PSA

Here is my public service announcement (PSA).

Not to be confused with prostate-specific antigen, Pharmaceutical Society of Australia and I’m sure many other words starting with those letters positioned in that order.

Do you take any medication? Any medications?? Even one medication?

“No, only vitamins, no medications”. “Which vitamins?” “Umm…”

“Just a blood pressure tablet…oh I don’t know what it’s called, its the pink one”

“The doctor started me on an antibiotic this week, no I don’t know what it is”

Here goes, my entire public service announcement: KNOW YOUR OWN MEDICATIONS.

Every day, somewhere between 4 to 18 times depending on shift length and how busy the department is, I walk into an ED cubicle and ask a patient, do you take any medications? And I get some frustrating answers: frustrating in that the patient or their carer hasn’t taken ownership for their own or the patient’s healthcare, frustrating in that I have to put in a lot of time and effort that the patient didn’t think was worthwhile, and isn’t necessary, and I forget why else; I’m sure there was something.

 

I’m not whinging about having to do my job. The whole point of a pharmacist is to elicit the best possible medication history from or for a patient, and I have to dig a lot to get the optimal history. It’s the reason I go to work and the challenge of it creates a real sense of satisfaction once I’m certain of a patient’s medications. But I do think that patient’s have to be engaged and do their part. Obviously I cheerfully exempt unconscious patients, those who are demented/delirious, institutionalised patients and anyone else not in charge of their own medications. But the rest of you? Own your health, for your own sake if nothing else.

You don’t have to be a doctor, a healthcare professional or know anything really about medicine to excel at managing your own medications. You just have to put in  a little time and effort, and get to know the following: the medication generic name (the one in small print), or the brand name (I can work with that), and the strength of the medication. That’s it. I’m not even asking you to memorise it. In fact I don’t want you to rely on your memory. When you’re in the ED, there are so many things going on that with you that your medication name and strength are going to get prioritised right out of your memory recall centre, and be useless to both me and you! So write it down, photograph it, tattoo it on your skin if you must! Okay, the last one is a joke, people!

After that, I need to know a couple of things about each medication: how many times a day you take it, what time of day you take it, and anything else pertinent to the medication specifically. If its written down, all you have to do is hand me the list and that’s all I need; if its on your phone just hand me the phone. So if you don’t want me bugging you, and asking you questions, be organised! I will reward you.

And as an added bonus, if your medications are written out neatly and the list shows you know your doses, your medication chart will be written up quicker, more accurately and your medication chart will be safer. I think that’s worth some effort.

For instance, one patient today brought all of their own medications in a box with a handwritten list saying what time of day each was taken. I was able to record all the information I need: generic medication name, strength (from the medications themselves), and the amount she took and what time of day she took it (from the handwritten list) while the patient was sleeping. When she woke up, I just quickly ran through the list with her to confirm it was up to date, and that was that! Easy, fast, and done, just like that! Her medication chart checked for accuracy and the patient was safe to go to the ward, medication-wise.

A lot of patient’s are very good at bringing in their own medications. In fact Epworth patients are exceptional at bringing in their own medications. This is mostly because they know from their last admission or from savvy ambulance drivers that if they don’t bring their own we’ll dispense what they need, but they’ll pay the same cost as if they were getting the medication dispensed at their usual pharmacy. Most figure they’ll just use what they already have. But having all the medications together in one place at the start makes taking a medication history a lot easier and more accurate, so there’s a hot tip for you.

 

Let’s try this again: do you take any medications? Yes? So what are they? Acceptable answers include:

  1. Here is a photo on my phone of all my current medications including vitamins showing the medication name and strength of the tablet/capsule clearly
  2. Here is my medication list that I keep in my wallet/handbag/toiletry bag that I bring to hospital with the name and strength of each medication and what time of day I take them
  3. Here are all of my medications in some sort of bag
  4. Here is the name of the pharmacy where I get all/most of my medications dispensed regularly

Personally? I carry a list in a plastic slip case that I got the the National Prescribing Service (NPS): it has sections for medication name, strength, amount, time of day, diseases, allergies all neatly in a double-sided fold up sheet that fits into a plastic cover; I think you can get them from NPS online.

So even if it’s one, or two, or “just” vitamins/non-prescribed medications, take the time to record them some way, some how. This isn’t just for hospital, but of course this is from my perspective working in a hospital. But I’m sure your GP, your specialists, and maybe others will make good use of your medication recording. So get going, and do me proud! I’d love to see your efforts, so send me your best!

Canberra Day Eighteen

Wednesday 28th September, 2016….yesterday still to come.

Well this is all out of order but I’m struggling a bit to keep things together. I took my tablets, and went to bed by 10pm last night to give myself the best chance for today. Slept okay I think, hard to remember, thought I was too drowsy and hungover when hubby was going off to work and tried to psych myself up, but he was actually getting up for his 5.30am morning bike ride!! So…back to sleep, and it’s always a struggle waking up from that second morning sleep. When my 9am alarm went off I just couldn’t feel like it was time for the day, and rolled over. Actually can’t remember now what time it was that I got up, somewhere around 10 or 10.30am. Had brekky around 11.30am, hubby reminded me to have lunch around 2 so at 2.30pm I finally got started on that.

Hubby is being my hero, yesterday and today. Not that he isn’t always; he is. But I really need a helper right now, and he’s being that. The photo of the day is his reminder to me of what I could eat for lunch. I have NO imagination for lunch, I’ve always eaten leftovers and when there aren’t any leftovers, I just stare at the pantry, in the fridge and I can’t think! So I default to drive-through which obviously isn’t ideal, but it’s so close to home, a quick drive away. You may have noticed that weight is a bit of an issue for me. Speaking mildly. It’s become a bit of a thing though, buying drive-through, and even when I don’t really want it, that’s what I do because I know what’s there, and it’s always there, and it’s no bother, and it’s just easy and doesn’t require thought or planning. Sad, you probably think. So do I, often. The rest of the time I’m just pleased that that’s lunch sorted for another day. Plus it tastes good sometimes; not all the time.

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I’m sure that hubby thinks its sad too, so I hide it. That’s become a thing, too. Not quite admitting to what I’ve eaten during the day. Burying the evidence at the bottom of the rubbish bin, or in the bin bag that’s on my side of the bed and only taking it out when I’m taking the bins out to the road, or worst comes the worst putting it in someone else’s bins. And that is not the way to have an honest relationship, which I’ve surprisingly taken a long time to figure out! It just puts up a little wall, stone by stone until you realise that there’s a barrier in the way of the two of you really connecting. Somehow it took an honest conversation last night about me hiding my food habits to start taking down some stones and building a bridge. It’s horrible to think we would have something between us! I’ve hated it lately. We have always been best friends and partners with no lies, no hiding, no buried pasts, full openness and honesty; and this is no time to change any of that!!! It’s hard enough keeping an equal relationship with mental illness on one side. It wasn’t intentional; I was doing the self-protection thing. Which does boil down more or less to selfishness, really. Where to avoid an uncomfortable discussion of my obesity, and eating food that can only contribute to more weight gain, and spending money of unhealthy food and so on, I’d hide anything to do with it: receipts, food scraps and packaging, and even pay cash so it doesn’t show on our credit card statement! It’s all become a sad rigmarole, embarrassing, and many other things; I’m sure you can fill in some of gaps.

But, we’ve opened the door, so here’s the new thing: planned lunches. So far today, so good. A nice toasted sandwich with prosciutto, cheese and tomato. Yum! I’ve got pies to cook with frozen veg, some bacon and cheese topped rolls, and a bit more confidence that I can do this! I can eat regular lunches like regular people and go back to the times before when the day manager at KFC knew me and greeted me with a smile every time I drove through, and had a joke with me! She’s a really lovely girl, is it beyond tragic to say I miss her? So much for new city, new habits!!

Well, that was a lot of spewing of internal bile that I hadn’t really planned on sharing today! But there we are.

All I can say about today is my planned ride and bird watching didn’t eventuate. Owing to the fact that it took me 20 minutes and a few sit downs to get dressed for the ride after a phone call to hubby for an inspirational speech, and after procrastinating all day! It didn’t seem like I could throw a leg over a bike! My main achievement was sitting around on the couch deleting a few MB of photos from my computer so I can fill it up again with the 800 or so photos that I took yesterday!!! Eventually I’m going to need my own server! And that was my day! So…not the greatest. Not one to remember. Quite frustrating really watching the brilliant sunshine and blue cloudless skies go by, knowing its the last fine day of the week! If only…but no, as hubby says, it wasn’t my day. Maybe tomorrow I’ll be firing on all cylinders just in time to watch an inch of rain pour down from the skies! Who knows? There doesn’t seem to be a rhyme or reason to me as to how I’m going to be each day. I am missing the routine of getting up early to take hubby to work, I think, but I doubt I’d actually have been up for it today and yesterday. I wasn’t up for it last Thursday; needed a sleep in. And he rode to work on Friday. Maybe this was coming all along and was just inevitable; after all I did surprisingly well for the first 10 days. It’s just annoying, because I can’t say one way or another. Am I just having a bad couple of days like anyone could? Or am I having a down swing with my moods that I should monitor and that might need some intervention? And on and on, my mind is just going round and round and round, on a slight downward trajectory. Things that don’t usually bother me are getting in my craw, so to speak. I’m thinking too much. A good nap has helped a bit, but in total that means that I slept from 10pm last night to 10am this morning, then for another 2 hours from 4.30 to 6.30pm. 14 hours a day isn’t really sustainable. I don’t know whether having a job would have helped or hindered today. Would having to get up have worked, or would it have been another sick day? I wouldn’t have been the best customer service! Enough! No more thinking for now. Off I go at snail’s pace to potter around about dinner. Hubby’s late, poor him. So here we go, off I go. Off I go…

The Brain

[Author’s note: written last Thursday]

Today I…

…Hmmm.

I just realised that a lot of my writing and thinking starts like this.

That’s one thing about being home by yourself for months; you get to thinking about yourself a lot! And not so much about others.

Plus, you know, the whole life-changing nervous breakdown thing that triggers a lot of soul searching, heart searching, mind searching etc.

Plus being in therapy which encourages looking into yourself and understanding yourself and changing yourself. Plus seeing doctors regularly who ask you about yourself and want an answer about yourself.

Don’t know whether it is bad or good but it is what it is. I’m just noting it for my own reference really. Without judgement, just like my psychologist, mindfulness teacher and gratitude life class coach would say!

So today I went to a free organ concert.

This is something that I’ve wanted to do for a while now and haven’t gotten around to. It’s actually something that I’ve wanted to do ever since school camp to Sydney way back, not sure which year; probably about a decade ago though!! We saw the majestic organ at the Opera House but never got to hear it played. So the idea of hearing an organ concert is something that has been lurking in the back of my brain ever since.

And now it popped up for free! Can’t beat that!

So I went along today and took in the concert.

Annoying thing is, I’m not sure if I enjoyed it. Annoying, frustrating, irritating, worrying, concerning,interesting; pick one, any one.

My logical brain appreciated the size and the grandeur of the organ and the work that went in to building such a large musical instrument. It registered the admirable fact that the organ has been in place for a long time and still rings true thanks to dedication of many people. It realised the lovely surroundings from where I sat including the bright colours of stained glass windows, lovely wooden furniture, carpets and heating that made the environment comfy cosy on a freezing cold rainy day. It took in the detail of paintings and carvings and settings that were meticulous and intricate.

My rational brain heard the satisfying chords of the music played and admired the skill of the organist, and the patience of the girl sitting by to turn pages. It was interested by the variety of other people with a like desire to hear organ music in this day and age, and the ongoing support of obvious regular attendees. It was intrigued by the range of notes and variety of styles in which the organ could be played; impressed really to hear fast furious pieces together with traditional classical music and lyrical hymns. It felt obliged to be satisfied overall because really, wasn’t I ticking off one of my longings?

My physical brain was engaged in making sure that I was comfortable. I overheat very rapidly these days because of my medicines so all my coats and scarves were off. But just to be sure my physical brain checked and checked again and found that I was in fact sweating. Seriously, it was 8 degrees outside and I had just walked into a mildly heated draughty room and I’m wiping sweat off my face! Argh. Moving on, my brain was okay with the seating, the position, the view. It was surprised to find the seats in fact very comfy for an old building, and the view to be very nice.

So my brain goes on, looking, checking, assessing, approving and appreciating.

But is it enjoying? Today I’m just not sure. Usually I can feel it; happiness, joy, enjoyment. But today is one of those days where everything is in place, but I just can’t quite get to where I think I want to be.

Is it the medication, is it the condition, is it just an off day? Was it my lunch not sitting well, the seat slightly skewed, the conversation I just had? Was it my planning for tomorrow, my list of others things I’d like to do, my thoughts on dinner?

I think it will take more time and experience before I know the difference and can say for sure which is which.

I’m glad I did what I’ve wanted to do for so long. I’m sorry I didn’t quite get out of it what I thought. Maybe my expectations were not aligned with reality or maybe today’s just not my day. At least I have the blessing of being able to try it again sometime since the concert is a recurring one. A lot of times we don’t get opportunity a second time so that’s definitely in the plus column!

Unwilling or unable?

Unwilling, or unable?

This is a difficult call to make.

It’s so subjective.

All that we have to go on is my opinion versus your opinion, with whatever evidence each of us has gathered plus whatever balancing knowledge we have at the time the call is made.

It’s something that I’m still battling with, and because I’m battling with it, I assume that there are others out there fighting with themselves over this. I don’t know for sure if there are, but I’m writing this anyway, for me and for anyone else who gets it.

Before I got sick. Such a statement! Also hard to define but I’ll use it anyway.

Before I got sick, I found this line easier to determine.

I’d get home from work, tired out and ready to relax and the thought of having to get together the where withal to get up and going again seemed impossible. Everyone has felt like that at some time.

So it comes down to a battle of the will.

I know I’m tired, will I allow myself to sit down and relax or will I get myself up and going to an exercise class I love and know I will enjoy/the supermarket for groceries to make a better dinner/the week night Bible study meeting which I’ll feel so refreshed after?

Will I, won’t I, will I, won’t I? It was a mental battle. From experience I knew that if I pushed myself I would get through whatever it was that I had planned on doing. It wasn’t physically impossible despite my tiredness. It was a matter of setting my mind to it being a non-negotiable task and doing it! Like work. You don’t wake up in the morning and think will I, won’t I go to work. You just get up, do what you have to to get organised and go!

Well at that stage I did. As the stress of my last job accumulated and compounded I did find myself waking up with a feeling of dread (hello anxiety!) and thinking do I really have to go? What if I just don’t go? What if I say I’m sick? What if I just stay in bed instead?

I guess I should have known that that was something else. That this was more than usual reluctance to get out of bed. I’ve always been a mid-morning person. Getting up has never been easy, but then again it had never been like this. Lying in bed watching the clock tick around to when I should be leaving. Feeling dread and stress and fear with a little smidgen of hope build up until I thought they could physically burst out of my chest.

But in our house growing up, the words “lazy-bones”, “wuss”, “sook” were tossed about like “hello”, “goodbye” and “how are you?”. As a consequence of those terrible words being acceptable to apply to children, I always question my own judgement towards myself, and wonder if indeed I am being a “wuss”, a “sook”, “weak”, “lazy”, lacking in having a backbone or courage or dedication or commitment or appropriate drive?

I think I’m learning these days to give myself more credit. To remember that I am a dedicated, committed professional who knows her responsibility in the workplace and fulfills her duties creditably; who wouldn’t “slack off” or “be lazy” or “not pull her weight” unless there was a solid decent reason. All words that no one else has used against me by the way, except for my old inner voice that I’m slowly chipping away.

I’m learning to know my limits and to communicate these to others. Not with the phrase “sorry to be a wuss but…”! With the phrase, “I have done x and y and z today and I’m pleased that I have accomplished so much. That is all that I can manage today. Thanks for your understanding”.

I think it’s called being assertive. Having been terrified of confrontation all my life I never really got the practice of asserting myself. I knew the theory but that only gets you so far. These days I’m realising that I am a person with valid opinions and thoughts. I’m finding that communicating this directly to others results in a better outcome for everyone. And I’m not so fearful of confrontation anymore. Because now I know that I am an equal part of the conversation/discussion/interview. I’m not the weaker part having to make up to the stronger part anymore. These are truly great days for my personal development!!

But it still comes down to this: what and where are the limits?

When is it enough without being too much? When could I push myself more? When am I taking it too far and risking exhaustion? Do I have more energy than I think I have? Could I maybe do just a little bit more, or should I call it a day?

How can anyone know the answers to these questions?

And then there are the other factors: I just don’t feel like talking to anyone today so I don’t want to go, I feel very anxious about going so I think it’d be better if I stayed home, I just can’t get my head together to go today, I’m too drowsy/sleepy/exhausted/tired.

I’ve been told to push myself, but to be careful not to exhaust myself. I’ve been told to learn to know my own body so it will tell me when enough is enough.

Who teaches these things? How can I learn these things? How can I know the difference between my body being tired and my mind being tired?

My body tricks me all the time. I’m sitting here an hour after a good dinner and my body is telling me it’s hungry. I know its not, but that’s not how it sees the situation! So how can I be sure about my body telling me when it has had enough? It feels like a marathon getting up, showered and dressed some days; my body tells me that it enough but surely that can’t be the limit.

If I can’t tell the limits, how can anyone else? I suppose this is my main point after all. Here’s me: I’ve got these limitations of conditions, medications, recuperation. How, considering all the variables, can any other person tell me what or how much or where or when I should be doing what I’m doing?

Not that many have tried, to give credit where credit is due. Most people have been endlessly helpful, patient with me in my disability, considerate of my limits and thoughtful of me in the middle trying to make me work.

I really do appreciate that!!

I guess it’s always a work in progress. The fact is that I can’t do everything that I would like to do; that’s just how it is right now. I am learning to accept these facts as they are without judging them or myself; that’s huge progress!

With the energy and motivation I do have, I do what I can. I get tired and worn out faster than I’d like. I don’t have the stamina I want. Some days I wake up and it’s just not my day. Then after a nap suddenly I’m firing on all cylinders again. And tomorrow, I might be rearing to go! I just don’t know, and can’t tell. It’s a trying, sometimes frustrating game trying to figure out my agenda for the week, or even the day, not knowing when or how or what I’ll be like with any definite prediction.

Another thing that it is very hard is to differentiate between what the condition causes and what the medication causes. Am I suffering from a side effect, or is this just the part of the condition that we haven’t got under control yet? I think only a trained doctor could answer that with any certainty, and maybe not even then.

So, in the meantime, I hope I’ll do what I can, but not too much, and hopefully figure out just what that is!!