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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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

Canberra Day 94

[Wednesday 14th December]

Well today was a terrible day career-wise, nothing fatal but nothing fun, so it’s a good thing that I’m in Canberra with a licence to explore and enjoy new experiences.

I’m having some issues with the Australian Health Practitioner Regulation Agency (AHPRA) that manages the registration of 14 different health professionals, including pharmacists. Previously we had our own pharmacy board, but in 2010 several boards were amalgamated and now we are managed jointly. This new organisation, AHPRA, manages our annual registration including our compulsory continuing professional development (CPD) requirements, whilst another organisation manages the regulation of pharmacies and pharmacy departments. All very boring and tedious, until your annual registration comes up against a problem. In my case a CPD problem. Each year between October 1st and September 30th, every registered pharmacist in Australia now has to achieve 40 hours of CPD to qualify to be re-registered. After the amalgamation the amount of CPD to be achieved began as 20 hours and increased over a couple of years. Its pretty standard now, and pretty achievable if you’re working, which is the point; to keep you up to date.

I first went on sick leave in March 2014 and stayed on sick leave for several months before I dragged my reluctant body back to work only part time for 6 weeks in September/October that year to complete my contract at the Alfred, in the vain hope that I would build up professional fitness quick enough to convince my workplace that I was fit and well to work and be re-hired. I was desperately hoping to stay on because I loved that job. It was a joke looking at it now; there was no way I was even fit for the very part time work I was doing then let alone more. But the point being, between October 1st 2013 and September 30th 2014, the annual CPD year, I worked 6 months and work generates CPD as does starting a new job as does changing positions within a job all of which applied to me. So even at the 6 month mark when I got sick I had oodles of CPD numbering probably around 50 or 60 hours. So I finished my feeble 6 weeks in dispensary, ended my contract and went back to bed.

By the time I got going again and went back to work, it was July of 2015. Already up to 9 out of 12 months of the CPD year, and to be honest, to this point CPD hadn’t even crossed my mind! A little teensy nervous breakdown and the associated issues had occupied the major part of my brain for months on end and work had just gone away. Even now returning to work I was conscious of the need to get up to date with the many new drugs and devices that had hit the market in the last year and a bit, but I hadn’t thought particularly of my CPD requirements with respect to my registration. I did all the required new job CPD, I did study on things that were relevant, I recorded it all and never really thought of whether I was making the 40 hour amount. Which is unfortunate, because I didn’t make it! I got 25 hours, not 40.

And there is no clause for people on sick leave. Or for people not working. You’re either practising or not practising. So, in November 2015 when I was re-registering as a pharmacist and got to the compulsory question about whether I had completed 40 hours in the previous year, I had to answer in the negative as in I did NOT meet the CPD requirements. And I won’t say that all hell broke loose, but all kinds of official pharmacy correspondence started flying around the web and through the postal service, and today is just another step in the painful process that is rectifying the situation! I’m not complaining about having to fix this up; I should have to. I’m a health professional and patients need to be sure of me being up to date and on top of the latest drugs and professional practice. I’m just complaining about the amazing bureaucracy that prevails in these matters! It is not easy to show that you have done your best to fix it, that you’ve learnt your lesson, and that you’ll do better in the future. Especially if you’re out of work again, because things just don’t come up when you’re not dispensing and reviewing medications on a daily basis. You have to actively look for things, and it’s just harder. But it’s part of my commitment and I have to just get on with it. So I’m off to send yet another email, which will probably get yet another “out of office” reply, followed by an actual reply sometime in the next two weeks or so telling me that there’s yet another technicality that I haven’t met because I was never told about it, followed by another email from me phrased very conservatively despite my inner rage and so on. You get the drill!

So there’s that, and following that the awful words “we’re terminating you”!! Seriously?! I went back to work officially in June 2015 with a fixed term 9 month contract. I guess I always assumed that there would be a possibility for extension at the end, assuming they liked me and my work was up to scratch etc. But no, despite putting me through two traditional interviews and a non traditional observation of practice interview I was never successful in getting an extension. So I was told I would be put on the casual list and they’d call me, which they never have but that suited me lately being in Canberra and all. So now out of the blue I get a call to say sorry, it’s just a HR thing but because you haven’t worked for us in 3 months we have to terminate you!! I’m sorry, what?! I’m costing you zip, I’m (usually) a resource available at short notice a 4 minute walk away, and if this was always a HR thing, why didn’t you just say goodbye at the end of my contract, instead of giving me an impression that I’d be called up to work?? So when I get back I have to return my keys and it’s all over. Well what a wake up!! Could this day get worse for my career?

Luckily I have good things planned so let’s off to the High Court to observe other people getting the rough end of the stick, potentially. I won’t pretend to understand the case that was being argued but the solemnity and the ceremony of it all was very impressive and the two counsels arguing were humorous in their own way, especially one who referred to “my learned friend” at the beginning or end of every sentence! I’m pretty sure even the 5 judges were smiling under their wigs. A bit of light relief, and I’m glad that becoming a lawyer was never on my list. I took my fill then left, remembering to pause and bow to the judges on my way out!

And now to really flush all that career mess out of my system!! I’ve been looking forward to this christmas concert by Igitur Nos at the National Library for a couple of weeks now. Turns out it wasn’t quite what I was expecting…more classical music, Latin and high brow Christmas songs than your typical carols. But it was pretty nice. Then a drive by a few places of interest: the historical and very pink Calthorpes House, and a few embassies.

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Lucky I have a lovely catch up with a friend after lunch. Nothing so soothing as hanging out with a friendly face and chatting away the afternoon. A super cute little baby helps just a little bit too! Happy day…in the end.

Canberra Day 82 to 84

Friday 2nd December, 2016

Today I’m going to the National Library’s ‘Treasures’ tour, a free tour on the current Treasures Gallery which right now is filled with an exhibition of Australian history. Apparently the library has 10 million objects as compared to 3 million books…something like that anyway. Surprising, but as they say, who else would keep these objects? And they all relate to books or to history in some way. Sitting in the atrium waiting for the tour (yes, me waiting) it was all Travatine marble, gorgeous tapestries, stunning stained glass windows…very impressive! A beautiful way to start the journey. Among the amazing things I saw on the tour was THE original Captain Cook diary from the original voyage; they turn the pages every page for another glimpse into history. Some fascinating maps: from when Australia was represented by just the Western Australian coastline single line drawing ending unfinished, then the first map that had the full outline of Australia. And so on. That was the guided tour, then I stayed before to have a better look at early Australia, and the fashion photography of Athol Shmith…not sure if that’s an accident or what. Well that was all brilliant, but exhausted my brain power for the day. I’ll do the other exhibition another day.

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Beautiful tapestries in the atrium of the National Library of Australia – of course ‘The Land of the Parrots’ on the right is my favourite. The space dish is beautiful but how can it compare?

When I was at the Belconnen Arts Centre I saw a brochure for an exhibition called Bipolar Bares All. Obviously an artist with bipolar doing art about bipolar appeals to me so I drove all the way down to Tuggeranong Arts Centre. I grabbed some lunch in town then went to the arts centre. The art was black pen drawings on white paper, some with captions or talking bubbles. It wasn’t quite what I thought it would be, but a couple were quite powerful. Then, since I was down there, I hit up Tuggeranong homestead. I enjoyed hanging over the white post and rail fence like a good ol farmer checking out the gorgeous brown girls feeding in the paddock, and I nearly ran over a blue tongue lizard! Luckily it didn’t go far so I got a few shots in. Then, for the second time this week, I walked in where I wasn’t welcome again! “Excuse me but would you mind telling me why you are taking photographs of my roses on private property” wasn’t how I thought the day would go! How was I to know that it was private property? The gate was open, the tourist sign was right there in the car park, and a sign at the exit of the car park towards the house said welcome! I mean, call me crazy (“crazy”), but it all looked okay to me! Anyway, I got the whole woes speel from the woman about how this always happens, about how photographers call up every week and have to be refused etc, yet right there on the lawn is a party obviously set up for tonight; its all rather confusing. In the end, when I would have been quite happy to leave already and not hear another word about it, they invite me in to have a look around and I got a 5 minute wizz around with the speed tour speech and I was on my way! What a kufuffle about nothing! You threaten me then invite me into the house? Sheesh! Home for a nap, but the adrenaline was still jumping through my arteries and I was buzzing like a bee; couldn’t get to sleep!!

Well, hubby was going to be late again, so I head to Red Hill lookout, the last of the lookouts that I saw in the rain when we were first here and haven’t been back to in fine weather. Gotta do something physical and burn off this adrenaline! And honestly I think Red Hill has some of the most stunning views because it looks out on the Brindabella ranges which are always blue and looking fabulous. Then we meet up for dinner at the food truck park, The Hamlet on Lonsdale Street and what a lovely way to end an interesting day!

Saturday 3rd December, 2016

I’ve been to the Australian National Botanic gardens but I wanted to go back for the Flora Explorer vehicle tour which only runs on Saturday; I figured I’d see more of the gardens that way rather than hiking around. It was pretty good, although the driving was pretty jumpy, but the commentary was great and it was a novel way to see more of the gardens. Then we went back to CMAG for the brand new Velocity exhibition of vintage racing bicycles which was really cool! Man we’ve come a long way to modern bikes! It was fascinating to look back and see what the early cyclists achieved with far inferior equipment!

Then on to the National War Memorial, something we’ve wanted to do together since we got here but it takes til the end of our time here to really force our hand and get us into gear! We had a wonderful time. We were just in time for the last guided tour of the day which was through the Great War section and our guide was fabulous. So snappy and great on the stories and anecdotes, really interesting and kept things moving nicely. Then we moved through the other sections ourselves as much as we could take in. We absolutely loved the dioramas, enjoyed the movies past and present, and the large models/souvenirs helped put everything in context. Then we finished off the day with the daily Last Post ceremony; what an experience! The war memorial is absolutely a must see in Canberra!

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Now for my weekly shower; sad, but very sadly true.

Sunday 4th December, 2016

Our usual meeting then we went to the Lanyon homestead for lunch. That didn’t turn out when we were booted off our nice table outside which was apparently reserved although there was no sign! Inside had low roofs and tiny windows and was quite a bit depressing, and the marquee had middle aged women drinking and celebrating Christmas, or something! No thanks. So we skipped our look through the homestead, disappointing, and headed off back to Braddon for lunch at Elemental on Lonsdale Street instead, then an afternoon nap.

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Happy Sunday views!