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This is a follow on piece from the ‘Bloopers’ topic of the other night. One of the bloopers turned sour in a big way, so I thought I should complete the picture. I guess it shouldn’t be a shock that bloopers in healthcare aren’t too funny, mostly. Some are interesting, some awful, and a few hilarious; that’s about how it works out, it seems.

You know that guy I was telling you about, the one with shoulder bursitis? The one whose wife and daughter gave him too much ibuprofen and paracetamol unintentionally, dosing him every 4 hours on the hour for several days due to his excruciating pain without observing the 24 hour maximum doses because they weren’t told about it by their doctor? And obviously they weren’t told about the maximum doses by pharmacy staff either if they bought the medication in a pharmacy, or maybe they bought it from the supermarket; this is my strong argument that these “simple” pain killers not be available from the supermarket. I guess the family never read the packet either, although English as a second language was a factor here for the wife, but not the daughter. This is the patient who was brought into ED after he started coughing up blood as a side effect of ibuprofen which irritates the stomach lining. You’ll remember that the family who wouldn’t give him the stronger pain killer Endone in case he got constipated, but had given him toxic doses of weaker pain killers. The patient who is an example of people being given incomplete advice about how to take their medications, and blindly following that advice without taking any initiative themselves.

Well, he died.

I saw him Saturday, he died early Monday morning. I was shocked when I found out!! I knew what they’d done was bad, and that he was going to suffer the consequences, but I never expected him to die! Not that fast, certainly. I planned on looking up which ward he was in in Monday morning so that I could handover the story to the ward pharmacist, but then it said: DECEASED. I had to read it twice. I thought I’d picked the wrong patient. But no, deceased, 0600 hours, 16-4-2018.

Wow!

So I looked into it. And right there as the cause of death: acute on chronic renal failure precipitated by NSAID use. That’s non-steroidal anti-inflammatory drugs: ibuprofen (Nurofen), diclofenac (Voltaren) etc. Acute on chronic means he had a degree of chronic permanent kidney failure that couldn’t be reversed, not unexpected at 77 yo, but it was made acutely much worse by something, in this case medication.

There are a few things you can do to help reverse acute kidney failure: give IV fluids to flush toxins out, stop all medications that are toxic to the kidneys, manage blood pressure with medication and fluid so that the kidneys have optimal perfusion, but at the end of the day there’s only so much that can be done without the patient going to the intensive care unit and being put on dialysis. Once the kidneys go off, fluid accumulates in the body. This patient already had heart failure which causes fluid to gather around the heart and lungs, and the kidneys failing to clear fluid adds additional pressure on the heart. This was listed as the secondary cause of death: heart failure. In fact 4 causes of death were described in more detail than the overall cause as I’ve put it above, acute on chronic kidney failure precipitated by NSAIDs: kidney failure, heart failure, NSAIDS and age. Once the snowball got kicked off it gathered momentum from pretty much every other medical condition that the patient already had, unsurprising since the whole body is in a delicate balance. But if that trigger hadn’t been there…

In this case because of his age and many other medical conditions, the family did the sensible thing and let things be as they would be; and in this case death is what would be. It’s a shame that kind of common sense thinking hadn’t prevailed any earlier in the case. I feel like this death could be listed as preventable.

If a patient asks me generally whether ibuprofen is good for them, there are several medical conditions I’d want to be sure the patient didn’t have before recommending it: asthma, stomach problems like previous ulcers or gastritis and even reflux, heart failure and kidney failure. So the ibuprofen probably shouldn’t have been started in the first place; a steroidal anti-inflammatory like prednisolone would have been more appropriate. Although sometimes we say cautiously, take it but for no more than x days. Of course we then also tell the patient the maximum dose and how best to take it. In this case I’m pretty sure if you had asked the patient’s cardiologist or nephrologist before hand whether this man should have been given a NSAID they would NEVER have signed off on it.

Then maybe he’d still be here, a bit fuzzy headed or nauseous on Endone, taking paracetamol less regularly than actually happened, and blood sugars high from prednisolone, but alive, his bursitis improving and his life going on at home.

RIP.

I’m sorry the system let you down.

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Sometimes you wonder what is going on in the world. A few things at work today made me shake my head.

[Edit: And I’m not exempt from bloopers, far from it. In photography as much as anywhere, as you can see!

An ED doctor called a renal physician, a specialist, asking advice about treating an immune compromised patient with antivirals. This was a perfectly reasonable request because the patient presented with severe diarrhoea which could be caused  by the cytomegalovirus (CMV) and to quote Australia’s Therapeutic Guidelines, the antiviral she wanted, ganciclovir, “is the cornerstone of therapy”. The specialist doesn’t sound like he really knew what he was talking about, or hadn’t come across the drug much before. That’s still no excuse for him to say, “just give her Tazocin, it covers just about anything”!! Tazocin is a broad-spectrum antibiotic that yes, does cover just about anything…bacteria-wise. It most certainly never has and never will treat viruses however, and if doctors are saying antibiotics treat viruses, how on earth can we expect our patients to be informed?? That was some poor advice!

Nick something-opoulos (name disguised for privacy not racism) keeps his meds in two Decor containers, one for the morning and one for the night. I was getting quite confused because it seemed that his medications were prescribed at weird and something plain wrong times…cholesterol tablet and warfarin being taken in the morning, anti-depressant and fluid tablets being taken at night, and others. I was about to go in there and have something to say, but lucky I asked a question first and found out that whoever went through the meds before me had inadvertently switched the lids. Obviously they didn’t realise how important it is to the patient that they are organised the correct way. Or how confusing and possibly dangerous it could be to have the meds prescribed at the wrong time if a health professional, like me, thought they were usually given at the wrong time and went with it, no questions asked. Luckily its my job to think about these things and we got it sorted. What could have been the consequences? Diuretics, frusemide in particular, are always given first thing in the morning so that the diuresis (fancy name for peeing out the excess fluid!) happens during the day, most particularly during waking hours. Diuresis with frusemide can be hard and past, patients often need to pass urine several times with urgency after taking their medication. Often patients won’t leave the house after taking it, or only if they go to familiar places where location of toilets are known, or they’ll skip it if they have to go out. It can be a significant nuisance. The aim of giving frusemide in the morning is to prevent patients needing to get up hurriedly and repeatedly to the toilet at night time which presents a falls risk, so its very rare to see patients take it at night; the first red flag. The second red flag was desvenlafaxine or Pristiq, an antidepressant, apparently being taken at night. It doesn’t have to be given in the morning but it is an energising medication that can cause insomnia so usually patients start taking it in the morning when its first prescribed, and maybe change it up of their own accord if it works for them to take it differently, but usually it stays as first prescribed. Next up is simvastatin, an anti-cholesterol medication, which must be given at night to work. Simple as that. That’s when cholesterol is manufactured from fats and being the relatively weakest drug in its class, it just must be given then so it can interrupt that process. Some others are stronger and can be taken any time. Then the last but no means least red flag, warfarin in the morning. It doesn’t have to be given at any specific time of day to be effective, but for practical purposes its always given at night. This way you can have your INR blood test taken in the morning, and there’s time for you to be contacted before your dose in case it needs to be increased or decreased. I have never seen a patient take it in the morning. So a whole lot of confusion made a whole lot simpler by switching lids on two containers!

But this was NOT the most confusing thing about this patient. This patient has bursitis of the shoulder and has been in intense pain for 2 weeks!! They’ve been seeing doctors and gradually getting a CT scan, then an xray, now awaiting MRI and has had a cortisone injection over that time. But the cortisone is slow onset and long acting so it hasn’t kicked in. They were told to take paracetamol (Panadol) and ibuprofen (Nurofen) every 4 hours, good advice, but not told to limit paracetamol to 8 tablets per 24 hours, or to limit ibuprofen to the same. This was a massive oversight!! Yeah, sure, it “only” Panadol, and “only” Nurofen but this is exactly how accidental paracetamol poisoning happens. As it turns out this is also how gastritis develops with the patient coughing pink-tinged mucous suggesting stomach irritation and low grade bleeding, VERY bad for a patient on warfarin, a blood thinner; this could get out of hand!! And he’s suffering now not only from bursitis pain, but gastric discomfort and bloating!! Great! Good healthcare. But wait, there’s more!! As I was walking out, the daughter tells me they were also prescribed oxycodone (Endone), a morphine derivative on Tuesday. This is great news, so how has he been going with that? Oh we never gave it to him. Um, why? Excruciating pain, 2 weeks worth, needing paracetamol/ibuprofen every 4 hours?? “Oh we thought it might be constipating”…

…Wait. Let me get this straight. You’ve been telling me how terrible its been watching your father in such bad pain needing pain meds so often…and you withheld medical treatment for 5 days because it might cause constipation;?? That might not even happen!! Excuse me for being incredulous!! Bar one or two, every single treatment for constipation is found on a shelf in your local pharmacy. Most of those are found in your supermarket!! You might never need them, but do have access to them 24 hours a day anywhere across Melbourne. So just give the drug! I think I communicated this point adequately. The daughter then back tracked and said she was worried about addiction!! Seriously, you haven’t given a single dose, and you’re worried about dependence which takes weeks or months to develop, if it does at all while you watch your father writhe!!! It was all I could do to not strangle her!! So because you never gave the drug, he ended up first with a cortisone injection (usually last resort) probably because the doctor thought you’d tried and failed with Endone which you hadn’t, and now he’s being hospitalised because he’s in too much pain, because you didn’t give the prescribed medication!! Constipation, dependence, these are issues that we can work through as we go along. Failing to give appropriate medication, withholding medical treatment; health professionals have been de-registered for these crimes. Yet people in their own homes can get away with it any old day!! What a scandal! If this were a nursing home or hospital it would be labelled “elder abuse” and there would be an investigation and heads would roll!

I shake my head!

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It’s the start of the footy season.

Did you know that, or care if you did?

Melbourne overall is supposed to be pretty footy mad, and I’m sure it is based on the shenanigans I saw in my work suburb of Richmond over the footy finals last year, but I’m fairly laid back about it. We’ve never had a telly which is probably the major reason why I’ve never followed the footy that much, but if we’re ever on holidays during the footy season I do get pretty enthusiastic watching the play and exclaiming and yelling and carrying on! Who me? Yes me! But following it by newspaper just doesn’t interest me. I’ve also only ever been to 2 games, neither involving my club so…I guess that hasn’t piqued my interest. Theoretically I barrack for Richmond footy club, ironic given I now work there, mostly cos that’s who my Dad barracks for but as soon as people start talking to me about players or games or stats I get lost…except Dustin Martin, I know Dustin Martin. So how about my Dad barracking for Richmond without a telly? The Saturday afternoon clean out of the work van!! The radio would go on, the Coke cans and pie wrappers would actually get removed from the passenger seat foot well, and all the paraphernalia of being an electrician (clippings of conduits, cable ties, old light globes, fuses and things that I’ve forgotten the names of) get methodically cleaned out and the van sorted out for the week ahead. Or a trip to the tip. Or cutting firewood, or taking other trips, or something. Anything, from memory.

So, footy season…why do I now care? Apart from catching a couple of good games over the Easter break when we stayed down at Fairhaven, I work Saturdays in the emergency department. Turns out, we (I mean the hospital I work for) have the contract for the AFL among other sports contracts like the Australian Open so we get injured (and famous!) players coming through our doors, as well as all kinds of junior league and general patients. We’re the only private ED in the city so people wanting fast turnaround, quick (often same day) access to orthopaedics or plastics, private facilities and considerate treatment of celebrities often come to us. Of course there’s still patient confidentiality procedures in place so I won’t be discussing patients by name…and anyway no AFL players came in today to my knowledge, at least not between 10am and 2pm. Who knows after that?

So what did I see today? At least 4 patients lead through the department still in their playing jerseys with various signs of injury: limping, guarding of limbs, blood, pain.

A young 19yo male playing footy this morning went for a mark and the footy hit his ring finger at the tip resulting in a compound (bone through the skin) fracture of his finger…think blood, broken skin, broken bone, and just to top it off, the nurse swore she could see the tendon!! Ick! And when I saw him, he and his mum thought they were being discharged home…sorry, no, this is gonna need surgery!

A young girl maybe 16yo-ish came in from women’s AFL, not the major league but an amateur game with a dislocated shoulder. I actually felt worse for her than the last one because she has to be awake while they sort that out, although on reflection they wouldn’t knock out a patient to fix their finger, just a regional nerve block, probably in the wrist. She still had the green penthrane (inhaled anaesthetic) whistle from the ambulance and after the first attempt to enlocate the shoulder and an enormous blood-curdling scream that shook the foundations, they gave it back for her to suck on in between huge sobs which turned into a panic attack so they switched to nitrous oxide (laughing gas) to both treat the pain and anxiety, and eventually got the shoulder back in! I did not envy her at all! Not pretty.

I didn’t see this guy, but apparently a 57yo male umpire got tackled from behind during a junior game, huge question as to why that even happened, and is now feeling pain pretty much all over his whole body which got unbearable at home so he came into ED. I don’t know what they found in the end, but I’m sure most of the problem was a 57yo rather than a 22yo guy hitting the deck like a sack of potatoes. They don’t bounce back like they used to!

There was another jersey but I never caught up with that one. So instead, another trauma. This one was very unfortunate; I guess all traumas are but when your pet attacks you, its unfortunate. This 21yo guy’s pet is a lovely house cat. His buddy came over to visit and without his knowledge brought his dog. As soon as the dog stepped into the house it went for the cat, of course, so the guy went to pick up the cat but it was freaked out and attacked him…properly! Think slash to the throat, slash to the forearm and wrist, slash under the nose, slash on the chin, and the crowning glory, not just a slash to the lip but a chunk taken right out!! Ouch! Several stitches required, and being a private hospital, and being that the injury is to the face, usually we get a plastics specialist to review the patient at least, if not get them to do the stitches themselves, for a better aesthetic outcome!! Does that sound private hospital-ish?

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Friday 16th March, 2018

This one is for a patient from ED tonight who I had a great chat with about photography. No I wasn’t neglecting my work, there weren’t that many other patients to see at that point, and it’s my hobby…always happy to chat about it!

I learnt a lot! About camera clubs at a local, state, national and international level including one that I might go along to locally, we talked about his 3 dark rooms, I heard about UV and infrared photography, and we talked camera models, good lenses for bird photography…and we could have gone on!! But eventually work has to come to the fore.

Anyway, since I shared my blog but haven’t put up a lot of my photos later, I guess I better. These are some shots that I liked from an outing with Birdlife Australia, Melbourne branch to Point Cook on Wednesday. A great walk, perfect bushwalking weather, nice company and a few stunning and semi-co-operative birds! It all makes for a great day out. The day was a bit misty/smoggy so as I cropped all the photos they became a bit murky; apologies!

Brown Falcon, better not shooting into the light! 

I got a whole series of shots of this gorgeous creature because you never know how close you’ll be able to get, but this was a youngish bird so we got very close in the end, slowly step by step. So the blurry shot isn’t really excusable, but unfortunately these days I have a degree of hand shaking that is bugging me – I really need to learn to wind up my shutter speed beyond what I’ve done in the past. I have cropped this shot.

Brown Falcon, same bird but shot into the glary sky

The conditions of the day make a huge difference as far as the photos you can achieve.

The glare of the sky adds so much light into the camera that it can be hard to make out detail of the subject when you shoot into the light and it is backlit; this is where being able to use your settings well really comes into play…or you just accept that you are operating in impossible conditions…but what fun would that be??

A Crested Tern on the wing

Love Terns, they are so acrobatic in the air and a delight to photograph!

Now THIS is a series I’m super proud of!! Just saying…a little stoush

Now THAT’S the type of shot I want to be taking!

Whistling Kite, not a great shot but the best I got

Perfect! Do you know how close I had to get to this Superb Fairywren for this shot? Actually I had to wait for it to get this close to me. Time and patience pays off! About 2 metres away

This scrappy looking guy is a male Superb Fairywren in eclipse, halfway moulting between immature and full male adult plumage in the non breeding season – this means he’s less than 5 years old

I was sitting at lunch and all the birds took off in a big Kuffluffle behind me! It’s a tell tale sign of a bird of prey flying over; there’s a consensus amongst all the birds that this is a bad thing. 4 magpies suddenly went into attack mode and I discovered exactly where the bird of prey was! Not in focus but a nice action shot, I didn’t have much time to get off a shot

Again, poor focus but I’m proud of this shot because I was the only one in a group of 20 that got a shot, and so I contributed a Brown Goshawk to the day’s count – I’m happy with that!!

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I’ve done this before. But since it’s a recurring theme with me, I guess it can be a recurring theme here too. It never ceases to amaze me the STUFF that goes along with medicating oneself.

The medications to start with, the prescriptions and repeats, script reminders when the repeats are running low, the safety net form to keep track off the scripts til I hopefully reach the concession limit, the receipts…well they aren’t mine but they remind me of what of mine I’ve spent…the script wallet.

And then there’s the waste. I’m a believer in recycling and the whole reduce, reuse, recycle ethos but what do you do with this?? And this is every TWO weeks!!

I bin or recycle, but there’s no way to reduce or reuse this lot!! Oh well, I guess that’s a bigger fight for another day.

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6th March, 2018

Well I had other ideas for today’s blog, but Facebook reminded me that today 4 years ago I was recovering at home, supervised by my hubby working from home, after a VERY long afternoon/night in the emergency department having finally come to the crunch point of my nervous breakdown.

It was the first day of many days off work: 6th March 2014 to 22nd July 2015.

It felt long!

It felt like it would never to over, that life would just trickle by forever. Me at home, on my own, barely able to fill the hours of the day, just dragging along until the next…what? Hour, day, week, year?

After 18 years of full time school; 4 years of full time study plus part time work; an intern year of full time work and study; and 4 years working full time (apart from a period of 9 day fortnights during 2013 for health/stress reasons, and a brave if futile attempt to get back to work and save my job by dragging myself 2 days a week to work in the outpatient dispensary at the Alfred in the month before my contract expired late 2014) it was a shock!

I didn’t know what to do with myself physically, let alone mentally. So came a long list of attempted hobbies to try to fill up my time, more or less successfully. 4 years on, some have stuck, some haven’t, but it’s a different problem now: finding time for those hobbies! Time for bird watching, for photography, for blogging, and my re-discovered love of gardening. I’m back at work, currently 4 to 5 days a week! Who would have ever thought?! And it’s cramping my style! How’s that for ironic? For months, years in fact I’m dying to get back to work, really back to working full time or close to it, and 5 minutes later I’m missing my me time!!

It could be worse. If anyone can say that it’s me. I was worse, I’ve been worse; so I really know that it could be worse. I do. But it’s the perspective you have at the time that frames how you see things. And my perspective now is mental wellness and relatively good physical health, so the smaller things weigh more, like doing my hobbies! It’s not a bad place to be, hey? Four years on.

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Here is my public service announcement (PSA).

Not to be confused with prostate-specific antigen, Pharmaceutical Society of Australia and I’m sure many other words starting with those letters positioned in that order.

Do you take any medication? Any medications?? Even one medication?

“No, only vitamins, no medications”. “Which vitamins?” “Umm…”

“Just a blood pressure tablet…oh I don’t know what it’s called, its the pink one”

“The doctor started me on an antibiotic this week, no I don’t know what it is”

Here goes, my entire public service announcement: KNOW YOUR OWN MEDICATIONS.

Every day, somewhere between 4 to 18 times depending on shift length and how busy the department is, I walk into an ED cubicle and ask a patient, do you take any medications? And I get some frustrating answers: frustrating in that the patient or their carer hasn’t taken ownership for their own or the patient’s healthcare, frustrating in that I have to put in a lot of time and effort that the patient didn’t think was worthwhile, and isn’t necessary, and I forget why else; I’m sure there was something.

I’m not whinging about having to do my job. The whole point of a pharmacist is to elicit the best possible medication history from or for a patient, and I have to dig a lot to get the optimal history. It’s the reason I go to work and the challenge of it creates a real sense of satisfaction once I’m certain of a patient’s medications. But I do think that patient’s have to be engaged and do their part. Obviously I cheerfully exempt unconscious patients, those who are demented/delirious, institutionalised patients and anyone else not in charge of their own medications. But the rest of you? Own your health, for your own sake if nothing else.

You don’t have to be a doctor, a healthcare professional or know anything really about medicine to excel at managing your own medications. You just have to put in  a little time and effort, and get to know the following: the medication generic name (the one in small print), or the brand name (I can work with that), and the strength of the medication. That’s it. I’m not even asking you to memorise it. In fact I don’t want you to rely on your memory. When you’re in the ED, there are so many things going on that with you that your medication name and strength are going to get prioritised right out of your memory recall centre, and be useless to both me and you! So write it down, photograph it, tattoo it on your skin if you must! Okay, the last one is a joke, people!

After that, I need to know a couple of things about each medication: how many times a day you take it, what time of day you take it, and anything else pertinent to the medication specifically. If its written down, all you have to do is hand me the list and that’s all I need; if its on your phone just hand me the phone. So if you don’t want me bugging you, and asking you questions, be organised! I will reward you.

And as an added bonus, if your medications are written out neatly and the list shows you know your doses, your medication chart will be written up quicker, more accurately and your medication chart will be safer. I think that’s worth some effort.

For instance, one patient today brought all of their own medications in a box with a handwritten list saying what time of day each was taken. I was able to record all the information I need: generic medication name, strength (from the medications themselves), and the amount she took and what time of day she took it (from the handwritten list) while the patient was sleeping. When she woke up, I just quickly ran through the list with her to confirm it was up to date, and that was that! Easy, fast, and done, just like that! Her medication chart checked for accuracy and the patient was safe to go to the ward, medication-wise.

A lot of patient’s are very good at bringing in their own medications. In fact Epworth patients are exceptional at bringing in their own medications. This is mostly because they know from their last admission or from savvy ambulance drivers that if they don’t bring their own we’ll dispense what they need, but they’ll pay the same cost as if they were getting the medication dispensed at their usual pharmacy. Most figure they’ll just use what they already have. But having all the medications together in one place at the start makes taking a medication history a lot easier and more accurate, so there’s a hot tip for you.

Let’s try this again: do you take any medications? Yes? So what are they? Acceptable answers include:

  1. Here is a photo on my phone of all my current medications including vitamins showing the medication name and strength of the tablet/capsule clearly
  2. Here is my medication list that I keep in my wallet/handbag/toiletry bag that I bring to hospital with the name and strength of each medication and what time of day I take them
  3. Here are all of my medications in some sort of bag
  4. Here is the name of the pharmacy where I get all/most of my medications dispensed regularly

Personally? I carry a list in a plastic slip case that I got the the National Prescribing Service (NPS): it has sections for medication name, strength, amount, time of day, diseases, allergies all neatly in a double-sided fold up sheet that fits into a plastic cover; I think you can get them from NPS online.

So even if it’s one, or two, or “just” vitamins/non-prescribed medications, take the time to record them some way, some how. This isn’t just for hospital, but of course this is from my perspective working in a hospital. But I’m sure your GP, your specialists, and maybe others will make good use of your medication recording. So get going, and do me proud! I’d love to see your efforts, so send me your best!

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Dear family and friends,

Could I make one request only should I ever be admitted to hospital? Shallow though it be?

Promise me that you will band today, draw up a roster and sit by me day and night holding my lower jaw to my skull so I’m not lying there with my mouth wide open to the elements. It’s all I ask.

It is probably the one thing that gives me the heeby geebies more than ANYTHING else: a patient lying there asleep on their back with their mouth agape just waiting for anything to fall in, drying out, and the hoarse snoring that goes along with each intake of air via mouth breathing. I can take blood, poo, wee, the stench of a total absence of hygiene, disgusting stale smoke and most smelly wounds, but an open mouth gasping for air just send shudders through me. It implies a total loss of self control I guess, which is probably the scary part to me; being totally vulnerable. It’s so ick! What if a spider crawls in my mouth? What if I choke on my drool and no one notices and I die?

I know its convenient to have patient’s positioned on their back while they’re in a hospital bed (especially while in ED) so their face can be monitored, so there’s easy access to put on the blood pressure cuff or get to veins for any medication infusion or blood test, or elevate limbs but I never sleep on my back and just don’t think its natural. I’ve had this conversation a few times when we were buying a mattress. Apparently you’re “supposed” to sleep on your back, and some insisted I lie on my back to test the mattresses, even though I would never again sleep like that again. Well that’s nice, but walking around the wards and glancing into rooms as I go I can tell you there’s nothing natural about patients lying there gaping! It pains me on their behalf.

So if you could just help me with this one, I’d be very grateful. End of shallow request. Thank you, and goodnight.

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I do love me an obscure heading but this one defines itself pretty quickly.

A recap: I started this job, as you know, in a casual position working in the dispensary at Epworth Richmond way back on August 30th 2017. Can you believe that it’s been 5 and a bit months that I’ve been here? It’s an absolutely essential role, yes, but one that I would be happy not to have to fill very much ever again for the remainder of my career. I don’t have anything against working in the dispensary, but I’ve been a clinical pharmacist on the wards since 2010, and being back in the dispensary had me feeling a bit boxed in! In fact I’ve been a clinical pharmacist in heart since my first hospital placement at the Austin hospital with the wonderful Grace in 2008, but that’s kind of beside the point, I guess. I loved working in the dispensary for the social side; there are some great people working dispensary. One of the things I never expected I’d miss when I left work was the social side of it, always having been a pretty independent worker. But you miss the chit chat when you’re home alone all day! I’m afraid its made me a bit of a chatter box now, and probably one of those annoying sharers of inane stories, but I’m just excited to be having a conversation with someone other than myself. This is ironic to myself because of one such annoying girl that I used to hardly be able to stand back in the day; full circle, around we come!

So I jumped, almost literally jumped, at the chance to switch lanes back to a clinical role in the emergency department when I heard about an opportunity. I interviewed for the spot on September 13th and started working with my new boss (love her!!) on the 25th. Going part time rather than purely casual was definitely a bonus, but I kept the casual position going since the part time gig is only 19 hours per week. I say only, at the beginning that was as much as I wanted, and putting on one other shift was all I could imagine. I’ve done several casual dispensary shifts in the months following at Richmond, and now also at Epworth Eastern (Box Hill) for some diversity, and because it takes 5 minutes walk to get there! It’s good money, being casual, especially if they’re shorter shifts that don’t take as much out of me physically, but I’ve learnt not to take on 2 days in a row standing up, or accept the dreaded 5 to 10pm dispensary shift at Richmond because all catastrophe breaks loose after 9pm! I don’t know what happens to hospital workers after dark, but it’s not good. Everyone gives you attitude, demands the impossible, gives you grief over everything, sends you ridiculous requests and it’s just generally chaotic. Plus the 5 to 10pm shift is usually paired with an 8am start next day and two of those combo shifts were enough! For most people its no big deal, but I can’t hack that turn around, I can’t handle my sleep being messed with; it’s just not worth it. Goodbye 10pm finishes, goodbye stand-all-day shifts day after day. That’s the beauty of being casual, you pick and choose whatever shifts work for you, so I keep being told. It’s taken me a good long while to get this through my head. I’m much more of the accepting-all-requests personality. But in the end, if it wears you down, if it affects your sleep, or your health then you have to make the tough call and say no, however much your personality yells, just this once, it’ll be okay, just say yes. I’m still bad at it, I’m always tempted to accept more than I know I should when that voice is asking me down the phone…but I have to remind myself to look after me first. The selfish choice, the reserve-your-super-powers-for-another-day choice. It’s hard to explain, its hard to do but you just have to.

Ever since I’ve been returning to work after that whole breakdown thing (Box Hill public hospital, Priceline Boronia and now at Epworth private), being on my feet has been the major rate-limiting step of each and every day. I keep hoping its going away, but its not. The old plantar fasciitis in my right heel just keeps on shooting up through my heel; the extra 40 kilograms I’m carrying is weighing down through my ankles contributing to the general ache I guess, I cannot seem to pick a good pair of work shoes to save myself it so heel blisters come and go and come and go, and getting a pair of sockettes that don’t fall down or bunch or cut in at the seams is another nightmare, and so we go on day to day, seeing if I can survive the amount of standing and walking that the day demands.  Sometimes I really barely can get those last steps to home, and I mean this literally. Stumbling up the drive in pain with blisters roaring, heel stabbing, desperate to get off my feet and get them legs horizontal! On standing-all-day days, my main strategy is shifting from foot to foot, walking whenever I can including extra “toilet” breaks, and more to the point, sitting at every single possible imaginable opportunity, sometimes ludicrously. All while trying to ensure no one realises what’s going on, because, like, you wouldn’t want to anyone to think you were weak, would you?!? Wretched pride. I’ll happily divulge my mental illness once I’ve known someone a short while, but pity help them finding out I can’t do the job physically! Sheesh, what a weirdo!! So I grit and grit and take every break I can squeeze and push on, but I do not relish those days when I know I’ll be standing all day, which are the days I spend on dispensary duty. At this point a saying comes to mind: “push through the barriers”. It’s been said to me, but if you only knew how much I push on through every work shift, how it drains me, how I die inside a bit…, believe me, I’m pushing on. Remember when I used to lay in bed all day? I daydream some days that I’m back there, mostly when I’ve been standing at the same bench for an hour. Ah, to be lying down with my legs up!

It’s getting easier now, in one sense, and harder in another. It’s getting easier to knock back the dispensary shifts because I am now getting offered clinical shifts on the wards!! Yeah baby!! The ED thing is a dream come true, and this is pretty close behind! So now that I’ve done some training I can formally back fill and cover the medical ward and kids ward for any pharmacist’s annual leave or sick leave. And at the moment, I’m doing some filling in for my boss who is acting director of pharmacy. Yippee! More clinical work, fuller calendar, less dispensary availability…that is apart from the shifts that I agreed to before this came up, but its all good; I’ll manage them as they come and then let them be bygones.

Which brings us to 34 hours. For THE first time since I walked out on my excellent fulfilling cutting edge full time job at the Alfred in mental health crisis in March 2014, I worked almost a full pharmacy week, which is 40 hours in public hospital; it’s actually less in private hospital but this has always been the goal in my mind. I worked 34 hours the week starting Monday 15th January and I’m thrilled! In my mind it brings me full circle to where I left off, and I have to admit two things: 1) that this has been a major goal in my mind, and 2) that I really did think it would never happen again in my lifetime; that I’d never be well enough ever again. You can sense the satisfaction, surely! I did it! I got back there! I came full circle and ticked a box that I felt doomed never to achieve, and it feels really good. Of course it’s not just the hours worked. It’s the work itself: feeling like I’m back to being useful, back to being the standard of pharmacist I was then (which I’m not fully, but the point is I’m on my way), that I’m back to being a functioning member of the workforce. I don’t know why being a useful home keeper never felt enough in my mind. I think its all about feeling torn from a place and occupation I loved, and the idealisation of that place and occupation as the ultimate indicator of success in bringing this mental illness beast under control and in subjection. Of course its folly to think its ever totally in control and subjection, but I dream! My GP so wisely pointed out that I am not to be doing it to make the point; that’s not a healthy perspective, and I think I’d realised that shortly before he said it. I did it, I ticked something in my mind, but that’s it now; there’s nothing more to prove. I proved it to myself, that’s all I ever needed, so now settle back and enjoy the work and the hours for their own sake, without any pressure to meet a target that in the end is pretty meaningless really.

Do you know what I think the most powerful balm is in all of this? Every shift I work on the wards or in ED beyond my part time hours, is filling in for someone either on leave or pulled somewhere else. I’m filling a role that were I not there, would not be filled. Excuse the false terminology but its the hero complex; the idea that were I not there, things would be worse, so I’m being so very useful. That can’t help but stroke the ego and I’m as vain as the next person, I suppose. Because I got out of bed and went to work instead of the opposite, I can do some good for a patient; it’s a powerful motivator on the reluctant mornings.

Anyway, here’s what I’ve been up to lately:

  • Week starting 15th Jan: 34 hours being my usual 19 hours plus 2 full day shifts, one shadowing the pharmacist rostered to the medical and paediatric wards, and one working side by side
  • Week starting 22nd Jan: 22.5 hours being my usual Monday only (1 public holiday Friday and 1 annual leave Saturday), and 2 full day extra shifts working the medical/paediatric wards
  • Week starting 29th Jan: 29 hours being my usual 19 hours plus 2 half day extra shifts in ED
  • Week starting 5th Feb: 31.5 hours being my usual 19 hours plus 1 extra full shift in ED and medical/paediatric combined, and 1 extra half shift in medical/paediatric
  • Week starting 12th Feb: 32.5 hours being my usual 19 hours plus 1 full day and 1 part day in the Epworth Eastern dispensary

I can hardly believe the numbers myself but they don’t lie. As for how it went, it’s taken me too many words and too much time getting this far, so the how can wait for the next edition. See you then!

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This is from yesterday morning.

Sometimes you just need a dose of good to top up those easily depleted stores.

One of my main happy places when I’m doing better is anywhere that I can find and photograph birds. By the way, when I run my regular scan of “how am I going?”, and I run this scan very regularly, me getting up at 7am on a sleep-in morning to go birding is right up there as proof of going well. Although in the spirit of full disclosure, I should admit to going back to bed for an hour’s sleep when I got back home at 9.30am, sneaking in a nap just before it was time to go to work.

So here’s this morning’s dose of happy:

Nothing fancy. A Rainbow Lorikeet reaching for a better branch. But it made me smile. I hope you like it too.

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