The big return

I had planned to make a big announcement about my new job when I started, just before my first official shift, but anyone who reads my blog regularly already knows about me starting work because I told you recently because of a blunder, and, well, anyone else just found out! So no announcement. Just a reminder really that I am OFFICIALLY starting my new job on Saturday 29th April, 2017.

My official pharmacist coat, the first time I’ve gotten to wear the traditional garb; my keys to EVERYTHING; a pink, personalised name badge; pocket with a pen holder, and I’m ready to go!

It’s not such a big thing, really, as I’ve already done 8 shifts over the last few weeks. Wow, eight shifts already! That crept up on me. Five of them were half days, but still; it’s work! I was really thankful that my new boss was as keen as I was for me to get in several practice shifts before I started, and it has helped me to feel comfortable and confident heading into my first shift. It has given me a chance for reacquaint myself with the FRED dispensing program, although pretty much nothing has changed since I last used it in 2009! It’s such an easy to use program compared to the 2 hospital pharmacy programs that I’ve used over the last 7 years, and nearly all of the scripts scan in; no typing involved! So cool! I’m still in love with this function!!

My name up in official pharmacy lights!

It’s given me the opportunity to learn the “order” of how drugs are arranged in the pharmacy. This is one of those words that means the opposite of what you would think…oxymoron? I think that’s the word. See whereas hospitals organise their medications sensibly by the drug name (generic name) in alphabetical order, community pharmacies have ridiculous systems, and no one, including those that work there, really know why they have such a dysfunctional “system”, and the system is different in every pharmacy.

In this pharmacy, originally drugs/medications were ordered A to Z by brand name, instead of generic drug name. Fair enough. Back when, before additional brand names and generic brand names, there was one brand name for each drug and everyone knew the brand name for each drug. Drugs were marketed by brand names and that’s mostly what they were referred to as by medical staff. So this system worked as an actual system.

Here’s that dispensary I’ve been telling you about

Then drugs started going ‘off patent’. This meant that other drug companies were allowed to come along after and use the generic drug that the original drug company had committed 10 to 15 years of research and development to, make their own formulation and sell it. Not having to spend any of that time in R & D, and just having to more or less copy what the first company has done means the new version, or “the generic” can be vastly cheaper! Their version has to be approved by the Australian Government as working in the same way, having the same drug and dosage, and having equivalent efficacy when compared to the original brand, and once this process is complete, the drug gets on the PBS like the original and off we go.

So we got the first batch of second brand names, that were still actually names. Like instead of Noten, we got Tenormin. So now we had two brand names; that was manageable. And then generics went bananas!! They stopped bothering with brand names and just wanted to spruick their company name. So instead of usable names like Noten and Tenormin that were brand names for atenolol, we got drug company names attached to the generic name like APO-atenolol, Terry White-atenolol, Chemmart-atenolol, atenolol-Amneal, atenolol-Sandoz and so on and so forth! You get the never-ending gist. A quick look online tells me that atenolol is available in 15 different brands in Australia.* In America it’s gone much more ridiculous with 143 companies making atenolol generics, and 289 brand names, all slight versions of the one before!!**

How is this relevant to me working in the dispensary? The dispensary is organised by brand name. Then the generic brand comes along and it gets its own slot. Noten is under N, Tenormin is under T. All is well. Then the company name generics come in. Our store has a deal with APO generics so where available we buy the APO generic. But it doesn’t make sense to put every generic in the A for APO section! So the generics get put away by the generic name. Atenolol still ends up in A, but APO-escitalopram goes in E and etc. Except sometimes you go to find APO-hydroxocobalamin and it’s not in H. You ask someone where you might find it and they go straight to N. You ask why, and the answer is: the original brand name was Neo-B12. Yes, that is true, but…”yeah we should move it, we should do that, we’ll do that”. But that was half the point of getting in a few shifts before the real thing, to work out some of these quirks. Another thing: in an effort to be helpful, someone decided that the top 20 most dispensed drugs should be moved out of order to the front of the stands for easy access. Sounds sort of reasonable, but its kind of annoying to go the S and remember, no, its not here, its in the section that I’ve already walked past! But hey, I’ve been able to yammer on about it this much so some of it must have sunk in.

So this shift on Saturday is my first shift “alone” as the “only” pharmacist in the pharmacy; definitely ideal for me. I say those things in talking marks because there will actually be another pharmacist out in the back room working on our supply of medications to 18 nursing homes at all times while I’m out front; another one of the ideal things about this position. So I will never be without a second opinion or some advice or instruction on how to do something that hasn’t cropped up so far, and that sounds great by me! Not that I’ll need it necessarily, but popping out the back to ask someone a quick question is much less full on than having to call the boss on a Saturday!

*http://www.nps.org.au/medicines/heart-blood-and-blood-vessels/beta-blocker-medicines/atenolol

**http://www.medindia.net/drug-price/atenolol.htm

Revolt

*WARNING (and spoiler alert): contains self-induced vomiting*

12th April, 2017

From one drama to the next! Honestly! Did I learn nothing from yesterday? The whole phone thing? Nothing about being careful and deliberate in my actions?

See, I have this system. Yeah right! A system is useless unless you stick to the system. Which I mostly do, but mostly isn’t really enough when there’s a system involved. You stick to the system, or you don’t.

This system involves my medications. I’ve probably been over this but I have a nice purple medicine box with 4 rows. One row for my morning tablets, one empty row, one row of 3 valproate tablets for each night still in their original foil because they go smooshy when exposed to air, and the final row for the rest of my night tablets. The valproate for the evening doesn’t fit with the other tablets, hence its own row, but the morning single valproate tablet fits it, hence the empty row. I have carefully marked the morning tablets, and the night tablets so that I can’t get confused. Plus there’s the fact that I unwrap one valproate tablet in the morning and three valproate tablets in the evening. The morning row has red and pink capsules of venlafaxine and 3 little white tablets; the evening row has a dark red iron tablet, a little pink cholesterol reducing tablet, and three chunky quetiapine tablets, apart from the lithium that is in both morning and evening. They are different, the morning and the night tablets; clearly distinguishable. They are not the same. If you take the time to notice, which I periodically don’t! Theoretically, I check all the tablets lying in my palm, to make sure every one is present and accounted for before swallowing them down. I have a list written on the back of the box telling me exactly what should and shouldn’t be there, for reference. But I’ve been on this same combination of tablets for well over 6 months now, and I’m very careful when I pack the box, supposed to be anyway, so sometimes I just pop the tablets and scull them down, get it over with!

Like yesterday. Before I knew what I was doing I had opened 3 valproate tablets, shaken out the dark red and pink tablets, noticed subconsciously the big chunky tablets, and sculled the lot! Even though it should have been obvious that I was taking the wrong tablets: wrong compartment, wrong colours, wrong amount. It took about 20 seconds to get that same shot through the gut as I had yesterday when I realised that I’d lost my phone. I knew then, consciously, that I’d really stuffed this one up!! It has happened before, once I think, but seriously! What was I thinking? And here’s the thing, I wasn’t. I was on auto pilot, distracted and that’s how it all blows up in your face. What’s the big deal? Those 3 valproate tablets, plus the 3 quetiapine tablets, they’s the big deal. They are basically my sleeping tablets, and here I’ve taken them 10 o’clock in the morning! They aren’t actually prescribed for sleeping, they are mood stabilisers but this is their major side effect. Any other day I’d just resign myself to going back to bed and sleeping them off, but not today.

Because there’s something else that I haven’t told you. I’ve got a job!!

I was going to save the excitement for my official start date on 29th April, however this happened, and on the first day that I’m going in to do the official orientation and get all of my paperwork sorted! I have a 4 hour shift starting in an hour and I’ve just taken my sleeping pills by accident/carelessness!! You can see the problem here. First impressions and all that, I don’t want to call in sick for my very first shift; I’m determined to be there and on time and get this job off to a good start. I don’t want to have to go home sick part way through the shift because I can’t keep my eyes open. I definitely don’t want anyone to think I’m under the influence, or unfit for work! That would be extremely unfortunate! Not just for this job, but for my career; the pharmacy board frowns heavily on pharmacists using any substance while on duty, oddly enough. So, what to do? I think you can see where we’re going now.

The ONLY way to try to prevent the sleepy pills doing what sleepy pills do is to get them out of my stomach before they are released from my stomach to my intestines, and absorbed into my bloodstream, making their insidious way to my poor brain. The only way to get them out of my stomach is to induce vomiting!! Honestly, I cannot think of a more revolting, horrifying task to have on ones hands than this. I don’t think I have ever made myself vomit before. I recognise now how compelling a disease bulimia is to convince you that this is a way to live. To me it is extremely repugnant. But what are my options here? It took a lot of psyching myself up for it, and a couple of false starts, don’t ask me how, but we got going. Here’s the killer: I ended up throwing up my entire breakfast which I’d had an hour and a half ago, yet there wasn’t a sign of the tablets and orange juice from 10 minutes ago. Here is the cleverness of your stomach. It knows that its job is to break down food into smaller pieces so that your intestines can do their job. But there’s nothing to break down in fluids, so your stomach lets them right past. In that 10 minute period, my stomach had already released all the fluid/orange juice, and the tablets with it, and they were gone. That whole disgusting, humiliating, distressing episode, for nothing!!

What next? Well, its time to go to work. Fingers crossed that I can handle this and get through what I need to get through.

Here’s the odd things about my sleepy pills. When I first started taking them I would be dead to the world within 30 minutes, or less. Honestly, I would take them and immediately get upstairs to bed because within 10 minutes all of the muscles in my legs would be jelly and I couldn’t step up a stair if I was being chased by an axe wielding madman! My arms would be equally useless. A couple of times I got into bed and then needed to go to the toilet. I would bounce off the wall, my bed, the dresser, my bed, the wardrobe, the bedroom door, the bathroom door and back again! I’m sure it looked completely hilarious from my husband’s point of view but I couldn’t even see straight, let alone have control of my legs. My eyes would go evil vampire red because of how much the medicine dried them out. Basically I was gone for the night. And I got the best sleep! I was drugged out really. And of course as my dose went up the effect continued.

But over time, as the dose has steadied out, I’ve become more tolerant. I don’t get that drugged out feeling now, and I can stay up sometimes for a couple of hours after taking my night tablets. On occasion it does make me drowsy enough to start blinking heavily, struggling a bit to keep my eyes open, but if I really want to I can keep them open; it doesn’t overpower me like it did before. It still helps to give me a good nights sleep, and without it I sleep pretty lightly and spasmodically. As I experienced last night, because after taking my night dose in the morning, I had to take my morning dose of valproate at night to keep the balance, and one tablet isn’t enough to sedate me; plus I had no quetiapine in my system.

So, I took the wrong dose, and didn’t manage to catch it before it got into my system. And now I have to go to work. Well this should be fun! Here’s hoping I can fight the effects for more than a couple of hours.

Okay, next strategy: a large Coke, no ice from Maccas. Hopefully the caffeine will do something!! I drove all the way to work (I was questioning whether that was a great plan, but I felt fine at this stage) feeling okay, until the last 5 minutes when that warm, fuzzy, about to go to bed for the night feeling settled in. I got a little lightheaded on standing, slightly dizzy if I turned my head quickly, and just plain drowsy. My eyes wanted to shut and go to sleep, my thoughts got a bit thicker, I was trying not to speak slower. I hope to goodness I managed to pull off looking as enthusiastic and committed as I wanted to. But there was a big challenge waiting for me. Most of the 4 hour shift involved sitting at a bench reading policies and procedures and signing off on them, and doing orientation quizzes on the computer!! I mean, seriously! Of all the days in the world, I really needed a stimulating day today, and I got reading of less than riveting material!! I think I pulled it off, I mean I got it all done, but I have no way of knowing whether I was doing it way slower than usual, a bit slower than usual, or how many micro sleeps I had sitting there at that bench! Luckily the chair was very uncomfortable so that keep a bit of an edge on my alertness, and after 2 hours when my supervisor went for lunch, I went out and got an iced coffee with plenty of sugar! I think that did help a bit to keep me going for another couple of hours! Plus the fresh air was good.

Yikes!! What a day! But I did survive, somehow, by some miracle, and I’m going back on Tuesday after the Easter break. To be continued.

Did I come home and go straight to bed? Yep, you betcha! A couple of hours sleep did wonders. Usually I can go straight back to sleep at night after an afternoon sleep because of my night tablets so I did struggle a bit getting to, and staying asleep without them. But I didn’t struggle catastrophically. I think I actually had a pretty good night’s sleep in the end, although I was awake from 5am on the dot this morning, Thursday 13th April.

I can’t double up once I’ve taken the tablets, even if they were the wrong tablets. So what’s the plan to get back on track from here? Most of my tablets can only be take once in 24 hours meaning I can’t take night tablets again today. So I’ll take my morning ones tonight, then my morning ones in the morning (the morning doses are smaller so it won’t be such a big deal taking them back to back) and my night ones tomorrow night; then I’ll be back on track. Until then I’m sniffing my head off because of the longer gap in between doses of quetiapine, from morning one day to evening the next. It usually dries me out so sniffing is unusual and annoying! Apart from that, and the obvious drowsiness there shouldn’t be any consequences from stuffing this up, luckily. When you take the same medication all the time, a one off dose mix up doesn’t tend to affect your overall medication levels enough for issues to arise.

And here it is 7am and I’ve written this blog and I’m ready for breakfast, bright and early. I could possibly be very productive without those night tablets, but it wouldn’t be worth it for my mood. Ah the catch 22’s in mental health treatment! 

So, have I learnt my lesson in being more careful? I’d like to hope so, but I find the lesson only lasts as long as my memory of it, and that’s a whole other story!

Downer

When  you suffer with anxiety or depression in any of their various forms, it doesn’t take much to get you down. In fact it takes a lot to keep you up!

I find this with a million stupid little things that turn a perfectly good day into a gloomy do! Usually its something that I’ve done that I’m annoyed at myself for, and I just can’t let myself off the hook about it. My husband can just cruise through these things and flick them off, just like water off a ducks back, as the cliche goes; it also helps that he doesn’t seem to make dumb errors in the first place! We have a joke that he’s always right…and it’s nearly always true! But I find myself berating myself over and over inside my head, mentally abusing myself for being so idiotic, self flagellating for my mistakes and lack of memory, or of thought, or of judgement. That just can’t make for a happy day.

I spent a lot of time with a psychologist when I first got sick and one of the main points of therapy involved reframing my thoughts, and interrupting a snowballing chain of thoughts. Reframing means to look at a situation and how you usually react, and try to consciously change your reaction to it so that you put yourself through less stress and hurt, and therefore are more well mentally. Interrupting a snowballing thought process means recognising when you’re starting down a line of negative thinking that is escalating to the dramatic and trying to stop it early, while its something that can be dealt with, before you’re almost to the point of a panic attack. I spent a lot of time working on this, and when you consciously and deliberately look at your thoughts, you do recognise a lot earlier where you can intervene and save yourself a lot of drama! Having said that, it does take a lot of energy to do this at the beginning. It gets to take a little less effort as you get more used to it, and you have less of these thoughts because of dealing with them in a better way. Eventually its more of a habit, but as soon as you think to yourself that you do it automatically and don’t need to put so much effort in, it can creep back in.

It is almost indispensable to have another person around who understands the work that you are trying to do with your head, and who can remind you what to do when you’re working yourself (unintentionally) into a bit of a tizzy! Someone who can remind you to breathe, that the drastic thoughts you’re having are just that: drastic thoughts; and of the techniques that you’ve learnt. I say it all the time but I have the utmost admiration for people on their own dealing with their beast. Kudos, and I don’t know how you do it!

Today started out as a great day. I had a good ride with my Wheel Women. We rode from Docklands to the pink lake in Westgate Park and back, and I had a superb raspberry jam donut (apparently it’s a “bombolini” according to this bakery) to top it off! I also had one of those San Pellegrino chinotto flavoured sodas in lieu of my usual Coke; that was not a highlight! Tastes like medicine!

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I was planning on doing a bit of extra riding today. I had planned to ride from Hawthorn velodrome to the start point of the Wheel Women ride, and then ride back there after the finish of the ride to add in some extra ks, but a little glitch with snoozing the alarm prevented me! Sometimes that would be enough to get me down, but I smiled through that mix up. I mean, just the fact that I wanted to do extra ks is a pretty good indicator that I’m sitting well up on the scale of blue.

I got to the start almost on time, and marvelled with everyone else at how stunningly beautiful Docklands and the water looked in the unexpected sunshine and after the rain. I really expected to get a bit wet with rain today after 2 days of LOTS of rain, but we lucked out. It was beautiful through the whole ride, and we agreed we could just keep riding and riding on a day like this where it was cool so we wouldn’t overheat, dry so we didn’t get cold with wet, not windy…perfect! Shame about me not getting up on time to do the extra riding; it would have been the ideal day for it. Oh well, let’s enjoy the ride I’ve got going on right now, instead of worrying about what I’ve missed. And there is some great re-framing and preventing of snowballing thoughts! And so the ride was just lovely!

And then, the error. The trigger.

Stupidly (it’s always stupidly by the way) I put my phone on the roof of my car.

I know!

Always a first. And last. Then some other first. Or another first if I just haven’t learnt my lesson. And so on.

3 blocks down the road from my car park, I went to put my phone in the holder and an adrenaline shot went right through my gut! I instantly KNEW what I’d done! On the bonus side, I’d been creeping along slowly since leaving the car park, hadn’t cracked 40kmph, maybe not even 30kmph…maybe it was still on the roof?!?

No!

Dulp!!

So back I go to re trace my wheels. I couldn’t get there fast enough; itching at every red light and pedestrian crossing until I got back to where I had been parked. There was a ute there now, so I got out and checked under it for my phone, once, twice etc. Then I carefully drove even slower where I’d driven already, retracing, scanning the street and gutters, wishing, hoping and more.

And back around again, and a third time! Nothing!! ARGH!!

And that’s how it starts. The adrenaline shot depletes a bit of your good mood, the persistent bad results of looking and not finding get you down more, knowing this is all your stupid fault hacks away at your confidence and suddenly you’re berating yourself and the day is not the same day it was before. It’s plummeting down through the levels of good into mediocre and before you know it, it’s not a good day anymore.

Although lately, I’ve been well, and more resilient. I knew this about myself, but this incident proved it without doubt.

I was SO bummed out over this stupid accident which should never have happened in the first place! How could I have been so thick as to put my phone on the roof?? I knew it was a bad idea, and I did it anyway. Who does that?? Typical! I make a rule, and I break my own rule, and of COURSE this is what happens! It’s okay to put the keys on the roof, because you can’t leave without them. But your phone? Idiot!

This is how my thinking goes, left to its own devices. Berating, accusing, bullying, incredulous of myself, throwing insults.

This is where the challenge lies. Putting my psychologist’s knowledge into practice in this moment and not letting the snowballing of negative thoughts get off to a head start. Re-framing the thoughts: instead of calling myself an idiot and stupid and dumb, realise that accidents happen (even if it’s often and always to me!) and this was just that, an accident, and give yourself a break!

So, having proved that my phone cannot be found and doesn’t seem to be anywhere that it should be, I head home. On the way I think of half a dozen reasons why having my phone right now would be so good: to find out the best route home, to take a photo of the city shining in the sun, to pop a starter note for this blog into my notes section, to check my calendar for what else I’m meant to be doing today, to use the Optus app to put my phone plan on hold, to call my hubby and let him know about my phone!! It really is my right hand and its going to be a bit painful without it. Stupid, stup…no, we agreed: not stupid; unfortunate. Accidental. Breathe.

But then, halfway through sliding down the blue scale into the depths, I slowed up and stopped. I stopped. That hasn’t really happened before. And it wasn’t like I put a heap of work into it, into stopping my thoughts. But my head is just in a better place lately, and this didn’t seem to be as big of a deal as similar events have been before, where I could wrap myself in guilt and grief for a whole day. Now I was stopped somewhere around the “okay” mark, still realising the inconvenience and bother I’d caused myself, but not fatalistic like many times before. What is this new feeling? Is this being well? Could it be?

I got home and flicked a message off to hubby about being out of phone contact. Then got out one of my comforters and I was pleasantly surprised that before long I was smiling and feeling quite serene about the whole thing! What is this? It was still annoying etc but it didn’t feel like it was taking up my whole world with distraught stress but like it was just one part of the picture. I like this feeling!

I believe that this is how you know you’re well. You can recover from events that happen, instead of collapsing into various levels of despair and misery. I’m not sure how this state came about, but I feel like the chemicals in my brain are finally aligned and things are just easier. It’s very exciting!! To say the least.

As to what happened with my phone? Hubby told me all the things I could do and so I went through Google’s ‘find my phone’ function online (just search for it) and I used that to lock my phone, to put a message on the lock screen to say please return my phone and to give the number to call, and to track my phone. I have to say that was the most satisfying and frustrating part, watching someone driving my phone along. It travelled the Bass Hwy towards Phillip Island via the koala park, and then stopping at the Nobbies, and I was unable to do a single thing about it!! But it was awesome to be able to watch them in the first place. I made a full report to the police and they were very helpful. But then my husband got a phone call from the person who picked it up: turns out they were a coach driver who found the phone in Docklands super close to where I’d driven past, and they planned to bring it back the next day! How kind and honest! So all’s well that ends well in the end. My husband biked from his work into the city in his lunchtime to pick up the phone, and everything is as it should be once again.

Lessons to be learned:

  1. Do NOT put your mobile phone on the roof of your car in any circumstances!
  2. Do leave your GPS function on so that you can track your phone if you ever lose it, it was accurate down to 6 metres at one point
  3. Do be aware of Google’s find your phone functions
  4. Ideally always have your screen locked, but know that you can lock it remotely in an emergency
  5. One day, after so much pain, stress, medication, therapy and time, you will be well again. Believe.