Work work work work work work

I love my job. Really love it. I think it must show because since I started working in the emergency department (ED) a few patients have commented to me that they can tell I love my job when I’ve been talking to them about different things. It has caught me off guard but on reflection I’d have to say, yep, its true, I do love my job. I just didn’t know it was showing so much.

It’s hard to define exactly what makes me love my job, but I think a lot of it is the nature of people and interacting with different backgrounds, beliefs, natures, religions, personalities and so on.

Like this tiny, feisty, skin-and-bones 80 year old never-had-kids-now-a-widow who fell over in her house yesterday when her left leg collapsed and was on the floor for 14 hours before her friend came over to her house and found her; lucky chance, that! What did she think about a personal alarm? Oh no, she didn’t want one of those, all they do is contact your next of kin or the emergency services, what’s the point??? Uuuummmm…that would be exactly the point, so next time you aren’t on the floor so long that your muscles start to break down! Did she have a power of attorney? No, she didn’t trust anyone enough! Did she take any medications? No (emphatically no!), and “if anyone tried to give her any she put up an argument”!! Fair enough, Gretel!! Obviously you’re going to do what you want how you want when you want. Now tell us exactly how you’re going to go home with a broken arm, muscle breakdown and severe bruising, and how you’re going to dress and feed yourself…you old battleaxe you!

I get it, it sucks to be older and have a failing body and maybe mind. I’m sure I would be clinging to whatever measure of control I had remaining. But protesting for the sake of protesting…what merit is there really? I often see this battle about giving up living at home, or a driver’s licence, and its fair enough to a point. I guess its just not exactly clear at what point to surrender with grace, necessarily. Speaking for myself.

Next patient? Gorgeous, perfectly coiffed 94 year old lady (in every sense of the word) who could pass for 80, or even younger probably; in fact she reminds me strongly of a family friend about 80. And she graciously attributes it all to modern medicine and the medications that she takes religiously exactly as her doctor prescribes them! Ah, music to my ears.

And next? A 29 year old girl with a brain tumour hoping on a trial drug suffering shocking side effects from medications prescribed for conditions she no longer has/never really needed treatment for in the beginning, and never reviewed. Suffering the effects of too many doctor’s fingers in the pie of her health, and no one doctor wanting to take responsibility for all of it at once, here is someone with a real case for complaining. Unable to say what a microwave or apple is although she “felt like they were really familiar, and she should know what it was”. Disorientated in her own house, not sure where she is or where she’s meant to be. Sedated and sleeping the day away, every day. Clumsy, unsteady gait, struggling to form words, relying on family to tell her what she’s been doing all day because she’s not sure, unable to leave the house in case she can’t find her way back. Pretty bad, huh!! But she was pretty accepting of the whole thing, just waiting it out patiently. Luckily she had a mother who didn’t take things lying down, but strongly advocated for her. The only problem with having such a strong voice on your side is a lot of doctors find it “challenging” and respond poorly. It shouldn’t be like that, but…

…so although I carefully, painstakingly formed a safe, detailed plan with her and her family of how to stop some of her more problematic medication (some of which had already been started by weaning doses of some medications) without creating new problems, we struck another case of a doctor not wanting to take on the full patient situation, just wanting to treat the precise reason for coming to ED and refer everything else back to her other doctors. This is actually a reasonable approach and I get it, but it would have been nice to have made things easier for the patient right then and there. At least the patient and family took on board everything we discussed and will put that into place when they get home. A bit disappointing that we couldn’t sort it out right then and there, having the opportunity to make a real, big difference to someone’s quality of life isn’t something that’s easy to pass up, especially for a cancer patient with a lot going on. But I do understand that if the ED doctor’s delved into a patient’s other issues every time they came to ED, the whole system would grind to a halt. That’s just one of life’s conundrums.

So this is a fascination with me. One patient refuses any intervention on principle, one gratefully and faithfully takes on any direction, and one just takes being mismanaged and goes with it. People, huh? Aren’t we so weird??

R U OK?

Today is R U OK? day. It’s an annual day nominated by the R U OK? suicide prevention charity to think about the people in our lives and consider if they are okay. More than that, it’s a day to take ourselves in hand, try to be brave and open a conversation if we think someone we know is struggling. Of course this is something that should happen every day. But today is a day to revive our intentions to be a good mate to our family, friends, colleagues, anyone we bump up against in our daily lives. It’s a day to understand a bit more about what drives people to consider suicide, and to learn ways that we can safely help them.

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I’d love each one of you my readers to check out the R U OK? website. Just pick one topic and give 5 minutes of your time to taking on some new knowledge, or understanding, or strategy. It really can change and even save a life. It’s that important.

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Some of the topics I think are great are Mates, resources for every day, news stories and information, but I’m sure you’ll find the topic that makes most sense, or means the most to you.

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I’ve been a mental health advocate (at least I think I have been) for a lot longer than I’ve been ill with mental illness. By that I mean that I’ve considered mentally ill people the same as myself just with a condition requiring treatment, and tried to show to others that they don’t need to be feared. As a child I was used to being around mentally unwell patients. One family friend had schizophrenia and another had bipolar disorder. We saw them regularly, saw them better and worse, visited them in hospital and knew they were just people like the rest of us. And they were just the people who had known, obvious, must-be-treated illnesses. Who knows how many people in my acquaintance had depression or anxiety that was more or less invisible. I wouldn’t know. It was never talked about. If they were there, I never knew. Which is a terrible shame.

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So today is about conversations. I want people to have conversations. But first of all I want to tell you why R U OK? as a charity and a question is so important to me.

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When I was depressed or anxious, I felt awful. I was barely dragging myself around, limping from bed to work and from work to bed. My brain was either whizzing or sluggish; it wasn’t very useful. I felt like all of this must be pasted across my face, and that surely someone would notice today that I was struggling and ask me about it. It had to be written on my forehead, I thought, why can no one see it, why is no one wondering what’s wrong with me? I was just dying for someone to see it and come to my aid.

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But nothing happened. I didn’t want to be attention seeking and bring it up myself, I wasn’t one of those people who was always making a fuss. But I was in pain here, it must be obvious. I thought of a hundred ways to bring it up, but I just couldn’t. It was too obvious a way to start a conversation, there was no easy lead in.

“So you’re having tuna for lunch, that’s interesting, did you know that I’m depressed?”

So I dragged myself around, wondering and waiting and hoping that someone would do the hard part for me and bring up so I could let it all pour out. And do you know the funny thing? Having felt so isolated, like no one could see the real me inside, like I was alone in this experience and so on, once I was officially sick and had told people about it, I had several comments along the lines “oh I thought so” and “I figured something was wrong” and “I knew something wasn’t right” and “you didn’t seem like your usual self”. If just one, only one person had actually said that out loud, it would have been such a relief, a balm, a comfort! It probably would have meant that I got help sooner. It could’ve shorten the process, and I would have been so thankful. It would’ve meant such a lot.

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Speak up. If you can see a change, say something. If things seem different, say so. The worst that can happen is that you’re wrong, and they are just having a bad day or week, or are preoccupied. But how can it hurt? At the least, I’m sure they’ll appreciate your concern, the effort that you’ve gone to, your care. It would be a rare person who would take exception to your kind heart.

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The second part is knowing what to say. The reason for this charity’s name is that R U OK? is a powerful question. It might not seem like it, or seem much different to our usual greetings, but it works. We say hello, hi, howdy, how are you going? what’s up? how’s it going? how’s things? alright? and a hundred similar things so many times a day. And we’re programmed to response almost rote: good thanks, hey there, great, how about you? not much, well, yep and so on. So much so that if someone says something different to these, we can accidentally get caught saying good thanks before we’ve even registered that they’ve asked us what’s up?!

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But R U OK? hits a different nerve. It makes us really think about how we are, and it elicits an honest answer.

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So here’s what I want to do. I want you, one day over the next day or two, to count how many greeting encounters you have in one day. I consider one encounter to be one person say hello and/or how are you and the other person responding. Now I know for myself, home most days, there aren’t very many encounters. But for people working in retail there might be many, maybe more than what I’ve allowed for. I really want to know what your number is! Please get involved and let’s see how many times we bump up against each other each day.

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I’ll post the results as early as possible once you’ve had a chance to respond with data from your working life today and tomorrow. If you don’t read this until the weekend, give me your weekend numbers too.

My aim for this poll is to think about how many times we have a typical hi/how are you conversation. The next step after this is to consider what might happen if we changed ONE of these rote conventional habits into an R U OK? conversation. What could U achieve, how could U have an impact on someone else’s life? You already read my tales of mental illness, so you already have a kind heart and I daresay you want to help others too. This is the perfect chance, and I hope to take the baton and run with it.

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