I know the point at which the caller broke down and cried.
I was there, and I heard it all.
It was during my second call, to conclude on a grim possibility of Methotrexate overdose in a very sick child.
Multiple co-morbidities.
1/
I was there, and I heard it all.
It was during my second call, to conclude on a grim possibility of Methotrexate overdose in a very sick child.
Multiple co-morbidities.
1/
Its 7.45pm - I'm due to leave at 8pm. I hope.
It’s never happened of course.
I feel a little mentally drained, I sip my cold coffee and wince.
Must get that thermal mug I keep promising myself.
2/
It’s never happened of course.
I feel a little mentally drained, I sip my cold coffee and wince.
Must get that thermal mug I keep promising myself.
2/
Case open, I read scant notes, I will realise later why.
The case came through with some haste.
I start my call.
The caller: a father.
I start to hear that "whoosh" sound in my ears.
Fight and flight response. I grab my paper pad and pen, start scribbling down notes.
3/
The case came through with some haste.
I start my call.
The caller: a father.
I start to hear that "whoosh" sound in my ears.
Fight and flight response. I grab my paper pad and pen, start scribbling down notes.
3/
Not even trusting to type at the same type so I don't miss those finite & offending numbers related to someone on Methotrexate.
While the pharmacist in me wants to dispense with details of in-depth pharmacokinetics around MTX toxicology & overdose in a young child..
4/
While the pharmacist in me wants to dispense with details of in-depth pharmacokinetics around MTX toxicology & overdose in a young child..
4/
I want to broach on the father, who makes the call.
He becomes my priority to help me manage this crisis.
He didn't realise he'd made a dose miscalculation. Something just didn't seem right after he'd done it for a few days.
5/
He becomes my priority to help me manage this crisis.
He didn't realise he'd made a dose miscalculation. Something just didn't seem right after he'd done it for a few days.
5/
It was something he'd remembered that made him double-check. Like when reality offends the day-dream.
I completely understand how that feeling translates.
When you have a child, an internal alert beacon flicks on. Even when on autopilot the sensor never sleeps.
6/
I completely understand how that feeling translates.
When you have a child, an internal alert beacon flicks on. Even when on autopilot the sensor never sleeps.
6/
His voice only trembles when I tell the father, I need to seek specialist guidance & I'm going to exercise promptness.
I know 2 things.
The ‘what’ and ‘how’ it happened.
I don't yet know the ‘why’?
7/
I know 2 things.
The ‘what’ and ‘how’ it happened.
I don't yet know the ‘why’?
7/
I check my resources first, then make that call to a dedicated national poison center to seek guidance & confirm the next steps.
The HCP's I speak to are swift, efficient, zero emotion.
Numbers are exchanged at a precise pace including which hospital they need to present.
8/
The HCP's I speak to are swift, efficient, zero emotion.
Numbers are exchanged at a precise pace including which hospital they need to present.
8/
Steely-eyed and stoic. Appropriate for this situation.
Yet I am morose.
I arrange a CAT1 ambulance.
I have specific instructions for the paramedics.
Time is of the essence.
We’re at 32 mins post recent dose.
"We've already left" they confirm.
9/
Yet I am morose.
I arrange a CAT1 ambulance.
I have specific instructions for the paramedics.
Time is of the essence.
We’re at 32 mins post recent dose.
"We've already left" they confirm.
9/
My second call to the father. He's quiet.
"He's gone to sleep," he says.
"It's his bedtime now, so I let him sleep."
I’m calculating what that could mean?
My pulse picks up again.
10/
"He's gone to sleep," he says.
"It's his bedtime now, so I let him sleep."
I’m calculating what that could mean?
My pulse picks up again.
10/
"Can you wake him up? Keep him awake for me so the paramedics can assess him.
Get him to drink something if you can.
The ambulance are on their way.
Mum is with child, please go outside and flag the ambulance down. I'm going to stay on the line with you.”
11/
Get him to drink something if you can.
The ambulance are on their way.
Mum is with child, please go outside and flag the ambulance down. I'm going to stay on the line with you.”
11/
"I'm going outside" he confirms.
I start “In your own words, tell me everything from before your son started the methotrexate?”
Silence.
“Dad are you there?
Can you hear me? If we get cut off I'll....”
12/
I start “In your own words, tell me everything from before your son started the methotrexate?”
Silence.
“Dad are you there?
Can you hear me? If we get cut off I'll....”
12/
The sobs are loud, restrained at times, verbal wincing in his own mental pain, muttering words I can barely comprehend.
I give him a minute.
"I've done this to him, it's my fault, its mine.
I’VE DONE this to him."
I sense his grief beyond my own realm of parenting.
13/
I give him a minute.
"I've done this to him, it's my fault, its mine.
I’VE DONE this to him."
I sense his grief beyond my own realm of parenting.
13/
I blink back my own tears, as I hear someone else share their own internal anguish.
Some of his words hit home like a salty breeze.
It's his truth.
I listen.
"I didn't realise"
“#COVID Lockdown”
"He's so little"
"I haven’t slept in weeks"
"I failed him"
14/
Some of his words hit home like a salty breeze.
It's his truth.
I listen.
"I didn't realise"
“#COVID Lockdown”
"He's so little"
"I haven’t slept in weeks"
"I failed him"
14/
As a parent, we sign up to an invisible contract to serve day/ night regardless of holidays, sick or duvet days. It is the ultimate sacrifice.
There are some acutely tough days.
Moments that push you to an edge.
I’ve been there.
No help.
15/
There are some acutely tough days.
Moments that push you to an edge.
I’ve been there.
No help.
15/
You later recriminate and punish yourself over it.
Yet if you voice this, then let the backlash save you that self-serving anguish.
"How could you even think..."
"You're a parent...."
16/
Yet if you voice this, then let the backlash save you that self-serving anguish.
"How could you even think..."
"You're a parent...."
16/
Yet a sick child with over-exhausted parents,
being asked to extrapolate up-titration of dosages from an external practice without adequate support during #COVID....is the alternative cost of this pandemic.
17/
being asked to extrapolate up-titration of dosages from an external practice without adequate support during #COVID....is the alternative cost of this pandemic.
17/
"This is not your fault. This is not your fault. It was an accident.
This is not your fault, you’re doing the very best you can." I'm clear and certain.
"I'm ashamed of myself - I risk manage others yet I failed him." He says.
We’re only human, we learn & heal, I relay.
18/
This is not your fault, you’re doing the very best you can." I'm clear and certain.
"I'm ashamed of myself - I risk manage others yet I failed him." He says.
We’re only human, we learn & heal, I relay.
18/
The ambulance triage and conclude their next steps.
My final words to the father.
"Your son is in good hands.
You are strong enough to see this through.
Your son knows everything you do for him.
You both make him proud.”
19/
My final words to the father.
"Your son is in good hands.
You are strong enough to see this through.
Your son knows everything you do for him.
You both make him proud.”
19/
(consented to share the narrative, only after the child was safe, well, & back at home. The case was used as a patient safety learning event across multiple organisations)
The consult details were more detailed but protected for anonymity.
20/
The consult details were more detailed but protected for anonymity.
20/
MTX has benefitted many patients, requires specialist management & extensive monitoring.
patient.info/medicine/metho…
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patient.info/medicine/metho…
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