessing to her and that I am a blessing to others as well. She said that she loves me. I am glad that she was able to sleep before my duty ended.

I know I am not a perfect person, I am not even the best nurse one can have. But I am just grateful that despite how hard nursing is, I have been appreciated by a person that is even a complete stranger to me. I might not even see again this patient that I met but I won’t forget her.

My health may fail and my spirit may grow weak, but God is the strength of my heart and my portion forever. I believe in God even when I can not see Him. I believe that He is the God who heals physical, emotional and mental baggages, pain, sadness and loneliness. God is my Healer. I believe.