Accidents happen: Part Two

Did I say “accidents happen” the other day??

What was I thinking?!

It’s like saying its q___t at work; never say the Q word!! It invites chaos and busyness and problem scripts one after another. But I said accidents happen, and so they did! Fate heard me, even though I don’t really believe in fate…oops, is that another invitation to the world to punish me?? Well punish is a bit dramatic, but you know what I mean.

So I’ve been recovering from accidents and errors ever since I wrote about accidents!! It wasn’t enough that I had my first ever minor car accident last Friday. On Wednesday, I had to go and fall down the stairs!! Like a really idiot!

I think it was sleep stupor, but to be honest I don’t really know. It was morning so sleep stupor could cover it; not much of a morning person, me. I took one step down leading with my right foot, another step down now with my left foot, another with my right and then I just slipped off the far edge of the next step with my left foot and I was gone. Our stairs go halfway straight down, turn 180 degrees then the other halfway straight down. Pretty standard. I slipped on almost the last stair before the turn. It might have to do with the stairs being shaped as wedges for the turn and I hit the tiny point of the wedge. I don’t really know how but somehow my left heel hit close to the edge of the stair and just slipped right out from under me and slipped over stair after stair after stair with no grip on any of them. My left leg was a useless slippery pointy thing sticking out in front of me causing nothing but trouble!!!

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Brain kicking into overdrive trying to figure out what to do, hoping to hit the wall at the bottom of the first half of the steps, grabbing the railing by instinct rather than thought, left leg useless sticking straight out front and can’t get a foot hold anywhere, getting half a grip on one stair after another but slipping over each and every one, poor right leg tucked underneath getting banged and scraped stair after stair after stair!!

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Luckily, and there is always an aspect of luck with me somehow, I was trailing my hand down the banister and managed to grab it! And even though my grasp slipped down the banister, it got caught on the post halfway down at the corner and I managed somehow to haul myself to a stop. I’ve seriously wrenched my neck and back and arm because of stopping myself but at least I didn’t go head over heels or something worse. And at least my hand was in contact with the banister when I fell; usually I don’t hold on at all! So it could have been much worse. Apparently its a workplace OH&S recommendation to have 3 points of contact with stairs at all times: 2 feet and 1 hand, or 1 foot and 2 hands if you are that person who just has to push the envelope! So maybe I need to put up some OH&S posters in my stairwell!

Panic as several steps went by and I missed the wall at the end, turning instead to start going down the next flight! Finally gripping the railing at the post as I slid to it and holding on for grim death!! Or is it life? Either way, I managed to stop on that poor banged up left hip with my useless left leg still sticking out in front, and the even more useless right leg underneath and my arm twisted backwards at some weird angle. So by the time my hand found a hold on the midway post, I was through the corner and heading down the next straight with my right leg tucked well under me getting cheese grated on each and every step where the carpet is bare and the strings are coming through. Basically I got a combination of carpet burn and grating right down my shin and a good few bumps on my left hip, which is swelling up nicely. I was feeling pretty shabby!!

So I was pretty stoked to have come to a stop, even if it was at the cost of the whole left side of my torso and arm. But how to get up?? I’m not a little thing, as most of you probably know. And unable to engage to use of either leg and one arm and side made getting up some kind of origami exercise! I actually can’t tell you how I got up, but there were a couple of bad moments where I started to slide again. But here I am to tell the tale!

So I grabbed on for dear life and managed to stop my fall. There was a moment of real horror thinking that the post might let go; I definitely felt it give. But when I went back afterwards it was as solid as ever. But as it turns out 120kg dangling by one arm is not only a threat to the wooden stair railing but to the muscles and soft tissue behind my shoulder blade. OUCH! Before too long I couldn’t turn my head to the left more than 20 degrees, behind my shoulder blade was singing and I was rapidly becoming frozen stiff. So a trip to the physio to get ironed out.

To look at you can’t even tell I’ve had an accident. Well not until I covered the grazes along my shin with white dressings that is, they kind of stand out on my tan! Not intentional but there you go. It saves me feeling like an attention seeker telling people about my accident; the bandages seek your attention on my behalf!! Is that the same thing?

Its amazing the pain and irritation such superficial scrapes create. Bed sheets, leggings, any clothing just rubs so I headed down to the pharmacy for some dressings so I can at least be a bit more comfortable. Now at least the stinging doesn’t keep getting set off again. But stretching the skin by moving it any way including walking is still aggravating. So here we are, another accident. What to make of this one? I really don’t know what went wrong so that I can avoid it again. Just one of those things? Or I should take more care?

So that was my fall. I thought that was enough, how about you?

But no. I get to work and start my usual Thursday; you know, all the packs and stuff that I wrote about recently. Then my boss brings one of the packs to me and says it has been brought back to the pharmacy over an error! That shoots straight through the heart. Especially right on the heels of having experienced a dispensing error and making (possibly) a big deal about it. As it turns out I hadn’t seen that there were 2 loratadine (you know, Claratyne the anti-histamine) tablets instead of one in Tuesday morning. It’s a robot error, but my job is to pick up that type of error, and I didn’t.

I could justify my omission by saying that its not that serious an error; in all likeliness there would be no side effects as loratadine generally has no more side effects than placebo (sugar pill). But the point is that I missed the error.

I could justify it by saying that the patient hadn’t taken it yet so it wasn’t so bad.

I could also justify the error with the conversations I’ve regularly had with other pharmacists checking packs discussing how extra tablets in packs is the hardest error to pick up, compared to other errors: broken tablets, missing tablets, wrong tablets. But I still missed the error. Not good. But it has made me further reconsider my response to the dispensing error that happened to me.

But wait, there’s more!! Unfortunately.

This, I suppose, is what happens when you only work twice a week. Short of them texting you about issues on your days off (it happens!) they save them up for next time you come in!

So, it seems that I dispensed a patient’s 500mg Epilim (valproate) correctly, then attached the labels to 200mg tablets. THIS is a problem. This is a big problem. I don’t know why the patient was taking Epilim but irrespective, taking this error over weeks to months WOULD have resulted in a relapse had the patient taken it: a relapse of epilepsy resulting in seizures, a relapse of bipolar resulting in depression, mania or suicide or worse. As someone who takes Epilim and dreads the probably inevitable day that I relapse, I can totally empathise with the patient in this scenario, as well as my position as pharmacist!!

I could justify this error by…nope, nothing!! I should have scanned the medication against the dispensing; this would have shown the error. I should have compared the original script to the box of tablets to reconcile the strength; this would have shown the error. I could have reviewed the history, but that’s an extra step. All I needed to do was the 2 steps mentioned; that would’ve prevented the error. Luckily the patient identified the error, brought the medication back and no harm, no foul.

Sound familiar?? My high horse is sinking through quicksand and I’m about to go down with it, unless I jump off and acknowledge that I just made an error as significant as that other pharmacist, and how do I want to be treated over this? What lessons do I need to learn? How would I feel about being reported to the pharmacy board? My boss knows, so that aspect can’t get worse, but he was very good about it actually.

Can I console myself with the errors that I did pick up today? 5 missing doses of magnesium in one pack, 2 missing dose of metformin (for diabetes) in another, a broken Panadol tablet making an underdose, a broken clonazepam tablet (for seizures or spasms) underdose, double the Efexor (antidepressant) dose in one slot, a random thyroxine (for underactive thyroid) tablet found in a pack where the patient doesn’t take that medication, and more. Does it make up for letting a more severe error pass through to the keeper? In short, no.

But it does make you think. Here I am, on a squared playing field, accepting that human error exists but there are systems to obey to minimise it, and ignoring the systems is just not on!

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Accidents happen

We all know this: accidents happen. It’s part of life.

But in some areas, accidents aren’t okay. So we make systems and safeguards and policies and procedures and checks and balances and we educate to minimise human error. Sometimes, even that isn’t enough.

I know mistakes happen. This week I had my first ever car accident. I’ve had plenty of near misses and close calls in the fourteen years since I got my learner’s permit, but luck has always been on my side. I did have to run off the road once when someone stopped dead in front of me on a 100kmph road…but apart from having a panic attack from a massive surge of adrenaline after I finally pulled the car to a stop in an orchard, there was no harm, no foul!

This week what happened was that my left front tyre slipped on the soft edge of the road made up of leaf litter, and despite me pulling on the steering wheel and braking hard I slid off the road into the shallow ditch and hit the bank on the other side! It was sort of interesting to note that the wheels did turn; once I got out of the car and found that my knee was just bruised, I found that the wheels were in a slightly turned position but obviously I just skidded. Luck was still on my side though: the side of the road, the mini ditch and the wall of the ditch that I ran into were all so soft that there was almost no damage at all, and I wasn’t hurt. In fact when I eventually got off the wall, it was running water; there was practically a river of water running out of it! The unlucky part was that I “crashed” (a dramatic word for sliding off a road at slowish speed) in the back of beyond on a road very infrequently used with no internet or mobile reception and no GPS! Couldn’t call hubby, couldn’t call RACV, couldn’t call work to tell them I was a bit delayed; nothing! I couldn’t message through Viber, Facebook, Twitter, Instagram, Gmail; nothing! No one could track my phone by GPS. So I had to sit there and wait. And wait. And wait! In the end I had to wait half an hour before the next car came along! Still, it could have been a lot worse.

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Doesn’t look too bad right? Just resting here…

 

I couldn’t leave the car to find better reception, even locked, because I was halfway between picking up a bucket load of drugs and delivering them to my pharmacy! Imagine: I’m a pharmacist in a new job, trusted for the first time with a pick up, and for the first time I have an actual car accident!! Not cool! Someone asked me if I told the boss…um no!! Sure I could get him to pay the repairs, but do I really want to start with that kind of problem two and a half months into my job? Please note this drug/medication transfer was a one-off event; my car is not usually filled with drugs!!

So I sat there. I yelled out loud at the top of my lungs a few times for no one to hear. Just expressing my frustration in a civil, calm manner. I tried slowly reversing back without spinning the wheels but the ground was too wet and the leaf litter was too deep; the front wheels gripped for a millisecond but slipped almost straight away. Pretty sure the back wheels didn’t budge…well of course they didn’t, its front wheel drive; duh!! My years of bumping around our block on the old Fergie tractor have finally come to some kind of use, especially that time I had to back myself out of an actual metre deep ditch! But it had better wheels more suited to this kind of situation; it could practically climb a wall! The leaf litter on the edge was so deep that when I stepped out of the car my foot went right down into it. I tried to push the car back out of the ditch from the drivers seat, I tried to push it from the back seat but it didn’t budge…oh whoops the hand brake is still on! Kind of redundant since I’m resting on a bank. But letting it off didn’t help, and whats that on my foot? EEEEK!!!! Screams at the top of her lungs!! A leech!! SWAT!! Thank goodness that’s gone. Oh no its on the steering wheel!! SWAT!! Now its on a different part of the steering wheel! ARGH this leech is a real sucker!! Who would have thought?! Jumps out of the car out of impulse trying to get away from the huge, enormous, blood sucking monster!! Almost as bad as a spider at close quarters!

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The exact view from my car window…so it wasn’t all bad!

 

 

Oh wait, what’s that?? A 4WD or ute or something big and heavy and revving is coming down the hill! Start waving, start waving!! Yes its a cab ute with 2 men and a towing engine thing on the front and a solid tow rope with a huge hook…oh yes, this is what I’ve been waiting for!! Waving, waving, getting out of the car, please help me!! It occurs to me belatedly…that I am in a deserted part of the world, with no mobile or internet reception, asking 2 men for help in a situation that I can’t help myself out of, and trusting to their good nature. When I was suffering anxiety, I would’ve been hiding in the boot of my car til sundown and my husband realised I was missing and sent out a search party!! Actually no, my boot was full of drugs…well maybe the back seat then. It just shows how far I’ve come, and that really most people you run into are good.

The driver’s reaction when he got out of the ute? “Oops!” Precisely, my good man! But he said he had the same accident on the next corner himself last year, so I felt better. Because of course up until this moment I had naturally assumed that this was the exact kind of idiotic, stupid thing that I always get myself into and no one else would ever do such a dumb thing and wasn’t I a prize numpty?! And that this was yet another episode of me damaging the car, because there have been many! Part of my reasoning for not telling my boss; assuming that I would be embarrassing myself! Not that I actually did anything, I just sat there while I slid in the mud. But I always insist to myself that I’m the one that stuffed up. So these 2 kind men dragged me off the bank backwards with tow ropes, but the back of the car was slipping into the ditch now, so we had to switch to dragging the front up onto the road and the rest of the car followed. Meanwhile whatever hound they had in the compartment on the tray of the ute was howling at me as loudly and as often as it could breathe!! Another piece of luck was going off the road while it was still bituminised; another 500 metres and it turned to packed dirt…pretty sure that would have hindered the towing process. So 45 minutes of my life and I’m back on the same bit of road I was before the accident.

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So I displaced the bank, and a bit of my bumper…not a bad result

As it turns out I shouldn’t have even been on that road! I turned 150 metres too soon, and should have been on Maroondah Highway where this would never have happened. Ahhh. But I definitely got the scenic route, although I probably would’ve been happier swapping a bit of scenery for a car trip with no accident. Only something that would’ve happened to me, or just an unfortunate happening that could happen to anyone? At least I didn’t have to get towed with all those meds on board!!! THAT would have been embarrassing to explain to the boss!

So with all this in mind, I’m still unhappy about an error that occurred today. I got several scripts dispensed at one of the pharmacies I routinely use near my GPs office and one of them was wrong. Not a little bit wrong like the price was out, or I was given the wrong quantity. I was given the wrong strength of lithium, 450mg instead of 250mg making it an overdose, and it was the slow release formulation instead of immediate release meaning it would hang around in my system longer after the overdose, and it had the usual twice daily directions that apply to the 250mg strength instead of daily which is how the 450mg slow release should be taken so the level of lithium in my system would accumulate quickly. My lithium level is already at the upper limit of okay, and my psychiatrist is thinking of reducing my dose; this would have found me in hospital within 3 days!!! It’s that serious, and potentially worse.

But I’m conflicted.

As a patient I’m outraged and think the pharmacist should be reported for this very serious error, that fortunately didn’t eventuate because I picked it up before taking it. I think that there should be some consequences for not taking the proper amount of care.

As a pharmacist I know how terrible I would feel if this were my error, but I also know that lithium is one of those medications that you should take extra care and attention with when dispensing. The error occurred because the pharmacist entered the wrong medication when typing, and so the scanning check wouldn’t pick this up. But there would have been a message saying that I previously had a different strength, which was ignored. And my history must not have been reviewed before dispensing, despite it popping up and having to be entered through before you can type in anything. Two checks ignored, besides the obvious check of visually comparing what is written on the script with what is typed before printing!! That’s three checks ignored. I’m not sure the the pharmacy board would see any reason for skipping any of these checks, especially as there were only two patients in the store at the time.

So this is my big beef with pharmacy at the moment, both in my workplace and in the pharmacies where I get my scripts dispensed. There IS a proper way to do pharmacy, and it’s not being done! For reasons which are specious and inadequate, and I believe, unacceptable! I miss hospital pharmacy for this reason: maybe we take more time but we do things as properly as we can, no shortcuts or conveniences. Of course the pharmacist felt terrible, its a natural reaction. But will it change her future practice? Will she do things properly next time? I really don’t want to report her, mostly out of colleague empathy. But is it something I should do, for the improvement of the profession? I probably won’t, but it’s still all milling around in my mind.

What’s an accident, and what’s an error? What’s okay and what’s not? Should I be pointing fingers when I make my own mistakes? I don’t know. What do you think?

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

Birdlife outings

This is a quick tour through what Birdlife Australia Melbourne branch outings look like to me. I love that there are organised bird watching outings, just like I love my Wheel Women outings; because it’s just harder on your own. You don’t know what locations to go to, where to find the best birds when you get there, and you just don’t have the local knowledge of what birds are around and where they might be. But Birdlife just isn’t the family that Wheel Women is. I know a few people to say hello to and have a chat with as we walk around together for a few hours. But I don’t really have a relationship with any of them outside of our bird watching outings. Still, its a very friendly, helpful group of people who are just dead keen of improving other’s skills at finding birds, helping us to learn their behaviour and hopefully finding new and different birds every outing. This is my photo journal of everything but the birds  (almost) from an outing to Woodlands Historic Park on 27th May 2017.

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First off, the car park meet up – yep they’re all ours

 

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Getting the briefing for how the day is going to run, what to look out for, who is leading and who is tailing, and the famous sign up sheet

 

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Hold up on the bridge as someone spots something…what, what, what have you got?? we call from the rear

 

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It’s REALLY time that I got binoculars! The camera does pretty well, but I think binoculars would adjust quicker and let more light in

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A bit more scattered along the track as we wander back for lunch

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Bring on lunch!!! It’s almost a stampede once 12.30 hits the second hand!!

 

And here is a quick snapshot of some of the birds that we saw. It wasn’t a tremendous day out, although that last bird was a first for me, the Fan-tailed Cuckoo. We got to see some beautiful Flame (above) and Scarlet Robins but at a long distance so there’s not a lot to show for it. Better photos next time!

Slowing down

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

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

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

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

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

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

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

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

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

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

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

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

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

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Cycling update

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

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

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

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

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

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

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

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

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

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

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

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No words.