When bloopers aren’t that funny…

This is a follow on piece from the ‘Bloopers’ topic of the other night. One of the bloopers turned sour in a big way, so I thought I should complete the picture. I guess it shouldn’t be a shock that bloopers in healthcare aren’t too funny, mostly. Some are interesting, some awful, and a few hilarious; that’s about how it works out, it seems.

You know that guy I was telling you about, the one with shoulder bursitis? The one whose wife and daughter gave him too much ibuprofen and paracetamol unintentionally, dosing him every 4 hours on the hour for several days due to his excruciating pain without observing the 24 hour maximum doses because they weren’t told about it by their doctor? And obviously they weren’t told about the maximum doses by pharmacy staff either if they bought the medication in a pharmacy, or maybe they bought it from the supermarket; this is my strong argument that these “simple” pain killers not be available from the supermarket. I guess the family never read the packet either, although English as a second language was a factor here for the wife, but not the daughter. This is the patient who was brought into ED after he started coughing up blood as a side effect of ibuprofen which irritates the stomach lining. You’ll remember that the family who wouldn’t give him the stronger pain killer Endone in case he got constipated, but had given him toxic doses of weaker pain killers. The patient who is an example of people being given incomplete advice about how to take their medications, and blindly following that advice without taking any initiative themselves.

Well, he died.

I saw him Saturday, he died early Monday morning. I was shocked when I found out!! I knew what they’d done was bad, and that he was going to suffer the consequences, but I never expected him to die! Not that fast, certainly. I planned on looking up which ward he was in in Monday morning so that I could handover the story to the ward pharmacist, but then it said: DECEASED. I had to read it twice. I thought I’d picked the wrong patient. But no, deceased, 0600 hours, 16-4-2018.

Wow!

So I looked into it. And right there as the cause of death: acute on chronic renal failure precipitated by NSAID use. That’s non-steroidal anti-inflammatory drugs: ibuprofen (Nurofen), diclofenac (Voltaren) etc. Acute on chronic means he had a degree of chronic permanent kidney failure that couldn’t be reversed, not unexpected at 77 yo, but it was made acutely much worse by something, in this case medication.

There are a few things you can do to help reverse acute kidney failure: give IV fluids to flush toxins out, stop all medications that are toxic to the kidneys, manage blood pressure with medication and fluid so that the kidneys have optimal perfusion, but at the end of the day there’s only so much that can be done without the patient going to the intensive care unit and being put on dialysis. Once the kidneys go off, fluid accumulates in the body. This patient already had heart failure which causes fluid to gather around the heart and lungs, and the kidneys failing to clear fluid adds additional pressure on the heart. This was listed as the secondary cause of death: heart failure. In fact 4 causes of death were described in more detail than the overall cause as I’ve put it above, acute on chronic kidney failure precipitated by NSAIDs: kidney failure, heart failure, NSAIDS and age. Once the snowball got kicked off it gathered momentum from pretty much every other medical condition that the patient already had, unsurprising since the whole body is in a delicate balance. But if that trigger hadn’t been there…

In this case because of his age and many other medical conditions, the family did the sensible thing and let things be as they would be; and in this case death is what would be. It’s a shame that kind of common sense thinking hadn’t prevailed any earlier in the case. I feel like this death could be listed as preventable.

If a patient asks me generally whether ibuprofen is good for them, there are several medical conditions I’d want to be sure the patient didn’t have before recommending it: asthma, stomach problems like previous ulcers or gastritis and even reflux, heart failure and kidney failure. So the ibuprofen probably shouldn’t have been started in the first place; a steroidal anti-inflammatory like prednisolone would have been more appropriate. Although sometimes we say cautiously, take it but for no more than x days. Of course we then also tell the patient the maximum dose and how best to take it. In this case I’m pretty sure if you had asked the patient’s cardiologist or nephrologist before hand whether this man should have been given a NSAID they would NEVER have signed off on it.

Then maybe he’d still be here, a bit fuzzy headed or nauseous on Endone, taking paracetamol less regularly than actually happened, and blood sugars high from prednisolone, but alive, his bursitis improving and his life going on at home.

RIP.

I’m sorry the system let you down.

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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.

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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!

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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.

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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!

Canberra Day 94

[Wednesday 14th December]

Well today was a terrible day career-wise, nothing fatal but nothing fun, so it’s a good thing that I’m in Canberra with a licence to explore and enjoy new experiences.

I’m having some issues with the Australian Health Practitioner Regulation Agency (AHPRA) that manages the registration of 14 different health professionals, including pharmacists. Previously we had our own pharmacy board, but in 2010 several boards were amalgamated and now we are managed jointly. This new organisation, AHPRA, manages our annual registration including our compulsory continuing professional development (CPD) requirements, whilst another organisation manages the regulation of pharmacies and pharmacy departments. All very boring and tedious, until your annual registration comes up against a problem. In my case a CPD problem. Each year between October 1st and September 30th, every registered pharmacist in Australia now has to achieve 40 hours of CPD to qualify to be re-registered. After the amalgamation the amount of CPD to be achieved began as 20 hours and increased over a couple of years. Its pretty standard now, and pretty achievable if you’re working, which is the point; to keep you up to date.

I first went on sick leave in March 2014 and stayed on sick leave for several months before I dragged my reluctant body back to work only part time for 6 weeks in September/October that year to complete my contract at the Alfred, in the vain hope that I would build up professional fitness quick enough to convince my workplace that I was fit and well to work and be re-hired. I was desperately hoping to stay on because I loved that job. It was a joke looking at it now; there was no way I was even fit for the very part time work I was doing then let alone more. But the point being, between October 1st 2013 and September 30th 2014, the annual CPD year, I worked 6 months and work generates CPD as does starting a new job as does changing positions within a job all of which applied to me. So even at the 6 month mark when I got sick I had oodles of CPD numbering probably around 50 or 60 hours. So I finished my feeble 6 weeks in dispensary, ended my contract and went back to bed.

By the time I got going again and went back to work, it was July of 2015. Already up to 9 out of 12 months of the CPD year, and to be honest, to this point CPD hadn’t even crossed my mind! A little teensy nervous breakdown and the associated issues had occupied the major part of my brain for months on end and work had just gone away. Even now returning to work I was conscious of the need to get up to date with the many new drugs and devices that had hit the market in the last year and a bit, but I hadn’t thought particularly of my CPD requirements with respect to my registration. I did all the required new job CPD, I did study on things that were relevant, I recorded it all and never really thought of whether I was making the 40 hour amount. Which is unfortunate, because I didn’t make it! I got 25 hours, not 40.

And there is no clause for people on sick leave. Or for people not working. You’re either practising or not practising. So, in November 2015 when I was re-registering as a pharmacist and got to the compulsory question about whether I had completed 40 hours in the previous year, I had to answer in the negative as in I did NOT meet the CPD requirements. And I won’t say that all hell broke loose, but all kinds of official pharmacy correspondence started flying around the web and through the postal service, and today is just another step in the painful process that is rectifying the situation! I’m not complaining about having to fix this up; I should have to. I’m a health professional and patients need to be sure of me being up to date and on top of the latest drugs and professional practice. I’m just complaining about the amazing bureaucracy that prevails in these matters! It is not easy to show that you have done your best to fix it, that you’ve learnt your lesson, and that you’ll do better in the future. Especially if you’re out of work again, because things just don’t come up when you’re not dispensing and reviewing medications on a daily basis. You have to actively look for things, and it’s just harder. But it’s part of my commitment and I have to just get on with it. So I’m off to send yet another email, which will probably get yet another “out of office” reply, followed by an actual reply sometime in the next two weeks or so telling me that there’s yet another technicality that I haven’t met because I was never told about it, followed by another email from me phrased very conservatively despite my inner rage and so on. You get the drill!

So there’s that, and following that the awful words “we’re terminating you”!! Seriously?! I went back to work officially in June 2015 with a fixed term 9 month contract. I guess I always assumed that there would be a possibility for extension at the end, assuming they liked me and my work was up to scratch etc. But no, despite putting me through two traditional interviews and a non traditional observation of practice interview I was never successful in getting an extension. So I was told I would be put on the casual list and they’d call me, which they never have but that suited me lately being in Canberra and all. So now out of the blue I get a call to say sorry, it’s just a HR thing but because you haven’t worked for us in 3 months we have to terminate you!! I’m sorry, what?! I’m costing you zip, I’m (usually) a resource available at short notice a 4 minute walk away, and if this was always a HR thing, why didn’t you just say goodbye at the end of my contract, instead of giving me an impression that I’d be called up to work?? So when I get back I have to return my keys and it’s all over. Well what a wake up!! Could this day get worse for my career?

Luckily I have good things planned so let’s off to the High Court to observe other people getting the rough end of the stick, potentially. I won’t pretend to understand the case that was being argued but the solemnity and the ceremony of it all was very impressive and the two counsels arguing were humorous in their own way, especially one who referred to “my learned friend” at the beginning or end of every sentence! I’m pretty sure even the 5 judges were smiling under their wigs. A bit of light relief, and I’m glad that becoming a lawyer was never on my list. I took my fill then left, remembering to pause and bow to the judges on my way out!

And now to really flush all that career mess out of my system!! I’ve been looking forward to this christmas concert by Igitur Nos at the National Library for a couple of weeks now. Turns out it wasn’t quite what I was expecting…more classical music, Latin and high brow Christmas songs than your typical carols. But it was pretty nice. Then a drive by a few places of interest: the historical and very pink Calthorpes House, and a few embassies.

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Lucky I have a lovely catch up with a friend after lunch. Nothing so soothing as hanging out with a friendly face and chatting away the afternoon. A super cute little baby helps just a little bit too! Happy day…in the end.

Canberra Day Thirty!

[Monday 10th October, 2016]

Day Thirty!! Do you know what that means? We’re a third of the way through our adventure! I can’t believe, time has gone so fast. So, time to get cracking on all those other things I plan on doing before we go home! I’ve done a lot but I still have a long list.

This week is World Mental Health Week and today is World Mental Health Day. There are so many days, and weeks, and months, and years that are assigned to different causes these days that it can be hard to have energy for any of them. All I ask is you just take a few minutes to think of your own mental health and make sure you’re okay. And if you’re not, make a plan to do something about it. Don’t just let it be, that never works out well.

So, day thirty. It wasn’t the best of mornings. I woke up with a headache and the pre-pharmacist in me, the uneducated one, tried to sleep it off. Two fitful hours of sleep later and the pharmacist in me finally prevailed and I got up and took 2 Nurofen! The only sensible plan. I love Nurofen, or any of the other brand names of ibuprofen. It really works for me whether it be a headache or period pain. Unfortunately it interacts with one of my mood stabilisers lithium, and so I’m not meant to take it anymore. But because I get severe period pain my psychiatrist has allowed me to take one dose if needed but only rarely. Same for headaches. If I took them together it stops lithium being cleared out of the body through the kidneys. I would get toxic levels of lithium leading to lots of side effects and possibly kidney damage which isn’t to be taken lightly, obviously. So that’s a bit of a pain, but as long as I use ibuprofen sparingly I get by okay. It’s just one of those things.

So, dosed up and ready to roll. Today’s pick was Cockington Green. I’ve been planning to go there since the start and even more so since I won a free day out with Maccas Monopoly! There aren’t many options for redeeming the day out in Canberra, mainly ten tin bowling or the dinosaur museum, but this is one I’m definitely keen on! And it was so worth it; an absolutely fabulous exhibit of 1/12th miniature houses and villages in old England plus an international section of 30 different countries and a mini steam train giving rides. YAY! Unfortunately the weather deteriorated to drizzle and became freezing cold so I did the international exhibit at a breakneck speed trying to out of there before I froze to death! Same with the train ride. Nevermind, I thoroughly enjoyed the main section especially with fairy wrens hopping all over it! But there’s only so much cold you can take even when you’re usually hot blooded like me. So home to put on the central heating and bask in the warmth! A lovely family dinner and games night, there won’t be many more of those! And off to bed.

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It doesn’t really look miniature here because the people and plants are in scale, but its only less than a foot tall.

 

Change

I have some big news! HUGE news! We’re moving cities!

What?? Yep we’re moving interstate! Not what we thought we’d be doing for the rest of the year!

Why?? My husband has been chosen by his workplace for a project. It involves tailoring and implementing his workplace’s software, and the customer wants him on site to help smooth the whole process.

Where? We’re moving to Canberra!

When?? Well apparently his start date is still Monday 12th September, as it was set a couple of weeks ago when the project came up. Yep, as in next Monday!! It seems that that is still going ahead, despite the fact that his workplace still haven’t organized our accommodation at all!! They are meant to be covering our moving costs etc, but right now it feels like what move?! Are we really moving? In a week? Like next weekend??

How long? The project is meant to be for 3 months, but you know projects…we’ll see. We might still be up there in February!

So! Once the shock subsided, I think we like this idea! I think we like it a lot. So many new things to be experienced.

Of course the list of down sides can be significant: missing friends and family, feeling displaced or lonely, far from my doctors/support network, leaving my stuff behind etc. But let’s leave all that til it happens. Right now, the opportunities are spilling out in front.

It’s going to be exciting!

What better time to be an unemployed pharmacist with no job ties? Talk about silver linings! This has to be a pretty big one. No taking leave, or a leave of absence. No having to quit a job I like. I can just up and go at a moment’s notice; which as it turns out is just as well, since it might come down to that!

I’m going to be a tourist in a new city with unlimited time to check out all the fun places it has. I’m smiling spontaneously and getting a buzz just thinking about the endless possibilities, the sights I might see and the people I might meet. And I’m off the hook about jobs! It is a relief. I’m unlikely to fall across a short term part time job while I’m up there so free time! Like last time when I was off work, when I was still sick enough to not need to think about returning to work, but well enough for short daytime adventures. Like an organ concert, a blogging class, a river cruise, taking the tourist bus or the city circle tourist tram around the city, a couple of hours at the zoo or wildlife park, sketching in the botanic gardens…I had so many hobbies and attempts at hobbies and really tried to get around the city as much as I could for free or cheap.

Remember this, self, remember the excitement when your anxiety about not knowing when you’re leaving for this new city, when you need to be packed up by, where you’re going to be living, what you need to take, how you’ll get around, if you’ll miss home, if you’ll find new friends, if you’ll….argh!! The big ol’ IF!!

I don’t deal as well with change these days, not like I used to. I tend to get anxious and become stressed about the unknowns in life which I would have sailed right through before I got sick. I need more notice, more time to think and consider the options, and I’m generally just more of a pain in the butt about the details! I need details!! Ask my poor long suffering husband! I have to be reminded, and reminded that things will work out just fine and not to get bogged down in the minutiae of a situation. Just breathe, and things will be fine. Of course they usually are just fine, but my brain doesn’t keep a record of all the times things have been just fine. It still goes straight to the what ifs.

And now I’m feeling thoughtful and pondering after that little detour, instead of happy and anticipatory of the future! Annoying. Let’s get this back on track: excitement, happiness, adventure!

I started a list of things to do once I get there, whenever that turns out to be. A reminder of all that I can look forward to, and a prompt for me to get out of the house once I get there and make the most of my time.

I’ve looked up places to go bird watching and practice my photography. I’ve ordered some tourist brochures for all the typical things to do. I’ve thought of a couple of friends I have up there, as well as my brother and sister in law. I’ve started checking out women’s bike riding groups and places to go riding. I’ve planned visits from people who may not yet be aware that they are coming to stay! I’ve chatted to some people who live an easy weekend away from where we’ll be living. Actually there’s so much to look forward to if you put your mind to it. Which I try to do these days.

I’m still writing my packing list and checking it twice. But since nothing has been happening about accommodation and no new information has come up, I’ve sort of put the packing thing off until I know for sure there’s a furnished house with our name on it that I can direct my things to. I had my initial freak out about which knives we must take and which tea towels were essential, but a Valium and a good night’s sleep mostly calmed my heart rate and thinking speed down to normal levels about that, and I’ve only been a normal level of anxious since. Well I think so anyway.

I will miss being close to my doctors. I think that will be the hardest thing. I don’t want to find new doctors; I’ll stay with the ones that I have. That probably means a couple of trips back for my psychiatrist, and I’m not sure what I’ll do about GP appointments. I know I can always call them on the phone so that’s reassuring. I’ll need to get new scripts for everything before I go. I just have to remember that I’m only a phone call away, rather than thinking of it being a 6 hour car ride away! Or however long the flight is. But nothing is impossible really. Just have to think of another way around it.

All of this shows, I think you’ll agree, that I’m going pretty well right now. Being able to see the positives, the blessings, the advantages, is not something you can force while you’re unwell, however much other people try to get you in the frame of mind. It comes with time, and with health. I’m grateful to have been able to take this enormous change so calmly, for me, and so positively. It could have thrown me well off kilter and returned my to bed for days. I’m glad that’s not the case.

So, all things being well, I’m off Canberra to have a fun and adventurous time for a couple of months, and I’ll certainly be filling you in on my life living above the blue line!

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!