Future planning

Dear family and friends,

Could I make one request only should I ever be admitted to hospital? Shallow though it be?

Promise me that you will band today, draw up a roster and sit by me day and night holding my lower jaw to my skull so I’m not lying there with my mouth wide open to the elements. It’s all I ask.

It is probably the one thing that gives me the heeby geebies more than ANYTHING else: a patient lying there asleep on their back with their mouth agape just waiting for anything to fall in, drying out, and the hoarse snoring that goes along with each intake of air via mouth breathing. I can take blood, poo, wee, the stench of a total absence of hygiene, disgusting stale smoke and most smelly wounds, but an open mouth gasping for air just send shudders through me. It implies a total loss of self control I guess, which is probably the scary part to me; being totally vulnerable. It’s so ick! What if a spider crawls in my mouth? What if I choke on my drool and no one notices and I die?

I know its convenient to have patient’s positioned on their back while they’re in a hospital bed (especially while in ED) so their face can be monitored, so there’s easy access to put on the blood pressure cuff or get to veins for any medication infusion or blood test, or elevate limbs but I never sleep on my back and just don’t think its natural. I’ve had this conversation a few times when we were buying a mattress. Apparently you’re “supposed” to sleep on your back, and some insisted I lie on my back to test the mattresses, even though I would never again sleep like that again. Well that’s nice, but walking around the wards and glancing into rooms as I go I can tell you there’s nothing natural about patients lying there gaping! It pains me on their behalf.

So if you could just help me with this one, I’d be very grateful. End of shallow request. Thank you, and goodnight.


Another day, another dollar

Yep, the stories go on and on. I’ll amuse myself telling tales and when you get sick of them, let me know 🙂

The person in this story isn’t a patient, although they seem to feel themselves at home in our hospital. Confidentiality isn’t really an issue here so using his name doesn’t concern me; although his surname, which would be more useful, is unknown. What fascinates me about this man is his brazenness! Not a word often used but totally applicable in this case. Bold, no shame, confident, aggressive, a real pain in the butt might be other terms equally suited. This man came up at our staff meeting today. This is a very rare occurrence; an individual being named in a staff meeting. Actually I don’t think it’s happened more than once before, and then for a very regular patient having treatments all over the hospital with the aim of improving provision of services.

So, why? Turns out this guy has been harassing staff all over the hospital. I’d been around once on night shift when he came into our retail pharmacy (out the front of the hospital dispensary) and it wasn’t pleasant. Staff reported he was swearing at and abusing pharmacy assistants and pharmacists alike including racial abuse to our gorgeous Asian pharmacist, and extremely inappropriate abuse to all of the women. Then he was tampering with products indicating no intention to buy (that’s the high brow description, attempting to steal is the other version) and generally being a big nuisance. They had to dedicate a staff member just to watch him, and when he saw that he got more aggressive and started on the poor unfortunate girl watching, then the pregnant pharmacy assistant. At which point the girls naturally wanted a fella out the front to try to get this guy out, but I think the guy they dragged out from the dispensary was more terrified than they were! At which point I found out that I don’t actually know how to call for security! No one has ever showed me! Dulp! In the end he took himself off, but since then its become a semi-regular occurrence that he comes in and makes a scene, so now in staff meeting we’re informed that not only have the police been involved with this drug-using, homeless guy in these subsequent incidents, but he is now officially banned from the pharmacy!

But wait…there’s more! Concurrent to these incidents, but not knowing it was the same person, I’d been made aware of a man who had walked right in the door of ED, straight into the patients toilets, and preceding to shoot up whatever drugs it was that he had on him at the time! He was interrupted with a needle in his vein and had to be dragged out and kicked out the door by police!! So there was a general alert put out: if you see this man, alert security and the police and don’t approach him directly; drug users are notorious for using syringes, clean or otherwise, used or otherwise as weapons, which ends badly. FYI this is the reason why its strongly recommended that all pharmacists are vaccinated against hepatitis A and B. It may be overkill but better safe than sorry if a pharmacy hold-up goes south. Next day? Back again, now in the ridiculous comic “disguise” of a sombrero and aviators!! Seriously dude? Where are you going with this? Luckily the triage nurse recognised him, called out his name and told him she’d call the police, so he did a cool, calm and collected about-face and sauntered on out again! Too bad he hasn’t been banned from the hospital, too bad for us I mean, but I guess hospitals can’t really ban folks, something about ethics I guess.

Next? A man, unknowingly the same man, now onto trick number 3 walks through the main entrance of the hospital, catches the lift up to the 5th level, walks into a patient room, into the bathroom, and has a shower!! Yes, he helps himself to a shower, then, wait for it…he tucks himself into bed!!! I’m still boggled at the nerve of someone to walk into a hospital like you belong, and just make yourself completely at home where you aren’t meant to be! So once again, police. They must get wretched tired of this gig!

So, now that everyone has finally come onto the same page (reminder of the importance of informing up the line about incidents) what is the sum decision? Banned from our pharmacy, alerts out for ED and the ward, and a letter sent to his home about the above. But hold the phone, isn’t he homeless? Where exactly did that letter go to…? So, he’ll know about this how? And next time he comes in? Well still call the police, and since he’s been “given” a warning, they can act further. Actually it turns out that the police are currently frustrated because a judge stuffed up a bail issue with this guy; he’s meant to be in jail not roaming around being an idiot. But I guess that’s another story.

Accidents happen

We all know this: accidents happen. It’s part of life.

But in some areas, accidents aren’t okay. So we make systems and safeguards and policies and procedures and checks and balances and we educate to minimise human error. Sometimes, even that isn’t enough.

I know mistakes happen. This week I had my first ever car accident. I’ve had plenty of near misses and close calls in the fourteen years since I got my learner’s permit, but luck has always been on my side. I did have to run off the road once when someone stopped dead in front of me on a 100kmph road…but apart from having a panic attack from a massive surge of adrenaline after I finally pulled the car to a stop in an orchard, there was no harm, no foul!

This week what happened was that my left front tyre slipped on the soft edge of the road made up of leaf litter, and despite me pulling on the steering wheel and braking hard I slid off the road into the shallow ditch and hit the bank on the other side! It was sort of interesting to note that the wheels did turn; once I got out of the car and found that my knee was just bruised, I found that the wheels were in a slightly turned position but obviously I just skidded. Luck was still on my side though: the side of the road, the mini ditch and the wall of the ditch that I ran into were all so soft that there was almost no damage at all, and I wasn’t hurt. In fact when I eventually got off the wall, it was running water; there was practically a river of water running out of it! The unlucky part was that I “crashed” (a dramatic word for sliding off a road at slowish speed) in the back of beyond on a road very infrequently used with no internet or mobile reception and no GPS! Couldn’t call hubby, couldn’t call RACV, couldn’t call work to tell them I was a bit delayed; nothing! I couldn’t message through Viber, Facebook, Twitter, Instagram, Gmail; nothing! No one could track my phone by GPS. So I had to sit there and wait. And wait. And wait! In the end I had to wait half an hour before the next car came along! Still, it could have been a lot worse.


Doesn’t look too bad right? Just resting here…


I couldn’t leave the car to find better reception, even locked, because I was halfway between picking up a bucket load of drugs and delivering them to my pharmacy! Imagine: I’m a pharmacist in a new job, trusted for the first time with a pick up, and for the first time I have an actual car accident!! Not cool! Someone asked me if I told the boss…um no!! Sure I could get him to pay the repairs, but do I really want to start with that kind of problem two and a half months into my job? Please note this drug/medication transfer was a one-off event; my car is not usually filled with drugs!!

So I sat there. I yelled out loud at the top of my lungs a few times for no one to hear. Just expressing my frustration in a civil, calm manner. I tried slowly reversing back without spinning the wheels but the ground was too wet and the leaf litter was too deep; the front wheels gripped for a millisecond but slipped almost straight away. Pretty sure the back wheels didn’t budge…well of course they didn’t, its front wheel drive; duh!! My years of bumping around our block on the old Fergie tractor have finally come to some kind of use, especially that time I had to back myself out of an actual metre deep ditch! But it had better wheels more suited to this kind of situation; it could practically climb a wall! The leaf litter on the edge was so deep that when I stepped out of the car my foot went right down into it. I tried to push the car back out of the ditch from the drivers seat, I tried to push it from the back seat but it didn’t budge…oh whoops the hand brake is still on! Kind of redundant since I’m resting on a bank. But letting it off didn’t help, and whats that on my foot? EEEEK!!!! Screams at the top of her lungs!! A leech!! SWAT!! Thank goodness that’s gone. Oh no its on the steering wheel!! SWAT!! Now its on a different part of the steering wheel! ARGH this leech is a real sucker!! Who would have thought?! Jumps out of the car out of impulse trying to get away from the huge, enormous, blood sucking monster!! Almost as bad as a spider at close quarters!


The exact view from my car window…so it wasn’t all bad!



Oh wait, what’s that?? A 4WD or ute or something big and heavy and revving is coming down the hill! Start waving, start waving!! Yes its a cab ute with 2 men and a towing engine thing on the front and a solid tow rope with a huge hook…oh yes, this is what I’ve been waiting for!! Waving, waving, getting out of the car, please help me!! It occurs to me belatedly…that I am in a deserted part of the world, with no mobile or internet reception, asking 2 men for help in a situation that I can’t help myself out of, and trusting to their good nature. When I was suffering anxiety, I would’ve been hiding in the boot of my car til sundown and my husband realised I was missing and sent out a search party!! Actually no, my boot was full of drugs…well maybe the back seat then. It just shows how far I’ve come, and that really most people you run into are good.

The driver’s reaction when he got out of the ute? “Oops!” Precisely, my good man! But he said he had the same accident on the next corner himself last year, so I felt better. Because of course up until this moment I had naturally assumed that this was the exact kind of idiotic, stupid thing that I always get myself into and no one else would ever do such a dumb thing and wasn’t I a prize numpty?! And that this was yet another episode of me damaging the car, because there have been many! Part of my reasoning for not telling my boss; assuming that I would be embarrassing myself! Not that I actually did anything, I just sat there while I slid in the mud. But I always insist to myself that I’m the one that stuffed up. So these 2 kind men dragged me off the bank backwards with tow ropes, but the back of the car was slipping into the ditch now, so we had to switch to dragging the front up onto the road and the rest of the car followed. Meanwhile whatever hound they had in the compartment on the tray of the ute was howling at me as loudly and as often as it could breathe!! Another piece of luck was going off the road while it was still bituminised; another 500 metres and it turned to packed dirt…pretty sure that would have hindered the towing process. So 45 minutes of my life and I’m back on the same bit of road I was before the accident.


So I displaced the bank, and a bit of my bumper…not a bad result

As it turns out I shouldn’t have even been on that road! I turned 150 metres too soon, and should have been on Maroondah Highway where this would never have happened. Ahhh. But I definitely got the scenic route, although I probably would’ve been happier swapping a bit of scenery for a car trip with no accident. Only something that would’ve happened to me, or just an unfortunate happening that could happen to anyone? At least I didn’t have to get towed with all those meds on board!!! THAT would have been embarrassing to explain to the boss!

So with all this in mind, I’m still unhappy about an error that occurred today. I got several scripts dispensed at one of the pharmacies I routinely use near my GPs office and one of them was wrong. Not a little bit wrong like the price was out, or I was given the wrong quantity. I was given the wrong strength of lithium, 450mg instead of 250mg making it an overdose, and it was the slow release formulation instead of immediate release meaning it would hang around in my system longer after the overdose, and it had the usual twice daily directions that apply to the 250mg strength instead of daily which is how the 450mg slow release should be taken so the level of lithium in my system would accumulate quickly. My lithium level is already at the upper limit of okay, and my psychiatrist is thinking of reducing my dose; this would have found me in hospital within 3 days!!! It’s that serious, and potentially worse.

But I’m conflicted.

As a patient I’m outraged and think the pharmacist should be reported for this very serious error, that fortunately didn’t eventuate because I picked it up before taking it. I think that there should be some consequences for not taking the proper amount of care.

As a pharmacist I know how terrible I would feel if this were my error, but I also know that lithium is one of those medications that you should take extra care and attention with when dispensing. The error occurred because the pharmacist entered the wrong medication when typing, and so the scanning check wouldn’t pick this up. But there would have been a message saying that I previously had a different strength, which was ignored. And my history must not have been reviewed before dispensing, despite it popping up and having to be entered through before you can type in anything. Two checks ignored, besides the obvious check of visually comparing what is written on the script with what is typed before printing!! That’s three checks ignored. I’m not sure the the pharmacy board would see any reason for skipping any of these checks, especially as there were only two patients in the store at the time.

So this is my big beef with pharmacy at the moment, both in my workplace and in the pharmacies where I get my scripts dispensed. There IS a proper way to do pharmacy, and it’s not being done! For reasons which are specious and inadequate, and I believe, unacceptable! I miss hospital pharmacy for this reason: maybe we take more time but we do things as properly as we can, no shortcuts or conveniences. Of course the pharmacist felt terrible, its a natural reaction. But will it change her future practice? Will she do things properly next time? I really don’t want to report her, mostly out of colleague empathy. But is it something I should do, for the improvement of the profession? I probably won’t, but it’s still all milling around in my mind.

What’s an accident, and what’s an error? What’s okay and what’s not? Should I be pointing fingers when I make my own mistakes? I don’t know. What do you think?


First day/s

[Saturday 29th, and Sunday 30th April 2017]

“So how was your first day at work?”

Well thanks for asking! Really. I’m so grateful to every person who has asked about my first shift, about starting this job, and about what’s next for me. It’s so encouraging and I hope this answers all of your questions!

Actually, it’s also a complete relief to have an answer! Being “unemployed” never got more satisfying as a reply when people asked what I was up to. Although “unemployed” is not how I ever thought of myself. I still thought of myself as a pharmacist, although the longer I wasn’t working, the looser that description felt. I thought of myself as a birdwatcher, a photographer, a bike rider, a lady who was able to lunch more days of the week than not; but that seemed to come off a bit lame as an explanation. These titles com in addition to the long term titles of wife and sort-of housekeep; although hubby would argue with the housekeep bit, most likely. And then there’s how sick I had been, and still was, and how that was impacting my ability to work (or not!). Yes, I thought of myself as sick, because it’s hard not to. I mean I was. But it’s hard to explain the full extent of that, and the gradual process of recovery, in a short conversation.

But here I am, a pharmacist again. And I’ve so surprised myself; I’ve fit back into the role like I never left! I really thought I’d lost something irreplaceable somewhere along the line!! Really! Something that would stop me being a pharmacist again. Despite my seven years as a hospital clinical pharmacist, despite everything that I’ve done well and every proof of my good work, I let some unfair feedback from my previous job get under my skin like I do with many little, minor things, plus I have some insecurity about the gaps in my work history and how they would look to a future employer, and I started to doubt myself and worry about what next.

But, thank goodness, no. I mean there are plenty of things I can brush up on, make no mistake about that. There are definitely things I’m rusty on, and there have been a couple of minor boo boos; nothing a bit less of a rush, and a bit more math couldn’t have solved! But I’m back, really back! After my first two full-on days as the in-charge pharmacist working flat chat alongside great staff, meeting lovely patients/customers, doing the job of a pharmacist I can tell you that I’ve come home with an exhausted, almost delirious but actual happy, contented smile on my face, and I feel good! I never quite got the adrenaline rush that’s meant to come from exercise, but work is definitely a rush! One of the biggest joys, and most surprising, of starting back at work has been the methadone/Suboxone customers on the opioid replacement program: they are a really friendly bunch and I’ve enjoyed chatting with them. Okay, so I might be quite starry eyed and all at this point, but it’s all gone better than I thought so I’m staying thrilled for now. I’m back. That’s the most important thing!

Okay what else? My feet have been KILLING me!! This should be no surprise when you spend 7 or 8 hours straight standing up with maybe 10 or 20 minutes sitting down. Especially when up till now it’s been more like 9 or 10 hours of sitting down with interjections of activity. Swollen ankles, aching legs, feet sending out electric shots and shooting daggers; all symptoms of half my blood supply pooling in my lower legs!! Home time means legs up above my heart to return all that blood back to my circulation…lying on the floor with feet on the couch does the trick, if you were wondering. A pharmacist who has specialised in wound care for 30 years or more recommends all pharmacists (and anyone else standing up most of their waking hours) wear compression stockings/socks every time they work for this very reason, to keep the blood flow from pooling causing varicose veins, venous ulcers, cellulitis and more. It’s a great plan. I did wear compression tights for a while in winter a few years back because they pass as opaque black tights and they make a huge difference in how tired your legs get. But honestly, have you seen those opaque beige stockings?? I may not have much to be vain about, but I’m not quite prepared for those stockings. Plus these days I keep too warm for stockings of any kind so that helps my case, but not my legs and feet.

It’s been busy! Not as busy as it should have been on Saturday, then way busier than it should have been today, Sunday! Which evened out to 2 solid days work but we only had to do 30 minutes overtime today, and got out on time yesterday so that’s a win. Unfortunately today was the day hubby was picking me up and he had to wait half an hour in the car! I’m going to drive on Saturdays, but Sundays I have to take the train cos hubby needs the car, and the timetable just doesn’t work nicely. I’m happy to sit around Ringwood station for half an hour on a Sunday morning, but I’m not keen after dark so he agreed to pick me up…dunno if he’ll be so keen next fortnight! But oddly I haven’t felt terribly stressed even when the work is stacking up. I think that these days I accept that I can’t do everything, and just pick one task after the next and keep at it till we get through them all. To give fair due, both days I have worked with amazing help in the dispensary: a 3rd/4th year pharmacy student all day on Saturday and a dispensary technician who I wasn’t supposed to have, but who balanced front of shop with helping me on Sunday. Both were very efficient dispensers, really excellent assistants and a great help with customer service and supply of pharmacy only and pharmacist only products. Plus the shop girls took all the load of processing payments as well as providing great product advice. And there was always that pharmacist out the back providing an invaluable back up to my uncertainty; what a team!!

For some reason whoever was working Friday hadn’t seemed to order medications as they used the last one on the shelf. This is the pharmaceutical equivalent of not only finding that the last sheet on the toilet paper roll has been used up, but going to the cupboard and finding that that was the last roll! And now you have a patient/customer who needs toilet paper or…you get the metaphor. We had a fair few of these annoying and really inexcusable outages on Saturday, and it was embarrassing. It’s also a problem because we can’t order on Saturday, or rather we can but it won’t come in until Monday anyway, so we couldn’t even tell people to come back tomorrow. By the end of the day we had a longer order of medications than I’ve seen so far on a weekday, and we couldn’t order anything; quite the irritation, especially for common medications.

This is going to be my main deal in this job, working every second weekend. After finishing this first one, I think it going to be okay, good even. People coming in on the weekend understand that you’re giving up your weekend for them (sometimes!) and can be really appreciative (or not)! But I think I like it! Even though I’ve taken a pay cut to be here, don’t like working Sundays, have no real entitlement to a lunch break or any other break on a weekend day, am more hectic than I’ve been in a good while, and have to keep processing scripts when I’m busting for the loo, its a job and a pretty good one, so there’s lots to be happy about! Yes, I’m happy!


The big return

I had planned to make a big announcement about my new job when I started, just before my first official shift, but anyone who reads my blog regularly already knows about me starting work because I told you recently because of a blunder, and, well, anyone else just found out! So no announcement. Just a reminder really that I am OFFICIALLY starting my new job on Saturday 29th April, 2017.

My official pharmacist coat, the first time I’ve gotten to wear the traditional garb; my keys to EVERYTHING; a pink, personalised name badge; pocket with a pen holder, and I’m ready to go!

It’s not such a big thing, really, as I’ve already done 8 shifts over the last few weeks. Wow, eight shifts already! That crept up on me. Five of them were half days, but still; it’s work! I was really thankful that my new boss was as keen as I was for me to get in several practice shifts before I started, and it has helped me to feel comfortable and confident heading into my first shift. It has given me a chance for reacquaint myself with the FRED dispensing program, although pretty much nothing has changed since I last used it in 2009! It’s such an easy to use program compared to the 2 hospital pharmacy programs that I’ve used over the last 7 years, and nearly all of the scripts scan in; no typing involved! So cool! I’m still in love with this function!!

My name up in official pharmacy lights!

It’s given me the opportunity to learn the “order” of how drugs are arranged in the pharmacy. This is one of those words that means the opposite of what you would think…oxymoron? I think that’s the word. See whereas hospitals organise their medications sensibly by the drug name (generic name) in alphabetical order, community pharmacies have ridiculous systems, and no one, including those that work there, really know why they have such a dysfunctional “system”, and the system is different in every pharmacy.

In this pharmacy, originally drugs/medications were ordered A to Z by brand name, instead of generic drug name. Fair enough. Back when, before additional brand names and generic brand names, there was one brand name for each drug and everyone knew the brand name for each drug. Drugs were marketed by brand names and that’s mostly what they were referred to as by medical staff. So this system worked as an actual system.

Here’s that dispensary I’ve been telling you about

Then drugs started going ‘off patent’. This meant that other drug companies were allowed to come along after and use the generic drug that the original drug company had committed 10 to 15 years of research and development to, make their own formulation and sell it. Not having to spend any of that time in R & D, and just having to more or less copy what the first company has done means the new version, or “the generic” can be vastly cheaper! Their version has to be approved by the Australian Government as working in the same way, having the same drug and dosage, and having equivalent efficacy when compared to the original brand, and once this process is complete, the drug gets on the PBS like the original and off we go.

So we got the first batch of second brand names, that were still actually names. Like instead of Noten, we got Tenormin. So now we had two brand names; that was manageable. And then generics went bananas!! They stopped bothering with brand names and just wanted to spruick their company name. So instead of usable names like Noten and Tenormin that were brand names for atenolol, we got drug company names attached to the generic name like APO-atenolol, Terry White-atenolol, Chemmart-atenolol, atenolol-Amneal, atenolol-Sandoz and so on and so forth! You get the never-ending gist. A quick look online tells me that atenolol is available in 15 different brands in Australia.* In America it’s gone much more ridiculous with 143 companies making atenolol generics, and 289 brand names, all slight versions of the one before!!**

How is this relevant to me working in the dispensary? The dispensary is organised by brand name. Then the generic brand comes along and it gets its own slot. Noten is under N, Tenormin is under T. All is well. Then the company name generics come in. Our store has a deal with APO generics so where available we buy the APO generic. But it doesn’t make sense to put every generic in the A for APO section! So the generics get put away by the generic name. Atenolol still ends up in A, but APO-escitalopram goes in E and etc. Except sometimes you go to find APO-hydroxocobalamin and it’s not in H. You ask someone where you might find it and they go straight to N. You ask why, and the answer is: the original brand name was Neo-B12. Yes, that is true, but…”yeah we should move it, we should do that, we’ll do that”. But that was half the point of getting in a few shifts before the real thing, to work out some of these quirks. Another thing: in an effort to be helpful, someone decided that the top 20 most dispensed drugs should be moved out of order to the front of the stands for easy access. Sounds sort of reasonable, but its kind of annoying to go the S and remember, no, its not here, its in the section that I’ve already walked past! But hey, I’ve been able to yammer on about it this much so some of it must have sunk in.

So this shift on Saturday is my first shift “alone” as the “only” pharmacist in the pharmacy; definitely ideal for me. I say those things in talking marks because there will actually be another pharmacist out in the back room working on our supply of medications to 18 nursing homes at all times while I’m out front; another one of the ideal things about this position. So I will never be without a second opinion or some advice or instruction on how to do something that hasn’t cropped up so far, and that sounds great by me! Not that I’ll need it necessarily, but popping out the back to ask someone a quick question is much less full on than having to call the boss on a Saturday!




One of those things

[written sunny Saturday 9th July, 2016; updated 12th July, 2016]

Today I brushed my teeth.

It shouldn’t be a big deal should it, but it is. No one can remember the last time that I brushed my teeth…last year? It’s terrible I know, and doesn’t exactly match my pharmacists’ health promotion ethos, does it? And it’s not something my husband relishes! Or others, possibly; I haven’t heard! But it’s just gotten to be one of those things. You know, those things? Things that you should do, but it’s just a bit too hard. So they’ve slipped down the priority scale, and dropped off the to-do list. I know I have new cavities from being so slack; I can feel them on the lower left side of my mouth when I eat hot food, drink cold drinks, eat something sugary etc. It’s going to need some attention and I’m happy to give it that, but I’ve got an insurance situation to sort out before I can afford it. Soon. Interestingly, or not, I pack my toothbrush every time I go away. I even pack my dental floss, the same dental floss that I’ve had since no one knows when! That’s extreme optimism for you, right there! I don’t know why I think it’s going to be different on holidays, why I think I’ll get it done. I guess it’s something to do with believing I’ll have more time on holidays, that I’ll feel differently on holidays, that everything will fall into place on holidays. But that’s not how it works, is it? What you have at home, your routines, your schedule, your habits, you take on holidays with you. So it just gets put off a little longer, and a little longer. I’ve never been great at this, but I’ve been a heck of a lot better than this, even committing to daily bleaching my teeth for 3 weeks once! It’s probably one of the bigger of those things.

Today I washed my hands.

That, of all things, should NOT be a big deal but washing and drying my hands has become a stand off with myself! It’s like a rebellion against something, I don’t even know what. But you’re supposed to wash your hands, yeah? Well I won’t! Terrible, childish thought process, I know. But it’s there, and it takes a lot of overcoming! Every time I should be washing my hands, this something rises up in me and I just sneak away without doing it. So silly, yet it persists. Obviously because I work in a hospital there are safety limits but a pump of alcohol or chemical based cleaner is a lot easier to me; maybe I should install a couple of home! It’s just one of those things. It’s not that I never wash my hands. If I think an activity warrants it, like dirt from gardening, dusty or greasy hands from my bike, food matter etc then yes they get a good wash; or a good rub down on a hand towel that will disguise it! I’m practically a kid when it comes to this! It’s the little times when my hands aren’t dirty, but its tradition (and probably hygiene!) like before a meal, after a meal, little things. In my mind. Probably not in others minds, but it feels like unnecessary energy that I can’t afford to waste, so I save my efforts for something more essential, as least to my way of thinking. It’s one of those things which seem like why wouldn’t you just do it, but I feel like it will take too much energy. It’s a fight with myself.

Today I walked one kilometer.

Walking, any walking, has become a big deal since I got sick. I never used to think about the things I asked my body to do. I walked as long as I needed, I ran for exercise, I loved swimming for fun, weights were my favourite form of exercise, I’ve done a couple of bootcamps including one at a boxing gym, pilates was my relaxation, and so on. But now, I struggle a lot with it! For various reasons, I suppose: I’m fat and heavy, I’m slow and sluggish, it takes energy and effort and motivation, I’d rather catch ANY other form of transportation, my legs rub together and chafe til they’re red raw unless I wear undershorts or leggings, it drains my mind and my body, and I’ve come to associate it with pain and suffering. I know, a little over dramatic! But there you have it, it’s one of those things! This walk in particular was slow, and it wasn’t for exercise; it was for bird watching and photography. But hey, it was outside in the sun and breeze, and it was a kilometer. I take it however I get it, and don’t sneeze at the little bits of exercise however they come. I’m meant to be exercising more. Well that was more than yesterday, more than the day before, and more in one go than I’d done for the whole week and probably longer so I’m counting it as a win!

Today I rode my bike.

And it reminded me that I do love my bike! I’d forgotten that. I quickly forget the joys, and never-endingly remember the pains; it’s not a good way to be! I keep planning to ride with Wheel Women and sign myself up for rides optimistically hoping I’ll feel like it by the time they comes around. But then I pull out closer to the day as it becomes clearer that not having left the house or changed out of PJs for 2 days, it really isn’t going to be likely that I’ll be up and dressed by 8.30am ready to drive 45 minutes across the city! Or I heave a sigh of relief when a planned ride is cancelled due to rain, path flooding or wild weather. Then I roll over and go back to sleep. Well that’s been the pattern lately while I haven’t been well. Before today I hadn’t ridden or been on my bike even since the 3rd of June! Five weeks out of it! I think I’ve had 5 weeks out of a lot of things, to be honest. It’s been reasonably bleak for me and with me, and that’s when all of these things, those things, fall away because it’s too much effort to keep them going. But flying downhill brought on that high, that endorphin burst and suddenly I was in my zone, loving it! And I flew all the way home, even up the hills, and that was that, I was back, mentally. And when you’re there mentally, you’re there!

Today I climbed hills on my bike.

If you know me and my riding, you know about me and hills; we have a difficult relationship! Frankly, right now, I’m not built for going up hills! My weight is very much against me when trying to defy gravity by going up. Nevertheless, the hills are there and they do come across my path, and at the end of the day I do have to get up them somehow. So when Wheel Women ran a class on climbing, cornering and descending, it sounded like exactly the skill set that I could benefit from! So how did I get to that class when I hadn’t gotten to any other rides? My innate cheapness!! I put down money for this class, little though it be, but it’s a powerful motivator in someone with Scottish blood, however diluted it be! And I did learn some super helpful tips to help me up those hills. And then I flew down them again, but that’s the fun bit, the bit that gives you a rush! The other bit, the climbing is different, but I guess it’s a means to an end if you like. It’s still hard. But I did it today! I conquered one of those things, at least for now.

At the end of the day, what a day?!

Better than I’ve had in quite a while! I’ve been struggling with depression lately and it has sucked, but suddenly on Thursday night when I woke up from my nap, something shifted! I was high, elevated in an energetic and motivated frame of mind. Just like that! If only I could click my fingers and get that result! Who on earth knows what it was that tipped me over, impossible to figure out. But YAY!

So what you’re seeing here is the chemicals in my brain giving me a booster shot to actually manage to do some of those things. I even cooked tea one night this week! Rare event these days! When the chemicals all line up, life is good. It’s easy, way less effort, far less forcing myself around. It just happens and we’re all relieved. And vice versa, you understand. But for now, for however little time I have this little break, it’s nice to use it to do something. It’s not perfect. My ride was still hard! The hills still hurt. My walking was still slow, although that was more for the sake of finding birds, and it wasn’t far, but still. I washed my hands but not all the time. And I brushed my teeth.

What I didn’t do today was shower. It’s probably the hugest of the things. To get into our shower you have to climb into the bathtub. Every time I think of having a shower, I think of having to hoick my leg over the side and it just seems like too much effort! It’s such a small thing, right, but it literally seems like it’s impossible. Once I’m in its great; I love a nice hot shower and feeling clean again, once I’m there. It’s just the getting started, which is after all, the issue with all of these things; getting started. It’s pretty much classic depression: issues with motivation, energy, self care. It is amazing what lengths I’ll go to not to have a shower, and how long I’ll go between showers. And by amazing, I also mean embarrassing! After Bali, I had a mega battle and I almost lost count but I think I went more than two weeks and no shower, and unwashed hair! You may have noticed! I still used deodorant and perfume so hopefully I didn’t stink, but it wasn’t a nice episode and finally my husband had to drag me to the shower and make me get in. And it was delightful! All that fuss and bother and argument, vanished, and I had a lovely time and came out feeling wonderful! It’s one of those things!!

That’s today [read: Saturday 9th July]. Tomorrow we have to wake up and do it again so we won’t get too carried away, but today those things have had a bit less hold over me.

So, the next day: Sunday morning, the hardest morning of the week. Mainly because I ideally would aim be up and going earlier than I may have done for the other 6 days of the week. But today I was up by 9am and actually feeling like I was up and going, not sluggish or doped out. My anticipation of the coming Sunday can mean that I go to bed late, and so not take my tablets til late just before I go to bed, and so I can be a bit sedated by the effect of my tablets lasting well into the morning. I have this contrary thought process that not going to bed will prolong the next day’s arrival…obviously it’s just the opposite. But it’s another reason why waking up Sunday is a complicated thing. Sunday morning is also traditionally when I wash my hair. I should really change that, if common sense prevails. It’s just another thing to get past to get to church: waking up, clearing my head, getting fed and watered and tabletted, showering, dressing and getting out the door not long after ten.

But today was pretty successful. I actually had a shower, and even dug out some moisturizer and did my legs! A miracle of a day! I’m energetic but not irritably manic, the best way to be. Touch wood for more days like these. I’m active, I’m wanting to fill in my day instead of hiding from it; I’m like a normal person!! YAY!


She didn’t want to bother anyone

Last week a patient on my ward was discharged home and I went up to the ward to go through the medicines with her. She was going back to the care of her dedicated daughter who was there to hear all about the medications changes. The patient, despite being in her late 80s, was still sharp and with it and until only a year earlier had looked after all her medications herself, which is very impressive.

I admire patient’s who take the initiative and really get to know their medications and take charge of their own health. It just adds another layer of checking to the medication system which can be vital.

So I sat down with the daughter to educate her about the current medication regimen, with the patient listening in and nodding.

And although I was there to teach, I learnt a whole lot!!

First medication. The dose of prazosin has been reduced to once a day rather than twice a day as it was when she came into hospital, I say. Why has it been reduced when she’s had high blood pressure while she’s been in here? she asked. Well, I was taking over from another pharmacist and didn’t know the answer. Did she know what the blood pressure had been, had she seen the chart? I ask, stalling. No but she just knew that it had been. So I get the obs chart which shows an occasional reading of high blood pressure, maybe one in 5 or 6 so I explain that treating those one off higher blood pressure readings to bring them down to normal would put her mother at high risk of low blood pressure the majority of the time, which explains why they dropped the dose. But the kidney specialist put her on that dose, she says. I understand that, I say, but blood pressure changes and so the dose has to be changed to adapt; I’m more than happy for her specialist or GP to change the dose at the next appointment if that’s appropriate. Oh well, it was probably just high while she was in hospital, they’ve treated her horribly, I’m told!

This is always a big disappointment to hear, because I’ve gotten to know a lot of the nurses on this ward and I’ve seen how they care for their patients, even the difficult and hard patients. This patient was easy and lovely so I find this hard to swallow. I’m not saying that awful patients are treated worse, but I’m saying if the nurses can do their best for stressful patients, I’m sure they would have given outstanding care to this sweetie.

Really? I ask, surprised. Oh yes, she nods, and her mother, the patient, nods. We’ve had the most terrible time while she’s been in hospital! Well I’m very sorry to hear that, I respond. Oh it’s not your fault dear, I shouldn’t have mentioned it.

Second medication. This is the anti-fungal cream that we’ve been applying three times a day to your mother’s groin (sorry people, TMI) to treat the rash, I start. Oh yes, do you know that those nurses left her in a wet nappy overnight, for 8 hours?? How terrible is that, she asks me, starting to wind up the tone and intensity? Really? I ask again, because I just find it very hard to believe. The patient nods, yes that’s what happened. Well I’m very sorry about that, I say, that shouldn’t have happened. I wonder out loud to the patient, did you tell the nurse about it? No, she shakes her head. The daughter chimes in, she doesn’t like to bother anyone.

For serious???

You are complaining, and I find out later that there’s an official complaint, or rather several official complaints, about wrongdoing by the nurses but you just sit there and let it all happen when you have a mouth that you are fully capable of using, and a hand to press the buzzer, and surely a desire to not sit in urine for 8 hours just for the sake of not using your voice or your hand!! I find that ludicrous, and really, unacceptable. This isn’t about victim blaming by the way, the incident happened no doubt about it, but it’s about why it shouldn’t have happened and it could have been prevented.

We have patients that can’t speak, or can’t put their thoughts into coherent speech, or can only make sounds, or who take what feels like forever to get the words out. We have patients who are immobile, paralysed, unable to move their limbs, or unable to know what to do to get help. She ain’t one of them!

I don’t think anyone likes to make a fuss, or a scene, or a big deal, or call attention to themselves, complain or whine. Maybe the odd person. But this isn’t about that. This is about bringing attention to an issue that needs to be fixed for the sake of your health. You aren’t putting someone out, or bothering them, the nurses are there to help; that’s their job! If they have something more pressing to do, they’ll let you know and come when they can. But the 8 hours overnight that she stayed in that wet nappy are the quietest hours in the hospital. Often nurses don’t have much to do other than be on call for patients…so call them!

Again, not victim blaming but a patient has to take responsibility for their care. If the nurse doesn’t know the nappy is wet, she won’t come and change it for a dry one. You aren’t a baby, your parent doesn’t come along and stick a hand down your pants into your nappy to check if its wet; it’s not someone else’s job to come by every 20 minutes to ask if you need a change. You’re an adult. You tell someone when you need something, right? No, apparently not! And this was only the start of it…

Medication number three. Trying to move along and get past that one. Codeine has been stopped while your mother has been in hospital, I start. Yes I know, that’s why she’s been in pain the whole time she’s been in hospital, she counters. Oh my, here we are again! Who leaves their mother in pain for 8 weeks instead of saying something? Who doesn’t speak up for themselves when they’re in pain? Oh I didn’t want to make a fuss, says the patient. Give me strength!! You either weren’t and aren’t in pain because if you actually were and are you would be begging for help, or you are competing in some martyr awards that I haven’t heard of! You don’t sit there in pain and not say anything. Do you? Am I on the right train here? Well, codeine is not the best pain killer, I try to continue, and we weren’t aware of any pain. She certainly hasn’t requested any pain relief. And I think, although nurses, doctors and allied health staff may be brilliant, we still can’t read minds! Surely anyone can see that making an official complaint about a patient being denied pain relief when no one knew that the patient was in pain isn’t quite logical!! And don’t tell me that she was never asked if she was in pain. It’s a rehab and geriatric progress ward, every pain is continually asked about pain, about their bowels, and obs are taken regularly. It all seems so unnecessary!

Well, what a way to start the day! I did get through the rest of the meds eventually, but I was ready to get out of there!

Didn’t want to make a fuss, didn’t want to bother anyone, didn’t want to get in the way, didn’t want to be a burden. I get that. Sometimes it’s hard to speak up when you need something. But you can’t have both sides, not speaking up AND making official complaints against care givers. I believe in the complaints process and wouldn’t discourage anyone from making a valid complaint. But this feels like making a scene over something that could have been nipped in the bud at the start. It feel like an attack on the nurses who try their very best, and who couldn’t have prevented any of it without the patient doing their part.

So maybe its something more people need to know about – for your own health’s sake, you need to speak up. Don’t wait til discharge to complain about problems when you never did your side of the job in speaking to your nurse during your hospital stay. It’s a two way street, nurses aren’t psychic so you need to tell them what’s on your mind. Is it too much to ask?