Future planning

Dear family and friends,

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

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

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

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

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

Advertisements

34 hours

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

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

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

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

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

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

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

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

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

 

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

Happy place

This is from yesterday morning.

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

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

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

IMG_8172.jpg

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

 

Private hospital 101

I work at a private hospital, in the emergency department (ED). Prior to starting this job in August last year, I had spent all of my career, apart from the obvious gaps when I was sick, in public hospitals. The change has been quite interesting from several financial prespectives.

  1. Funding private hospital ED

In a public hospital emergency department, as long as you have a Medicare card, everything is free. To you, I mean; obviously the cost has to go somewhere, so it goes to the government because they believe in free access to healthcare for all Australians through their funded hospitals. It’s actually one of THE most amazing, and EXTREMELY underappreciated benefits to living in Australia. Whatever you think of any government down under, you absolutely SHOULD respect and appreciate this benefit of life here. If you had any idea how much money you rack up in one long wait in ED for nursing care, medical care, tests and scans, medications, interventions and so on, I think you would be shocked! We are talking hundreds if not thousands of dollars over several hours, and that’s just in ED. Try to think of healthcare, and paying your taxes, from this perspective; maybe you’ll be calmer in the ED, and more resigned to all that money you fork over to the government.

To access the emergency department where I work, you pay $300 upfront before you walk in the door which is an out of pocket fee, not rebatable by your health insurance, paid on the spot before anything else happens. Basically it’s a general fee against the types of costs you rack up, such as medications, blood tests, Xrays and CT scans. If you end up accumulating costs above this payment, they may be charged to you. At the beginning of working here I thought this wasn’t great, or fair, as far as healthcare equity goes . But now I think about it differently. We are one private hospital. In the city of Melbourne there are 3 major public hospitals: Royal Melbourne Hospital, St Vincent’s public hospital, and The Alfred, as well as specialized public hospitals: Victorian Comprehensive Cancer Care, Royal Children’s hospital, The Women’s, Eye and Ear hospital. That’s plenty of public health to go around, and its just in Melbourne city; not the suburbs. There are other private hospitals as well, and I’ve come around to accepting that there’s a valid place for both. We are only trying to recuperate costs outlaid because the government doesn’t fund our patients, we do, at least in the outpatient setting. That’s what category the ED technically falls into, outpatient; in fact sometimes you hear it referred to as outpatients. Private health insurance, check the small print, only covers the INPATIENT stay once the patient is admitted to the ward so if we don’t get some money somehow for what we do in ED, we are totally out of pocket ourselves, and as a private enterprise, we wouldn’t be able to continue to offer healthcare, which would be bad for everyone, not least of all me whose whole day is spent in ED which I love!! So yes, I do now see the virtue. Yet somehow, when I see someone on a stretcher with a vomit bag being asked to sign waiver forms for their $300, it still generates an ick factor!! Weird, huh?!?

I would add, because it is relevant, that the $300 fee does also serve a function of natural selection where those who can afford it come into our ED, and those who can’t afford it, don’t. That’s not to say that they are just turned away, not at all. We always ensure they are transferred to a public hospital that can care for them without the money burden. And all patients coming in by ambulance are informed before arriving that the fee applies to them, so that they can choose to go to a public hospital should they not want to pay. So, would you pay?

Another day, another dollar

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

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

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

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

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

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

Work work work work work work

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

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

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

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

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

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

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

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

Work tales

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

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

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

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

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

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

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

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