The Patient that Made the Difference

Her initials were the same as mine, and we greeted one another after a few phone conversations with "Hi, BB, it's BB." 

We had this connection. Two grown women. Both single and young. The big difference was that I was her home health pharmacist in charge of her pain pump and she had terminal cancer.

When you are halfway through your life (and maybe your career) there comes a time when you look back and remember the patients that change your life and maybe even validate the half-ass "I want to be a pharmacist" decision made by a young twenty-something with no idea how profound the decision would have on every aspect of your life. 

B wanted to go to Florida and be in the ocean one more time.  Her boyfriend was in Florida and since she knew her time was short, the ocean was on her bucket list... with the dilemma of a pain pump. That's where I fit into the story, finding a creative way to make it happen along with a couple home health nurses and some supplies. She was a nurse, too, and was a big part of her own end-of-life care.

It has been eleven years ago. B was 33 years old. I had been a pharmacist for only four years; a baby in the working world with little idea of how that year would change my life.

I had these biweekly chats with her concerning supplies she might need, including the intravenous pain medication itself but we often left the rigid discussion of how we were connected through pharmacist and patient to human conversation of "please do monthly self breast exams," to "live a full life and travel Beth!" to "who cares what people think about you, you certainly won't care when you are at the end of your life" and "I wish I could have been a mother." It was almost as if I had been granted insight into the world of a life ending way too soon and maybe learning my own lesson along the way. I sure did.

I finally went to meet her the last few days of her life. I waited much too long to meet my friend and that is my only regret. There is a professional line you have to keep in place with your patients, but sometimes that looks a little different patient to patient.  She squeezed my hand and had a picture of her vibrant former self before cancer ravaged her body sitting on her nightstand. "You are beautiful," I had said although wishing I had arrived months before.

Pharmacists and nurses along with other healthcare providers can make a difference. 

I witnessed the same thing with my father-in-law's nurse at the VA in Nashville caring for a man that had no family at bedside because of a lack of a relationship with his family. His nurse was amazing and was not only his nurse but his friend.  

I saw it again in Memphis on a hospice rotation where I saw different patients in different stages of terminal illness along with their families in different stages of grief. 

My life changed with each of these moments and patients who touched my life and maybe that young twenty-something college student knew more than I thought about selecting a career?

New Year's Resolutions for the Pharmacist

Most of the time, the New Year ushers in thoughts of dropping 15-20 lbs and signing up for a few road races.  No, not to race, but just to finish.  This year, I have been much more introspective thinking about life and career and all the above.  Maybe some of these pharmacy related resolutions will be similar to yours.

1. Begin studying for another certification.  I am heavily learning toward the BCNSP.  I am in no hurry because quite honestly, there is no reason professionally to obtain.  I would just accomplish something that has interested me in the past.  I used to work for a home infusion company and there was a pharmacist (JB) who was quite fabulous.  I am sure he still is today, but I noticed he has this designation and is probably running circles around most in the area when it comes to nutrition.  It is quite an in-depth topic from enteral to parenteral nutrition, and I am predicting another 1-2 year study.  I have purchased the material and have started though not nearly as much gusto as the BCPS so far.  If you are not certified, consider it.  IT MATTERS.
2. Stop worrying about what other pharmacists think about you.  You cannot live your professional life trying to beat out or outsmart the guy/gal next to you.  Yes, you may be in fact more qualified and more experienced, but you cannot control how a company decides to utilize your experience or knowledge.  Perhaps a position in a different area will open up and any type of learning on the side you have pursued will open doors!?  Sometimes it is just timing and sometimes just sheer luck.  In the meantime, focus on being a better pharmacist.  Focus on remaining competitive and the go-to person for all things current.  If you keep up with the current practice and move forward, the people who win are your patients.
3. Look to the future.  Prepare for the future so that when it happens, you will be ready to step right into the role without any problems.

Those are my resolutions for pharmacy this year.  I hope 2014 holds many wonderful things for you in your career whether it is pursuing a board certification or attending an update to begin the process to do more for your patients than last year.

Cheers!

Ode to the Squatty Potty

In reference to the Squatty Potty.  Recommended by a friend, Chloe.  Healthy colon: Happy life! I have a coworker who was quite enthused about the squatty potty in normal conversation.  Being that I am in my forties now and ramping up for obsession with my stool, how often, and the not so wonderful effects of having two children, exercising quite a bit, AND crappy genetics in the tail-end (sorry Mom and Dad, but I do have vivid memories of keeping Preparation H stocked in our home as a child), I thought I'd give the ole squatter a try.

And in response to a wonderful product that could possibly change the world, I thought I would compose a poem right here and now:

Oh Squatty Potty!

My BMs are no longer so knotty!

I no longer need a hot totty

After going for a poop.

The angle is quite right

I often smile in delight

My BMs no longer have stage fright

I know you wanted the scoop!

We were designed to squat to eliminate

I don't want to discriminate

Let the video below illustrate

How we are SUPPOSED to poop!

And PS...

my colon (and the rest) thanks you, Chloe.

Doing What You Love

There is this paradox of thought that creeps in most days (if I allow it) and most of the time I will even ask a fellow coworker, "Do you love what you do?"  or "If you could go back in time, would you choose pharmacy again?" This article by Paul Graham found its way to my feed this morning through another reading, and though it took me all morning to read and digest the whole thing, I feel validated.  There are moments when I look at myself from another's point-of-view and think, "Is she happy?"  Happiness is the thing that I tend to search for... you see I couldn't tell you exactly how much money I make to the penny.  I have no idea to the hour how much PTO I have built up.  I can tell you I have been a drug expert since 1999 and only recently so feel I can use that term and MEAN it.

Would I do my job without pay?  That, according to the article, seems to be one of the qualifiers of finding and doing what you love.  Would I do right now for money for free?  Maybe.  I mean, I would definitely change the job.  First, I wouldn't sit in a room and just enter orders all day.  I would probably do more of a clinical job but not clinical that is defined in my current job today.

What would that look like?  More patient contact.  More ER contact.  More of a presence where knowledge is valued and needed in a moment's notice.  I have that to offer.  It would make me happy, even if momentarily in that the Sallie Mae bill I continue to pay monthly would see more worthy.

But, if I was really honest with myself I would stop and say I may find something else someday.  Even if it is something on the side.  Being in-demand was a lovely time when district managers valued your license (not so much your credentials) and would throw new cars, sign-on bonuses and time off your way.  They would appear like vultures outside the retail pharmacy with a suit on and ready to beg.

Today?  The students are graduating and learning the art of begging.

The creative life doesn't seem to coincide with making money.

"The most important thing a creative per­son can learn professionally is where to draw the red line that separates what you are willing to do, and what you are not.

Art suffers the moment other people start paying for it. The more you need the money, the more people will tell you what to do. The less control you will have. The more bullshit you will have to swallow. The less joy it will bring. Know this and plan accordingly.” - Hugh McLeod

And this one by him:

"The best way to get approval is not to need it.

This is equally true in art and business. And love. And sex. And just about everything else worth having.”

What about approval from myself because I am so excited to face the day and go to work because it is not work but my passion?  Is that possible?

Steve Jobs:

Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don’t settle.

What if that looking takes more than 20 years because quite honestly I am THERE.  20 years and able to say apologetically I am still seeking.

The bottom line is start doing the things you love.  What do I love?  Well, I do love medicine.  I would be lying if I didn't admit that.  I do like how convoluted and complicated it can get.  Throw in another disease state and another medication and a genetic tendency to metabolize differently and weight changes.  Throw in some food or no food or grapefruit juice (though in some medications you would have to drink about a quart a day maybe?) and complicate the black and white definition.

Then give it some time because years ago hormone replacement therapy was all the rage and now it's not.  Thank you Women's Health Initiative for that one.

Back to the question at hand...

The realization:  A 21-year-old chose this career path for me.  She, in her silver spoon mentality felt it was prestigious but not to a fault.  She could forsee perhaps having a family and not being on call.  Oh, and Todd Gean's house was close to the biggest house in Adamsville, TN.  He owned and still owns his own drugstore.  Guess what?  I never spent ONE SINGLE DAY in his pharmacy prior to going to pharmacy school.  I am not even sure I was aware what went on except he put pills in a bottle all day.

“If one wanted to crush and destroy a man entirely, to mete out to him the most terrible punishment,”wrote Dostoevsky, “all one would have to do would be to make him do work that was completely and utterly devoid of usefulness and meaning.”

Yes, I am searching.

When People Fail

I am personally struggling with two pieces of information today.  The first is that Lance Armstrong has come clean with Oprah about his doping scandal.  I had hoped that it was all fabricated by those who were jealous, but alas he is guilty.  I cannot even understand why the leagues (baseball, biking etc...) don't realize that the cost of winning is at ALL costs.  Why not just make these substances all legal and do away with that aspect of what we are capable of doing on our own.  This is 2013.  I would say at this point most sports has seen their very best without enhancement.  What is left?  Enhancement. I know that seems bizarre for a pharmacist to say publicly that doping for sports should be made legal, but that is what I am saying.  As long as it stays illegal, the coaches and trainers and others involved in making the best of the best will go at all lengths to find substances that are not yet known or tested and continue to dope.  It is inevitable.

The other piece of information that I am struggling with today is that a former classmate in pharmacy school (who I will call Ed for his own privacy) has made a deal in pleading guilty in a case that I have had a hard time understanding.

You see, Ed was the type of student in our class who was a man of character.  He was one of the good guys.  I believe he was already married and was in the pharmacy fraternity that was more studious and less partying.  You can imagine that I was in the partying one and you would imagine right.  Ed has a large family now; he has small children and a wife that need him.

Ed has had some legal trouble in which there was some sort of federal charge brought against him for distributing controlled substance (Oxycontin) from his pharmacy.  I don't know how this whole thing began, but apparently it began fairly innocent enough with perhaps one bad decision or perhaps another part of the story that I do not know.  Maybe it was driven by needing money.  Perhaps it was driven by a bad decision further snowballing into extortion by some drug addicted criminals.

Either way, Ed is going to likely go to prison for around five years or so, and my heart breaks for him.

I know that it is easy for many to condemn a man like Lance Armstrong for doping but the bigger offense being the lies he told over the years and nastiness that ensued.  He threatened, sued and was a bully for the most part.  He "beat" cancer of the brain metastasized from testicular cancer, and he founded Livestrong.  There was good to the fame and notoriety even if he came by it by cheating.  Does the means justify the end?  Sometimes?

Fifteen years ago I would have looked at both men making bad decisions and would have spewed my opinion, and it would have been quite judgmental.  I tend to not do that as much because the situation is much more complicated the older I get.  You see, people fail.  People are human - even the most trusted professional, the pharmacist.  The moment that I believe that I am infallible of filling will be the moment where I am the most vulnerable.  We must always strive to do our best.  Do not compromise even for a moment the integrity and good name you have.  It is all you have in the way of public opinion, and in the case of Ed, I was a little saddened to read that he has struck a deal with the government about pleading guilty to one count and going to prison.  He will be sentenced right before this summer, and I dread it for him and his sweet wife and children.

I do hope for a silver lining for Lance Armstrong somehow.  I hope that he is able to look back at his life and see his own shortcomings and how they shaped him into something even better.  Yes, he made a mistake and turned that mistake into a snowball of lies and more denials that took years for him to admit, but there are good things that he has done.

My friend made a mistake and is going to pay the consequence for it by missing five years of his children's lives.  Both of them still are men I can admire for good things in the past and I hope even better things in the future.  Somehow.

The Power of Quizlet and Studying for the BCPS 2013

Quizlet is an amazing online flashcard storage site where there are many many sets of different types of collections of cards or "sets" to study.  I do not remember exactly how I found Quizlet, but suffice it to say that it is a great resource.  I am "lofgrenb" on there if you are looking for me.  I have tons of sets that are mostly set to private, but would be glad to share.  Just message me. Basically you create a profile either by hand or like everything else out there on the interwebs, just link it to your Facebook, because you KNOW you want everyone to know your business.  (wink wink)

In the "search Quizlet" box, you will type in BCPS.  Right now it's 2012 and 2011 cards that pop up, but as more and more BCPS pharmacists-to-be (including me) start creating new sets, you will be able to see them.  There is a "copy" button where you can copy the entire set that the user spent hours on and make it your own.  I know, slick right?  I have done a bit of both:  making my own and copying others and then editing to my liking.  Since there isn't a lot of ACCP material on regulations and stats, I highly recommend taking a look at some sets I like at the moment.

This is a regulatory one.

See this user:  rx_jenn:  All of her sets are fabulous.

If anyone knows her, tell her Blonde Pharmacist thanks her.  I should have spent a little more time studying to pass rather than barely failing, but I'm ready to tackle the beast again.

Anyone want to join in on flashcard creating?

Anyone up for meeting in Reno, NV at the ACCP 2013 Update in Therapeutics?  I will be there!

Not By the Hair of My Chinny Chin Chin

Chin implants are the fastest-growing cosmetic procedure according to The America Society of Plastic Surgeons (or called the “chinplant”) in 2011. Of course, as aging happens and things begin to drop, the chin is something that helps hold the face in place. A lack of a chin can make the lower half of a person’s profile look weak and unattractive. And now that everyone’s pictures are being plastered all over the internet with Facebook, twitter, and videos like Facetime, it’s no wonder chinplants are on the rise. The humorous part of this tale to me is that I sort of smugly smile. I have a chin. In fact, I have enough chins for a couple of people. I lovingly refer to my chin as a Jay Leno chin, and on a female, it’s not necessarily something so desired.

I used to not think a thing about my chin. I obsessed over my upper lip which sort of dips down like a cupid’s bow (ever see Little Albert on Little House on the Prairie back in the 1980’s?). I remember kids (oh, aren’t they mean?) who would call me bird lip. Even the husband of a friend I haven’t seen in YEARS remarked at dinner just a couple of years ago, “You don’t even have a top lip.” Stop. Where does that even COME from considering he was carrying around an extra forty pounds, and I would NEVER dare say a word about their weight. It just didn’t seem fair.

What was even less fair was the time when I was at the local orthodontist’s office getting my braces off for the second time. I was thrilled. No more cross bite. My teeth were SO straight! The orthodontist to the local celebrities flashed his over whitened straight smile and brought with him the x-ray of my skull. Creepy. He showed it to me and then said while pointing his golden pen toward my chin, “Now if you would just have a smaller chin HERE, you would have the PERFECT profile.” No. He. Didn’t.

I couldn’t believe he said it, but it sent me into a google searching frenzy at home, “Chin reductions, chin shortening, etc….” I tried them all, but all in all, I’ve never had anything changed about my chin.

So today’s news about chinplasty being the fastest rising surgery of today really makes me smile and stick my chin out even further!

Dreaming

I would LOVE to hear if you are a pharmacist out there what you would do if you could do it all over again. Would you be a pharmacist? Would you be a physician? I'm super curious. My own journey was a flukey one. I had every intention of going into medicine. My entire childhood was filled with whispers from my over-achieving parents. "You will be a physician." Yes, I sort of failed them, but I'm quite alright with it. When I see tweets about having to tell a patient they have cancer or hearing about my OB missing a lot of days with her kids due to births, I relish in the fact that when I sign off for the day, I've signed off for the DAY. There are exceptions to taking the job home with you - when I was in home health and carried the dreaded black pager - but for the most part, I've enjoyed my six figure salary and even overtime stints where I've made $100/hr. Not too bad. What would YOU be? If you had the opportunity to never have to work pharmacy again... what would you do?

Dakota Fanning Here...

Well I had a pingback in my email this morning from The Angriest Pharmacist.  Somehow he views my post as "another enemy" and "cheap shot." Gosh, not hardly.  My post, if you read it is what you would label as satirical sarcasm.... in other words, how deep does this rivalry go?  Apparently deep at the reaction I received from him.  Yes, I rank low (sorry guys and gals, I don't blog for anyone but myself really, and I know I know... that's a bad blogger, you should really think of your audience when blogging ;)).  Yes I post things that are boring to most of you... but there's are a few of us that keep up with FDA stuff...  No, I'm not quite as witty and angry.  I don't have customers or patients yelling in my face.  I'm not in a rivalry with The Red Pharmacist, The Brunette Pharmacist, or heck even the other female pharmacists out there.  Who has the time really?  Dakota Fanning is cute ;)

But anyway, suffice it to say the Angry, Angriest, Anger, and so forth runs deep in the pharmacy blogosphere.  LOL  You can't really drag the Blonde into it.  Because really insults and rankings don't really bother this one.  In fact, it just made me smile this morning on a long ten hour day... of course, I'm kicked back in my PJs, reading the paper, eating some Cocoa Puffs, and getting ready to log into some hospitals to do my job for the next twelve hours sans any sort of crap from patients demanding a 3 minute turnaround on their xanax refill.

Really Angriest, I'm a fan, not an enemy... I actually read your blog!  I need to come up with the kind of post you COULD interpret as enemy and picking a fight material so that the next time you'll be able to take off your angry colored glasses and see that in reality this is what you call "jest," "facetious," etc...  ;) And the rankings? I graduated from high school many years ago... I really don't get very motivated by popularity contests, unfortunately. Maybe I WOULD have a better blog if I did!

Oh and just in case my reply to him does not get published:

Blonde Pharmacist says March 26th, 2008 at 7:14 am Your comment is awaiting moderation. You are really hilarious. My post is tongue-in-cheek… an enemy? I hardly think so! I think if your readers read my post, they’ll see it’s what you would call facetious, no hardly enemy material… I really don’t mind if there are other bloggers with Blonde in the name… As far as popularity on the net goes? That is yet another thing that doesn’t matter to me. I don’t scour the internet trying to find where I rank, but thanks for letting me know. LOL

What is really funny here is your reaction to a post in jest. I find it funny and ironic that there was even a fight between two bloggers that use different forms of the word angry! It cracks me up actually…

Considering I am not angry enough to really elaborate on a short post noticing the two of you… wondering who came first, the chicken or the egg… I find it even MORE amusing that you inserted your own anger into my post to interpret it as a FIGHT?

A fight? No, sweetie… Blonde Pharmacist isn’t picking a fight. I’m just noticing something that made me chuckle awhile back and thought I’d post about it (for myself) - and then later see who is still left standing in the end. Not that it matters, but more for my own innate curiosity.

Yours truly, Dakota Fanning ;)

I don't know... is it just me... or maybe it's the "semi-jacking" of the name that makes me think that perhaps either the attention was GOOD for their ratings (if ratings DO matter) OR is it that a creative, witty, ORIGINAL name (not claiming I have that either) would be more apropos?

What advice I would give students graduating from pharmacy school

Seems others are doing the same, so I'll put in my 2 cents. 1.  Don't assume that all of pharmacy is retail.  Yes, you will make the most bucks in retail and if you have gone the way of borrowing your way into a huge hole, then it may be your only way to make it out and then find something else.  Perhaps retail is your goal, and you love it, but personally, I found 3 years of retail to be enough pharmacy prostituting that I could do.  The bucks WERE nice, but the abuse to my body from standing 14 hours a day, lack of bathroom breaks, treatment from STORE managers who have barely any sort of education, abuse from patients, and abuse from non-caring technicians, I look back now and say RUN -- no I SCREAM RUN!  There are some great jobs out there that don't involve retail at all.

2.  If you DO choose retail know that the longer you stay IN retail, the less likely you'll ever get out.  It's like getting hooked on a drug.  You keep doing it saying you'll quit, but by the time you are ready to leave, it's almost too late, unless you are lucky and some poor sweet manager in a different realm of pharmacy sees the pain you have experienced and wants to throw you a lifeline.  I had one of those - a female pharmacist that I am forever indebted to.... thanks J!

3.  Make pharmacy a hobby somehow.  Read and read and read.  The only difference between you and the girl (since girls are taking over ;)) standing next to you is that you somehow have made yourself marketable... you are reading publications and keeping up.  You are giving a rats ass about pharmacy and all the crap going on...  You know how to find anything FAST...  you can think on your toes.  Who care what you made in Biochem.  No one cares.  But do you know the difference between using Primaxin/Fortaz vs. Tygacil in different situations?  Can you think critically?

My top advice... DO NOT GO INTO RETAIL!!!!!!!!!!!!!!!!!!!!!!!!!!!