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!

Mental as

This week is Mental Health Week from 5th to 12th of October and today, Friday 10th October, is World Mental Health Day.

You know me; that’s just way too much of an opportunity for me to let it pass!

There have been some amazing efforts put forward this week by various agencies to improve our understanding of mental health conditions, treatments and the help available to every single one of us. In particular today’s theme is Schizophrenia so there will be a lot of information available about this condition specifically.

If you haven’t already seen some of these efforts come up on Facebook/Twitter/MySpace/ Instagram/email/TV/the streets, you may want to check out the Black Dog Institute, the South African Depression and Anxiety group, Beyond Blue, ABC TV, Headspace, lifeline or one of the many other groups, associations and publishers that have websites, social media presence and who are doing remarkable work to help us all.

Mental Health Week allows mental health issues to be brought to the foreground as a topic for discussion in workplaces, at home, in schools, TAFEs and universities, among certain ethnic, socioeconomic and cultural groups and generally everywhere.

I think the very much most important-ist place to talk about mental health is with yourself. What do YOU think about mental health? What are your fears, concerns, issues, problems with mental health? What do you know, and what don’t you know? Is it a personal issue for you; is it a family, personal, friend, colleague, acquaintance issue? What do you want, need, hope for, wish for about mental health? Etc…you can think up the questions.

The second most important place at discuss mental health is at home. Around the dinner table, in front of the TV, in the car on the way to school etc. If we are all too afraid to talk about it when it isn’t an issue for anyone important to us, how on earth are we going to be able to bring the topic into the house if and when it does become something that we need to talk about?! So start a conversation today. Do it. Just do it. For your future self, or family member, just in case.

Mental health week is a chance for the concerns, the issues, the requests for resources, the commendations of individuals and organisations to be heard. It’s also a time when each party puts forward their specific focus and area of interest.

So what’s mine? And what’s yours? I’d love to hear them, and I’m sure any of the organisations and even government bodies putting in a presence this week would appreciate knowing your opinion too. In fact you can pledge your promise to improve mental health and share it via the awesome R U OK? website or social media.

My dream is that every single solitary person in this lucky country would understand mental illness.

Or if they don’t understand it, that at least they would know what mental illness is, how it can treated, where help can be found and when to intervene to help somebody. That would make me so happy!

‘Mental illness’ is a vast and changing term but my dream is that at a minimum depression, anxiety disorders, bipolar disorder and schizophrenia would be understood or known by everyone. I know there are a whole lot of other disorders and illnesses that are equally important and need to be educated around, but this is my dream.

I want mental health education to start in the first year of high school as part of health, or English, or science, or SOSE, or PE, or languages or ANYTHING! I don’t care what bracket it’s taught under; I just want every child to know what can be out there for a friend, family members or themselves.

Since I have been talking about my mental health, a friend has contacted me to say her mother was undiagnosed with bipolar for her whole childhood and teen years and treated unsuccessfully for depression, which can be a common course. She wrote to say how glad she was that I got the right diagnosis so quickly (18 months didn’t feel quick, but it’s relative), and to say how much she wished it had been found out earlier in her mother, because it would have changed everything!

So consider this: some education to family members earlier in life may, just may, have changed lives!

I don’t want mental health to scare people. On my return to work, a health professional colleague responded to my statement that how I’d been off work with a nervous breakdown by saying: “Depression scares me! Sometimes I find my mood getting low and it freaks me out so I make myself be happy again. I don’t want anything messing with my brain”!!! This is a health professional! With clearly no more understanding of mental illness than a goose, which is very unfortunate!

We need everyone, and especially health professionals, educators and anyone dealing with the public, but we might as well go for ALL people while we are at it, to UNDERSTAND mental illness!

Not just read about it, swot it for exams, know the diagnostic criteria! We need people to know that depression doesn’t change your brain, yes it’s not nice but no reason to be terrified of it!

It’s not any more scary than diabetes which can kill or damage nerves causing severe pain, blind you, deafen you, make you prone to infections, put you at risk of stroke and heart attack!! That’s a LOT more scary to me than a serotonin imbalance that can be corrected with medication, counselling, time and support.

So here’s to dreams! And the tiny steps we can take to today, to start to get there!

*I’d like to acknowledge the slogan of the ABC’s fabulous efforts in broadcasting mental health education and issues for Mental Health Week as the inspiration for my title*