BT is our long term patient who has been here since 23/1/08. He is a 61 year old gentleman who was admitted from IMH due to a displaced plating of the left supracaudylan femur. Currently, his issue is that of a left distal femoral non union fracture. He also has a medical history of psychosis and schizophrenia.

BT complained to me about worsening knee pain. I checked on him and found his left knee to be red and swollen, with effusion. I suspected an infection and informed the HO about this. BT was referred to the infectious disease (ID) team. The next day when I checked on BT again, his pain had worsened. The ID team had yet to see him. Worried, I spoke to the doctor again. As antibiotics had already been started for him, I suggested giving him pethidine (already inked up in the IMR) to alleviate his pain while waiting for the ID team to review him again. The doctor agreed and I spoke to the next nurse in charge ( change of shift then) of BT regarding the need for pethidine. To my surprise, the nurse told me not to give BT the jab. I was puzzled and asked her for her reason. She told me that this was because BT is a patient who has schizophrenia and taking pethidine would cause his condition to aggravate. What really turned me off was when she told me that she didn’t want BT to go ‘psychotic’ during her shift and that she may give it to him later on nearing the end of her shift if he was still in pain. ( I was annoyed because if she were to be correct of the patient going psychotic, the night staff will suffer as there were fewer staff then) Moreover, when BT started to groan and shout due to the pain, the nurse just brushed it off as him ‘acting up again’. She then used that to confirm her reasoning that pethidine should all the more not be given as ‘patient was now unstable’.

Puzzled by the nurse’s reasoning that pethidine can cause psychiatric (PSY) patients to become more confused, I went to pharmacopedia (an online site used by staff to get info of drugs) to check on the contraindications of using this drug. However, I found no contraindications against using it for PSY patients. To make sure that it was really so, I double confirmed it with a doctor and my clinical liason. Both of them agreed that giving pethidine to BT was not a problem, given that his pain score was 10 and that he had not been given it for a long while. As I was really concerned about BT’s cries of pain ( which was unusual of him to do so), I tried to ask another nurse to give him the pethidine jab. She agreed and gave it to BT who received it with relieve.

This incident got me into a dilemma as to whether I was to be an advocate for my patient, or to let the matter rest by letting the nurse-in-charge decide what was best for him. I ended up choosing the formal as I felt a great sense of injustice if I were to just go off with BT groaning in pain. I realised that staff tend to look at PSY patients with prejudice and their biasness could lead them to brush off the patient’s concerns. I learnt that these patients really do need more understanding from the nurses and doctors and that pain is as real to them as to that of other patients.

I pray that when the stress and pressure of being in-charge comes upon me in future, I will still remember that I’m there not to do a job, but to truly serve my patients from a heart of love and compassion. I pray too, that prejudice and biasness will never blind my eyes to the oppressed and outcast of society. That I will truly be an advocator for my patients and to always put their interest first before mine. That I will let the love of God radiate and permeate my every thought, work and deed.