As a home palliative care nurse, pushing a suitcase full of medical equipment to patients’ homes is Nancy’s daily routine.
The year Nancy Tan turned 11, her father was diagnosed with nasopharyngeal carcinoma. However, for the six long months that he was hospitalised, she and her siblings were forbidden to visit their father. "My late mother was very superstitious, and she felt that children should not set foot in a hospital. I had to pester her over and over again until she caved in."
By the time she visited her father, his cancer was already at the terminal stage and the cancerous cells had spread to his bones. Once a burly man, he was all skin and bones when Nancy saw him again. The visit went smoothly, until her father had to relieve himself. He screamed in pain when a shouty nurse shoved a bedpan under his bare buttocks, scraping his skin and jabbing his bones. Feeling a vicarious anger, Nancy lashed out at the nurse for her rough and careless handling. The adult nurse in turn scolded her for speaking out of turn. "My mother had to restrain me. She said, 'We have no choice – your father's a 'C Ward' patient. We must know our place in society.'"
That did not sit right with the young Nancy, who retorted, "A C Ward patient is still a human. How would you feel if that were you?"
The incident left such an indelible mark on Nancy that it compelled her to make a vow of becoming a nurse. "I vowed to be a nurse who would treat all my patients compassionately and equally." A month after the visit, Nancy's father passed away.
From the fires, the strongest steel is forged
The passage of time did little to whittle Nancy's resolve, and not even the bright prospect of a bursary could sway her. Immediately after her O-Levels, she enrolled in the nursing school at the then Toa Payoh Hospital. Her decision was in part to help her mother, who took on multiple odd jobs to raise five children single-handedly. Now under a paid-to-study scheme, Nancy could help shoulder the burden.
After two years of training, Nancy was assigned to work in the Intensive Care Unit (ICU) of the Alexandra Hospital's cardiothoracic wing. Medical procedures of yesteryears were markedly different from modern approaches. While testing for blood glucose is a cinch these days with test strips, back then it was a tedious routine. Like students embarking on a science experiment, nurses had to conduct the Benedict's test, which involved holding test tubes over a Bunsen burner's open flame. "Sometimes, when we're tired, we'd doze off, and the mixture of urine sample and Benedict's solution would boil vigorously and gush out of the test tube. Not only did we have a mess to clean up, we also had to redo the whole test," quipped Nancy.
Medical equipment, from forceps to kidney dishes and scissors, were sterilised in a big boiler. Each injection needle, which would be reused, also had to be sharpened manually. Rolling the heavy oxygen cylinders was how young Nancy transported them to the bedside. Privacy screens, bulky and towering, would topple over onto her when she wheeled them. All these laborious works forged Nancy's grit and her resilience. "There's a certain toughness to my generation of nurses," she said.
While her career was mostly smooth sailing, Nancy recalled one incident that would teach her the importance of meticulousness. Whereas today medical dispensing has gone digital thanks to the advent of barcode scanning, circa the 1990s, every record had to be manually entered. Once, a nurse had dispensed morphine as per the doctor's order but failed to record it. When the next shift started, the inventory came up short. Accounting for the controlled drugs was Nancy's onus as the nurse in charge. As a result, she had to undergo the cumbersome process of checking in with every patient. "I learnt to never take things for granted."
Being in a high-stakes career involving life-and-death situations, Nancy formed deep bonds with her colleagues through the shared pressures of their work.
At the age of 39, when she had built a family and was riding a career high, Nancy was dealt a blow in the form of a medical crisis. The hormonal changes and constant worries about her children chipped away at her bubbly self, so much so that others around her noticed a deterioration in her mental wellness. Now, the healer was in need of healing. Her ordeal, from diagnosis to recovery, lasted five years. Being in this position gave her a greater sense of empathy, having experienced firsthand the emotional turmoil a patient endures.
After spending a decade working in a public hospital, Nancy followed her former boss, a liver cancer specialist, when he launched his own private practice. For the next 28 years, she assisted with his oncology specialty as well as research into the hepatitis B virus genome.
At the clinic, she saw many international patients. To ease their understanding, she translated complex medical jargon into layman terms. As many of them were in Singapore only for a few days, Nancy would volunteer to come in on weekends whenever they were scheduled for a medical procedure, so their treatments would not be delayed until the following week. Filled with gratitude, many of the patients to this day still meet up with her whenever they are in town.
Nancy revisited her old Alexandra Hospital hostel, more than four decades after she had lived there.
A spiritual message
When her former boss retired, Nancy decided to go into freelance nursing. She returned to her roots of working at National University Hospital, a public hospital. Around the same time, her husband got to know about Tzu-Chi Foundation (Singapore) through the Singapore Tzu Chi Entrepreneur Association. He began introducing Tzu Chi to her and persuaded her to join some of the activities.
As a Catholic, Nancy was initially very resistant. "I had so many pre-conceived notions. I thought Jing Si Hall was a temple, and I didn't want to step into one. I told my husband I wasn't good at Mandarin, so I didn't want to join the sessions." With her husband's constant urging, she finally relented, only to pacify him.
Together with her husband and daughter, Nancy visited Jing Si Hall for the first time in 2014. She immediately felt the warmth exuded by the volunteers, who were clad in the signature "Blue Sky White Clouds" uniforms. But it was not until she went to the Buddha Hall that she had a deeply surreal experience. Beholding Master Cheng Yen's portrait, which hangs on the wall, Nancy felt the Holy Spirit course through her. Her eyes welled up with tears. When her daughter became concerned, she assured her that these were tears of joy.
2025 marks Nancy's 50th year in nursing.
Following that fateful day, Nancy went to join one of the sharing sessions held at Buddhist Tzu Chi TCM Free Clinic (Redhill). It was then she was asked to fill a vacancy in the home care department, as one of the nurses was about to go on maternity leave. Despite having decades of nursing experience under her belt, this field was a whole new ball game. For one, she would leave behind the air-conditioned comfort of a ward and have to lug her equipment and move from house to house in Singapore's humid weather. "My husband, who knows I dread perspiring, thought I wouldn't be up for it."
Still, Nancy shadowed a fellow nurse, and found that above everything, she enjoyed interacting with the elderly beneficiaries. Now she was faced with a decision: to stay put in an environment where she knew she would excel, or branch into a different field. That very night, her late mother came into her dreams — the first time in 26 years. "She said to me, 'All your children have already grown up and are successful in their own ways. You must give back to society. Since you love working with the elderly, this is your chance. '"
When she woke up, Nancy pondered the meaning of her mother's message. Soon, she made up her mind and joined Tzu Chi, shifting her focus to home care as well as palliative care.
"Choose your love and love your choice"
Nancy caring for the late Mr Siva. "His eyes would gleam whenever Nancy is here," said his daughter Erajesvare.
As a home care nurse, the procedures Nancy has to handle are largely the same. For her patients, she packs their medicine and ensures their adherence. She also changes their dressing as well as feeding tubes and urine tubes. The biggest difference is that she is now on call, 24/7, ready to assist a patient or their caregiver via video conferencing. Be it administering injections to alleviate breathlessness or giving oral medication to calm an agitated patient, Nancy is always there to guide the family.
It is a responsibility she gladly takes on. Getting to relieve some of the patient’s or caregiver's distress is Nancy's job satisfaction. She also finds greater meaning tailoring care to different patients. "In a hospital, you are busy with so many things that you don't really have time to examine other factors. However, for home care nurses, we look at the patients’ overall wellbeing. We listen to their woes, try to pinpoint their underlying issues, and then bring their health back on the right track."
Going beyond her duties, Nancy also makes it a point to fulfil the last wishes of her end-of-life patients. She once brought a patient to Jewel Changi Airport, as he had been cooped up at his home in Jurong. This was no small feat, as the patient was wheelchair bound and needed his oxygen tank. Despite the challenges, Nancy made his dream a reality. Her can-do attitude harkened back to the resilience she developed during her younger days. When he returned home, the patient, who had seventeen children, endearingly referred to Nancy as his eighteenth child.
Nancy also helped to facilitate an advanced 50th anniversary wedding photoshoot for the late Chua Lye Hock, who had terminal lung failure. (Photos by Jacob Chua)
As a palliative care nurse, Nancy often finds herself at the centre of many families' most intimate moments. More than just alleviating their physical symptoms, she takes on the unenviable role of helping her patients come to terms with dying. Many of the patients cling on because they have unresolved issues.
"I once had this patient who was already in a semi-comatose state, yet she didn't let go. So I asked, 'Is there anybody missing?' True enough, the daughter was in the United States, waiting to fly back that afternoon. I told them to do a video call, and have the daughter convey her love, ask for forgiveness, and tell her mother to go if she could no longer wait. After that call, the elderly lady passed on peacefully."
While dealing with death is never easy, Nancy finds solace in knowing that her patients’ suffering has ceased. "Knowing they are free from pain and are at peace brings joy to me." Though her own faith differs, Nancy respects the beliefs of her patients, many of whom believe in reincarnation, and she offers blessings for their next lives.
Fifty years have passed in the blink of an eye. Nancy's passion runs deeper, thanks to her work at Tzu Chi. Despite the pressures and demands of the job, burnout is not something the veteran nurse experiences. I always advise my children, "Choose your love, and love your choice. When you know your direction in life and follow it, nothing is ever difficult."
Master Cheng Yen's tireless spirit is also an inspiration for Nancy. "At the age of 88, she is still going strong, overseeing the charitable initiatives across so many countries. I'd love to follow in her footsteps and be able to continue doing my work until my very last breath."
And what would her 11-year-old self say to her if they were to meet today? "I think she would say, 'Well done. You have kept your vow, and you have followed your aspiration.' I think she would be proud of me."
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