I have the pleasure here to nominate Mary Ann Arnobit Madriaga for the DAISY Award having worked with her in the past three years as a fellow physician in Pulmonary Critical Care at Loma Linda University Medical Center. We have worked closely throughout my experience in the Medical ICU here from the COVID-19 pandemic and the period thereafter to the present. She is the best critical care nurse I have ever worked with without any doubt. I have been blessed to have worked with and supported by many caring experienced floor and ICU nurses throughout my career here and at my previous organization. However, Mary Ann is the nurse that has changed my perspective of what a truly compassionate healthcare worker can and should be in practice. I have learned from her experience, loving spirit, and compassion. I frankly hope to be like her in her positive attitude and care for others. She consistently values every individual, including all the staff, patients, learners (including residents, students, preceptees), and families in the unit. She has a constant positive attitude and deeply cares for each person, truly like a saint. During some of the most challenging times that I have had taken care of the MICU patients with short-staffed ICUs, high census of critically ill patients and with my own personal and professional struggles adding to the stress of the ICU environment, I have always been able to count on Mary Ann to help each patient in the ICU (and her fellow critical care nurses). I have always been able to count on her friendship and professionalism in the MICU. On my hardest nights, she has uplifted me and encouraged me. She has shown me the care that she must be delivering her patients, and I can understand from nurses like her why LLUMC truly provides compassionate care.

I have countless experiences (from every single night that I have had the pleasure to work with her) which I could describe in this nomination, but I will highlight the foremost case of her absolute exceptional care here that displays her redeeming qualities.

One of the sickest patients that I have ever managed in my career now of 6 years was a patient with cirrhosis that was decompensated and presented here as a transfer for liver transplant evaluation. This patient declined massively and abruptly and ultimately bled to the point that the Surgical ICU, Trauma, and GI services in addition to many ICU nurses and I were managing the patient for 12 continuous hours in our shift together. This patient was profoundly ill to the point that he required 52 units of blood product transfusions throughout the night and several ICU procedures from catheter placements, bronchoscopy, EGD, and transporting down to the CT scanner on multiple vasopressors. He did not survive but his family knew how hard we worked, and how hard Mary Ann worked. She never left the patient's side for a single second - and she never left me. She did as much as she could (even in the 4 codes this patient had overnight). She kept the spirit of the room together; she kept me together in this life-changing case.

She stayed hours beyond her shift in the morning consoling the family that arrived from out of state, consoling the staff that had been through this emotionally and physically exhaustive night, and in completing all the duties and charting of the hectic night. Her conduct in such a grueling shift with the sickest patient I have ever had was impressive. I was blessed she had that patient with me that night. She returned the next shift and gave it 100% like she always does.

Similarly, whenever I have any of the sickest patients that are admitted, upgraded, or transferred to the MICU, I know the charge nurses and critical care nurses can count on Mary Ann if she is the primary nurse or if she is on service to help in managing these patients. When anyone struggles in the MICU, as we inevitably will for whatever reason, she consistently reminds me and all those around her that we are a team, and we are doing well. This is a team player that epitomizes good communication and compassion.

To summarize, I give my highest endorsement and strongest recommendation for Mary Ann Madriaga to be awarded for her commitment, compassion, knowledge, and professionalism. She has been a blessing for me and my patients. She should know that awards are well deserved, but she is the real prize. I know that no award can come close to the satisfaction that she must feel with her strong work ethic and dedication, but I believe she deserves recognition. Thank you, Mary Ann, for your commitment to our patients and medicine, your professionalism, your friendship, and your love. Thank you for all that you have done.