Thursdays

I’ve been wanting to fill you in on my new job, and I’m finally getting to it. I’m enjoying being back at work: the social side of it, chatting to patients (sorry: customers!) and staff; using my brain in a critical way not just considering what to eat for the next meal; and earning a pay check is not a bad thing either! Especially since we’ve started to think about buying a house for ourselves, and I just found out from a broker that banks don’t accept income from insurance companies in their calculations!! Which means before this job my effective income to a bank for house buying purposes was zero!! Ouch! Now its more than zero from this job; not by much, but hey, the little things have to be appreciated. It just might take a bit longer for that goal to eventuate. It’s a bit sucky to be penalised for being sick though, and unfair to Chester. But putting that aside, I thought I’d do a bit of show and tell about my regular Thursday shift.

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The medications, and my initials and the date after checking each and every last one!

On Thursdays I check Webster packs. Most people look at me blankly when I say that. I keep forgetting that its really only a sentence that makes sense to healthcare professionals or people who have a Webster pack. Even in the last case, the concept of checking a Webster pack still might not be evident. So let me explain.

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I love how the the colours sometimes work out so well! Something to amuse myself with

When I walk in on Thursday morning, I make my way through the pharmacy shop, through the dispensary to the “checking tables” in a corner in the room behind the dispensary. Someone else more involved in making the packs will have printed out lists for several nursing homes with their patient’s names printed alphabetically. This is basically my to-do list for the day. I don’t know which list get printed on which days, or what order they go in, or how it’s all decided; I leave that alone. I just pick up the top list and head out into yet another room. On a shelf “out the back” (an enormous shed-sized room behind the room behind the dispensary) will be a box or two of dose administration aids (DAAs) sorted alphabetically for each nursing home. I mostly call DAAs Webster Paks because that was the original patented name, or the most well known name anyway, but there are other brand names so you might hear them called by: Medico Paks, Sure Paks, others. It’s a cardboard manilla-type folder (but sturdier) with holes cut out for a plastic insert to fit that collects the patient’s medications in the appropriate amount at the correct time slot and then is sealed with an aluminium backing and heat, usually an iron. Yep just your regular everyday iron will do the trick! Don’t forget to turn it off before you go home!

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I appreciate a mix of colours in a Webster pack: all white tablets makes it hard to check!!

This is not the type of plastic box with clip shut lids that you purchase in a pharmacy; that’s called a dosette box. We’re dealing with a more disposable option.

So, at the start of the day I grab the top nursing home list, find the matching box, and the start checking. How fast I’m meant to go, how many packs I’m meant to check per unit of time, whether I’m on schedule or not are among many other things that I don’t know and haven’t yet had explained to me about this pack checking business; maybe some day I’ll understand how and why!

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A different view showing the day to take the medications

So here is the box as it comes off the shelf. Obviously I’ve ensure patient privacy so there are no names or faces. You can see that there are a lot of packs per box, and usually between 1 and 3 boxes per nursing home, or section of the nursing home; some are very large!! So you can see the cardboard “folder” with a front flat cardboard flap, a square spine and then a cut out back piece ready for the plastic insert to fit into the holes. There are four times of day that medications can be given in a standard pack, but we can be quite flexible for example with Parkinson’s patients who need more frequent doses at more times across the day. Medications are filled into the plastic insert while its laying flat then immediately sealed with heat to ensure the medication’s integrity.

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The box

On the left is a pack as it looks when you open up the folder and lay it flat. The foil does make it challenging to check sometimes with the light reflecting into your eyes at certain angles. On the right side of this photo is the checking list, names not included but room number, how many packs the patient has, and over by their name is a section that I sign to say that I have checked the pack and it is accurate to what is prescribed. No more, no less.

 

What I’d LIKE my signature to mean is that I’ve reviewed the dose, the duration, the reason for taking it, the frequency that its taken, whether it interacts with anything else, whether it fits current guidelines, whether its still needed…but I dream! Not my job, not my place. Too thorough, says my boss. So stick to the script, and you’ll be thanked by your workplace, even if your inner pharmacist is dying inside!! Melodrama much! I’d so love to be the review pharmacist, or back in my familiar hospital setting but I’m not, so to save myself a lot of trauma and the mental anguish that is reality not agreeing with ideals, I must resign myself to checking what is actually there against what the doctor, rightly or wrongly, wants to be there and that will be that! To sooth my inner pharmacist I’m writing down issues as I go. I can’t do anything about them, but somehow noting that I’ve picked up on it makes me more peaceful. Of course I’ll never be able to do anything with it but its a token gesture.

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The list on the right, cropped for privacy, and one of the packs

Say I look at the patient in room 069 at the top of that list. They have one pack. I get their pack out of the box, and then I check it…hence the “checking” table. It’s terribly inventive! To check it, I need to look at the other side of the pack. The pack comes like a manilla folder: inside the front flap is this list of all the medications in the pack, and inside the back flap are all the medications in their slots. See below. I have to say I love the descriptions, when they are complete. Knowing the colour, the shape, any markings, whether its scored and more makes checking quicker for sure. But I’ve found quite a few descriptions aren’t complete and leave you a bit up the creek, and some of the colours are quite off the actual colour, but you get used it. There are only so many medications that the majority of nursing home patients are on so you get very familiar with a lot of appearances.

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A TERRIBLE photo at some angles, but its accurate in that we have to tilt the backing of the folder this way, that way, another way to see all of the tablets, and to see them without distortion from the plastic refraction or the foil glare and reflection.

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Okay so it’s a terrible photo, but trying to photograph a foil backing without glare or reflection is HARD!

As you can see, the inside front flap has a lot of detailed information about the medication name and brand name, strength, type of formulation e.g tablet or capsule, shape, colour, markings and more. This information is used to cross check each and EVERY medication with perfect accuracy down to the individual tablet before I sign off to say that every that is meant to be in the pack is in there.

Give it a go. I know the visuals are poor, but can you identify the tablets based on their description? That’s pretty much the majority of my task.

Do you need to be a pharmacist to do this job? At this point yes, because legally a pharmacist must perform the final check of every prescription-only dispensed medication before it is released outside of the pharmacy. Strictly speaking this is just an accuracy check, as in checking that one white tablet with BL marking is in slot B. In another industry a less qualified person would be doing this job. But its wasteful to have a technician check the medication if a pharmacist has to come along behind and do the exact same thing. I will say that knowledge of drug formulations, of doses, of the classification of scripts as prescription-only or drug-of-dependence, knowing which medications are cytotoxic or only given weekly only is pretty essential to the task. And they don’t do a short course for that; it takes a four year degree to transfer that knowledge into a brain. Which means that for now pharmacists are stuck with what can be a tedious task! Especially for 8 hours straight! Luckily I do it one day a week only. I mean we understand how important it is, but its still tedious!! I distract myself thinking of other aspects like whether the dosing is correct, whether they really need the medications that they are prescribed and…oops! Not meant to be thinking about that!

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So box after box, list after list, pack after pack we plow on! And that, my dear friends, is my Thursday!

It can be very satisfying when I pick up errors, I have to say. A tablet that accidentally got chopped in half so we only have a half dose here; a duplicate capsule in one slot there making a double dose; an empty pack, some glitch of the packing machine; a random capsule of goodness knows what that’s dropped in one slot, something the patient isn’t prescribed; a chipped tablet so we can’t determine the strength; a couple of missing doses; a tablet missing from one slot found in another slot; a label that doesn’t match the medications – whose are they? When I’m finding errors I feel like its a worthwhile job. When I’m not finding anything I feel like I’m missing something, and that I’m wasting time: is the other checker finding more than me, less than me? Should it be the same, different, nobody knows? After all the errors should be random, but sometimes there’s a trend.

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I forgot to mention the reason that we check these packs, other than that a pharmacist legally must perform the final check before a medication is handed out. The packs are filled using robot machines so there is potential for error if a tablet drops from a canister when its not supposed to; if the tablet is damaged when it drops from the canister onto the receiving tray; if a canister runs out of medication in the middle of a pack; and many more permutations.

MYOB

[6th June, 2017]

Okay, wait. Just give me a minute, read on and it will all (hopefully) become clear.

“What other people think of you is none of your business” – various, or unknown

I had never heard of this philosophy until I needed psychology and psychiatry to fix my mind, or before I got into self improvement-type thoughts and ideas to do my part. Before the last 4 years, what other people thought of me was a major part of my daily life. Anxiety about who thought what about me, insecurity about how others saw me, fretting over any less than perfect social interaction, losing sleep over a joke at my expense, nightmares about potentially horrific social scenarios; I could go on. But I’ve tried hard to put these things in the past with helpful sentiments like the one above. It doesn’t always work, but it works a lot better than it did before I ever tried it! Now I try to mind my own business when it comes to my life, and just do my own thing.

It doesn’t always work out that you can afford to ignore other people’s thoughts about you. This last week I’ve been dealing with a not-so-hot probation review, a first  ever for me. It seems like it doubles as a first warning so its been pretty hard to process that one without losing sleep and getting pretty ruffled in my mind! More about that later. In the meantime its a challenge to work out what is my business to attend to, and what I can let pass through my brain and somehow spit out without it doing too much damage on the way through. And isn’t this the central dilemma of this philosophy? Applying it 100% would lead to big problems, but knowing what degree to apply it to a situation is not a science; its definitely an art!

So…any ideas? I’m still thinking.

For now, I’m going to go and do the things that I know I can do, and do well, which today is bird watching and photography. And isn’t this a clincher for bird of the day? It’s slightly out of focus here due to how WordPress handles cropping photos, sorry.

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Superb Fairy Wren, male at least 4 to 5 years of age

Something to enjoy, to feel good about, to distract from unpleasantness in life: that’s birding to me. Never mind that for about half of the 3 hour walk it was showering rain. Doesn’t matter that my socks and shoes got thoroughly wet and I squelched all the way back to the car park. Don’t worry that my legs got chafed and my feet got sore. Can’t help it that the long distance photos were all blurry and foggy from the rain and mist.

It was a day out of the house, where I had to get dressed, and eat meals, and talk to other humans; lovely humans who wanted to talk about our common interests and nothing else. Where all I had to do was mind my own business and attend to my own interests and needs. Somewhat selfishly I suppose, but in a therapeutic way. I saw 41 different types of birds myself in 3 hours, which has to come close to being a personal record. I walked for hours in picturesque surroundings which were beautiful, even through rain. And captured photos like the one above, like this one here. Photos that soothe my mind, pictures to look back on maybe, to publish somewhere possibly. And it made the day a good day. Today was a good day. Better than any day since that review. This is a good thing. So for now, I’m good. The rest will come back in time, and I’ll deal with it then, but for now I’m minding my own business.

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Red-browed finch

Slowing down

If you look carefully, and you shouldn’t feel the need to, you can see the signs of me slowing down. Mornings get harder (and they’re never really my strong suite, but I’ve impressed myself lately), I stop answering the phone (which is always my strong preference but sometimes I’m better at it), I stop doing anything much around the house (which isn’t saying much but still), I stay in bed longer and longer, getting up and going is harder, and I dive into my laptop and live there because its more predictable and controllable in there than in the outside world. I jump into a world that isn’t reality, where beautiful music and sitcom laughter falsely pep me up. But I take falsely pepped up over no pep most days.

This week I haven’t been doing so well. I know why, but I can’t seem to shift it and improve my mood. There’s just been this one thing that’s bugging me, and I haven’t been able to physically do anything about it to this point and its just biting and biting. That has worn me down as well as consuming my thoughts with less than impressive ideas about myself. It’s brought about a constant level of fight or flight instinct in me, and between palpitations and just feeling amped up it hasn’t been fun.

At work on Sunday a patient came in desperate for something to help him sleep. He really seemed quite beside himself, saying he can’t get to sleep til 2am, doesn’t sleep long, and then is bombed out all day and can’t get anything done for being tired. It seems like a pretty clear case for handing out a Pharmacist Only sleeping tablet, but this man is on an old school medication that interacts with EVERYTHING! He was well aware of this and told me about it before I could ask about other medications. So I did the proper thing and checked to make sure that I could offer him a safe option. Most of the medications we can sell are sedating antihistamines like Phenergan and Polaramine which you may well have heard of. But these interact with his medication so they’re out. There was only one option (other than referring him to his doctor whenever he could get in) so I set him up with that, explained it all to him, reassured him that it was fine, advised him to take a half dose to start with and we both went on our way happy.

Then I got a call from him saying he’d read the leaflet in the box (of course, he would be the one in twenty to do so!) and it said not to take it. I explained again that the reason not to take it with his medication was because of drowsiness not another side effect, and in his case we wanted the drowsiness. At this point I recommended he discuss it with his doctor before taking it if he didn’t feel confident, but he said I was the medicine expert so if I said it was okay, then he was okay with it. Flattering to hear, but a bit of a terrifying responsibility at the same time. But I was happy from what I read so all good. But that call back set off some doubt in myself, some insecurity that maybe I got it wrong and I just cannot get rid of the [insert adjective] questioning in my head!! I looked it up again, and again, and although it seems right, there’s just something!! Did I do the wrong thing? Should I have not given him anything and hoped he could see his specialist soon? Is my knowledge still not up to date enough? What if something happens?? That last one is a killer of peaceful thoughts! Is it likely? No. But…and that is pretty much the loop my brain is feeding me.

I’ve tried to breathe: in 2 3, out 2 3 4 5. I’ve tried distracting myself, thinking of something else like our holiday to Queensland sometime later this year: I now have put together the most thorough bird watching to-do list that you’ve ever seen, have an order pending for a Cairns specific bird book, and GPS coordinates for good locations! I tried eating: fail. Telling a colleague: they weren’t concerned but what does that mean? The responsibility doesn’t rest on their shoulders so…I was asked to work yesterday so I was going to look the patient up and give them a call to check everything is okay, but my shift got canned. So that phone call got pushed out til tomorrow. It’s been a long week!! I’m just stuck in quandry, in limbo waiting for the knife to fall, the bell to toll, the consequence to descend on me. ARGH!

So my mood has struggled. Monday I was in bed til lunchtime, or after lunchtime; sometime around 3pm possibly. I don’t think I did a single thing. Wake up, sleep, wake up and breakfast, sleep, wake up and snack, sleep, wake up and drive 2 minutes for KFC, sleep, dinner, sleep. Very interesting. I was bugged by this sleeping tablet business all day, but I didn’t realise how much it was sapping my energy, motivation, interest in anything else til later. But every time I woke up either overnight or during the day it was right there, clear as crystal in the front of my mind!

Yesterday I managed to get out because I had a voucher with a use-by date to redeem at the aquarium, and at Pancake Parlour; freebies are a good motivator. Breakfast/brunch near an open fire while sorting bird photos on my laptop was pretty fun!!

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Then on to the aquarium where I enjoyed walking around in a removed kind of way, apart from the lovely shallow rock pool with little rays and elephant sharks (which are so ugly!!) and little fishies; that was awesome. Then on to the behind the scene package where we got in a glass bottom boat and watched rays and sharks and fish swim just beneath us. That was pretty cool. But the breakthrough was feeding the rays. I’m not talking about the little ones, I mean the Smooth Stingray species that is 3 or 4 metres across. They come up to the side of the tank for feeding, and they aren’t meant to, but they flap flap flap their “wings” against the side and cause huge splashes!! So naughty, and so fun fun to watch and take photos of! That got me laughing out loud; I really enjoyed that. I was smiling for ages after that.

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Then I went down a couple of levels to the bottom of that tank so I could watch the big sharks and rays swimming around through the glass; another wonderful experience! That really did it for me, and it is SO important to have things that do it for you on not so great days. Last stop was the penguins, and a cute penguin onesie for a baby who I know will be coming later in the year. I was still wrecked by the end of the day, I was still dragging myself around the levels of the aquarium, I was still tired but I got some smiles and laughs in which makes it a win as far as I’m concerned. It didn’t take much to suck that out of me, but at least it was sucking from happy to regular, not from regular to down. That’s a good thing too.

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We had a chat last night, hubby and me. Something about me being in a rut, lost in my laptop, not really engaging with the world or him. And I recognised it then as a symptom, that I really was down a bit and struggling a bit and it was cause and effect happening right there in my easy chair. I was almost at a point to make an appointment with my GP for a pep talk and pick me up, but I’m still holding that card because I see my psychiatrist next Tuesday.

So what about today? There is purely one reason why today worked. Wheel Women had a ride on that I had RSVP’d too but wasn’t sure if the weather would turn out good enough. Last night hubby said: “go even if its raining because there’s only meant to be a small amount of rain, so if it’s raining its probably nearly done”. And it happened exactly like that. Even though it was POURING rain when I woke up, I got up, got dressed, got ready, checked in to make sure the ride was still going ahead, and drove over to Kensington. It rained the ENTIRE way over there, except the last 1 to 2km, and then it was the most spectacular morning you could possibly imagine. Blue skies, the Maribyrnong river was looking stunning in blue as it reflected the sky, the grass was green and it was good to be alive with friends enjoying the sunshine and the fresh morning. That alone does it for me, and I would have been so disappointed had I stayed home.

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Instead we had a lovely time chatting while we rode, chatting over coffee and chatting all the way home again!!! And then, because I wanted to check out some birds (so wishing I had my camera in these perfect conditions!!) and get some shots of the city that I couldn’t take while I was riding, I did the whole thing again!! Yep, 2 loops along the Maribyrong and I can’t think of a better way to spend the day! Right now, I’m happy. I have a low level of anxiety still going on but I think I might take a Valium to give me a bit of a break from that so I can enjoy this feeling of happiness and friendship and accomplishment. Every time I do that ride along the Maribyrnong I remember the first time when I thought it was the hardest thing in the world! Now I just spin along and enjoy it for the scenery, and don’t even notice the kilometres going by. It’s nice having landmarks to show how far you’ve come!! I always appreciate them.

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What else was good about today? I went back again to look at birds and I found some terrific ones!! A Hardhead duck so close I could touch it when they’re normally shy birds. A stunning male Superb Fairy Wren in full blue plumage on a fence post in the sun (oh camera, wherefore art thou camera??!!). A group of Little Black Cormorants fishing together. A pair of Red-rumped Parrots flying off JUST in front of my wheel! A Great Egret in slow, graceful flight. Beautiful, lovely day. Plus a new Wheel Women friend. And watching a recent Wheel Women member improving with every ride; I love that!! Let’s hold on to that happy!!

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Cycling update

Recently I shared with you my love of social cycling, and all the hard work that goes into it, and fun that comes out of it. I had ridden an epic (for me) number of 7 rides in 2 weeks with Wheel Women last time I was talking to you, but where to from there? When you hit a personal best, whatever follows can feel a bit mediocre.

So here’s a little update on my riding. After that two week period, I rode 2 rides the next week, one the week following and one ride the week after that. Since then I haven’t ridden much. Oddly this has coincided with unofficially and then officially starting work. I’ve either been working on the day that a ride was scheduled, recovering from work the day a ride was scheduled or the weather hasn’t been that great. It sounds a lot less impressive, doing less rides, but each ride was significant in its own right.

One ride was at sunset along St Kilda esplanade which was stunning!

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We had to change route without warning when 40 joggers turned onto the path in front of us (seriously forty!!), and I loved finding our way through the quaint Port Melbourne suburban streets until we got to the beach. We stopped for the fish and chip special up past the yachts, then rode back in the dark with lights. I hadn’t ridden with lights at night before, and I really wanted to try that with others before attempting it on my own, and yay, I ticked that off the list. I have to say whizzing along in the dark on a balmy night along the beach then into the city was pretty thrilling!

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Then I voluntarily signed up to do a big long hill climb lesson one Saturday, figuring that after the very hilly Torquay circuit that I survived, I should strike while the iron was hot and keep working on my hill climbing skills! What’s the saying, sucker for punishment? Or something like that. There was a large group of us and I think that we each learnt something different, relative to our own ability and the experience of climbing that hill. Most of all, we had a go. Having a chance to try something is such a big part of Wheel Women. I wouldn’t think of doing a 8km hill with an average 5% gradient by myself. I probably wouldn’t try it with a friend; I most definitely wouldn’t try it with my husband! He’s an amazing hill climber: lean and muscular, terrific cardiac capacity, mentally tougher and most of all 50kg lighter than me!! Yep, that’s the difference between us! But being so competent, I think his coaching wouldn’t translate as well as from someone who has been through the learning process themselves relatively recently. Maybe I’m wrong, but I like attempting it this way, with several female coaches who have gotten into riding in the last few years and recently trained as coaches. The climb was a bit torturous, and I admit I put my foot down about 7 times for a “breather” or for a sip or five of water or to let the lactic acid burn in my quads abate, but I didn’t stay stopped. I had a good friend riding alongside coaching me; she really helped change how I thought about doing the ride, and I did better because of her!

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By the end I actually felt like I could go back another day and using her techniques I could get to the top by myself; but it’s more fun with friends. I was last to the top, but boy did I make up for it on the way down!! I was second by a small margin and rocketed through those curves; now that’s bike riding!!!

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For the third ride we rode 40km in a loop around Geelong via the chocolaterie. I was so proud of this ride. Despite the wind we rode into at times, I felt really strong and mostly rode up in the front group going faster than my usual average speed, and the couple of hills we came up against I hit hard, and punched up them. I found it really interesting riding around the refineries, the suburbs, and the coast of Geelong; and the chocolates were delicious! I’m proud of what I’ve achieved in skills and experience on these few rides.

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The last one was just for fun! A loop from Docklands to Port Melbourne around our usual spots: the apartments on the marina, the industrial zone, up to the beach for a moment of longing for a swim in better weather, a stop by the pink lake at Westgate Park and back for coffee and treats at a gorgeous little bakery opposite Etihad stadium. And then I went and drove off with my phone on the roof!! But we’ve already covered that.

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Well believe it or not that was back in the middle of April!! My last ride was the exact day before I started unofficially at work, and finally today I got out there again! And it was a stunner. We started in the thick fog that has been hanging around every morning this week. And it was cold! I pulled up my riding jacket over my chin and mouth after they started to go numb, fogging up my glasses and causing condensation and I began to think that a balaclava has some merit for winter riding! And I forgot my gloves!! Argh, not great with metal brake levers. But boy was it stunning along the river with the fog. Especially when we got to the outlet of warm water from some industrial place, and watched the steam coming off the water into the foggy air; beautiful. We stopped off for a look at Stony Creek backwash and the birds in the mist, especially a graceful pure white Great Egret, REALLY made me wish that I had my camera, especially when there was a lady there with a really nice lens.

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But the most stunning scene of all was when we got to the Williamstown yacht club which is always lovely, but with this morning’s fog the boats were somehow perfectly clear but behind them was nothing. Usually there’s a view across the bay to St Kilda beach and all the houses, but with all the fog it was like being at the edge of the world…just the boats and then nothing, a hidden horizon. Somehow it was so mysterious, and I was dying to photograph it!! So I did, but my phone shots are nothing on what I could have taken with my digital camera.

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The reflections today with the fog and lack of wind were PERFECT! Just perfect. But then would you believe, by the time we had coffee and started cycling back it looked like this!!

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No words.

First day/s

[Saturday 29th, and Sunday 30th April 2017]

“So how was your first day at work?”

Well thanks for asking! Really. I’m so grateful to every person who has asked about my first shift, about starting this job, and about what’s next for me. It’s so encouraging and I hope this answers all of your questions!

Actually, it’s also a complete relief to have an answer! Being “unemployed” never got more satisfying as a reply when people asked what I was up to. Although “unemployed” is not how I ever thought of myself. I still thought of myself as a pharmacist, although the longer I wasn’t working, the looser that description felt. I thought of myself as a birdwatcher, a photographer, a bike rider, a lady who was able to lunch more days of the week than not; but that seemed to come off a bit lame as an explanation. These titles com in addition to the long term titles of wife and sort-of housekeep; although hubby would argue with the housekeep bit, most likely. And then there’s how sick I had been, and still was, and how that was impacting my ability to work (or not!). Yes, I thought of myself as sick, because it’s hard not to. I mean I was. But it’s hard to explain the full extent of that, and the gradual process of recovery, in a short conversation.

But here I am, a pharmacist again. And I’ve so surprised myself; I’ve fit back into the role like I never left! I really thought I’d lost something irreplaceable somewhere along the line!! Really! Something that would stop me being a pharmacist again. Despite my seven years as a hospital clinical pharmacist, despite everything that I’ve done well and every proof of my good work, I let some unfair feedback from my previous job get under my skin like I do with many little, minor things, plus I have some insecurity about the gaps in my work history and how they would look to a future employer, and I started to doubt myself and worry about what next.

But, thank goodness, no. I mean there are plenty of things I can brush up on, make no mistake about that. There are definitely things I’m rusty on, and there have been a couple of minor boo boos; nothing a bit less of a rush, and a bit more math couldn’t have solved! But I’m back, really back! After my first two full-on days as the in-charge pharmacist working flat chat alongside great staff, meeting lovely patients/customers, doing the job of a pharmacist I can tell you that I’ve come home with an exhausted, almost delirious but actual happy, contented smile on my face, and I feel good! I never quite got the adrenaline rush that’s meant to come from exercise, but work is definitely a rush! One of the biggest joys, and most surprising, of starting back at work has been the methadone/Suboxone customers on the opioid replacement program: they are a really friendly bunch and I’ve enjoyed chatting with them. Okay, so I might be quite starry eyed and all at this point, but it’s all gone better than I thought so I’m staying thrilled for now. I’m back. That’s the most important thing!

Okay what else? My feet have been KILLING me!! This should be no surprise when you spend 7 or 8 hours straight standing up with maybe 10 or 20 minutes sitting down. Especially when up till now it’s been more like 9 or 10 hours of sitting down with interjections of activity. Swollen ankles, aching legs, feet sending out electric shots and shooting daggers; all symptoms of half my blood supply pooling in my lower legs!! Home time means legs up above my heart to return all that blood back to my circulation…lying on the floor with feet on the couch does the trick, if you were wondering. A pharmacist who has specialised in wound care for 30 years or more recommends all pharmacists (and anyone else standing up most of their waking hours) wear compression stockings/socks every time they work for this very reason, to keep the blood flow from pooling causing varicose veins, venous ulcers, cellulitis and more. It’s a great plan. I did wear compression tights for a while in winter a few years back because they pass as opaque black tights and they make a huge difference in how tired your legs get. But honestly, have you seen those opaque beige stockings?? I may not have much to be vain about, but I’m not quite prepared for those stockings. Plus these days I keep too warm for stockings of any kind so that helps my case, but not my legs and feet.

It’s been busy! Not as busy as it should have been on Saturday, then way busier than it should have been today, Sunday! Which evened out to 2 solid days work but we only had to do 30 minutes overtime today, and got out on time yesterday so that’s a win. Unfortunately today was the day hubby was picking me up and he had to wait half an hour in the car! I’m going to drive on Saturdays, but Sundays I have to take the train cos hubby needs the car, and the timetable just doesn’t work nicely. I’m happy to sit around Ringwood station for half an hour on a Sunday morning, but I’m not keen after dark so he agreed to pick me up…dunno if he’ll be so keen next fortnight! But oddly I haven’t felt terribly stressed even when the work is stacking up. I think that these days I accept that I can’t do everything, and just pick one task after the next and keep at it till we get through them all. To give fair due, both days I have worked with amazing help in the dispensary: a 3rd/4th year pharmacy student all day on Saturday and a dispensary technician who I wasn’t supposed to have, but who balanced front of shop with helping me on Sunday. Both were very efficient dispensers, really excellent assistants and a great help with customer service and supply of pharmacy only and pharmacist only products. Plus the shop girls took all the load of processing payments as well as providing great product advice. And there was always that pharmacist out the back providing an invaluable back up to my uncertainty; what a team!!

For some reason whoever was working Friday hadn’t seemed to order medications as they used the last one on the shelf. This is the pharmaceutical equivalent of not only finding that the last sheet on the toilet paper roll has been used up, but going to the cupboard and finding that that was the last roll! And now you have a patient/customer who needs toilet paper or…you get the metaphor. We had a fair few of these annoying and really inexcusable outages on Saturday, and it was embarrassing. It’s also a problem because we can’t order on Saturday, or rather we can but it won’t come in until Monday anyway, so we couldn’t even tell people to come back tomorrow. By the end of the day we had a longer order of medications than I’ve seen so far on a weekday, and we couldn’t order anything; quite the irritation, especially for common medications.

This is going to be my main deal in this job, working every second weekend. After finishing this first one, I think it going to be okay, good even. People coming in on the weekend understand that you’re giving up your weekend for them (sometimes!) and can be really appreciative (or not)! But I think I like it! Even though I’ve taken a pay cut to be here, don’t like working Sundays, have no real entitlement to a lunch break or any other break on a weekend day, am more hectic than I’ve been in a good while, and have to keep processing scripts when I’m busting for the loo, its a job and a pretty good one, so there’s lots to be happy about! Yes, I’m happy!

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!