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.

Downer

When  you suffer with anxiety or depression in any of their various forms, it doesn’t take much to get you down. In fact it takes a lot to keep you up!

I find this with a million stupid little things that turn a perfectly good day into a gloomy do! Usually its something that I’ve done that I’m annoyed at myself for, and I just can’t let myself off the hook about it. My husband can just cruise through these things and flick them off, just like water off a ducks back, as the cliche goes; it also helps that he doesn’t seem to make dumb errors in the first place! We have a joke that he’s always right…and it’s nearly always true! But I find myself berating myself over and over inside my head, mentally abusing myself for being so idiotic, self flagellating for my mistakes and lack of memory, or of thought, or of judgement. That just can’t make for a happy day.

I spent a lot of time with a psychologist when I first got sick and one of the main points of therapy involved reframing my thoughts, and interrupting a snowballing chain of thoughts. Reframing means to look at a situation and how you usually react, and try to consciously change your reaction to it so that you put yourself through less stress and hurt, and therefore are more well mentally. Interrupting a snowballing thought process means recognising when you’re starting down a line of negative thinking that is escalating to the dramatic and trying to stop it early, while its something that can be dealt with, before you’re almost to the point of a panic attack. I spent a lot of time working on this, and when you consciously and deliberately look at your thoughts, you do recognise a lot earlier where you can intervene and save yourself a lot of drama! Having said that, it does take a lot of energy to do this at the beginning. It gets to take a little less effort as you get more used to it, and you have less of these thoughts because of dealing with them in a better way. Eventually its more of a habit, but as soon as you think to yourself that you do it automatically and don’t need to put so much effort in, it can creep back in.

It is almost indispensable to have another person around who understands the work that you are trying to do with your head, and who can remind you what to do when you’re working yourself (unintentionally) into a bit of a tizzy! Someone who can remind you to breathe, that the drastic thoughts you’re having are just that: drastic thoughts; and of the techniques that you’ve learnt. I say it all the time but I have the utmost admiration for people on their own dealing with their beast. Kudos, and I don’t know how you do it!

Today started out as a great day. I had a good ride with my Wheel Women. We rode from Docklands to the pink lake in Westgate Park and back, and I had a superb raspberry jam donut (apparently it’s a “bombolini” according to this bakery) to top it off! I also had one of those San Pellegrino chinotto flavoured sodas in lieu of my usual Coke; that was not a highlight! Tastes like medicine!

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I was planning on doing a bit of extra riding today. I had planned to ride from Hawthorn velodrome to the start point of the Wheel Women ride, and then ride back there after the finish of the ride to add in some extra ks, but a little glitch with snoozing the alarm prevented me! Sometimes that would be enough to get me down, but I smiled through that mix up. I mean, just the fact that I wanted to do extra ks is a pretty good indicator that I’m sitting well up on the scale of blue.

I got to the start almost on time, and marvelled with everyone else at how stunningly beautiful Docklands and the water looked in the unexpected sunshine and after the rain. I really expected to get a bit wet with rain today after 2 days of LOTS of rain, but we lucked out. It was beautiful through the whole ride, and we agreed we could just keep riding and riding on a day like this where it was cool so we wouldn’t overheat, dry so we didn’t get cold with wet, not windy…perfect! Shame about me not getting up on time to do the extra riding; it would have been the ideal day for it. Oh well, let’s enjoy the ride I’ve got going on right now, instead of worrying about what I’ve missed. And there is some great re-framing and preventing of snowballing thoughts! And so the ride was just lovely!

And then, the error. The trigger.

Stupidly (it’s always stupidly by the way) I put my phone on the roof of my car.

I know!

Always a first. And last. Then some other first. Or another first if I just haven’t learnt my lesson. And so on.

3 blocks down the road from my car park, I went to put my phone in the holder and an adrenaline shot went right through my gut! I instantly KNEW what I’d done! On the bonus side, I’d been creeping along slowly since leaving the car park, hadn’t cracked 40kmph, maybe not even 30kmph…maybe it was still on the roof?!?

No!

Dulp!!

So back I go to re trace my wheels. I couldn’t get there fast enough; itching at every red light and pedestrian crossing until I got back to where I had been parked. There was a ute there now, so I got out and checked under it for my phone, once, twice etc. Then I carefully drove even slower where I’d driven already, retracing, scanning the street and gutters, wishing, hoping and more.

And back around again, and a third time! Nothing!! ARGH!!

And that’s how it starts. The adrenaline shot depletes a bit of your good mood, the persistent bad results of looking and not finding get you down more, knowing this is all your stupid fault hacks away at your confidence and suddenly you’re berating yourself and the day is not the same day it was before. It’s plummeting down through the levels of good into mediocre and before you know it, it’s not a good day anymore.

Although lately, I’ve been well, and more resilient. I knew this about myself, but this incident proved it without doubt.

I was SO bummed out over this stupid accident which should never have happened in the first place! How could I have been so thick as to put my phone on the roof?? I knew it was a bad idea, and I did it anyway. Who does that?? Typical! I make a rule, and I break my own rule, and of COURSE this is what happens! It’s okay to put the keys on the roof, because you can’t leave without them. But your phone? Idiot!

This is how my thinking goes, left to its own devices. Berating, accusing, bullying, incredulous of myself, throwing insults.

This is where the challenge lies. Putting my psychologist’s knowledge into practice in this moment and not letting the snowballing of negative thoughts get off to a head start. Re-framing the thoughts: instead of calling myself an idiot and stupid and dumb, realise that accidents happen (even if it’s often and always to me!) and this was just that, an accident, and give yourself a break!

So, having proved that my phone cannot be found and doesn’t seem to be anywhere that it should be, I head home. On the way I think of half a dozen reasons why having my phone right now would be so good: to find out the best route home, to take a photo of the city shining in the sun, to pop a starter note for this blog into my notes section, to check my calendar for what else I’m meant to be doing today, to use the Optus app to put my phone plan on hold, to call my hubby and let him know about my phone!! It really is my right hand and its going to be a bit painful without it. Stupid, stup…no, we agreed: not stupid; unfortunate. Accidental. Breathe.

But then, halfway through sliding down the blue scale into the depths, I slowed up and stopped. I stopped. That hasn’t really happened before. And it wasn’t like I put a heap of work into it, into stopping my thoughts. But my head is just in a better place lately, and this didn’t seem to be as big of a deal as similar events have been before, where I could wrap myself in guilt and grief for a whole day. Now I was stopped somewhere around the “okay” mark, still realising the inconvenience and bother I’d caused myself, but not fatalistic like many times before. What is this new feeling? Is this being well? Could it be?

I got home and flicked a message off to hubby about being out of phone contact. Then got out one of my comforters and I was pleasantly surprised that before long I was smiling and feeling quite serene about the whole thing! What is this? It was still annoying etc but it didn’t feel like it was taking up my whole world with distraught stress but like it was just one part of the picture. I like this feeling!

I believe that this is how you know you’re well. You can recover from events that happen, instead of collapsing into various levels of despair and misery. I’m not sure how this state came about, but I feel like the chemicals in my brain are finally aligned and things are just easier. It’s very exciting!! To say the least.

As to what happened with my phone? Hubby told me all the things I could do and so I went through Google’s ‘find my phone’ function online (just search for it) and I used that to lock my phone, to put a message on the lock screen to say please return my phone and to give the number to call, and to track my phone. I have to say that was the most satisfying and frustrating part, watching someone driving my phone along. It travelled the Bass Hwy towards Phillip Island via the koala park, and then stopping at the Nobbies, and I was unable to do a single thing about it!! But it was awesome to be able to watch them in the first place. I made a full report to the police and they were very helpful. But then my husband got a phone call from the person who picked it up: turns out they were a coach driver who found the phone in Docklands super close to where I’d driven past, and they planned to bring it back the next day! How kind and honest! So all’s well that ends well in the end. My husband biked from his work into the city in his lunchtime to pick up the phone, and everything is as it should be once again.

Lessons to be learned:

  1. Do NOT put your mobile phone on the roof of your car in any circumstances!
  2. Do leave your GPS function on so that you can track your phone if you ever lose it, it was accurate down to 6 metres at one point
  3. Do be aware of Google’s find your phone functions
  4. Ideally always have your screen locked, but know that you can lock it remotely in an emergency
  5. One day, after so much pain, stress, medication, therapy and time, you will be well again. Believe.

Finding the light

Hello friends,

I’m back. Sorry about missing the blog last week! I tried. I came up with one draft, then discovered it was totally over-dramatic and not what I wanted to say. I did another one, but when I read it back over it just didn’t really seem like much of anything! So, here I am with two discarded drafts, no post for last week, overdue for this week and next week is coming around fast! A bit frustrated!

Why am I so stuck? Why am I spinning my wheels? I want to write about suicide, but this time it’s real, somebody that I used to know. And despite however much distance you’d think “used to know” would put between me and this event, it has gotten under my skin.

For people who suffer with mental illness, hearing about another person’s experiences can be a trigger for a worsening of your own condition. We’re so susceptible to worsening when we’re unwell. It’s different when we’re doing well; we’re resilient and strong. This is especially true abut suicide. Talking about suicide, hearing about suicide, reading about suicide can be a trigger for someone who is unwell to start thinking in circles, over and over about suicide. That’s not to say that someone can cause another person’s suicide. But to a person on the edge metaphorically, it only takes a tiny bump to over-balance.

I’m not suicidal. I’ll clear that up now, and relieve any worried minds. I’m actually doing quite well, but this event has given me pause to think about not being well. It’s quite a long time since I have been suicidal. I have been very fortunate that suicidal thoughts have only been a small part of what I’ve experienced over the last 3 years. I tend towards grey days, nothing dramatic. But still, hearing about someone I’ve known, someone who was one of my first childhood friends, someone who I grew up with ending their life creates a moment of questioning of the situation and myself.

Of course there’re so many questions that come with any death by suicide. Thankfully in this case some of those were answered before the last day. The family were well aware of the mental illness and very supportive of their son, including providing a flexible workplace. Relationships were good, things had seemed to be going well. But there was no questioning why he died because the answer was clear: mental illness. Of course there was the question of could we have done more? But the answer is no: medications, counselling, support all given in full. Just an overwhelming sense of wishing it hadn’t ended this way this soon, but feeling that maybe it couldn’t have gone any other way.

Could something have stopped it happening that day? Yes. Would that have stopped it ever happening? No. Could we the long lost friends have done more, kept in touch? Yes. Would it have changed anything? No. Because it’s not about us, the friends and family. It’s about the mental illness battle ground in a person’s head. However much we love someone and want to help them, we can’t climb inside their head and fight the fight for them. We can only do what we can do from the outside.

Someone with mental illness has different questions that are all for themselves. This person had depression, I have depression; he ended his life, so where does that leave me? If it took xyz for my friend to take his life, what would it take for me to get to that point? They took their life this way, could I do that; if not, what would I do? It’s like being inactively suicidal and contemplating ideas and theoretical points of view, but you have no plan to carry them out; no active suicidality (the medical term for being suicidal). It’s like ruminating on whether I’ll get to go on holidays this year, and if I do where will I go, and what luggage will I need to pack? When patients are actively suicidal they will often have their will written, letters completed to their family, plans for handing over the business and literally will have signed themselves out of their life having hoarded enough poison, collected enough rope, built up the nerve to jump in front of the train etc. Then again sometimes it’s pure impulse on a background of ongoing suicidal thoughts that are just eating away at your will to live. A tipping point is reached, and that’s that.

So I’ve had a period of questioning myself: how am I? Am I doing okay? Are things still under control like they were before I heard the news? I run through my “on the edge” symptom check but there are no tell tales signs; maybe I’m a bit more shaky in my left hand, maybe I’m a touch more anxious, a bit more fixated on anything changing. But after giving myself a few days to take the impact of the news, attend the funeral and debrief, things are okay. I’ve gotten through a potential trigger okay.

Which is bully for me! For the family, the friends grieving now and for a good while to come, where is the light? Where are they to look to find something good out of this? One place that I’ve found comfort is to see the men and boys in my old friends life passing the okay sign around on Facebook in a campaign to vow to listen to each other, to talk about mental illness and suicide, and to try to prevent this from happening again. This has to be one of the best ways to commemorate a death by suicide; a pledge to fight it’s influence and talk about it openly.

I know that its difficult for people to talk about this awful thing that’s happening in their heads. And it’s hard for others to hear what they have to say about it! But we have to be brave; be strong and talk about it. Bringing it out into the daylight is the only way to make it less scary, and to take away its power over us. Talk, talk, talk, talk, talk. And remember the souls who couldn’t fight it’s power anymore. It wasn’t their fault, they didn’t mean it or even want it, but they were overpowered. Remember that. They were fighting the battle and lost, through no fault of their own. Remember them. Talk about them. Share their story. There is someone out there that you can help if you talk about suicide.

Check out Conversations Matter for videos, fact sheets and resources for talking about suicide.

Use one of the umpteen helpline services that are available in this country. You don’t have to have a mental illness to call. You can call to talk about a friend, someone you knew who died, or just to learn more about mental health. So many people are reluctant to call, so go ahead and buck the trend! Call! Ask questions, learn things, talk to someone on the end of the line anonymously before you talk to a friend. Whatever you do, do something to improve awareness of suicide and prevent it occurring again.

beyondblue 1300 22 4636

SANE 1800 18 7263

Lifeline 13 11 14 (crisis support and suicide prevention service)

Suicide Call Back Service 1300 659 467 (free service for people who are suicidal, caring for someone who is suicidal, bereaved by suicide)

Kids Help Line 1800 55 1800 (5 to 25 years old)

Victorian State Suicide Help Line 1300 651 251

Mensline 1300 78 9978

Veterans and veterans families counselling service 1800 011 046

Qlife 1800 184 527 (lesbian, gay, bisexual, transgender and intersex communities)

Carers Australia 1800 242 636

Many more helpful phone numbers and web sites can be found at Mental Health Commission’s Get help page