pwned

Heeey guys… whats up? Ok so I just realized that this is gonna be really long- so you might want to read in chunks/take a pit stop halfway through/drink a redbull or something before you attempt to go the distance… I’ve divided up this into part 1 and 2… but part 1 is really long… so it doesn’t really matter… part 1 is pharmacy related, and part 2 is music/cat/swimming stuff… probably more for the casual reader…

Part 1:

Just catching up on some Grey’s anatomy (thanks to ABC’s website-how awesome is that??) - this one was really one of the best in recent memory… (sorry HouseMD, maybe I’ll give you a chance someday…)

Just got our first year’s worth of rotation schedules- just FYI- here it is…

January- Selective (like a one month intensive elective- think of it like a one month summer school class but still a full class… ex. Cardiology, drug induced disease)
Feb- Basic Clinical at Baptist out in Germantown
March- ‘clinical research’ at a lab on campus
April- my second and final Selective month
May- OFF
June- Clinical ‘Medicine’ at Methodist with Dr. Lobo- (really smart guy… I actually talked movies with him for about… 20 seconds?... maybe he’ll remember me) I’ve heard this one is really tough and I’m a little bummed because its my first really hard-core clinical “everything” kind of rotation and he expects a lot… actually I just discovered a student’s perspective-style review of all the Memphis rotations and preceptors (yeah- thanks Aryan)! This is kind of neat to check over… some are really well written and some are kind of brief- there is a GREAT review of Lobo’s rotation that really gives a great picture of what life will be like- its by a student who had him last year… in other words… this is a normal day… (its kind of long, but for those of you who are interested, I think you’ll really learn a lot about the nitty-gritty of what really goes on):
“Arrive at 8:00 am, and depart at about 6:00 pm Monday through Friday
*Go to morning report, a meeting to discuss medical topics or patient cases in detail with numerous physicians, residents, interns, and medical students from 8:00am to 9:00 am.
*Check your patient’s labs, vitals, get results of procedures, and retrieve a daily computer generated medication list for each of your patients before rounds. Your list of patients can consist of up to fifteen or more. Depending on how many patients you can adequately track per day, you may only see some of the patients assigned to you medical team daily.
*Report to rounds (you may sit in a conference room or walk around to see each patient depending on the attending physician’s preference that day) with medical team from 9:15am (for long call days) or 10:30 am (for short call days), which last until 12:00 pm usually. During this meeting you will talk about each patient and get more detailed information about the reasons your patient was admitted, why and what procedures or treatment they are receiving, and determine with your team what changes can be made to improve treatment. During rounds you will need to make suggestions to your medical team concerning any changes that should be made to the patient’s medication lists, including but not limited to changing doses, changing therapy, adding or eliminating medications according to labs, vitals, adverse drug reactions, interactions, or the patient’s clinical progress.
*Report to noon conference with the medical staff each day, which usually last from 12:00 pm until 1:00 pm. During noon conference you will get lectures about medical topics that can be in person or by correspondence with UT professors. Also, noon conference can be with the pharmacy staff, about a medication therapy topic probably only once a week.
*You will be required to see your patients and read their charts on your own time to get your own personal assessment of their progress (this can usually be done before rounds or after noon conferences). Reading your patients’ charts on your own and seeing your patients is your chance to catch any clinical problems that your team may have missed/caused. This is an opportunity to talk to your patients and see them in person. You may also do most of your patient education/counseling, and history clarification (requirements) during this time.
*Meet each day, around 4:00 pm (or earlier if necessary), with your preceptor and pharmacy resident to discuss your patient’s medication list and any changes/adjustments you see as necessary to their drug regimen. You will also be responsible for giving “snap shots” of your patients, which include giving a report of the patient’s medical history (past and hospital), problem list, reasons for admission, and present/past procedures. You will be asked questions about the patient’s medication history, indications for medications, etc. You will be required to know the therapeutics, mechanism of action, pharmacology, drug interactions, drug class, dosing, brand/generic names, side effects, co-morbidity precautions, black box warnings, and indications, etc. of every drug your patient is on and has taken in the past. You will definitely be asked questions concerning your patient’s medications.
*Also, during the meeting you will discuss a topic about anything from our therapeutics classes. For instance, if you are told that the topic will be about VTE, you will be required to know any and everything, including updated information since this topic was taught in therapeutics. You will be required and questioned about anything from drug therapy, dosing, medication indications (when to give and when not to give medications depending of the patient specificity), pharmacology, medical procedures (i.e. Greenfield Filters), etc.”

Wow… that’s quite a contrast from sitting in class for a few hours a day… I guess I don't know what more to say about that than just- what a month that’s going to be… no doubt humbling, educational, fun, scary, and intimidating all rolled into one… In a way I’m looking forward to it… in another way- I’ve got a really big fear of looking dumb in front of peers and I hope I can handle it… I’m sure I can… I usually do a decent job at my applied therapeutics classes (at Methodist this past semester actually)… I hope that can carry over to rotations… I think it will… its like… this is when we really step up into the light... when we go from being talked to, to actually doing the talking… when we go from not mattering to making a difference out in the world… its an interesting feeling just thinking about it... I don't know if I could really tell you what it feels like- and I’m sure I’ll know much better at that point… the words Responsibility, Opportunity, Pressure, and Exposure all come to mind… you can probably fill in what might go between them...

Ok back to the list- Kudos if you’re still reading at this point!
July: OFF (MTSU and/or INDY DCI shows- yep- also ‘blooo’)
Aug: Clinical Medicine- Dr. Self- still at Methodist… Dr. Self is a LEGEND in several areas… I look up to and respect him a ton… I’d really like to impress him, but I know that’s going to be hard to do… he’s my current Applied Therapeutics (like rotation stuff but just once a week) preceptor and he’s been tough, but I think I’ve got him figured out in terms of what kind of stuff he likes to focus on (remember what I was saying about ‘primary literature’ dad?)…
Sept: CARDIOLOGY! (more Methodist)- I’m really really looking forward to this one- that was my favorite topic in therapeutics- I know we’ll get to see some cool surgeries…
Oct: Ambulatory care- at “the MED”… the med is where you go if you don't have insurance… if you get shot, if you get in a motorcycle accident, you go to the MED… ambulatory care= outpatient= people aren’t so sick that they need to be in a hospital bed- think more chronic conditions- Diabetes, Heart Failure, Hypertension management, a lot of anticoagulation stuff… its really hands on… he’s an interesting section from the student review of this one…
“Beginning with Day 2 of rotation, you’ll have one exam everyday for 4 days. Exam 1 is anticoagulation, exam 2 is diabetes, exam 3 is hypertension, and exam 4 is hyperlipidemia. You have to make at least 75% on these competency exams to be able to see patients”…

November: adult nutrition- heard this was hard (guess that’s a relative term…)… not one of my big interests- and its kind of a different skill set than the other rotations up to this point…
December: Off (yessss)
January: AM care with Dr. Cross in East TN- Kingsport to be specific- Dr. Cross is really a pioneer with AM care stuff- very respected in the medical community for his hands on patient care… this was my “priority pick”… sooo Knoxville Family/friends- I’ll be around… we should do something on the weekends? (yeah… its only 14 months away)…
Feb-April: this will be scheduled later- they want us to get a feel of what we like and what we don't so we’ll know which way to steer…

PART 2:

HEY- I’m going to a concert tomorrow- I’m actually really excited about it… I feel like this concert was tailor made for me…
The Format
Starting Line
All American Rejects

How about that? And what are the odds that I have the most recent 2 (yeah 2) albums for EACH one of those bands??… so I’ll basically know most or all their music… I can honestly say, from knowing their stuff, and from being a long time fan (especially format and starting line- albums I listened to DAILY on tour with the bluecoats back in ‘03… really bring back some memories…) that it really means a lot for me to be able to actually just drive 20 minutes down the road and go see them… thanks todd for introducing me to both of those bands back in the day- you did good… Todd and Josh- I cant say this has always been true- but now I think I can really understand your excitement with the nashville music scene because- when you know the groups and you know their stuff, maybe feel like you have a history with them (like you and Todd do)- it just makes it more personal- its almost like this concert tomorrow is all about what makes me happy- like it was just put here for me to go to and enjoy as crazy as that sounds… I mean I’m not that self-cenetered… if I didn’t know the groups, if I didn’t have the history that I have listening to them, it wouldn't really mean all that much… I mean I don't know the Black Keys- I cant tell you one song they’re known for… and if I had gone with you guys to that, I dare say that while I may have had a good chance of being entertained that I wouldn't have been able to really appreciate it like you guys could…it wouldn't mean as much to me personally… this should be fun…

(seriously- has anyone seen my camera? I’d kind of like to have it now ::frowny face::)

Ok that’s all I got- its bed time…
And just as an update-
Lizzy is great- she’s getting bigger… she’s just really sweet and loving and stuff- more now than ever… I can just hold her like the little bundle of warm furry fuzzyness that she is all day… want to watch a movie? She can go the distance… I’ve been really impressed with that… and its just incredible to me that she hasn’t missed the litter box… I mean I know small children who wouldn't be able to figure out the whole “proper means of disposing of feces” problem of life without years of training… but she totally gets that she’s supposed to go in this little 1x1 box every single time…

Swimming is also great- I knocked out the mile in 34 minutes- I think the other day my reporting of 32 minutes was probably a little on the fast side of what it really was because they fixed the big clock in the pool and I could get a more accurate time and it was right at 34 and I think I went just as fast… but still… that’s still 18-20 minutes off my starting time 3 months ago (wow- 3 months ago… crazy…)

Ok that’s really I got…
exept this really funny year from my senior year at UTK- stupid Dobbs and HG... and i was taking a nap there too... i guess they thought it was time for be to get a rude awakening... times have changed a little you think?