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!

Job update

Hello? Is anybody out there? Is anyone still listening?

Apologies for the radio silence over the last few months. It wasn’t for lack of ideas and thoughts to share, but more for lack of motivation and follow through. It’s been a long, cold winter for me! How about you?

The run-down of this winter is coming in instalments, because a lot has happened despite the long cold. First off, and the main event, an update on work.

I quit my old job in August, yep the same one that I started in April, and moved on to another job. I’ve never “given up” so soon! But it was a good move, probably the best career move I’ve ever made despite quitting being seen generally as a negative thing. Four months in community pharmacy, and I’m done! It wasn’t the community, it was the pharmacy, more specifically the management of the pharmacy, and more especially the owner/manager/slacker/ingrate/greedy pig/jerk. I’ve done that fight in a job once, and it changed the course of my mental health for life! This time, I knew enough not to stay, and I’m proud of that! It shows that I learnt something that first time around, and that’s a victory. As soon as I realised that the situation wasn’t going to change (another thing I’m proud of recognising this time around) and that my initiative was unappreciated, I started planning my departure.

And karma smiled. Well I don’t believe in karma, or the universe, or fate. But everything fell into place like it would if you did believe in one or the other of those things. I monitored the regular SEEK pharmacist job alerts that I’d signed up to receive before this job, as well as the Society of Hospital Pharmacists job register. I was still searching for my escape route (you know, never leave a job until you’ve got another job), when I got a call from Slade Pharmacy at Epworth Private Hospital in Richmond asking if I would like to interview for a casual position! Ah yes! I would definitely like to interview for a job with flexible hours in a hospital, albeit the dispensary! Especially since you called me; is this a dream come true? So why did they call me? Turns out that when I interviewed for them last year and didn’t get the job, they said “can we keep your resume on file?” and meant it! How about that? I thought it was just a line that everyone says when you don’t get a job as a consolation that maybe in the future there’ll be something there for you. But this time there’s an actual consolation prize in form of a job! Amazing.

So, interview, check. Job offer, check. Give notice that I’m leaving, check. Get obnoxious response from boss, check. Leave job feeling even better about my decision to leave, check. His response when I said I was leaving? “That’s a relief. Return the keys. Retail is not for you”! Sorry. You’re wrong. Retail pharmacy is for me, in fact during uni days I worked in retail pharmacy for 3 years and had a great time. But you’re right, the way you mis-manage it, it’s not for me. Ciao!

Usually when someone is looking for work, changing jobs, planning a career or whatnot, they consult their own needs and maybe that of a partner or family member. It comes down to what you want from a job, where you want to work, what you want to do in your job and that’s it. That’s true for me too, but in my case, there are a few other factors that contribute as well.

Number one: how will this job affect my health? That’s always the first consideration nowadays. Do you ever even think about this when considering a job? I certainly never did before I got sick. Could I work fulltime, could I manage the stress, how would I manage my workload? I never even thought about these as issues, I never thought about it period. I just knew inside myself that I would manage whatever came to me. I never doubted being able to do whatever job I got. I didn’t understand there being any option but doing the job well and going home to rest before going back the next day. Until the last year of my first job led to my physical health falling apart, and my mental health beginning to deteriorate. My second job was endlessly fulfilling but my mental health was already on the way out and too far gone for me to hold my head together, so I had to bow out. Ever since then I’ve been returning to work and thinking about what I can physically and mentally manage in a job.

Number two: what do my doctors think? Their opinion isn’t the end of the matter, but it has a lot of weight and sometimes it does decide the issue. My psychiatrist for instance has an old-school understanding of what hospital pharmacists do, but a very up-to-date understanding of how my previous jobs have affected my mental health. His current stipulation has been no hospitals, which of course I’ve found very challenging to accept! Hospitals are my place, I’m sure of it, but the politics of my first and third hospital jobs have been tough on my health for different reasons. So, I did what he suggested and tried retail pharmacy. I wasn’t very enthusiastic at first, but I tried to see it as a challenge, as a chance to update and broaden my drug knowledge and expand my mind with a different type of practice. But unfortunately, I found a great job in a terrible environment. I tried hard to make it work, but it began to drag me down after a couple of months and my psychiatrist could see that clearly, once referring to my ex-boss as Frankenstein’s brother, and another time as a peasant which amused me greatly! But still, when I broached my new job at Slade Pharmacy with him, I went cautiously and emphasised the words dispensary, retail, community pharmacy, and minimised the word hospital. But as it turns out, that first job as a casual dispensary pharmacist starting in September was easy to sell. Meanwhile my GP is supportive of anything that I want to put my hand to, even recommending I just not work for a while longer if it suited me. But getting back to work has always been a driving force with me, for better or for worse.

A week into my casual dispensary role, I heard someone dropping the words job and emergency department!! Wait!! What?? My favourite ever job so far! On offer right here? Where I already have a job? Ears pricked, senses heightened, on full alert I went into action finding out as much as I could. As soon as possible I interviewed for and was then offered later that week a role in the emergency department, 2 weeks into my casual dispensary position. I was more hesitant in telling my psychiatrist about that. I used words like part time, structured, working with another pharmacist, dedicated time, no involvement with the main hospital. But it went over easily. He saw how the community pharmacy thing went; we tried that. So now this is a new thing that I wanna try, and we’ll watch and wait this time.

The third and last factor is a third party checking in on the progress of my work. I’m receiving income protection payments from an insurer, and they check in on me every month. There’s a lot of filling in of forms by myself and my GP, supplying payslips when I’m working, and periodic check ins with a “rehabilitation consultant” who keeps tabs on my work and my health, and a case manager who keeps tabs generally. They do keep the pressure on to remain in paid work, of course, and they aim to get me back to full time work, something that I’m by no means convinced is possible. When I wasn’t happy in that retail job, I did experience some pressure from them to keep going rather than quit, but I was sure I was doing the right thing, and now in hindsight they agree. It’s just another little something in the mix that complicates my plans for what work I want to do and how I want to do it.

How to Remove Rainbow Banner from WordPress Reader (Temporarily)

Because we should have a choice of how our own blog appears

russell & pascal

In her post titled Listen Up WordPress, InsanityBytes explained her frustration over the rainbow banner that WordPress put at the top of the Reader – signifying marriage equality and the Supreme Court’s decision today – and her inability to remove said banner. If you still see the rainbow banner (I have no idea how long they’ll keep it up) and want to temporarily remove it, there is a way. It’s as simple as unchecking a box, but finding the right box will require a bit of exploration into the inner workings of browser code (which might be fun for you). The downside is that the rainbow will show up again if you refresh the page, but that shouldn’t be a problem since the Reader loads new posts without reloading the whole page. If you need a more permanent solution, go here.

How to make the rainbow banner image disappear…

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Rain, rain, not so bad…

[Monday 21st August]

It’s always a good day out with birds.

Even when the day is one of the worst this winter.

It’s raining lightly but steadily, the temperature is heading from a freezing 4 degrees to a frosty maximum of 6 degrees for a chilly winter’s day, it’s slippery and slushy underfoot, I missed my bird watching group meet time by a few minutes but saw them crossing the road as I parked, then they disappeared on me while I was getting my stuff together!!

But with some of my new resilience I decide to power on. It sucks that I missed them, but I can’t find any fault with them at all. It was a typical Danika move.

Looking at the forecast the night before I wondered if I was up for the task of wandering around for 5 hours in not only the cold, which you can dress against, but the wet. I’ve gotten wet and cold on one bird watching outing recently, feet and legs mostly, and it wasn’t fun. But I can dress warmer this time and be prepared. About that wet though, do I really want to be walking around in it through thick undergrowth for 3 of the 5 hours, according to the forecast? I couldn’t decide. Originally I definitely wanted to go because this birding outing was one that I haven’t seen come up before, a walk through the Sherbrooke Forest and…ding ding ding…lyrebirds! I’ve glimpsed a couple in the wild, and seen one at Healesville Sanctuary in their awesome recent lyrebird exhibit, but I’d love a better look!

But that wet…and so I dithered all night, didn’t make a decision, looked up what time I’d need to leave by, couldn’t decide when I woke up in the morning, called the leader to confirm it was on, slept a bit more, thought I wouldn’t go, thought I would go, left it too late and took too much time putting on my two pairs of socks, three tops, packing my 3 jackets and so I had no time for breakfast before I had to jump in the car post-haste.

This is a big flaw for me that I’m trying to work on: skipping breakfast. Actually not skipping breakfast as such, because I can’t make it to 10am if I don’t eat in the morning. I’ve always felt nauseous and faint if I don’t eat breakfast. And taking a handful of tablets on an empty stomach doesn’t go well. But I’ve also never been a morning person since I was a baby. So it’s a tussle between getting up in time for a proper breakfast and getting up, full stop! Lately this has taken the form of skipping a sustaining breakfast like my standard 2 pieces of toast with spreads for getting out the door on time, then making a 2 minute stop at the local Coles Express for something less sustaining but at least food and drink. I reserve the right to tell you what kind of food or drink I would usually pick up!

Google maps told me when I left that I was going to be 3 minutes late, as in arrival time 10.03am. This is okay, most times you can make up this difference along the way and arrive on time. Although not properly on time, which is 5 minutes early as my husband will say. In this case probably 10 or 15 minutes early would be ideal for putting on jackets, unfolding umbrellas, getting the camera ready etc. So really I’m  way behind, but I’m telling myself that 10am is okay. But still, no breakfast yet and I can’t walk around in the forest for hours without breakfast, let alone without lunch that I haven’t accounted for, and the Dandenongs aren’t really ideal for ready to go food. But luckily I did find a quick mart type general store at Tremont just before Sherbrooke forest and got some Twisties and drinks; not ideal but it’ll keep me going. Forgot to get lunch but at least this is a start. Except…


This doesn’t even show how deep the colour blue was on my tongue, fingers and lips!! What the heck?? Apparently although these Twisties look like Twisties, smell like Twisties, taste like Twisties, they are Blue Tongue Twisties! Well that’s new, and not necessarily great for me. Busted about eating Twisties though; hubby will be happy. Luckily after my afternoon nap the blue on my tongue had been digested by my mouth enzymes, but I had to scrub the life out of my lips to clear them up, and I’ve still got blue around my nails 2 days later!! Argh!

But I got myself going, and I got these:


The charming Eastern Yellow Robin


They are so skilled at gravity-defying grip onto trees


A clearer shot finally: the rain really messes with clarity


Murdering the “snake” by whipping it and mashing it and tearing it into bite sized pieces


Nearly got its head off, now to…





“Is it dead yet?”


Another flick through the air and whack! against the root


See how far around it can rotate its head? Somehow with such a large prey compared to its body it manages to get the right amount of acceleration then bang it against something hard


See how its eye looks weird? Its called a nicitating membrane. It like a second eyelid but its see-through. Birds use it to protect their eye when they still need to see but are at risk of, for instance, having half a worm flick them in the eye


Finally a bite sized piece! Yum yum, down the hatch


“Get away from my snake!!”



Uh oh. An invader. Territory wars over a juicy worm!


Standing on it should keep it safe


“Are you done yet?”


Oops, spotted me!


This is a fully zoomed out view of the little birdy. It was probably 3 metres away by my judgement, which isn’t the best. I love zoom!

A good day that came out of a shaky start; I love these days. Now home for a lovely nap.