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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Canberra Day Twelve

I had such a wonderful surprise on Tuesday! I was idly wandering around Facebook when I saw a post from some old friends that I grew up with from about 3 or 4 years old which showed their location as Canberra! I thought, really? So I messaged them and yep we had managed to coincide in a city that neither of us had really been to before! So we organised to catch up for dinner and it was the best night! All the years and events that have passed since I left home 10 years ago haven’t changed a thing and it was a fabulous evening of yummy Thai food and chatting about everything under the sun.

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So the cake, what’s that about? Well, while this family have been on Victorian school holidays visiting Canberra, the youngest girl had her birthday and this was the cake she had. It was huge, tall and sugary with the fakest colours available, a horror to some of the family who wouldn’t choose this kind of thing ordinarily, and only half eaten. They’re moving on Saturday and really can’t take the cake with them. So a condition of our catch up was coming back to the hotel to eat cake! Not the worst thing in the world hey…and the absolute delight of hubby who will eat anything colourful! Fruit loops, smartie smiley face cookies, sprinkles, cakes of exactly this description etc. It was delicious, but I didn’t get through it; turned out it was pretty sweet after all! But what a lovely way to end the day: old friends and familiar faces in an unfamiliar city. Bliss!

Otherwise the day was washing, drying, folding, making phone calls I’ve been putting off for ages, writing emails I’ve been putting off for ages, organising a catch up, trying to decide on accomodation for a long weekend coming up, and watching for rain so I could decide when to do a bike ride. Turns out that I watched for rain all day and it never rained. But then it was the end of the day. And I didn’t get to ride. I wonder where I went wrong? In my defense it poured the entire previous day. So. Also, I realise as I’m writing this down what a social day I had; quite unusual for me generally. I must be going pretty well at the moment. I guess I already knew that, but it’s nice to have proof.

 

Suicide *warning: the following material may be very disturbing*

Author’s note: I wrote this piece two weeks ago. Then while re-reading it prior to publishing I had some reservations. My personal editor (aka my husband) also had some reservations about how it would affect other people so we decided to wait a while and see if we really wanted to publish this.

I’ve decided that I do want to write publicly about this issue. I apologise if it is disturbing, or frightening, or confrontational, or triggers emotions that are hard to deal with.

I can write about this issue openly now that I am past these horror days and now that I feel reasonably confident that I won’t experience them again, at least nowhere near the depths that I did sink to before. Thanks to an antidepressant and two mood stabilisers, and a team of psychologist, psychiatrist, very accessible and caring GP, fabulous husband and great friends!!

But I do feel that the population of the world fortunate enough never to plunge to these awful depths should have some understanding of the suffering that is out and about in the world, walking around trying to contain their sorrow and hurt. My favourite saying comes to mind:

“Always be kind. Every person you meet is fighting a battle you know nothing about.”

lease PLEASE remember that however impossible it feels, severe depression can be survived. It doesn’t feel like but just ask for help and let someone in! Tell your partner, your friend, your family, your colleague, a local doctor or go to the local emergency department. Tell someone; don’t suffer alone!! You know the numbers:

Lifeline: 13 11 14

Suicide Callback Service: 1300 659 467

Men’s Line Australia: 1300 789 978

Kids Helpline: 1800 55 1800

Employee Assistance Program (employees of public hospitals): 1300 361 008

beyond blue: 1300 22 4636

Suicide Line (Victoria only): 1300 651 251

Suicide Prevention Foundation: 1300 465 366

So here we go!

Suicide. Death by one’s self.

We don’t talk about it enough.

It’s taboo. It’s avoided, ignored, swept out of sight.

There can be sense of shame about it. Some consider it selfish.

In some places and in some era’s it is and has been illegal.

Some insurance companies won’t pay out life insurance policies if a death is determined to be a suicide.

Yet, along the death spectrum a ways, people campaign for euthanasia, the right to kill oneself if life becomes physically unbearable.

What about when life becomes emotionally unbearable? Mentally unbearable? Somehow people never consider the rights of a person suffering in this way.

But this is a dreadful, terrible, awful way to suffer.

Why are we sympathetic to cancer patients with terminal illness suffering physical agony but don’t give the same thought to mentally ill people suffering emotional agony without relief?

And to some people there seems to be or is no end in sight; treatments that don’t work or take too much time to work, emotional turmoil with no relief, desperation. What then?

Personally, I don’t believe suicide is right. Morally, that is. I believe what the Bible says: thou shall not kill, including oneself.

But it was a whole different story when I found myself in the grips of severe depression and assailed with suicidal thoughts.

Suicidal wasn’t about self-harm and ending my life. Initially.

It was about feeling terribly awful in the midst of my perfect life, so awful that I didn’t know if I could survive, if I would ever feel good or well again and I just wanted a break!

It was about dragging myself through the motions every day and wondering if I would ever feel like every physical step wasn’t a tiresome chore. It was about emotionally forcing myself through the duties of the day, pasting a smile on my face and coping when I felt like crawling into bed and never coming out.

I wanted an escape, to step into a time warp that would take me out of my life for as long as it took for the depression to go away. Then I could just step back into my life and take off where I’d left off, minus the awful distress.

I wanted the escape, but didn’t know how to get it. I was on two antidepressants, an unusual combination and a bit risky. But that was what it took to get me feeling better and sleeping. To start with, but then I started having odd thoughts as my mood took a steep dive downwards, the first time I experienced what I would later find out was a mood swing.

What would happen if I just stepped out in front of the bus? If I just took one step out…

Would it hurt? Would I just die or would I be injured and gain nothing but more pain?

I’ve always been against the idea of committing suicide by using another person driving a vehicle. I’ve called it selfish. I’ve called it unfair and sympathised with train, bus, truck and car drivers used in this awful way.

Is this karma? To be wondering whether I would actually take that step? To be thinking not about the awfulness that the driver would experience, but to be wondering if I could be that person? Wondering if it would solve my problems? If it would just take everything away so I didn’t have to try to deal with it day by day by day.

I’ve always been nervous about people standing close to the edge at train stations. I’ve always been half-prepared to see something so awful that it would damage me for life.

But then nothing happened and this mental disease arrived, bit by bit. Maybe it was the anxiety in me the whole time, all these years worrying and thinking about such things.

This was my thought process, back then, before I went to hospital.

I could never jump in front of a train. I’ve read ‘Dear Miffy’ by John Marsden. I know what happens when a jump in front of a train is misjudged! I don’t want to be in a wheelchair or completely dependant on someone else.

I don’t think I would jump in front of a car; too small, more likely to end up alive and well with a couple of broken bones. So that’s out.

So that leaves a bus.

Or an overdose. But I know that the medications that I’m taking are relatively safe in overdose. They won’t kill me. I’ll maybe sleep for a while then wake up back where I started. With the added stigma of having tried to kill myself!

I don’t want that for me, but mostly I don’t want that for my husband. I don’t want to leave him with the bill, so to speak. He doesn’t deserve a life of questioning what went wrong, where could he have done something or done it differently, of blame. He doesn’t deserve any of that. No one deserves that. So I came to this: I can’t do any of those things. I have to keep on going, to keep trying, to keep fighting. Because I can’t do that to him. But it’s so hard!

Another day I got to thinking again: what if I just jumped off these rocks into the crash of waves breaking? Would it hurt? How long would it take? Would someone rescue me? Would it just be easy and instant?

What about sharps? One of my horrors is paper cuts to my eyelids, no idea why! But I’m always super careful around knives and I hate blades, which is why I now wax instead of shave; I’ve cut myself enough times as a total accident to give away shaving! And our knife set is new and super sharp, but I don’t think I could ever do that.

I don’t have a gun and I wouldn’t know what to do with it.

What about painkillers? I don’t have any above supermarket strength and I know they don’t work in overdose, it’s just long slow painful illness of liver failure that can take forever and is a terrible idea. Or bleeding, also slow and awful, not at all a solution.

I’m not great with heights, I just know I could never make myself jump.

So, all out of ideas.

And that’s how I came to be in my doctor’s office at midday on a Monday, bawling my eyes out.

The doctor asked me, have you had any suicidal thoughts? Yes, I sobbed.

Do you have a plan to harm yourself? No, because I can’t think of a way that would work! Sobbing harder and harder.

If I let you go, can you promise me that you won’t hurt yourself? I don’t know, I think so but I’m not sure, I feel so terrible! Sobbing, and sobbing, and sobbing!

A terrible, awful point for me in such despair and not even able to come up with a good way out. Still believing that it’s wrong, but needing so badly some relief! Just a few hours off, just a day of rest from the hurt and chaos in my mind!

Which I did get, later. I took a Valium on the way to the hospital, they gave me another one in the emergency department a few hours later. I slept then, for a few hours. That was just what I needed. But then I woke up and they wouldn’t keep me. As desperate and at the end of my rope as I was, they sent me home.

With 2 temazepam, double the usual dose of this sleeping pill. Which gave me another 8 hours of absence until I could come to terms with going on, dealing with a new day, another battle, keeping on keeping on. Until they could send members from the outpatient psychiatry team to visit and help me.

And then they started the long path to bring me back to today.

Starting new medications, changing doses, scrapping that one, starting another one, altering, fiddling, trying and failing and trying again in the long haul to now, a better day.

Today it is 77 days since I was in the emergency department of my local hospital (author’s note: written two weeks ago). Not the hospital I work at, another one near home. I could never have gone in that state to work and shown any of my colleagues the face under my usual coping face.

77 days. None of them spent working. All of them spent here at home. Making tiny steps of progress, going backward, coming forward, a couple steps one way, another few the other way, teetering backward and forward on the scale from deep depression to hypomania and somehow, at long last, feeling like I’ve settled in the middle around a place that I could call home, somewhere around about “normal”.

My husband in fact thinks maybe I’m better than “normal”. He sees now that maybe I’ve never been as good as I am now.

Sure I still get tired, and have the odd afternoon nap. But I’m more productive, I’m more energetic, I’m more engaged, I’m enjoying life, I’m driving a bit, I’m shopping a bit, I’m doing the dishes occasionally, the laundry sometimes, making the bed some days, hosting visitors rarely, doing day trips every now and then, actually living my life 🙂

We know there will still be days that are further toward one end of the scale or the other. The aim of all the treatment is to not go so far toward either end. My personal goal is to never ever in my whole entire life get anywhere near as deeply depressed as I have been. I don’t ever want to see the shape or colour of that place ever again!!

But we’re living life, and enjoying life! That’s something to be deeply grateful for every day. We’re alive, and relatively well, and life is good! Well, better anyway. That’s something.

I want to live life to the fullest. It’s a cliche, but that’s what I want. My aim is to enjoy every day that I can enjoy because depression is not ruling my life with it’s inability to enjoy pleasure, or it’s sadness, and hopelessness, and pointlessness.

Now ruling my life is just…life. Just life. Getting less complicated, more predictable, more fun! Yes, it takes an solid dose of antidepressant and a good going dose of two mood stabilisers/anti-psychotics. It takes weekly visits with my GP and psychologist, and fortnightly visit to my psychiatrist. It takes good doses of friends and hobbies and enjoyable activities. Who cares? What works, works and I have no argument against that!

Link: how to talk about suicide