4 years

6th March, 2018

Well I had other ideas for today’s blog, but Facebook reminded me that today 4 years ago I was recovering at home, supervised by my hubby working from home, after a VERY long afternoon/night in the emergency department having finally come to the crunch point of my nervous breakdown.

It was the first day of many days off work: 6th March 2014 to 22nd July 2015.

It felt long!

It felt like it would never to over, that life would just trickle by forever. Me at home, on my own, barely able to fill the hours of the day, just dragging along until the next…what? Hour, day, week, year?

After 18 years of full time school; 4 years of full time study plus part time work; an intern year of full time work and study; and 4 years working full time (apart from a period of 9 day fortnights during 2013 for health/stress reasons, and a brave if futile attempt to get back to work and save my job by dragging myself 2 days a week to work in the outpatient dispensary at the Alfred in the month before my contract expired late 2014) it was a shock!

I didn’t know what to do with myself physically, let alone mentally. So came a long list of attempted hobbies to try to fill up my time, more or less successfully. 4 years on, some have stuck, some haven’t, but it’s a different problem now: finding time for those hobbies! Time for bird watching, for photography, for blogging, and my re-discovered love of gardening. I’m back at work, currently 4 to 5 days a week! Who would have ever thought?! And it’s cramping my style! How’s that for ironic? For months, years in fact I’m dying to get back to work, really back to working full time or close to it, and 5 minutes later I’m missing my me time!!

It could be worse. If anyone can say that it’s me. I was worse, I’ve been worse; so I really know that it could be worse. I do. But it’s the perspective you have at the time that frames how you see things. And my perspective now is mental wellness and relatively good physical health, so the smaller things weigh more, like doing my hobbies! It’s not a bad place to be, hey? Four years on.

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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?

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??

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.