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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Tired

Tired. Being tired. Feeling tired.

This is still the hardest thing of all for me to deal with. Especially so because I can’t really see that much of an end to it coming up with any haste.

Being or feeling tired, is pretty much the physical equal of being or feeling depressed, mentally. In fact I think they are different ends of the same condition. I’m sure that every depressed person feels tired; I’m not sure if every tired person, who is tired from some other cause that is ongoing and continuous, feels depressed but I’m guessing the percentage that do feel depressed is pretty high.

Most of the stereotypes are exactly the same.

You know, all the old favourites: “you don’t look tired”, “you don’t seem tired”, “I bet if you pushed yourself you would find that you’re not that tired”, “if you just tried a bit harder I’m sure you’d be fine”, “exercise is good for people when they’re feeling tired”, “if you were really tired you’d be sleeping instead of just laying around”, “are you eating properly because if you were I’m sure you’d find you weren’t so tired”, “are you sure you’re not just being lazy”, “are you sure you wouldn’t feel better if you did something for the day instead of sitting/lying there”, “are you sure quitting is good for you? If you pushed yourself I think you could keep going”, “everyone gets tired, you just have to push through it”.

Yawn! Surely it can't be time to get up! bed

Yawn! Surely it can’t be time to get up!

Really?! So let me get this straight. It’s not bad enough that I’m suffering with tiredness, but now you get to judge me for the affliction which I would never have wished for, and condemn me for however I somehow manage my way through it. Hmmm. Yep that sounds reasonable.

Rant over; that’s not what this is about. But I will make a side point here before we move one. Every single time that you want to ask someone a question that subtly suggests they are being useless and not helping themselves, think about this.

If that person had cancer and was suffering from whatever-it-is, in this case let’s say tiredness since that’s the topic, would you still ask the question? Would you still hint that they could do better and be better?

If that fails, try, and I mean REALLY try, to empathise with the subject, in this case, let’s say me. How about, as a mental exrcise, you imagine you were me? You may be a friend who knows a little about me, family who knows a bit more about me, or a stranger unmet that knows only what’s written here…but try. And if you can’t imagine it, or have insufficient information to really get into my shoes, then maybe it would be appropriate for you to consider that you also have no right to comment.

And please don’t take this as a rudeness or a get-out-of-here sentence! It’s meant only as a demonstration because I’m certain that most people commenting on health and mental health these days are not the people who have an inside and intimate view of the various conditions that exist.

So; being tired.

Here is the 50 million dollar question: is it physical or mental?

Here is the 25 million dollar: does it matter?

And here’s the question that I want answered that I’m not sure there is even an answer to: what the ……. am I supposed to do about it??? Fill in the blank yourself.

I have no idea what to do about it. No clue.

Everyone else has a lot of ideas.

Who has the answer that is best for me?

So here’s my systematic approach.

Why am I tired?

First cab off the ranks: I have depression, bipolar depression that comes with lack of motivation, lack of energy, lack of stamina, lack of feeling. So there’s that.

Second idea: medications including quetiapine (Seroquel) which literally puts me to sleep at night and possible hangs over a bit the next day; lithium which is known to slow you down a bit, so there’s a bit more.

Third thing: I have underactive thyroid which was caused by lithium and we’re still working on getting the thyroxine (Oroxine) dose right. I started on half a tablet, now I’m on a full tablet of the lowest strength and we’re waiting the 6 weeks before we can take a blood test to check if we need to bump it up again. Also I’ve had iron deficiency anaemia over the last year and while my iron levels are finally okay, my iron stores are still low so I’m still getting that sorted out with iron tablets and I’m also enrolled in a clinical trial to help with iron levels. None of that helps.

Fourth: the weight gain thing. The last time I ran around and got excited about jumping up and down, I was 30kg lighter! Thirty kilograms. It should surprise no one that a person carrying a bag of 30kg moves slower than they used to! It’s logical maths.

So actually, when I see it all written out on paper in detail…I realise maybe I could be giving myself a break.

Hmm. That’s actually quite a lot of reasons to be going slow…maybe I need to go back to psychology basics and re-frame my life these days. Maybe what is desperately needed here is some of that self compassion that I blab about but forget to apply, and a new perspective.

The perspective that says, Danika, whatever you can get done today is excellent. Congratulate yourself for getting up out of bed, for having breakfast, for getting out of the house, for getting through a shift of work, for whatever activity you do.

Forget about wondering why you can’t this and that, why you used to be able to do this and can’t now, why it’s hard to get through what you want to get through.

Try being excited and satisfied and happy about whatever you can get done. Give yourself a break. Don’t just say it, give it! It’s not a theory, it needs to be a practice. Give yourself a break!

And remember that you have hope of improving in the future: the plan to eventually wean you off sleepy quetiapine, your intention to slow weight slowly but steadily, your commitment to your medication that should correct your thyroid function and anaemia.

RIght now, it doesn’t matter what the tiredness is; could be anything off the list. Just take each day as it comes, and try not to have excessive expectations of yourself in your current state. You aren’t last year, you aren’t later this year; you’re right now, so just handle what you can handle, and leave the rest to another day.

And seriously: take your own advice! Don’t just right these easy lines for someone else’s benefit; read them and believe them and check in on them again each day. Every day. I don’t want you getting into a state about this tiredness thing anymore; give yourself a break!