Another day, another dollar

Yep, the stories go on and on. I’ll amuse myself telling tales and when you get sick of them, let me know ūüôā

The person in this story isn’t a patient, although they seem to feel themselves at home in our hospital. Confidentiality isn’t really an issue here so using his name doesn’t concern me; although his surname, which would be more useful, is unknown. What fascinates me about this man is his brazenness! Not a word often used but totally applicable in this case. Bold, no shame, confident, aggressive, a real pain in the butt might be other terms equally suited. This man came up at our staff meeting today. This is a very rare occurrence; an individual being named in a staff meeting. Actually I don’t think it’s happened more than once before, and then for a very regular patient having treatments all over the hospital with the aim of improving provision of services.

So, why? Turns out this guy has been harassing staff all over the hospital. I’d been around once on night shift when he came into our retail pharmacy (out the front of the hospital dispensary) and it wasn’t pleasant. Staff reported he was swearing at and abusing pharmacy assistants and pharmacists alike including racial abuse to our gorgeous Asian pharmacist, and extremely inappropriate abuse to all of the women. Then he was tampering with products indicating no intention to buy (that’s the high brow description, attempting to steal is the other version) and generally being a big nuisance. They had to dedicate a staff member just to watch him, and when he saw that he got more aggressive and started on the poor unfortunate girl watching, then the pregnant pharmacy assistant. At which point the girls naturally wanted a fella out the front to try to get this guy out, but I think the guy they dragged out from the dispensary was more terrified than they were! At which point I found out that I don’t actually know how to call for security! No one has ever showed me! Dulp! In the end he took himself off, but since then its become a semi-regular occurrence that he comes in and makes a scene, so now in staff meeting we’re informed that not only have the police been involved with this drug-using, homeless guy in these subsequent incidents, but he is now officially banned from the pharmacy!

But wait…there’s more! Concurrent to these incidents, but not knowing it was the same person, I’d been made aware of a man who had walked right in the door of ED, straight into the patients toilets, and preceding to shoot up whatever drugs it was that he had on him at the time! He was interrupted with a needle in his vein and had to be dragged out and kicked out the door by police!! So there was a general alert put out: if you see this man, alert security and the police and don’t approach him directly; drug users are notorious for using syringes, clean or otherwise, used or otherwise as weapons, which ends badly. FYI this is the reason why its strongly recommended that all pharmacists are vaccinated against hepatitis A and B. It may be overkill but better safe than sorry if a pharmacy hold-up goes south. Next day? Back again, now in the ridiculous comic “disguise” of a sombrero and aviators!! Seriously dude? Where are you going with this? Luckily the triage nurse recognised him, called out his name and told him she’d call the police, so he did a cool, calm and collected about-face and sauntered on out again! Too bad he hasn’t been banned from the hospital, too bad for us I mean, but I guess hospitals can’t really ban folks, something about ethics I guess.

Next? A man, unknowingly the same man, now onto trick number 3 walks through the main entrance of the hospital, catches the lift up to the 5th level, walks into a patient room, into the bathroom, and has a shower!! Yes, he helps himself to a shower, then, wait for it…he tucks himself into bed!!! I’m still boggled at the nerve of someone to walk into a hospital like you belong, and just make yourself completely at home where you aren’t meant to be! So once again, police. They must get wretched tired of this gig!

So, now that everyone has finally come onto the same page (reminder of the importance of informing up the line about incidents) what is the sum decision? Banned from our pharmacy, alerts out for ED and the ward, and a letter sent to his home about the above. But hold the phone, isn’t he homeless? Where exactly did that letter go to…? So, he’ll know about this how? And next time he comes in? Well still call the police, and since he’s been “given” a warning, they can act further. Actually it turns out that the police are currently frustrated because a judge stuffed up a bail issue with this guy; he’s meant to be in jail not roaming around being an idiot. But I guess that’s another story.

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Work work work work work work

I love my job. Really love it. I think it must show because since I started working in the emergency department (ED) a few patients have commented to me that they can tell I love my job when I’ve been talking to them about different things. It has caught me off guard but on reflection I’d have to say, yep, its true, I do love my job. I just didn’t know it was showing so much.

It’s hard to define exactly what makes me love my job, but I think a lot of it is the nature of people and interacting with different backgrounds, beliefs, natures, religions, personalities and so on.

Like this tiny, feisty, skin-and-bones 80 year old never-had-kids-now-a-widow who fell over in her house yesterday when her left leg collapsed and was on the floor for 14 hours before her friend came over to her house and found her; lucky chance, that! What did she think about a personal alarm? Oh no, she didn’t want one of those, all they do is contact your next of kin or the emergency services, what’s the point??? Uuuummmm…that would be exactly the point, so next time you aren’t on the floor so long that your muscles start to break down! Did she have a power of attorney? No, she didn’t trust anyone enough! Did she take any medications? No (emphatically no!), and “if anyone tried to give her any she put up an argument”!! Fair enough, Gretel!! Obviously you’re going to do what you want how you want when you want. Now tell us exactly how you’re going to go home with a broken arm, muscle breakdown and severe bruising, and how you’re going to dress and feed yourself…you old battleaxe you!

I get it, it sucks to be older and have a failing body and maybe mind. I’m sure I would be clinging to whatever measure of control I had remaining. But protesting for the sake of protesting…what merit is there really? I often see this battle about giving up living at home, or a driver’s licence, and its fair enough to a point. I guess its just not exactly clear at what point to surrender with grace, necessarily. Speaking for myself.

Next patient? Gorgeous, perfectly coiffed 94 year old lady (in every sense of the word) who could pass for 80, or even younger probably; in fact she reminds me strongly of a family friend about 80. And she graciously attributes it all to modern medicine and the medications that she takes religiously exactly as her doctor prescribes them! Ah, music to my ears.

And next? A 29 year old girl with a brain tumour hoping on a trial drug suffering shocking side effects from medications prescribed for conditions she no longer has/never really needed treatment for in the beginning, and never reviewed. Suffering the effects of too many doctor’s fingers in the pie of her health, and no one doctor wanting to take responsibility for all of it at once, here is someone with a real case for complaining. Unable to say what a microwave or apple is although she “felt like they were really familiar, and she should know what it was”. Disorientated in her own house, not sure where she is or where she’s meant to be. Sedated and sleeping the day away, every day. Clumsy, unsteady gait, struggling to form words, relying on family to tell her what she’s been doing all day because she’s not sure, unable to leave the house in case she can’t find her way back. Pretty bad, huh!! But she was pretty accepting of the whole thing, just waiting it out patiently. Luckily she had a mother who didn’t take things lying down, but strongly advocated for her. The only problem with having such a strong voice on your side is a lot of doctors find it “challenging” and respond poorly. It shouldn’t be like that, but…

…so although I carefully, painstakingly formed a safe, detailed plan with her and her family of how to stop some of her more problematic medication (some of which had already been started by weaning doses of some medications) without creating new problems, we struck another case of a doctor not wanting to take on the full patient situation, just wanting to treat the precise reason for coming to ED and refer everything else back to her other doctors. This is actually a reasonable approach and I get it, but it would have been nice to have made things easier for the patient right then and there. At least the patient and family took on board everything we discussed and will put that into place when they get home. A bit disappointing that we couldn’t sort it out right then and there, having the opportunity to make a real, big difference to someone’s quality of life isn’t something that’s easy to pass up, especially for a cancer patient with a lot going on. But I do understand that if the ED doctor’s delved into a patient’s other issues every time they came to ED, the whole system would grind to a halt. That’s just one of life’s conundrums.

So this is a fascination with me. One patient refuses any intervention on principle, one gratefully and faithfully takes on any direction, and one just takes being mismanaged and goes with it. People, huh? Aren’t we so weird??

Work tales

Well I’m months behind in this again, but here we go.

I love my job. Really love it. Working as a clinical pharmacist in a hospital really ticks all the boxes of what I want to achieve professionally, and to some degree personally.

Throughout my illness, work has always been something that I aimed to return to, and for someone with no motivation, that little motivation was something to take seriously.

So getting back to any job was a boon, getting back inside a hospital on official terms was exciting, and returning to work in the emergency department was beyond awesome!! I’m very happy, and there are some opportunities coming up that could be thrilling so hopefully things are going to stay on the up and up.

But you know what a return to the emergency department, hereafter the ED, means, don’t you? Stories! Of course I do not violate confidentiality. You will not ever learn names, dates, ages, addresses, significant medical details etcetera. But there are some adventures that must be shared for posterity’s sake.

Like, for instance, the case of the the missing front plate.

When you walk into a cubicle and find a guy with four missing front teeth, you don’t expect him to be…well…old! Right?¬†Or am I ageist, or whatever they call discriminating against people by their age? I just figure that fist fighting and knocking out teeth is more of a teens/twenties/thirties-if-you-really-still-haven’t-grown-up thing, right? Not so much a mid-70 year old. Anyway, a man missing 4 front teeth. Turns out¬†the teeth were the reason that he had come into hospital. He tipped out his morning medications into his palm as usual, got a glass of water ready, threw the pills into his mouth as usual and swallowed them down with the help of the water as usual. What was not usual is that he hit his front plate with the palm/side of his hand as the medications went in and swallowed that down too! I’m not talking he choked on his 4 teeth attached to a metal bracket and coughed them up, and I’m not talking he retched on them and vomited them up…I’m talking swallowed them down past his choke reflex, past his gag reflex, then through his oesophageal sphincter and past this into his oesophagus where they got lodged!! The sphincter and oesophagus by the way are very small – have you ever swallowed too big a piece of meat through your sphincter and down your oesophagus? Painful! I don’t actually even know how the teeth were physically able to happen down through the sphincter! The surgeon was very nervous about the idea of the plate having already perforated the oesophagus. Either way, perforated or not, that oesophagus had to be opened up to get the plate out, and I understand the surgeon’s nerves about that; contents of the digestive system should not be mixed with the rest of abdomen: strong acid, bacteria, half digested matter are meant to be contained and infection was a real risk. But let’s not lose the punchline of the story in the details: the guy swallowed his teeth right down into his oesophagus!!

Well that’s just one to keep you going. There’ll be more, don’t worry about that! But I wanted to send a little something your way to say thank you for reading, sorry it’s been so long, I’ll once again try to keep it a bit more regular this time, and chat soon!