SIMPLE ART OF CARING

By MARILES A. RALLOS, BSN, RN

Plant Nurse, Pepsi Cola Products Philippines, Inc
University of Cebu Alumni, 2007

Nursing is an art: and if it is to be made an art,

It requires an exclusive devotion
as hard a preparation, as any painter’s or sculptor’s work;
for what is the having to do with dead canvas or dead marble,
compared with having to do with the living body, the temple of God’s spirit?
It is one of the Fine Arts: I had almost said, the finest of Fine Arts.
-Florence Nightingale, poem “Nursing is an art.”

One hot summer of 2006, I find myself sitting on a cozy arm chair. Somehow, I felt
so lonely and empty within. It seemed like I was just observing the clamorous
crowd in the 5th floor lobby yet people sitting next to me noticed that I was
thinking of the oceans. “Hey!” a gloomy, dreadful voice was heard over my ears.
“What’s wrong with you? I then realized that one of my group mates asked. “I’m
good. I just remembered her”. I felt satiable warmth when everyone gave me a big
hug. I slowly closed the window of my soul and vividly recalled the memories I had
with one of my patients during our enhancement duty that passed away few days
back.

It was 9th of May, I was preparing myself and went on afternoon shift. My clinical
instructor assigned me to monitor a female patient in Room 706. Upon
endorsement and studying the patient’s thick chart, I find out that we were of the
same age, and been admitted in the hospital for three days. Patient X was
suffering from a life threatening condition called Stevens - Johnson syndrome.
Stevens-Johnson syndrome is a serious systemic (bodywide) allergic reaction with
a characteristic rash involving the skin and mucous membranes, including the
buccal mucosa (inside of the mouth). The disease is due to a hypersensitive
(allergic) reaction to one of a number of immunologic stimuli including drugs and
infectious agents. SJS is a rare condition, with a reported incidence of around 2.6
to 6.1 cases per million people per year. In the United States, there are about 300
new diagnoses per year. The condition is more common in adults than in children.
Women are affected more often than men, with cases occurring at a three to two
sex ratio. (http://en.wikipedia.org/wiki/
StevensJohnson_syndrome). According to the history of her present illness , her condition
was caused by hypersensitivity to drug when she was under Chloramphenicol
treatment, the drug of choice to treat Typhoid fever and was first confined in their
provincial hospital 2 weeks prior to admission. At first, I was trying to remember
what her condition really was. I approached my C.I. for confirmation. Perhaps I
recalled that one of our lecturer’s had included this topic in our Medical-Surgical
subject. She even claimed that she hasn’t actually cared for a patient with this
rare kind of illness.

Together with the staff nurses, our clinical instructor, and some of my group
mates, I entered patient X’s room during the nurse’s rounds. We first greeted her
and introduced ourselves. Identified our patient, assessed her intravenous fluid
level and site, verified the amount of oxygen that she’s receiving and checked on
her in general. After the rounds, I was left inside the room and started to interact
with patient x and to her significant others. She was lying on bed, awake, coherent
and oriented to time and place. I obtained her vital signs, with temperature of 40
°C, heart rate of 98 beats/min and respiratory rate of 25 cycles /min. She had pale
and dry skin, from the scalp down to her lower extremities, and arms were filled
with small lesions. Her lips and gums were slightly bleeding which causes mild
pain when she opens her mouth, like in talking and eating.

After that 20-minute interaction, I started to formulate my nursing care plan.

Since she had a high fever, I utilized this realistic plan on top of three nursing
priorities that I identified that could be done in my eight-hour duty. Part of
bedside care, I gave her a tepid sponge bath and after two hours, her temperature
lowered down from 40 °C down to 38 °C. “That was amazing! Her mother claimed.
“Everyone from that 4-corner room was filled with glee and they were all smiling
at me. At the back of my mind, I definitely said, Wow! What I did was just an
ordinary thing yet for them it was so amazing. For a couple of hours that I was on
her side, it built an extraordinary kind of friendship. Her sister Sheryl said, that she
haven’t seen her sister so happy and even it’s a bit painful for her to smile
because of her chopped and bleeding lips, she could now stand the pain and
afforded to show a wonderful smile. When I was about to end my shift, I went back
to my patient’s room to bid goodbye. She held my hands, tight and firm, spoke in
a soft and low-tone of voice saying, “Thank you nurse”. “You’re welcome”, I
replied. Her eyes were teary and had shown the best smile that I’d seen in my
whole life. I went out from her room, knowing that another shift on that week was
over but the story never ended there yet.

The next day, I went to the same hospital and submitted our OR gowns for
autoclaving in preparation for our OR exposure the following week. I and two of
my group mates decided to dropped by patient X’s room. We saw her side-lying
on her bed and I noticed that a working ventilator was on her bed side. “Hi, how
are you? I asked her. She’s not smiling but she kept on staring at me, trying to say
something. I think you wanted to say something. Can you tell me more about it?
Then she replied,” I’m tired. Please pray for me”. My heart was torn into pieces
and I didn’t know what to say. I just held her hand, I was silent for 5 seconds and
replied, “Sure, I will. Actually, I and my friends would visit the Holy sacrament later
this afternoon. Do you want to come with us?” Finally, she smiled and held my
hand with earnest desire to come over. On the other hand, her mother and sister
Sheryl were at my back. They said that she was under code blue that early
morning and they were hopeless about her condition. They were sad and I
understood what they went through. After that quick visit, I went to Basilica del
Sto. Nino with my friends, Johanna Marie and Maria Richelle. When I arrived
home, I took a nap in my bed. I suddenly dreamt of her, she was smiling back at
me and was totally well. I was abruptly awakened by a telephone call from her
sister Sheryl, crying out loud and informed me that her sister passed away couple
of minutes ago. Heavy goose bumps ruled over me and couldn’t really believe it.
That was the first time that my assigned patient passed away. Since they were not
from Cebu, her sister asked me to drop by the hospital before they went back to
their province the next day. I met her family and they were so grateful about the
support and care that I contributed to them. Her big brother attempted to gave
me cold cash but I impetuously refused.
I got a reality check from this experience. Caring can’t only be acquired inside the
classroom. Patient care is part of a nurse's role since we have to assist them in
their needs which they were not capable in doing. However, the simple art of
caring is much appreciated when experienced and shared. It means that we are
giving our time and best effort to alleviate our patient’s suffering, not only to our
patients, but most of the time those who are in need of our help. It might be our
own families, relatives, friends and neighbors.

Should someone choose nursing as a profession? "Yes!" Working so intimately

with ill people and experiencing the pain of others directly affects how we nurses
view life.

Nursing lets me go home with a good feeling in my heart. Every day I hear "Thank
you" or "I'm glad you are here." Knowing I have made a difference makes the long
hours and late lunches worth the effort. For me, the career has been nursing, and
for every nurses, mastering the art of caring is a lifelong mission. God Bless!

Patient with Stevens - Johnson syndrome