bleh-thirty PM

well i had to postpone my "thank goodness its friday" celebrations until about 10:30... i went in to the hospital around my normal time- had to call a pharmacy to check up on someone's compliance of some of their post-MI meds before they were re-admitted a few days ago... turns out it was rite aid!- so i call this morning and get the info and i get "its really great that you called- we just had somebody get sick today and we're short. can you come in just for a few hours when you get off? we'll move the schedule around so that it all works out if you can just cover fro 5-10pm"- and of course- my inability to say "no" kicked in and yada yada yada- it was 10:30 before i got home for good today after having left at 7:30am... i don't feel horrible (due probably in large part to the fact that "full throttle"s were on sale 2/3.00 at rite aid and i indulged myself)... could be worse really- i just remember being in a sort of bad mood all day because i knew i had to go into "my other job" even if it was just for a few hours- because- well yeah- i'm already kinda tired...

had a really great heart-failure discussion with my cardiology preceptor today-- i just think she rocks so much... i can already see her probably being my favorite... we had a good 2+ hour talk today- just me and her and the resident... i present all the patients (they really put a lot on me, and its challenging- but like i said- i really do enjoy a good challenge!)... presenting meaning i have about 2 pages of history/meds/labs for each person we follow- (between 8 and 10 so far...) and i explain everything that's happened to the person since they were admitted- why they're here, what meds the MDs on our team have added (and if i agree with their choices or not) and they'll ask me questions about it- if i agree with what's been done- [examples of questions: "has this dose been adjusted for their reduced renal function?" "does this antibiotic cover the likely organisms- what have their cultures grown?" "is this beta-blocker one of the ones approved for use in this particular disease state?" "how long should they be treated with these antiplatelet medications after we send them home after their procedure?"] that and then after its all over we'll go back up to the floor and make recommendations in the chart- or counsel people on new meds that they'll be leaving with and starting for the first time... but before we did that we actually had another good hour of heart failure talk- and there were at least 2 instances where she seemed impressed by my answers and that felt really good (preceptors are like really hard to please parents) the second of the two times she actually said "wow- most of my students don't get that one right..." and that made me feel awesome... i really just do want to shine on this one- i want to really apply myself and make a difference and all that good stuff... i love being around people who really do CARE... believe it or not there are still a lot of those people out there and i'd like to consider myself one of them-

actually had someone pass away yesterday while i was there... and the family was there... i guess i was right outside the room when it happened... it was in the ICU and they had already decided to stop treating the cancer and let it run it's course- but i don't think the family expected it to happen so soon- they weren't ready, not that you ever can be for something like that... but wow- those screams will stick with me for a long time. I don't know anything about that family- but when you're feet away from that- you can't ignore it- i was looking at a chart at the nurses station and tried to pretend unphased - but i really was bothered... i just find it hard to not empathize with people in general. it wasn't like i really had anything to do with it- nobody did anything "wrong"... and i really wasn't anything close to an integral part of his medical care at all- i was pretty far removed in a sense- but i had spent some time that morning going on my own rounds to see my people and i checked his IVs probably spent a good 2 minutes in his room just looking over things- just me and him- still alive- asleep- just hours before the end-


deciding to withdraw care happens so much more often than i ever imagined before i started rotations... not just with cancer- i was always under the impression that "do everything possible as long as you can no matter what" was the way to go when taking care of people... but that's really not it- medicine still has lots of limitations- there's one nurse in particular who's the head of the palliative care/hospice/end of life care and i've heard her give her talk to families a few times now at this point... and she's so unemotional about it all... she's older- and i'm sure she's been involved in so many of those tough decisions that she knows that she has to be firm to be helpful... something like "there's nothing more we can do...."- its just always hard for me to hear... and it's really interesting to hear the consistent nature of clinicians in hospitals like this say things to the effect of "i've got my living will already made up so that people will know when i get to X point when i realize i'm not going to recover to just go ahead and let me go- because that's no way to live"... its the people who have been around this for awhile who aren't the least bit afraid to just come out and tell you that... i remember going on rounds with the internal medicine team and those attending physicians (think: Dr. Cox on 'Scrubs') all came out and said something like that on different days- we had 4 different ones and they all ended up sharing that with us on different occasions- its interesting that this particular-specific conversation (how you'd like to "go" if you were faced with these same medical decisions...) came up with every single one of them... i remember thinking how funny that was- but then again they've been around this long enough to know when its time to fight and when its time to let go- my preceptor and resident got talking about that today too...

but i think i'm doing well- my resident (who is also a pro- she knows a lot and really owns the whole pharmacy thing... she's never afraid to page the attending and let them know exactly where they went wrong with the meds... its fun- and they all really seem to respect her for it... ) asked me in the beginning of the month how hard i wanted to go at this- and i said something to the effect of "well- i'd rather get in a little over my head so i can learn to swim than just hang out in the shallow end- if you catch my drift" and she said "ok"... and thats how i got to the point of being assigned every patient on our service and presenting every patient every day... and you know- i feel like i'm really starting to keep my head above the water- it seemed overwhelming the first 3 days- but today it started clicking more than it ever has... and tonight i counseled every single person who came in with new meds- and people really seem to appreciate that- if you ask every person "do you have questions about this?" 99% of the time they say no even if they don't have any clue what they're getting or why their doctor put them on it... I've found if i go with the "have you taken this before?" approach- i can catch all the people who say "no" and give them a quick little talk- and they all seem really happy to have that... its getting easier all the time to do that... i can tell a huge difference in my confidence and counseling abilities since i've been on rotation for over a year now... i can't knock the system- it seems to work. ok- its really bed time now... does everyone feel like they learned a lot about pharmacy stuff?

(Aryan- just remember you're not my audience!)