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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The price of good health

Here’s my thing about the current mental health system. I know everyone has a different “thing”; this is mine at the moment.

Despite really needing them, I have exhausted the maximum number of Medicare-subsidised psychologist appointments that I am entitled to in a calendar year. I ran out in April. 4 months into the year!! Leaving me in the unenviable position of having to pay $145 per one hour session weekly with no Medicare rebate of $85 if I want to keep seeing my counsellor and improving my mental health. Not a great encouragement to continue therapy.

$145 is a lot of money for someone who has been off work for 100 days and ran out of sick leave after four and a half weeks! But this is not just about me, it’s about every patient who is getting treatment for mental illness. It’s a lot of money to anyone! So I tried to go without my psychologist session,then I tried spacing them out to two weeks or three weeks. Didn’t work terribly well or please my doctor or psychiatrist! Or me for that matter.

Luckily for me, in a freak moment of paranoia in 2010 I signed up for income protection insurance after a work colleague was diagnosed with cancer and couldn’t get insurance. Because of this I am getting a kind of substitute wage. So I am doing 10 tonnes of paperwork every month for the insurance company to pay me a benefit in arrears. So far I’ve had one payment. It was a great payment, but it was once! But there are a lot of people out there in the world who wouldn’t have been prepared to pay $85 per month for the last 4 years for the sake of an insurance payout that might never be needed. Thank goodness I did pay for it, though!!! It cost me but I am getting the benefit now.

In the case of people without income protection insurance they would be doing 10 tonnes of paperwork for Centrelink disability or sickness benefit or health care card or something else similar! For a lot less money probably. The government doesn’t match your current wage.

In an effort to address this problem with paying $145 out-of-pocket each week, I changed my insurance over in April so that I now pay a lot more per month for better psychologist and psychiatrist and inpatient psychiatry cover. Again, not something a lot of people would be prepared or able to do. Unfortunately I then had to wait two months to be able to use it! And I only get $250 worth of psychologist cover, not even two sessions!! Not quite worth it for that part.

Luckily, there is another benefit of income protection insurance that I was not aware of; in their portfolio of helping me they have agreed to fund 10 sessions!! Thank goodness!! And they have offered to put me through a meditation course, which I was already thinking of doing, so there’s a few perks to having paid privately for this insurance. But like I say, how many people could or would pay for this? How many people develop mental illness, which never comes in a planned way or at a convenient time, and have to make the choice between paying a huge amount  of money or go without treatment?

So this is the reason why there are crazy and hurting and needing-help people walking the streets; the private system is expensive!

And you can’t get admitted in the public system unless things are diabolically bad! They refused to admit me when I was suicidal and didn’t think I could keep going. I begged them to!! They would not do it. They just kept saying it would do me more harm than good. I kept begging. They kept refusing. They won. I got sent home. It wasn’t nice!!

They asked me if I had private insurance. Yes, yes I do. Well we’ll look for a private hospital bed for you. Okay sounds great, I just need to have someone look after me. Well we’ve called your insurance company and you will be $2500 out of pocket up front plus $400 per day. We don’t know how long you will need to be in hospital. Ummm, okay, maybe not! That’s a whopping lot of money! I know you can’t put a price on your health, but that’s a large pile of money that could be put to some other large life investment! Another reason for upgrading my insurance.

Now that I’ve served my waiting period of two months, I can get private hospital admission for only a few hundred dollars out of pocket. Will I need it? Maybe not, but I’d rather know that I can get it if the need arises because not being able to access it last time left me feeling even more desperate when I didn’t think it was possible!! But it’s a toss up, spend over a hundred a month to save a couple of thousand…how long til it adds up to that much anyway? But I have a plan to reduce my insurance if I don’t use it this year.

So instead of a hospital admission, the community psychiatric team came and visited me or called me once a day for 10 days until the new medication had kicked in and I started to see life in a more hopeful light. I have to say they were amazing and helped me so much. And I continued to see my usual GP and psychologist in that time, as well as a psychiatrist in training at the local office.

Which brings me to another point. I have been seeing a doctor once a week since last November. After the worst episode of suicidal thoughts and desperation I saw my GP twice a week for a couple of months, then went back to weekly. We’ve planned to stretch it out to fortnightly but we’ve never quite gotten there due to either a relapse or medication change.

The first doctor I saw charged me $73 per session. This is pretty standard. My current GP who I’ve been seeing since December usually charges $70 per session but bulk bills me because I’m a mental health patient and he doesn’t want mental health patients to not see him because they are worried about the cost. Which is a very important consideration!! And it actually does make all the difference! I know I can go in and see him anytime and I don’t worry about the cost, when I would otherwise consider that before booking an appointment.

Imagine $70 at least once a week since December. That’s 6 months. 23 weeks. If I had had to pay $70 per session I would be at least $1600 out of pocket!! Again, a lot of money for someone who hasn’t worked for 3 of those months. Or anyone, for that matter!! The Government has put in place a medical safety net so that if you have medical costs over a certain amount you can get a benefit at tax time. But you have to spend even more than this before you get the benefit, as I understand it. You really have to spend a fortune to get any help or subsidy.

Bulk billing is one of the greatest inventions but it relies on doctors being willing to take a Government-determined payment for their services rather than the larger fee that they could justifiably charge. That takes a dedicated and altruistic physician, and I’m so glad for every doctor that offers bulk billing! You are the hope of the sick and poor!!

Doctors that don’t bulk bill are private (non-hospital) psychiatrists. Which is understandable because they invest more than 10 years of their post-high school life to achieving the knowledge and expertise to work in that position. My psychiatrist charges $315 for the first consultation and $215 for subsequent appointments! Understanding this the Government rebates $221 for the first appointment and $113 for the second appointment. Not bad but still a fair amount of money to pay on a regular basis.

Then of course there are the medications. Lithium, venlafaxine, quetiapine. Diazepam for emergencies when I’m really anxious. Pantoprazole for gastric upset on lithium and venlafaxine. Levlen to avoid becoming pregnant on lithium and quetiapine. Cholecalciferol for reduced vitamin D from spending the last 3 months mostly indoors. Tooth mousse for increased cavities on quetiapine due to dry mouth. Anti-perspirant for over-heating and increased sweating on venlafaxine. High protein diet for iron deficiency. Low cholesterol diet for high cholesterol due to eating badly and quetiapine. Calorie restriction for increased appetite due to quetiapine and lithium and venlafaxine. Altogether it comes to about $150 per month for meds. There is also a prescription safety net, but this only comes into play after you have about 60 scripts dispensed in a calendar year. I’ll come in just under this so no safety net for me.

So that’s my whinge for today. From my position I feel lucky for the investment I made in insurance years ago, and I’m glad that I now have better insurance for the present and I’m glad that I’m in a position to afford these things. I’m not wealthy but I’m comfortable, and I feel for those people who really don’t have the money to get the treatment that they so badly need. Should we be subsidising treatment more than we do? Should people be made to have better insurance? Who pays for all of this? It’s not really an answerable dilemma, but I’d like to be more thankful that I’ve been able to get the treatment that I needed at times when I’ve really needed it!! Maybe not as much as I wanted but enough to keep me safe and pushing on.

And as I always say to my patients, I need to thank my stars that I was born in Australia not America. If I lived in America I would have had to pay for all of this and pay for it dearly! I’d probably have taken out a $20,000 personal loan by now or have completely used up our life savings.

Health. When it’s good, you don’t even think about it; it’s just there and we all take it for granted. We expect our bodies and minds to work in a predictable manner. We feel let down when they don’t work to our plans despite it being quite the miracle that all the intricate functions of our bodies work smoothly without a hitch.

But I’d like to take more time to be thankful for the days when my health comes to me easily! When it doesn’t take doctor’s visits, hospital admissions, psychologists, psychiatrists, medications, time off work to achieve a type of health. When I wake up and I’m just well! It really is a miracle and I want to appreciate it.