Nightingale’s Pledge

May 6 is the worldwide day for nurses, which is more than 2 months away. But I don’t need to wait for that day to write a tribute for nurses, right?

I know many people who are nurses even before I chose a career in medicine. If you don’t know it already, Philippines is one of the countries who produce world’s premier nurses. We export nurses to all over the world. When I was growing up, most parents would tell their kids to become a nurse. Perhaps we view that that profession as the fastest way to get out of the country and to have a brighter future. In fact many of my high school classmates became nurses, and many of them flew over to distant shores.

I never dreamed of becoming a nurse though. It’s not that I don’t esteem nurses, but because I know their work is difficult, and that they are sometimes under compensated, especially in the Philippines, and many times under appreciated.

Many people don’t really recognize the true worth of a nurse. Are they just glorified caregivers? Don’t get me wrong, I appreciate caregivers, as this world definitely needs them. But are nurses only good for cleaning the patient when they pooped, or getting the bedpan or urinals when they need them? Are they only good in administering the medicine that the doctors ordered? I am not glad that we have a pandemic, but one good thing that this pandemic brought is that it made the world realize the real value of nurses. They are truly the first-liners in every sense of the word.

After working in the ICU for more than 20 years, I have so much respect to these nurses. A doctor may round once in a day on these patients but the nurses will be dealing with them for the whole duration of their shift, which is 12 hours or so. That means that if their patient is confused, or delirious, or belligerent, then that nurse would have a bad day, and maybe cussed at, spat at, or worse get hit.

Or if their patient is really critical, with 3 to 30 drug drips that are infusing simultaneously, or if their patient is on a ventilator, or continuous dialysis, or intra-aortic balloon pumps, or extracorporeal membrane oxygen therapy, and other advanced life support, then those nurses would need the technical skills of a rocket engineer to fine tune the drug infusions and operate those life saving machines. In addition, they should have the attentiveness of an air traffic controller to prevent their patients from crashing.

To be a nurse requires intelligence, skills and patience. But more importantly it needs a loving heart. Here’s an example to a day’s work of a nurse:

Sometime last year, when COVID-19 was raging havoc in our hospital system, there was a ‘no-visitor-allowed’ policy implemented in all hospitals to try to curtail the spread of the virus. This applies even to patients who were dying. It were the loneliest deaths I have ever seen, as COVID-19 patients died alone. No friends, nor family members were with them during their final hours.

I’m glad that this policy has been changed, as we now allow family members to be with their dying loved ones in the ICU, even if they have the COVID-19. There are still some limitations, but at least we allowed them as long as they wear masks, gloves and gowns.

During that time, we have an elderly man who got the COVID-19 and it was clear that he was not getting better, but rather, was getting worse. He was placed on a high-flow O2 as his respiratory status was precarious. He was still awake and coherent, and he made the decision that he does not want to be on mechanical ventilator, nor does he want to be resuscitated if his heart stops. As long hours and days passed, he remained to struggle with every breath. The time came that he said that he does not want to suffer anymore, and that he just wanted to be made comfortable and let nature takes its course.

We made a phone call to the family, and they agreed to honor the patient’s wishes. We then took him off the high flow O2 and gave him medications to ease his suffering.

Not too long after, his oxygen level plummeted down. His nurse who just came out of the room and who doffed off her personal protective equipment, noted from the central nurses’ station monitors the patient’s dropping vitals. We all knew that death was imminent and would be quick.

The nurse just took a quick bathroom break, and hurried back to put her gown and respirator, and went inside the patient’s room. She was committed that her patient would not leave this world alone.

So our patient died with his nurse holding his hands.

These are the devoted nurses that I work with everyday.

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Addendum: Here’s the original version of Florence Nightingale’s Pledge:

I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practise my profession faithfully.
I shall abstain from whatever is deleterious and mischievous, and shall not take or knowingly administer any harmful drug.
I shall do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling.
I shall be loyal to my work and devoted towards the welfare of those committed to my care.