Bloopers

Sometimes you wonder what is going on in the world. A few things at work today made me shake my head.

[Edit: And I’m not exempt from bloopers, far from it. In photography as much as anywhere, as you can see!

IMG_5116

 

An ED doctor called a renal physician, a specialist, asking advice about treating an immune compromised patient with antivirals. This was a perfectly reasonable request because the patient presented with severe diarrhoea which could be caused  by the cytomegalovirus (CMV) and to quote Australia’s Therapeutic Guidelines, the antiviral she wanted, ganciclovir, “is the cornerstone of therapy”. The specialist doesn’t sound like he really knew what he was talking about, or hadn’t come across the drug much before. That’s still no excuse for him to say, “just give her Tazocin, it covers just about anything”!! Tazocin is a broad-spectrum antibiotic that yes, does cover just about anything…bacteria-wise. It most certainly never has and never will treat viruses however, and if doctors are saying antibiotics treat viruses, how on earth can we expect our patients to be informed?? That was some poor advice!

Nick something-opoulos (name disguised for privacy not racism) keeps his meds in two Decor containers, one for the morning and one for the night. I was getting quite confused because it seemed that his medications were prescribed at weird and something plain wrong times…cholesterol tablet and warfarin being taken in the morning, anti-depressant and fluid tablets being taken at night, and others. I was about to go in there and have something to say, but lucky I asked a question first and found out that whoever went through the meds before me had inadvertently switched the lids. Obviously they didn’t realise how important it is to the patient that they are organised the correct way. Or how confusing and possibly dangerous it could be to have the meds prescribed at the wrong time if a health professional, like me, thought they were usually given at the wrong time and went with it, no questions asked. Luckily its my job to think about these things and we got it sorted. What could have been the consequences? Diuretics, frusemide in particular, are always given first thing in the morning so that the diuresis (fancy name for peeing out the excess fluid!) happens during the day, most particularly during waking hours. Diuresis with frusemide can be hard and past, patients often need to pass urine several times with urgency after taking their medication. Often patients won’t leave the house after taking it, or only if they go to familiar places where location of toilets are known, or they’ll skip it if they have to go out. It can be a significant nuisance. The aim of giving frusemide in the morning is to prevent patients needing to get up hurriedly and repeatedly to the toilet at night time which presents a falls risk, so its very rare to see patients take it at night; the first red flag. The second red flag was desvenlafaxine or Pristiq, an antidepressant, apparently being taken at night. It doesn’t have to be given in the morning but it is an energising medication that can cause insomnia so usually patients start taking it in the morning when its first prescribed, and maybe change it up of their own accord if it works for them to take it differently, but usually it stays as first prescribed. Next up is simvastatin, an anti-cholesterol medication, which must be given at night to work. Simple as that. That’s when cholesterol is manufactured from fats and being the relatively weakest drug in its class, it just must be given then so it can interrupt that process. Some others are stronger and can be taken any time. Then the last but no means least red flag, warfarin in the morning. It doesn’t have to be given at any specific time of day to be effective, but for practical purposes its always given at night. This way you can have your INR blood test taken in the morning, and there’s time for you to be contacted before your dose in case it needs to be increased or decreased. I have never seen a patient take it in the morning. So a whole lot of confusion made a whole lot simpler by switching lids on two containers!

But this was NOT the most confusing thing about this patient. This patient has bursitis of the shoulder and has been in intense pain for 2 weeks!! They’ve been seeing doctors and gradually getting a CT scan, then an xray, now awaiting MRI and has had a cortisone injection over that time. But the cortisone is slow onset and long acting so it hasn’t kicked in. They were told to take paracetamol (Panadol) and ibuprofen (Nurofen) every 4 hours, good advice, but not told to limit paracetamol to 8 tablets per 24 hours, or to limit ibuprofen to the same. This was a massive oversight!! Yeah, sure, it “only” Panadol, and “only” Nurofen but this is exactly how accidental paracetamol poisoning happens. As it turns out this is also how gastritis develops with the patient coughing pink-tinged mucous suggesting stomach irritation and low grade bleeding, VERY bad for a patient on warfarin, a blood thinner; this could get out of hand!! And he’s suffering now not only from bursitis pain, but gastric discomfort and bloating!! Great! Good healthcare. But wait, there’s more!! As I was walking out, the daughter tells me they were also prescribed oxycodone (Endone), a morphine derivative on Tuesday. This is great news, so how has he been going with that? Oh we never gave it to him. Um, why? Excruciating pain, 2 weeks worth, needing paracetamol/ibuprofen every 4 hours?? “Oh we thought it might be constipating”…

…Wait. Let me get this straight. You’ve been telling me how terrible its been watching your father in such bad pain needing pain meds so often…and you withheld medical treatment for 5 days because it might cause constipation;?? That might not even happen!! Excuse me for being incredulous!! Bar one or two, every single treatment for constipation is found on a shelf in your local pharmacy. Most of those are found in your supermarket!! You might never need them, but do have access to them 24 hours a day anywhere across Melbourne. So just give the drug! I think I communicated this point adequately. The daughter then back tracked and said she was worried about addiction!! Seriously, you haven’t given a single dose, and you’re worried about dependence which takes weeks or months to develop, if it does at all while you watch your father writhe!!! It was all I could do to not strangle her!! So because you never gave the drug, he ended up first with a cortisone injection (usually last resort) probably because the doctor thought you’d tried and failed with Endone which you hadn’t, and now he’s being hospitalised because he’s in too much pain, because you didn’t give the prescribed medication!! Constipation, dependence, these are issues that we can work through as we go along. Failing to give appropriate medication, withholding medical treatment; health professionals have been de-registered for these crimes. Yet people in their own homes can get away with it any old day!! What a scandal! If this were a nursing home or hospital it would be labelled “elder abuse” and there would be an investigation and heads would roll!

I shake my head!

Advertisements

Footy season

It’s the start of the footy season.

Did you know that, or care if you did?

Melbourne overall is supposed to be pretty footy mad, and I’m sure it is based on the shenanigans I saw in my work suburb of Richmond over the footy finals last year, but I’m fairly laid back about it. We’ve never had a telly which is probably the major reason why I’ve never followed the footy that much, but if we’re ever on holidays during the footy season I do get pretty enthusiastic watching the play and exclaiming and yelling and carrying on! Who me? Yes me! But following it by newspaper just doesn’t interest me. I’ve also only ever been to 2 games, neither involving my club so…I guess that hasn’t piqued my interest. Theoretically I barrack for Richmond footy club, ironic given I now work there, mostly cos that’s who my Dad barracks for but as soon as people start talking to me about players or games or stats I get lost…except Dustin Martin, I know Dustin Martin. So how about my Dad barracking for Richmond without a telly? The Saturday afternoon clean out of the work van!! The radio would go on, the Coke cans and pie wrappers would actually get removed from the passenger seat foot well, and all the paraphernalia of being an electrician (clippings of conduits, cable ties, old light globes, fuses and things that I’ve forgotten the names of) get methodically cleaned out and the van sorted out for the week ahead. Or a trip to the tip. Or cutting firewood, or taking other trips, or something. Anything, from memory.

So, footy season…why do I now care? Apart from catching a couple of good games over the Easter break when we stayed down at Fairhaven, I work Saturdays in the emergency department. Turns out, we (I mean the hospital I work for) have the contract for the AFL among other sports contracts like the Australian Open so we get injured (and famous!) players coming through our doors, as well as all kinds of junior league and general patients. We’re the only private ED in the city so people wanting fast turnaround, quick (often same day) access to orthopaedics or plastics, private facilities and considerate treatment of celebrities often come to us. Of course there’s still patient confidentiality procedures in place so I won’t be discussing patients by name…and anyway no AFL players came in today to my knowledge, at least not between 10am and 2pm. Who knows after that?

So what did I see today? At least 4 patients lead through the department still in their playing jerseys with various signs of injury: limping, guarding of limbs, blood, pain.

A young 19yo male playing footy this morning went for a mark and the footy hit his ring finger at the tip resulting in a compound (bone through the skin) fracture of his finger…think blood, broken skin, broken bone, and just to top it off, the nurse swore she could see the tendon!! Ick! And when I saw him, he and his mum thought they were being discharged home…sorry, no, this is gonna need surgery!

A young girl maybe 16yo-ish came in from women’s AFL, not the major league but an amateur game with a dislocated shoulder. I actually felt worse for her than the last one because she has to be awake while they sort that out, although on reflection they wouldn’t knock out a patient to fix their finger, just a regional nerve block, probably in the wrist. She still had the green penthrane (inhaled anaesthetic) whistle from the ambulance and after the first attempt to enlocate the shoulder and an enormous blood-curdling scream that shook the foundations, they gave it back for her to suck on in between huge sobs which turned into a panic attack so they switched to nitrous oxide (laughing gas) to both treat the pain and anxiety, and eventually got the shoulder back in! I did not envy her at all! Not pretty.

I didn’t see this guy, but apparently a 57yo male umpire got tackled from behind during a junior game, huge question as to why that even happened, and is now feeling pain pretty much all over his whole body which got unbearable at home so he came into ED. I don’t know what they found in the end, but I’m sure most of the problem was a 57yo rather than a 22yo guy hitting the deck like a sack of potatoes. They don’t bounce back like they used to!

There was another jersey but I never caught up with that one. So instead, another trauma. This one was very unfortunate; I guess all traumas are but when your pet attacks you, its unfortunate. This 21yo guy’s pet is a lovely house cat. His buddy came over to visit and without his knowledge brought his dog. As soon as the dog stepped into the house it went for the cat, of course, so the guy went to pick up the cat but it was freaked out and attacked him…properly! Think slash to the throat, slash to the forearm and wrist, slash under the nose, slash on the chin, and the crowning glory, not just a slash to the lip but a chunk taken right out!! Ouch! Several stitches required, and being a private hospital, and being that the injury is to the face, usually we get a plastics specialist to review the patient at least, if not get them to do the stitches themselves, for a better aesthetic outcome!! Does that sound private hospital-ish?

Point Cook

Friday 16th March, 2018

This one is for a patient from ED tonight who I had a great chat with about photography. No I wasn’t neglecting my work, there weren’t that many other patients to see at that point, and it’s my hobby…always happy to chat about it!

I learnt a lot! About camera clubs at a local, state, national and international level including one that I might go along to locally, we talked about his 3 dark rooms, I heard about UV and infrared photography, and we talked camera models, good lenses for bird photography…and we could have gone on!! But eventually work has to come to the fore.

Anyway, since I shared my blog but haven’t put up a lot of my photos later, I guess I better. These are some shots that I liked from an outing with Birdlife Australia, Melbourne branch to Point Cook on Wednesday. A great walk, perfect bushwalking weather, nice company and a few stunning and semi-co-operative birds! It all makes for a great day out. The day was a bit misty/smoggy so as I cropped all the photos they became a bit murky; apologies!

Brown Falcon

Brown Falcon, better not shooting into the light! 

I got a whole series of shots of this gorgeous creature because you never know how close you’ll be able to get, but this was a youngish bird so we got very close in the end, slowly step by step. So the blurry shot isn’t really excusable, but unfortunately these days I have a degree of hand shaking that is bugging me – I really need to learn to wind up my shutter speed beyond what I’ve done in the past. I have cropped this shot.

IMG_9595

Brown Falcon, same bird but shot into the glary sky

The conditions of the day make a huge difference as far as the photos you can achieve.

IMG_9641

The glare of the sky adds so much light into the camera that it can be hard to make out detail of the subject when you shoot into the light and it is backlit; this is where being able to use your settings well really comes into play…or you just accept that you are operating in impossible conditions…but what fun would that be??

img_9665.jpg

A Crested Tern on the wing

IMG_9680

Love Terns, they are so acrobatic in the air and a delight to photograph!

IMG_9793

Now THIS is a series I’m super proud of!! Just saying…a little stoush

IMG_9794

IMG_9795

Now THAT’S the type of shot I want to be taking!

IMG_9884

Whistling Kite, not a great shot but the best I got

IMG_9959

Perfect! Do you know how close I had to get to this Superb Fairywren for this shot? Actually I had to wait for it to get this close to me. Time and patience pays off! About 2 metres away

IMG_9978

This scrappy looking guy is a male Superb Fairywren in eclipse, halfway moulting between immature and full male adult plumage in the non breeding season – this means he’s less than 5 years old

IMG_0009

I was sitting at lunch and all the birds took off in a big Kuffluffle behind me! It’s a tell tale sign of a bird of prey flying over; there’s a consensus amongst all the birds that this is a bad thing. 4 magpies suddenly went into attack mode and I discovered exactly where the bird of prey was! Not in focus but a nice action shot, I didn’t have much time to get off a shot

IMG_0013

Again, poor focus but I’m proud of this shot because I was the only one in a group of 20 that got a shot, and so I contributed a Brown Goshawk to the day’s count – I’m happy with that!!

IMG_0051

Spot the Little Wattlebird!

IMG_9549

Not perfect but a Black Kite right above my head?? Wow!

IMG_9560

And 2 Black Kites up there?? Perfection!

IMG_9674

This was my other moment of contribution – an immature Australasian Gannet, in the bay, out of the colony, away from Geelong, all on its own! I picked it out, someone else labelled it, lots of excitement all around! Love the spotty plumage – the adult is very monochrome

IMG_9677

Silver gulls (usually called Seagulls), Crested Terns, Chestnut Teal ducks, Little Pied Cormorant – these are all roosting in shallow water in the bay

IMG_9743

Little Pied Cormorants and Pied Cormorants – you can see the size difference clearly

Well, there’s some recent photos. I was overall a bit disappointed with the quality which was partly due to the weather with the glare and the smog, partly due to the settings being poorly managed and somewhat to do with this shake. Maybe I need to make a tripod part of my regular outfit for camera stability, maybe I need to go back to photography school to refresh the basics of which settings to use when, and let’s see what the doctor says about my tremor!

Enjoy!!

34 hours

I do love me an obscure heading but this one defines itself pretty quickly.

A recap: I started this job, as you know, in a casual position working in the dispensary at Epworth Richmond way back on August 30th 2017. Can you believe that it’s been 5 and a bit months that I’ve been here? It’s an absolutely essential role, yes, but one that I would be happy not to have to fill very much ever again for the remainder of my career. I don’t have anything against working in the dispensary, but I’ve been a clinical pharmacist on the wards since 2010, and being back in the dispensary had me feeling a bit boxed in! In fact I’ve been a clinical pharmacist in heart since my first hospital placement at the Austin hospital with the wonderful Grace in 2008, but that’s kind of beside the point, I guess. I loved working in the dispensary for the social side; there are some great people working dispensary. One of the things I never expected I’d miss when I left work was the social side of it, always having been a pretty independent worker. But you miss the chit chat when you’re home alone all day! I’m afraid its made me a bit of a chatter box now, and probably one of those annoying sharers of inane stories, but I’m just excited to be having a conversation with someone other than myself. This is ironic to myself because of one such annoying girl that I used to hardly be able to stand back in the day; full circle, around we come!

So I jumped, almost literally jumped, at the chance to switch lanes back to a clinical role in the emergency department when I heard about an opportunity. I interviewed for the spot on September 13th and started working with my new boss (love her!!) on the 25th. Going part time rather than purely casual was definitely a bonus, but I kept the casual position going since the part time gig is only 19 hours per week. I say only, at the beginning that was as much as I wanted, and putting on one other shift was all I could imagine. I’ve done several casual dispensary shifts in the months following at Richmond, and now also at Epworth Eastern (Box Hill) for some diversity, and because it takes 5 minutes walk to get there! It’s good money, being casual, especially if they’re shorter shifts that don’t take as much out of me physically, but I’ve learnt not to take on 2 days in a row standing up, or accept the dreaded 5 to 10pm dispensary shift at Richmond because all catastrophe breaks loose after 9pm! I don’t know what happens to hospital workers after dark, but it’s not good. Everyone gives you attitude, demands the impossible, gives you grief over everything, sends you ridiculous requests and it’s just generally chaotic. Plus the 5 to 10pm shift is usually paired with an 8am start next day and two of those combo shifts were enough! For most people its no big deal, but I can’t hack that turn around, I can’t handle my sleep being messed with; it’s just not worth it. Goodbye 10pm finishes, goodbye stand-all-day shifts day after day. That’s the beauty of being casual, you pick and choose whatever shifts work for you, so I keep being told. It’s taken me a good long while to get this through my head. I’m much more of the accepting-all-requests personality. But in the end, if it wears you down, if it affects your sleep, or your health then you have to make the tough call and say no, however much your personality yells, just this once, it’ll be okay, just say yes. I’m still bad at it, I’m always tempted to accept more than I know I should when that voice is asking me down the phone…but I have to remind myself to look after me first. The selfish choice, the reserve-your-super-powers-for-another-day choice. It’s hard to explain, its hard to do but you just have to.

Ever since I’ve been returning to work after that whole breakdown thing (Box Hill public hospital, Priceline Boronia and now at Epworth private), being on my feet has been the major rate-limiting step of each and every day. I keep hoping its going away, but its not. The old plantar fasciitis in my right heel just keeps on shooting up through my heel; the extra 40 kilograms I’m carrying is weighing down through my ankles contributing to the general ache I guess, I cannot seem to pick a good pair of work shoes to save myself it so heel blisters come and go and come and go, and getting a pair of sockettes that don’t fall down or bunch or cut in at the seams is another nightmare, and so we go on day to day, seeing if I can survive the amount of standing and walking that the day demands.  Sometimes I really barely can get those last steps to home, and I mean this literally. Stumbling up the drive in pain with blisters roaring, heel stabbing, desperate to get off my feet and get them legs horizontal! On standing-all-day days, my main strategy is shifting from foot to foot, walking whenever I can including extra “toilet” breaks, and more to the point, sitting at every single possible imaginable opportunity, sometimes ludicrously. All while trying to ensure no one realises what’s going on, because, like, you wouldn’t want to anyone to think you were weak, would you?!? Wretched pride. I’ll happily divulge my mental illness once I’ve known someone a short while, but pity help them finding out I can’t do the job physically! Sheesh, what a weirdo!! So I grit and grit and take every break I can squeeze and push on, but I do not relish those days when I know I’ll be standing all day, which are the days I spend on dispensary duty. At this point a saying comes to mind: “push through the barriers”. It’s been said to me, but if you only knew how much I push on through every work shift, how it drains me, how I die inside a bit…, believe me, I’m pushing on. Remember when I used to lay in bed all day? I daydream some days that I’m back there, mostly when I’ve been standing at the same bench for an hour. Ah, to be lying down with my legs up!

It’s getting easier now, in one sense, and harder in another. It’s getting easier to knock back the dispensary shifts because I am now getting offered clinical shifts on the wards!! Yeah baby!! The ED thing is a dream come true, and this is pretty close behind! So now that I’ve done some training I can formally back fill and cover the medical ward and kids ward for any pharmacist’s annual leave or sick leave. And at the moment, I’m doing some filling in for my boss who is acting director of pharmacy. Yippee! More clinical work, fuller calendar, less dispensary availability…that is apart from the shifts that I agreed to before this came up, but its all good; I’ll manage them as they come and then let them be bygones.

Which brings us to 34 hours. For THE first time since I walked out on my excellent fulfilling cutting edge full time job at the Alfred in mental health crisis in March 2014, I worked almost a full pharmacy week, which is 40 hours in public hospital; it’s actually less in private hospital but this has always been the goal in my mind. I worked 34 hours the week starting Monday 15th January and I’m thrilled! In my mind it brings me full circle to where I left off, and I have to admit two things: 1) that this has been a major goal in my mind, and 2) that I really did think it would never happen again in my lifetime; that I’d never be well enough ever again. You can sense the satisfaction, surely! I did it! I got back there! I came full circle and ticked a box that I felt doomed never to achieve, and it feels really good. Of course it’s not just the hours worked. It’s the work itself: feeling like I’m back to being useful, back to being the standard of pharmacist I was then (which I’m not fully, but the point is I’m on my way), that I’m back to being a functioning member of the workforce. I don’t know why being a useful home keeper never felt enough in my mind. I think its all about feeling torn from a place and occupation I loved, and the idealisation of that place and occupation as the ultimate indicator of success in bringing this mental illness beast under control and in subjection. Of course its folly to think its ever totally in control and subjection, but I dream! My GP so wisely pointed out that I am not to be doing it to make the point; that’s not a healthy perspective, and I think I’d realised that shortly before he said it. I did it, I ticked something in my mind, but that’s it now; there’s nothing more to prove. I proved it to myself, that’s all I ever needed, so now settle back and enjoy the work and the hours for their own sake, without any pressure to meet a target that in the end is pretty meaningless really.

Do you know what I think the most powerful balm is in all of this? Every shift I work on the wards or in ED beyond my part time hours, is filling in for someone either on leave or pulled somewhere else. I’m filling a role that were I not there, would not be filled. Excuse the false terminology but its the hero complex; the idea that were I not there, things would be worse, so I’m being so very useful. That can’t help but stroke the ego and I’m as vain as the next person, I suppose. Because I got out of bed and went to work instead of the opposite, I can do some good for a patient; it’s a powerful motivator on the reluctant mornings.

Anyway, here’s what I’ve been up to lately:

  • Week starting 15th Jan: 34 hours being my usual 19 hours plus 2 full day shifts, one shadowing the pharmacist rostered to the medical and paediatric wards, and one working side by side
  • Week starting 22nd Jan: 22.5 hours being my usual Monday only (1 public holiday Friday and 1 annual leave Saturday), and 2 full day extra shifts working the medical/paediatric wards
  • Week starting 29th Jan: 29 hours being my usual 19 hours plus 2 half day extra shifts in ED
  • Week starting 5th Feb: 31.5 hours being my usual 19 hours plus 1 extra full shift in ED and medical/paediatric combined, and 1 extra half shift in medical/paediatric
  • Week starting 12th Feb: 32.5 hours being my usual 19 hours plus 1 full day and 1 part day in the Epworth Eastern dispensary

 

I can hardly believe the numbers myself but they don’t lie. As for how it went, it’s taken me too many words and too much time getting this far, so the how can wait for the next edition. See you then!

Private hospital 101

I work at a private hospital, in the emergency department (ED). Prior to starting this job in August last year, I had spent all of my career, apart from the obvious gaps when I was sick, in public hospitals. The change has been quite interesting from several financial prespectives.

  1. Funding private hospital ED

In a public hospital emergency department, as long as you have a Medicare card, everything is free. To you, I mean; obviously the cost has to go somewhere, so it goes to the government because they believe in free access to healthcare for all Australians through their funded hospitals. It’s actually one of THE most amazing, and EXTREMELY underappreciated benefits to living in Australia. Whatever you think of any government down under, you absolutely SHOULD respect and appreciate this benefit of life here. If you had any idea how much money you rack up in one long wait in ED for nursing care, medical care, tests and scans, medications, interventions and so on, I think you would be shocked! We are talking hundreds if not thousands of dollars over several hours, and that’s just in ED. Try to think of healthcare, and paying your taxes, from this perspective; maybe you’ll be calmer in the ED, and more resigned to all that money you fork over to the government.

To access the emergency department where I work, you pay $300 upfront before you walk in the door which is an out of pocket fee, not rebatable by your health insurance, paid on the spot before anything else happens. Basically it’s a general fee against the types of costs you rack up, such as medications, blood tests, Xrays and CT scans. If you end up accumulating costs above this payment, they may be charged to you. At the beginning of working here I thought this wasn’t great, or fair, as far as healthcare equity goes . But now I think about it differently. We are one private hospital. In the city of Melbourne there are 3 major public hospitals: Royal Melbourne Hospital, St Vincent’s public hospital, and The Alfred, as well as specialized public hospitals: Victorian Comprehensive Cancer Care, Royal Children’s hospital, The Women’s, Eye and Ear hospital. That’s plenty of public health to go around, and its just in Melbourne city; not the suburbs. There are other private hospitals as well, and I’ve come around to accepting that there’s a valid place for both. We are only trying to recuperate costs outlaid because the government doesn’t fund our patients, we do, at least in the outpatient setting. That’s what category the ED technically falls into, outpatient; in fact sometimes you hear it referred to as outpatients. Private health insurance, check the small print, only covers the INPATIENT stay once the patient is admitted to the ward so if we don’t get some money somehow for what we do in ED, we are totally out of pocket ourselves, and as a private enterprise, we wouldn’t be able to continue to offer healthcare, which would be bad for everyone, not least of all me whose whole day is spent in ED which I love!! So yes, I do now see the virtue. Yet somehow, when I see someone on a stretcher with a vomit bag being asked to sign waiver forms for their $300, it still generates an ick factor!! Weird, huh?!?

I would add, because it is relevant, that the $300 fee does also serve a function of natural selection where those who can afford it come into our ED, and those who can’t afford it, don’t. That’s not to say that they are just turned away, not at all. We always ensure they are transferred to a public hospital that can care for them without the money burden. And all patients coming in by ambulance are informed before arriving that the fee applies to them, so that they can choose to go to a public hospital should they not want to pay. So, would you pay?

Another day, another dollar

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

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

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

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

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

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

Job update

Hello? Is anybody out there? Is anyone still listening?

Apologies for the radio silence over the last few months. It wasn’t for lack of ideas and thoughts to share, but more for lack of motivation and follow through. It’s been a long, cold winter for me! How about you?

The run-down of this winter is coming in instalments, because a lot has happened despite the long cold. First off, and the main event, an update on work.

I quit my old job in August, yep the same one that I started in April, and moved on to another job. I’ve never “given up” so soon! But it was a good move, probably the best career move I’ve ever made despite quitting being seen generally as a negative thing. Four months in community pharmacy, and I’m done! It wasn’t the community, it was the pharmacy, more specifically the management of the pharmacy, and more especially the owner/manager/slacker/ingrate/greedy pig/jerk. I’ve done that fight in a job once, and it changed the course of my mental health for life! This time, I knew enough not to stay, and I’m proud of that! It shows that I learnt something that first time around, and that’s a victory. As soon as I realised that the situation wasn’t going to change (another thing I’m proud of recognising this time around) and that my initiative was unappreciated, I started planning my departure.

And karma smiled. Well I don’t believe in karma, or the universe, or fate. But everything fell into place like it would if you did believe in one or the other of those things. I monitored the regular SEEK pharmacist job alerts that I’d signed up to receive before this job, as well as the Society of Hospital Pharmacists job register. I was still searching for my escape route (you know, never leave a job until you’ve got another job), when I got a call from Slade Pharmacy at Epworth Private Hospital in Richmond asking if I would like to interview for a casual position! Ah yes! I would definitely like to interview for a job with flexible hours in a hospital, albeit the dispensary! Especially since you called me; is this a dream come true? So why did they call me? Turns out that when I interviewed for them last year and didn’t get the job, they said “can we keep your resume on file?” and meant it! How about that? I thought it was just a line that everyone says when you don’t get a job as a consolation that maybe in the future there’ll be something there for you. But this time there’s an actual consolation prize in form of a job! Amazing.

So, interview, check. Job offer, check. Give notice that I’m leaving, check. Get obnoxious response from boss, check. Leave job feeling even better about my decision to leave, check. His response when I said I was leaving? “That’s a relief. Return the keys. Retail is not for you”! Sorry. You’re wrong. Retail pharmacy is for me, in fact during uni days I worked in retail pharmacy for 3 years and had a great time. But you’re right, the way you mis-manage it, it’s not for me. Ciao!

Usually when someone is looking for work, changing jobs, planning a career or whatnot, they consult their own needs and maybe that of a partner or family member. It comes down to what you want from a job, where you want to work, what you want to do in your job and that’s it. That’s true for me too, but in my case, there are a few other factors that contribute as well.

Number one: how will this job affect my health? That’s always the first consideration nowadays. Do you ever even think about this when considering a job? I certainly never did before I got sick. Could I work fulltime, could I manage the stress, how would I manage my workload? I never even thought about these as issues, I never thought about it period. I just knew inside myself that I would manage whatever came to me. I never doubted being able to do whatever job I got. I didn’t understand there being any option but doing the job well and going home to rest before going back the next day. Until the last year of my first job led to my physical health falling apart, and my mental health beginning to deteriorate. My second job was endlessly fulfilling but my mental health was already on the way out and too far gone for me to hold my head together, so I had to bow out. Ever since then I’ve been returning to work and thinking about what I can physically and mentally manage in a job.

Number two: what do my doctors think? Their opinion isn’t the end of the matter, but it has a lot of weight and sometimes it does decide the issue. My psychiatrist for instance has an old-school understanding of what hospital pharmacists do, but a very up-to-date understanding of how my previous jobs have affected my mental health. His current stipulation has been no hospitals, which of course I’ve found very challenging to accept! Hospitals are my place, I’m sure of it, but the politics of my first and third hospital jobs have been tough on my health for different reasons. So, I did what he suggested and tried retail pharmacy. I wasn’t very enthusiastic at first, but I tried to see it as a challenge, as a chance to update and broaden my drug knowledge and expand my mind with a different type of practice. But unfortunately, I found a great job in a terrible environment. I tried hard to make it work, but it began to drag me down after a couple of months and my psychiatrist could see that clearly, once referring to my ex-boss as Frankenstein’s brother, and another time as a peasant which amused me greatly! But still, when I broached my new job at Slade Pharmacy with him, I went cautiously and emphasised the words dispensary, retail, community pharmacy, and minimised the word hospital. But as it turns out, that first job as a casual dispensary pharmacist starting in September was easy to sell. Meanwhile my GP is supportive of anything that I want to put my hand to, even recommending I just not work for a while longer if it suited me. But getting back to work has always been a driving force with me, for better or for worse.

A week into my casual dispensary role, I heard someone dropping the words job and emergency department!! Wait!! What?? My favourite ever job so far! On offer right here? Where I already have a job? Ears pricked, senses heightened, on full alert I went into action finding out as much as I could. As soon as possible I interviewed for and was then offered later that week a role in the emergency department, 2 weeks into my casual dispensary position. I was more hesitant in telling my psychiatrist about that. I used words like part time, structured, working with another pharmacist, dedicated time, no involvement with the main hospital. But it went over easily. He saw how the community pharmacy thing went; we tried that. So now this is a new thing that I wanna try, and we’ll watch and wait this time.

The third and last factor is a third party checking in on the progress of my work. I’m receiving income protection payments from an insurer, and they check in on me every month. There’s a lot of filling in of forms by myself and my GP, supplying payslips when I’m working, and periodic check ins with a “rehabilitation consultant” who keeps tabs on my work and my health, and a case manager who keeps tabs generally. They do keep the pressure on to remain in paid work, of course, and they aim to get me back to full time work, something that I’m by no means convinced is possible. When I wasn’t happy in that retail job, I did experience some pressure from them to keep going rather than quit, but I was sure I was doing the right thing, and now in hindsight they agree. It’s just another little something in the mix that complicates my plans for what work I want to do and how I want to do it.