Wallpaper vs. Desks

According to my parents, and some of the ladies at work, the ultimate "couple/team building" experience is wallpapering together. If you two can communicate and survive hanging wallpaper in a room in your house, you're set for life.

Thomas and I don't have a house yet. Even if we did, wallpaper is not my favorite decorating medium; and since I hate painting, I doubt wallpaper would fall in any category remotely close to fun. Thomas and I build furniture. Since moving in to our townhouse apartment, we have built 1 book shelf, 1 DVD cabinet, 1 desk, 1 credenza, 2 hutches, and an office chair. We are no longer shy of items listed as "some assembly required" that really translates to "all assembly required."

We started off with many boxes that looked like this:

And now we have things that look like this:

That is at least our combined DVD collection. And we still have room to add more!!

The best thing about the office, and Thomas, is I left for work with it looking like the above photos. Only the desks in the room. When I came back, it looked like this:

I'd like to thank the delivery guys for bringing in all those boxes, the drill and extra battery for the ability to screw screws faster, Thomas for filling up two bookshelves with his books, and my 8th grade Shop Trophy for making this room possible!

Way overdue for an update!!

I'll do the updates in categories so you can easily skip to the part you're most interested in!!

Work: pretty ho-hum at this point. I've gotten better at order entry, but still don't feel entirely comfortable. And talking to doctors freaks me out, I don't know why I'm such a wuss. Drug shortages and low staff are the two major cons at work right now. We always seem behind and struggling to keep up with the work to be done because we don't have enough people. They're trying to hire more, but in the meantime the powers that be are making changes to weekends and "on call" responsibilities that has everyone griping a little more. One a positive note, due to a drug shortage for one of the TPN (IV nutrition) products, they have picked only a few pharmacists to make TPNs throughout the shortage. Yours truly has been picked as one of the lucky ones to deal with the increasingly complicated order set! I'm sure there will be times I will get frustrated with the new process, but it was a HUGE confidence builder during a week that I really needed one and I am thankful for that.

Housing: Thomas and I have MOVED! We are now living together (hey, I have a ring on my finger!) in a 3 bedroom, 2.5 bath townhouse apartment about 10 minutes away from both hospitals (and 5 minutes from one set of parents, 15 to the other). We LOVE it!! We've been here about 3 weeks now and many rooms are put together. Every time we set a new piece of furniture I get excited about the life we're putting together for ourselves. Our biggest challenge left: the office, and hanging all the artwork.

Life: I've had the opportunity to visit with different friends every weekend for the last three weeks and it has been awesome! Kappa Delta started a new chapter at NC State and I was there for bid day when about 130-ish women put on new KD letters. It was a sight to see!! My friend Megan from Georgia came this past weekend. We hit the movies and Discovery Place, a hands-on science museum I've loved since I was a kid. Thomas and I also took her to Yama, our favorite sushi place! T and I are looking forward to getting settled in and trying to find some new neighborhood friends soon (and kids trick-or-treating this year!)

and Wedding: Its less than 300 days away! We've made so much progress since I last posted about this. We have our date (July 30, 2011) and venue/caterer, our florist, invitations, dj, photographer, dresses, ceremony music ideas, and themes worked out! We'll be pulling a lot of inspiration from Paris and I want lots of bright colors! Flowers will include lilies (the first flower Thomas ever gave me), white roses (for KD), snap dragons, calla lilies, hydrangeas, belles of ireland, jasmine, hypericum berries, and probably more things I can't remember. We've also set up a wedding website with details about the day. We'll be updating it with information about hotels and things to do in town as we get closer!

Happy October everyone!

Another first day

Today was my first day as an order entry pharmacist on my own. It was a pretty good day. We still haven't finished our clinical training, so other pharmacists took care of my renal (kidney function) monitoring sheets for me. I would have liked to try to do them on my own because I've watched pharmacists do them quite a bit, and because I'm going to have to learn to do them on my own soon anyways, but it was nice to not have to do them today.

The day started off a little slow, and I didn't get too many phone calls interrupting my train of thought. I did still have lots of questions though. By lunch time, however, as the trend has been, my little world exploded with phone calls and difficult orders. Order sets for IV heparin (an anticoagulant that can be very dangerous if given as an overdose) almost always have something missing that I have to call a nurse and/or doctor about and then are just confusing to enter. I seem to get those a lot just before lunch.

Last week was also a good week. On the days I was training on order entry, I was able to actually enter orders all day instead of having to let my trainer do it because we were so busy. I'm starting to recognize things I've done before, and to recognize problem orders sooner.

In other fun, non-work related news, Thomas, Mom and I went to a bridal showcase this weekend and got lots of cards and flyers. Mom and I have Friday off before I work the weekend and have set up appointments with florists for this week and next. Also, Thomas bought his very first BRAND NEW CAR!!! He got a 2011 Toyota Camry XLE in a beautiful blue color. It looks really nice and he's happy to have a car he's not worried about falling apart anymore. He took me for a spin around the block and now I'm ready for a road trip!

Some wedding things...

As I wait for my room to cool off so I can workout, I'll share some wedding plans with you. We've picked a date: July 30, 2010 and a venue: the Charlotte Country Club. I've picked a dress for me and my 'maids! Even Mom has found a dress already! We're making little decisions here and there, but each one makes me feel accomplised (that is until I look at the planning manual and realize all the other decisions to be made!)

Thomas and I think we have the wedding party set and our friends and families are very excited to be a part of our day. Last weekend we went out to the Club to meet with our event planner and to see how they were setting up for another wedding. It was super helpful to see the rooms set and to start thinking about where we want tables, and how many, and what kinds. And to do the math to make sure we can fit enough chairs in the room for the ceremony and that sort of thing. Our event planner also gave us their Preferred Vendor List. We don't have to use those folks necessarily, but they do have more experience working with them so it narrows the field a bit.

So, decisions made: venue (and caterer), clothes for the girls, photographer, and shape of the wedding cake (and possibly another dessert surprise)!
Decisions left to make: officiant, boys clothes, baker, flowers, music, menu.....lots! Good thing we're going to a Bridal Showcase in a couple of weeks!

A couple days alone and my first weekend

Last Friday was my first day working as a pharmacist all by myself. I was the "Front" pharmacist which meant my primary responsibility was checking things. There is a lot to check! I had been training for over a week in that position, but Friday happened to be a busy day and we were one pharmacist short, making my task that much harder. Before even an hour into the shift I felt like I was being pulled in 3 different directions between new orders being started, narcotics to check, and the Pyxis pull to refill the automated dispensing machines around the hospital. Thankfully, around the middle of the day things calmed down just enough for me to feel in control.

This was my first weekend to work as well. Thomas and I made plans a couple months ago to go see our wedding venue set up for a wedding this July and since it happened to be this weekend, I got out of working Saturday. (It was super helpful to see the space, more on that in my next entry!) Anyways, Sunday felt busy again, and all these extra responsibilities kept popping up. For example, our IV pharmacist went upstairs for a hour or two to make some chemo and that left me to check IVs as well as the oral/topical medications. And since there isn't a pharmacist at the Orthopaedic hospital on the weekends, I had to check their cart fill (a 24 hour supply of medications for each patient) as well as the Main hospitals. It was too bad, it was just startling to realize I had all these other things to do when I already felt overwhelmed.

Training has its ups and downs. I'm looking forward to the next few weeks when I can concentrate on order entry and start to feel like I'm really contributing to the team. One of the criticisms I received over my last year in pharmacy school is that I'm too hard on myself and not patient enough with myself when trying to learn a new skill. I don't like doing things wrong even though I know you learn from your mistakes, so I am trying very hard to be patient with myself for the next few weeks (ahem, months) of training.

Signing my initials

About a week and a half ago I took a few days off from work. Less than a month in and already requesting a vacation? Not so much. It was cramming time. For 48 hours I tried to refresh my memory on everything pharmacy law related. Then last Friday Thomas and I arrived at the testing center, had our fingerprints recorded, our palm veins scanned, our pictures taken, our stuff locked away and led into the testing room to begin the first of two licensing exams. We were given 2 hours but were finished in just over an hour.

For the weekend, more cramming. Another 48 hours to shove as much pharmacy knowledge back into my head. Learn something about HIV and oncology drugs, remember which pysch meds have the worst side effects, learn about some over the counter medications since I don't ever see them working in a hospital. At 7:15 on Monday morning, Thomas and I were the first two in line at the testing center. We repeated the check in process and started the second exam, this time with a 4 hour time limit. Right at the two hour mark I heard Thomas leave, he was finished. I on the other hand was getting hit with compounding and calculations questions I didn't have a clue how to begin to solve. I wanted to cry. I pushed through, but seriously thought this was the worst I'd ever felt about a test, there was no way I could pass.

Tuesday afternoon we got the results of our law test, we passed! Wednesday night we got the results of our board exam, we passed! Thursday morning I logged on to the Board of Pharmacy website and enter my name in the search field to "verify a license." There I am! I have a license number! I'm a "real pharmacist" now!! My coworkers were ecstatic! My reward? Here, here's a counter full of meds to go to the floor and cart fill (a 24 hour supply of meds for each patient), start checking!

So for about two days now I've been signing my initials on things. I've caught mistakes technicians have made and at times I've felt overwhelmed with the amount of things that needed my attention. I even realized they've already given my technician number away to a new person. Its been a little strange, and I don't know that its my favorite role to play, but at least I feel productive at work now and not like I'm just in the way or hogging a chair. We had a celebratory dinner at my mom's house last night and need to plan one with Thomas's family soon. Along with celebrating his license, he needs to celebrate finally getting his official employment offer and starting orientation this Monday. We're starting to feel like grown-ups, and that's pretty awesome.

My first week

Last week was my first day as an almost pharmacist. I won't be licensed until the middle of July, but we're getting a jump start on training so when I do get licensed I'll be ready to go (maybe).

My boss called me the week before to chat and told me to be there at 0700 on Monday. She had decided our other new grad, Kerry (also a friend from my class), would start with the "Front" position that is mostly checking meds that need to go up to the floors. Kerry is already licensed so they want to be able to use her on her own ASAP. My boss wasn't sure who she'd have me shadow, but I'd find out on Monday. Fine with me.

On Monday, I got up EARLY. Super duper early for someone that hasn't been working for 6 weeks. Got all dressed up in my new outfit, excited that for once I didn't have to wear scrubs or my hair in a ponytail and I could actually look like a nice young lady. Packed my lunch and headed out. When I got there, I met Kerry and showed her to the pharmacy and started introducing her around. Finally I found our scheduler and asked her what I was supposed to be doing today. "You'll be in the IV room for the week." Great, glad I did my hair!

I love the IV room, it "home" to me at the pharmacy. Its the only area I've really worked when I've come back on breaks for the last 5+ years. Its familiar, its the most comfortable place to start learning, but for once, I wasn't really excited to be there. The day, and the week really, went well. My technicians accepted my new transition from fellow technician to pharmacist very well. We have a new IV room manager and are all learning the new changes she is implementing and they helped inform me of those. I even caught a mistake on my first day!

Over the week I had the opportunity to work with three to four different pharmacists and learn their way of doing things. Everyone has a slightly different method and it will take time for me to develop my own, but its good to know what each one of them likes to focus on. I continued to catch mistakes throughout the week as I checked things before the pharmacist and I gained confidence that this will be a smooth transition for me. Next week, that's all likely to go out the window as I start shadowing and training on order entry. I will be seeing a new side of our pharmacy computer software and will have to think about many different things at one time instead of just: correct fluid, correct volume, correct drug, correct amount -- check!

Paris (Part 3)

Saturday began with Haden and her dad going out for pastries for the family. They were so delicious (my mouth is watering now as I think of them). After we ate breakfast (and cleaned up the crumbs) we head to the metro to go to Monmarte. Monmarte is a big hill you can see from many of the sites in Paris and it has a huge church, Sacre Coeure (Sacred Heart), at the top. There are also a lot of street artists that come and paint or draw portraits for money. Angie and Gerin wanted portraits of everyone in the family and since it took so long to get them drawn, we all ended up getting other portraits of ourselves as well.

Thomas and I also hit up the Dali Museum that was up there. I have been a fan of Salvador Dali since a high school trip to Europe that included Spain, his home country. I was a little disappointed at how small I felt the museum was (and the rude kids running, not walking quickly but RUNNING, through the museum). They did have a "penny smusher" machine which is one of my favorite souvenirs to get! We skipped the big church due to the crowd and met back up with Gerin, Haden, and Allison at CLUNY, a medieval history museum.

On Sunday, Angie was feeling under the weather so she decided to stay home while the rest of us set off on the train to Fountainebleu. It is an old chateau, much like Versailles, but not quite as popular. Old kings of France had lived there, or passed through and stopped while touring the country. Napolean lived there and we saw his throne room. We also saw the table on which he signed his abdication before heading into exile. It was a really fun day trip.

Monday was our last day in Paris so we all split up to visit last minute shops and museums. Thomas, Gerin, Julie and I went to the Paris Sewer Museum (learning all about the sewers while being down in the tunnels above the sludge) before going back to Angelina's for lunch and hot chocolate. I bought some last minute gifts, and Thomas and I headed to a Naval Museum. There were replicas of lots of old ships (Thomas now wants to start building his own models of ships) and there were lots of paintings of ships and storms and the sea. There were also a lot of models of modern war ships from European countries as well as the US. We took a few more pictures at our carousel and then met everyone at Baci for one last dinner. Haden and Allison had found some purses they were excited about. Angie and Gerin found some steak knives they really liked. And Gerin and Julie found an antique sword to add to Gerin's collection. All in all, a great ending to a fabulous trip!

Paris (Part 2)

Alrighty, Tuesday was arriving and rainy day, Wednesday was engagement day, that brings us to Thursday: church day.

Thomas and I, along with Haden and Allison, got up early Thursday morning and made our way towards the Latin Quarter. Haden was especially looking forward to this as this area is where some of her classes were last year. We headed for her favorite crepe stand, and were disappointed to find it wasn't open yet. We decided to keep moving and went on to see Notre Dame. We took a few pictures outside and marveled at the carvings above the doorways and the architecture. We went inside before the crowds got too overwhelming. Mass began while we were inside and it was both beautiful and surreal to hear the chanting and know most everyone there is just walking around to have a look.

Thomas and I decided to climb the towers while Haden and Allison went off to look at other things. It was a very tight spiraling staircase leading up and they only let a certain number of people up at a time for crowd control.

Interesting tidbit we learned about medieval staircases on this trip: most are built clockwise to make them easier to defend. The defender coming down the stairs will be on the larger portion of the stair and his sword arm will be more free to swing from the top right (outside) to the bottom left (inside) where the attacker will be trying to swing up and from the smaller portion of the stair. Anywho, we climbed the tower and saw lots of Paris and took lots of pictures.

We met up with Allison and Haden and were going to go to St. Chappelle but the line to get in was enormous. Also, its located within a government building so you have to go through more security in order to see it. Instead, we decided to go see St. Sulpice. There was a pretty fountain in front, but a lot of the outside of the church was covered in scaffolding for renovation.

Friday was the first day all 8 of us stayed together. We started off with a visit to the History of Chocolate museum where we saw the progression of chocolate from a form of currency to a spicy drink only for royals and the military to a sweet drink and then finally commercialized. There were old ads and china cups used to drink hot chocolate out of. At the end of the museum, there was a demonstration and a tasting!!

We all wandered the streets for most of the day, slowing making our way to the History of Paris museum. Unfortunately there weren't a lot of english translations, but once we got to the swords and armor, the guys were pretty entertained without translations! Also, there were paintings of the French Revolution and everyone marveled over the death of Marie Antoinette and the tiny gushes of blood depicted.

We went to a restaurant called Baci for dinner and had wonderful pasta, I had a cheeseburger, and Gerin and Thomas had one of the most mouth watering steaks I've ever tasted. We also had desserts of pineapple with basil and a chocolate cake thing we couldn't pronounce but definitely could eat twice!

Happy... everything!

May has been (well was since its June now) a very exciting month!! We started the month off by ending our 4th year of Pharmacy school and finishing up rotations. Mother's Day weekend brought a huge celebration of family (Mom's of course) and graduation from Pharmacy school. My mom and grandmother were especially proud to have a doctor in the family again.

Just after graduation we dashed off to Paris (I promise to post more about that trip soon) and got engaged!! It was an amazing surprise and a wonderful way to get to know Thomas's family better. I'm glad we all got along and am happy they will be my family one day.

After Paris, the job search continued. After a second interview with Presby, where I have worked for many years already, I was officially offered a pharmacist's position. I took a few hours to think about it and accepted! I will start as an intern later this month until I get licensed in July. It wasn't the goal I set for myself when I started pharmacy school, but a lot has changed since then and this is the best move I can make right now. I will continue to pursue nuclear pharmacy as a career option, but its important for me to start working as quickly as possible and gain experience any and everywhere I can.

To finish off the month of course, was BIRTHDAYS!! Thomas and I had some friends and his parents over to my parents house this weekend for a nice party. BBQ pork sandwiches, home-made slaw and fruit salad, and his sister made us a cake! It was great to have friends around to celebrate with. It certainly was a great month!!

Paris (Part 1)

Here's the beginning of the trip, and the story everyone wants to know!

We left for Paris on Monday, May 10th. All of Thomas's family: Angie & Gerin, Gerin & Julie, Haden & her friend Allison, and Thomas & I. It was a long flight due to the volcano that is still erupting. We had to fly all the way up to Greenland and around Iceland before going south to France, but we made it. We tried sleeping on the plane but just never could quite get comfortable and fall asleep, and poor Thomas got sick when we finally landed Tuesday morning.

We made our way through customs, got our bags loaded in taxis, and were off to our flat for the week. It was a nice place, 4 bedrooms, 3 baths with a living room, kitchen, dining room, and study. The weather wasn't very pretty and it was raining a bit, but we set out to find a Monoprix (grocery store) to get some snacks. We wandered around Paris for a while and stopped at a big department store to look at jackets and scarves since it was colder than we had planned for.

On Wednesday, Gerin & Julie headed off on their own while the rest of us headed over towards the Eiffel Tower. Last year when Gerin & Angie went to visit Haden studying in Paris, Gerin took a picture of a carousel that is across the river from the Eiffel Tower. It looks something like this, but at night and WAY better than mine. Thomas had the picture framed and gave it to me for my birthday last year. I LOVE carousels and as we approached the one from the picture and the Eiffel Tower, I asked if we could stop and ride it.

Haden, Allison, and I decided to ride it and I thought Thomas was just missing out on the most fun part of the morning. As the ride ended, I climbed off my horse and made my way over to the steps to walk down. Thomas was walking over to meet me and I thought to be a gentleman and offer to help me down the steps. Instead, he pulled out a diamond ring, smiled at my very surprised face, and said "By the way, will you marry me?" I was so excited, it took me several attempts at saying "yes" before he finally heard me. His dad took lots of pictures, but here are a couple.

Afterwards, we went up to the observation decks of the Eiffel Tower, but not all the way to the top because the lifts weren't working. Then we headed off to the Place de la Concorde and walked the length of the Champs-Elysee to the Place Charles de Gaulle with the Arc de Triomphe. We only spent a few minutes at the Arc because they were closing it for some big ceremony before heading home to rest and regroup for dinner.

Today I'm a Doctor

This weekend was graduation. It was both stressful and fun to have so many people in town to celebrate with me. Friday night, my father's side of the family flew in to RDU and we went out to dinner and visited late into the night. Then on Saturday, my mom and Mark's side of the family drove in as well as Thomas's family. We all had a big lunch before the ceremony and then everyone got to watch us walk across stage and get hooded. On Sunday, Thomas and I had breakfast with my mom's family and then went to pick up our diplomas! We. are. DOCTORS!

My friend Carrie took some photos of us before graduation. Here's one of each of us.

An update

Okie dokie, pardon the absence, somehow life without school/work got more hectic than life with it. My month in Winston with PETNET was great. The guys there taught me a lot about the high energy, PET side of nukes and really worked hard to help me find a job. I'm definately saving their contact information and looking for them at pharmacy meetings in the future.

PET wasn't quite as fun as traditional, SPECT nukes. Its really only one major product at this point, where as with traditional you're making different kits. And those manipulator arms really hurt "my texting fingers" aka thumbs. It wouldn't keep me from doing it, but I'd prefer the traditional stuff.

As for the job situation: blargh. The nuke company starting up a new lab has decided to hold off hiring their third pharmacist. There is still a shortage of the technetium isotope and they are trying to break in to a new market, so they just think its best for business to wait. I understand that, and they seemed honest with me about it, but that still leaves me without a job. I had an interview this week with my hospital. I think it went well and we scheduled a second interview with managers and pharmacists for the end of May (yeah, I would really have liked that to be earlier on the calendar). I'm still looking around and still stressing out.

Graduation is THIS weekend. Last week we were all back in Chapel Hill to practice and get our regalia and visit. It was great to see our friends and sad to leave them again. My KD sister, Carrie Richardson, came and took pictures of Thomas and I in our regalia so we don't have to fight the crowds on graduation weekend. My family will start arriving in Chapel Hill tomorrow through Saturday morning. Pharmacy school graduation is on Saturday night and then "big" UNC graduation is Sunday.

And on Monday.... PARIS! I'll have limited internet time, but I'll try to add some tidbits here and there. Happy May everyone!

Networking makes me feel like a slimebug...

I hate asking for help. I hate asking for money (the 'rents may choose to disagree, but I really do dislike it). I hate the "its who you know, not what you know concept." Networking makes me feel like a slimebug...ick.

Graduation is three (1, 2, 3) weeks away and I am still looking for a job. Thomas is still looking for a job. Other classmates are still looking for jobs. So as we get closer and closer to getting kicked off the payroll, we're turning to each other and parents with connections. We're emailing old bosses or have our mom's talk to their bosses to pull an application here and contact someone there and although, clearly, this is how the world works, I just don't like it. It feels fake. It feels like contacting someone just because you need or want something from them. I don't know that I'm going to be very good at this in life.

Speaking of jobs and interviews and the like... over the last two weeks I have had a phone interview and met the owner of an independent nuclear pharmacy company in the Carolinas. He is opening up a brand new nuclear lab and compounding facility near the Winston-Salem/Greensboro NC area. I toured the facility and its all new and shiney! I'm really excited about it. They have another candidate to interview early this coming week, but should be making a decision soon. Finger crossed, I might have a job by the end of the week!

I've realized that I haven't told you much about this month still. Last week I worked a CRAZY schedule. Monday, Tuesday, and Wednesday I went in at 0300 in the morning and worked until all the doses were out. Then on Wednesday I went to meet the nuclear guy. Thursday I worked in the morning before going home to nap and go back in at 2100 (9pm) and work overnight. Overnight I learned (or relearned in some cases) how to set up the box for the chemistry to make the FDG, how to validate/calibrate all of the instruments for the day (dose calibrators and the QC equipement), and wrapped doses, prepped transport boxes and the hot cell for the days work. Surprisingly, the night went by rather quickly. I've had a really good month at PETNET and I think the people I've worked with have taught me things I will use in the future. I hope to stay in touch with them and maybe one day I can use them as networking contacts and feel slimey all over again!

PETNET

This month I am at PETNET in Winston-Salem NC. It is a nuclear pharmacy that produces PET, or positron emission tomography, materials. The product they produce is called F18-FDG which is a compound similar to glucose with a radioactive fluoride molecule on it.


Glucose is a naturally occuring sugar in our body that produces the fuel for metabolism processes in the body. As cells go about their daily lives, they use glucose for energy to make and breakdown compounds throughout their day. The busier the cells are, the more glucose they use. How does that relate to FDG? Well, cancer cells use a LOT of energy and since FDG looks like glucose, they snag all of it they can. FDG is not the same as glucose, however, so it just gets trapped in the cells instead of getting used, so we can take a picture of it. In essence, PET nuclear medicine is used to identify and stage cancer (for the most part), and traditional SPECT nuclear medicine is used for diagnostic testing to see if organs are functioning properly.


PET has a higher energy than the traditional technetium-based products, so exposure (and thus shielding) is higher. Instead of working in a regular IV hood with an L-block to protect my torso, PET doses are drawn up in an enclosed "hot box" with manipulator arms. The "pigs," lead or tungsten containers used to hold and shield doses for transport, are larger and so are the boxes used for transporting doses. An empty box weighs about 70 pounds!


Another difference between PET and traditional nuclear pharmacy is how we get our products. With technetium, we have a generator made of molybdenum that decays to Tc-99m that we used to make kits (the radioactive saline is added to vials of powder containing the drug and some other compounds necessary for the chemistry). In PET, we have a cyclotron that bombards O18-water (regular oxygen is O16) with protons to make F18. We physically make the radionuclide onsite. Once we have F18, we transfer it to a mini-cell that makes and purifies F18-FDg from scratch. PET labs are divided to have one area that is a manufacturer and one area that is the pharmacy (which also means more regulations!).


It has been pretty interesting so far to learn all the chemistry and the quality control procedures necessary to satisfy both pharmacy and manufacturing requirements. My preceptor has also been letting me draw and ship doses this week. Those manipulator arms are more difficult to work than I thought, and I've used mucles I never thought I would need for pharmacy! I still love nuclear, I think its fantastic. PET is growing and there are more products in the works, they just need more data before getting approved by the FDA. Its amazing to see how nuclear pharmacy has progressed from the 1970s and I can't wait to see how it will change throughout my career!!

Six Weeks

Six weeks from now I will graduate from pharmacy school. Six weeks and I will be Dr. Hirsch. Wow, these will be the longest and shortest six weeks I can imagine. What will I do next?

I'm wrapping up my second to last rotation here in Franklin. Its been a good month, although slow at times. The work flow is different here than in other settings I've worked, but I've figured it out and its not so bad. I've gotten comfortable enough with the physicians to ask them questions about their physical exam and also about their therapy choices. That's always hard as an outsider. My confidence has increased this month, I really needed that.

I had a phone interview with a residency program earlier this week and quickly realized we weren't matching up. It didn't take them long to let me know they had selected someone else. Not really what I wanted to hear, but what I expected. Now I'm focusing on my career in nuclear pharmacy, and probably applying for some back-up choices in hospitals or maybe even a VA.

I move again on Wednesday and start nuclear pharmacy again on Thursday. This time will be PET, positron emission tomography, which is most often used to detect cancers. Its more radioactive than the kind I did on my internship or my September rotation so there will be more shielding involved -- which mostly means everything will be a lot heavier (maybe then I won't have to lift weights at the gym)! I'm really excited to get started and learn more about nukes, and a different side of it all together.

Only six more weeks...

Spring has sprung?

Its hard to believe it is Spring already, especially when its still snowing in Franklin NC! Today I spent time in the Emergency Department shadowing nurses. Well, trying to at least. Unfortunately, the ED was dead. We had a little 4 year old girl with belly pain that was mostly environmental factors and stress and poor diet taking a toll on her GI tract. One fella came in to have his stiches removed. Nothing exciting.

Tidbit of advice for anyone that may training students: if you send them to another department to shadow/observe/learn, make sure more than just the director of that department knows they are coming. Numerous times this month, and this year, my preceptors have set up time for me to go shadow somewhere, but no one I will actually be working with knows I'm coming so I get ignored half the time I'm there.

Oh well. Graduation is quickly approaching and we've come to the part of the year where I need to figure out what to do with my life. Last week was Residency Match Day. A little over 2900 applicants participated in the Match this year. However, only about 1950 positions were available, leaving many people unmatched to a program. Many of my friends and classmates matched to programs and are very happy with their placement for next year. Quite a few of my friends as well as myself did not match and have the option of talking to programs that did not match all of their spots in what is called the Post Match Scramble. Its pretty much every man, woman, and program for themselves fighting to get the spots filled. I have a phone interview tomorrow morning with a program in nothern VA.... fingers crossed.

Down in the OR

I spent Monday morning in the OR. I have worked in scrubs for many years, but for some reason, OR scrubs to fit funny. People that work in the OR all the time seem to have figured out how to make them work, but I always feel goofy.

Our first case was a power port placement for a woman with rectal cancer. This is a port placed beneath the skin and threaded to a central vein to allow better access for chemotherapy. With central access, versus peripheral, you can give more medication in a given time frame and harsher meds because they get diluted so much faster due to the amount of blood in the central vein.

The second case was an inguinal hernia repair. This old man was very frail and it took Dr. Robles quite a while to fix his abdominal wall tears. Apparently, this was a recurring hernia and the patient didn't want to get it repaired and it just became a big mess. Surgery doesn't make me squimish, but I definately had no idea what I was looking at most of the time. Lesson of this surgery (from the surgeon's opinion): Get all hernias repaired as soon as diagnosed, otherwise they become a pain in the a$$ for the surgeon.

The third case I watched was pretty quick, but rather interesting. He was doing a bilateral temporal artery biopsy to determine if the patient has temporal arteritis. So the surgery involved finding the temporal artery, right near the ear, and cuting a little piece out. The most difficult part of the surgery: the lady kept moving her head. She was anesthetized, but it wasn't general anesthsia, so she could still move and squirm a bit. Temporal arteritis is an inflammation of the arteries in your head that stem from arteries in your neck. One of the common symptoms is headaches, and one of the large concerns is that it will cause a stroke. The treatment is prednisone and due to the negative side effects of long term steroid use, you want to make sure arteritis is causing the problem before prescribing the meds.

It was an interesting day. I really like surgery actually. I think if I had been a doctor, I might have wanted to be a surgeon. This month is going very well. I really like the people I am working with and I definately feel like I'm making a meaningful contribution to patient care. I did miss rounds this morning though. I went to look for Dr. Patel at 8:10 and he had already rounded on his 2 patients! Oh small hospitals -- the census got down to 7 today!

Medic 3

Today I got to spend the day with the Macon County EMS. Before I had gotten there, they had already responded to two calls: a seizure and a drug seeker. Things were slow for the better part of the morning which allowed for some quality trivia TV time (Cash Cab and Family Fued) and some terrible screaming/fighting/bleeping/you are not the father TV (Maury).

We finally got a call a little before 12 noon: 90-something year old female, possible stroke. Off we went, sirens on, gas pedal to the floor. I was riding in the back but could peak to the front to see the speedometer creep up towards 100mph. Not that I want people to get hurt, but that part was a little bit fun! When we arrived, the woman was not very coherent, couldn't speak, and we couldn't get a blood pressure. We gave her some oxygen and started an IV hoping the fluids would increase her BP. No such luck, as we made our way down the mountain her BP was hanging around the 80s/40s and once again we hit the sirens and punched to the hospital.

At the hospital, another paramedic team (12) was getting called to another scene: seizure-like activity. I hopped in their truck and off we went to the Franklin Historical Society. There we found a lady on the ground who had started having a seizure while half way up a flight of stairs and fell down them. She has a history of seizures and knows her medication is not controlling them. She had had 4 witnessed seizures before we got there, and had 3 more as we were working on her to try to start an IV. Paramedics only have certain medications with them and the meds they have to give for seizures can only be given IV, but they couldn't get access, her veins were terrible. Once at the hospital, the doctor ordered a different med (which works better anyway) and they must have gotten the seizures under control. Later in the day, we heard they let her go home calling her episodes "pseudo-seizures." The paramedics and I don't really agree with that call, but its not our decision to make.

Call #3 was to back up Medic 9 that was responding to an elderly lady that had fallen on her face in an apartment parking lot. Her sister had a syncopal episode (passed out) and now also needed attention and transport. The woman apparently got excited playing with her grandchild and fell then her sister, who has a history of low BP, got excited about the fall and her BP bottomed out and she passed out. The sister probably went home this afternoon, the lady with face trauma might have to spend the night.

My last call of the day was helping transport a lady home from the hospital. This woman was brought in earlier in the morning by Medic 12 because her O2 sat (amount of oxygen she was breathing in) was in the 70s. For normal healthy people its in the high 90s; for people with respiratory conditions, they typically qualify for home oxygen when their sats drop into the 80s with walking. This lady's O2 sats are typically in the low 80s because of her size, she weighs over 800 lbs. Yep, two zeros behind that eight. It took all four paramedics from trucks 3 and 12 plus 3 nurses and a nursing student to transfer her to the stretcher. The stretcher and the bed in hospital have been specially purchased for her size. Then at her house, it took the 4 paramedics plus two guys from the fire department that met us there to get her back in her bed at home. That was an experience. Perfectly pleasant lady with what has to be a terrible quality of life and definately some medical problems that would not exist if she was not the size she was. I just don't understand how people let themselves get that big. Gain some weight yes, but 800 lbs, there is no excuse for that.

Overall, a pretty exciting day. They had never had a pharmacy student ride along with them and thought it was pretty cool that I would choose to do that. Hopefully I'll never ride in an ambulance again, but I definately enjoyed the opportunity to see another perspective of healthcare.

Rank List Certified

Last Friday, I had to "certify" my rank list. It's official, I'm going for a residency. Hopefully March 17 will bring good news and I will start making plans to move to Richmond or Columbia. If not, let the job search begin.

This month I'm having a "rural hospital" experience. The hospital I am at has a Critical Access designation meaning not only do they function as a pit stop on the road to bigger hospitals, but they are an integral stop in the healthcare chain that saves a lot of people a longer drive to get care. And there's the money aspect, they also get more reimbursement from CMS (Center for Medicare and Medicaid Services) to help them keep their doors open.

Angel is a small, 25 bed hospital. Yes, you read correctly, 25 beds (babies and long-term OT/PT patients don't count apparently). For reference, the ICU I worked in in January was 14 beds and my inpatient service in November was 17 patients max. This morning, our census was 13, including the babies! Its an adjustment.

I go on rounds in the morning with the Hospitalist. I've met two of them so far and they are very different in teaching styles and patient care, and hopefully I will learn something from them as well as gain confidence in making recommendations and asking for changes. I also monitor 5 - 6 reports each day. I make sure antibiotics are chosen appropriately, I check lab values related to blood thiners and kidney function, I update people's allergies, and if we have someone on IV nutrition I watch those lab values as well. Overall, I stay fairly busy all day long.

I'm finally feeling some moments of coming in to my own. I can recognize certian doses or routes of administration that should be changed with out having to look them up. I can ask a physician to change a dose or order a different medication without being scared of what they will say and also not take it personally if they choose not to follow my recommendation. Yep, in a couple of months I'm going to be a pharmacist. I know I won't feel comfortable with that for many months after getting licensed, but I'm starting to realize that one day I will be comfortable with it, and that's reassuring.

Well don't that beat all...

Its my last day at Kerr Drug. I have been unhappy with the rotation most of the month, until about 3 days ago. We went to another store in Weaverville and I actually got to see patients! It was great. They came to their appointments, they actually talked and asked questions and I was able to help them understand.

I had the opportunity to teach them why its best to take their statin at night (when you're body is making its own cholesterol) and why its best to separate their calcium plus D from their thyroid medication (so both will be absorbed properly). We even gave out a few shots. I had one fella that is bipolar and has finally found a medication that works for him. The only problem is its so expensive he'll land in the doughnut hole in about June, but we're going to work on that.

Yesterday we had some folks come by for Shingles vaccines and we reviewed their medications with them as well. One lady was diagnosed with diabetes about 4 years ago and had never really been properly taught about the disease and all the damage it can cause in your body. My goal for today is to get her enrolled in the diabetes classes Anthony is starting.

Overall the rotation was not what I expected nor the best learning tool for me. But at least the last 3 days have shown me I am better at this than I think I am. I can talk to patients and they get what I'm saying and we all have smiles on our faces at the end of it. Whoo! Now on to March, only 2 more left to go!! :)

Residency Interviews

I know I haven't been talking much about this month. To be frank, I'm really not enjoying it. My personality and the personalities of my preceptors are just not getting along and I'm not getting the opportunities I thought I would get. So to avoid complaining all the time or being a super Negative Nancy, I'm just not talking about it.

On to more exciting things. This week I had my two interviews for residency programs. Last Wednesday was my interview at the Veterans Affairs Medical Center in Columbia SC. I didn't get to really get on the road Tuesday until about 6:30pm so I got to Columbia around 9pm, checked in to my hotel room and proceeded to freak out! Totally nervous and anxious all night, barely slept, hardly ate breakfast - bleh.

Once I got to the VA in the morning, I met the other candidate interviewing that day and we waited for the program director. We all talked about their program for a bit. They conduct the research portion of the residency a little different than most programs and I like that aspect. They also have a lot of flexibility in scheduling which seems like it will give me the oppotunities to do I want. Their scheduling, however, is in one month blocks, like my 4th year has been, not longitudinal like some other programs, which is not my favorite. I feel like I really connected well with the pharmacists and they really like to retain their residents after their residency year.

This weekend, Thomas and I went to Richmond VA. We both had interviews at the VA there on Monday. We arrived Saturday evening and a SUPER run down hotel. The windows were boarded up and it didn't look like people had been there in months so we ditched it and found something better. Sunday we drove around town. We found a Krispy Kreme and got fresh doughnuts and then found our way to the VA, the restuarant we were going to for dinner, and we drove around downtown.

Sunday night we went to dinner with a couple of the clinical pharmacists in The Fan District of Richmond, clost to VCU. Dinner was a BLAST! The pharmacists we were with were very entertaining and kept us laughing all night. On Monday, we took a tour of the Medical Center and then spent a couple hours with the program director in their clinic as they saw patients. I felt like the interview questions were a little tougher there at Richmond, but I absolutely LOVED the program and the people. Its mine and Thomas's top choice for next year. We'll find out on St. Patrick's Day.

On a side note:

Mom, here's a picture of the MAHEC house after the last snow

And below are pictures of the lilies Thomas sent me for Valentine's Day. Big smiles! :)

Clinical Community Pharmacy

This month I am at Kerr Drug here in Asheville. I am on my Advance Community rotation, which for most people is just another retail experience counting to 30 and all that jazz. Not for me. I am doing Clinical Community which to me is really a lot more like ambulatory care.

The pharmacists I am working with this month, Anthony and J.J., are there to do more than fill prescriptions. They spend the day doing medication reviews in multiple fashions. Patients that have Medicaid get "locked in" to a pharmacy when they get more than 11 prescriptions filled in one month. Once these patients are locked in, a pharmacist has to review all their medications every 3 months. Also. Medicare patients qualify to meet with a pharmacist once a year face to face to review all their medications. Anthony and J.J. also see City of Asheville and Mission Hospitals employees on a semi-annual basis to review their diseases states and medications as part of employee sponsored Wellness Programs.

After reviewing medications and disease management with the patients, we also contact the doctors. We fax them a note of what we talked about and make any recommendations we see. Usually we are trying to find cost savings alternatives for medications to reduce spending on the part of the patient and reduce healthcare dollars. And shots! LOTS of shots. Today, alone, we gave 9 Shingles vaccines, 6 H1N1, and 2 seasonal flu vaccines.

And there's follow up and billing. We also call the patients a few days or a week or so after our meeting or after their doctor has made changes to their medications to check up on them. We see how they're doing, how they like their medications, and have a way to hold them accountable to the goals they set with us for managing their disease. The best part is we can bill for these services. It has been a challenge for community pharmacists to show they know more than how to check pills and that they can make a difference in the lives of their patients. The federal government has acknowledged, to some degree anyways, that these are valuable services provided by pharmacists and they should be reimbursed for their time. Pharmacists know a lot more than they get credit for a lot of times, so remember to ask your friendly neighborhood pharmacist for help and advice next time you have a question about your health.

Rotation Switch-a-roo

I realized last night that I hadn't told you all about my rotation changes. The hospital I was scheduled to go to in February cancelled my rotation (and another student's January rotation) due to "staffing loss." One of my roommates was there in October and saw the drama brewing -- it apparently got worse after her rotation. I'm glad the hospital told the school "hey we don't have time to teach students, they won't have a good experience, please find them something else" because I hate being in people's way and wasting everyone's time, but it really screwed up my schedule for a bit.

Things got moved and cancelled and moved again. They thought there was a simple fix, but then they got their stories mixed up and it wasn't so simple. So instead of advanced hospital in Hendersonville, nuclear in Charlotte, and advanced community in Asheville, my new schedule is:

February - Advanced Community, Kerr Drug, Asheville NC
March - Advanced Hospital, Angel Medical Center, Franklin NC
April - Nuclear Pharmacy, PETNET Solutions, Winston-Salem, NC

The biggest differences with this new schedule are that I won't be going back to Charlotte for a month, the kind of nuclear pharmacy is different than what I did this summer at my internship or last September which will teach me something new and allow me to network with a new company, and my advanced hospital rotation went from a 30 minute commute to and hour and half ONE WAY!

Is it April yet?

Today, I'll even settle for February.

I'm not loving 2010 too much so far. This rotation in the ICU is really not my favorite. I know last time I blogged I was all excited about my preceptor, well he's not as awesome as I had hoped. Really he's just too busy. He's responsible not only for order entry/verification but also all the consult notes, and not just for the ICU, for the step down units as well. So he really has a lot to do with getting ready for rounds and getting things entered for the nurses and making sure things are dosed right all the time. Doesn't leave much time for teaching (which he, by the way, not so subtly pointed out last week).

This week he's working evenings, so I have won myself some stand in pharmacists. Today my pharmacist hadn't worked in critical care for so long they had moved the unit to a new building (which is still underconstruction) and she didn't even know where she was supposed to go. Her direction for me for the day: do whatever you think will teach you something, because I don't even know what you kids learn in school these days. Gee, helpful. I'll have a different pharmacist tomorrow through the rest of the week, hopefully she'll be willing to share her knowledge a little more.

In addition to checking ICU off the list of Pharmacy Areas Suzanne Might Want To Work In Someday, I'm also feeling neglected about pharmacy residency interviews. Several of my classmates have already lined up multiple interviews and I haven't been invited to one yet. I did get a mighty fine (sucky) form email from Mission (my top choice) letting me know that of the 71 applicants for their TWO residency positions, they would only be inviting 15 people to interview and I was not one of the lucky ones. I am genuinely happy and excited for all of my friends that have interviews and wish them all the best of luck. I am also quite pleased with myself that I am not a trainwreck because I haven't been invited yet. I'm growing up. And I'll get a job too somewhere someday.

So yeah, today was definately not my favorite, but its mostly over. I'll read some of my fun book, eat a coffee gelato truffle, and just keep wondering... is it April yet?

Snow flurries

I know Western North Carolina is the mountains. I know the mountains get cold. And I know that I chose to come here, but its COLD!! For the past three days I have bundled up: gloves, scarf, coat, ear muffs (they never quite fit right, but I had them with me) and walked to and from work in the snow flurries. I start off with a jolt as I walk out the back door of the AHEC house and mildly adjust to the cold about a third of the way there. Then as I approach the traffic light to cross the street my ears start to feel like ice blocks that want to fall off. And finally, as I round the bend to walk up to the front door of the Heart Tower, a wind that was previously non-existant suddenly feels like a tornado of penetrating cold air that literally knocks me backwards. I shiver just thinking about it. At least today, I got my ear muffs to fit right and the flurries stopped on the walk home.

On a warmer note, my preceptor bought me a cup of coffee today! He's been on vacation and the pharmacist I've been working with hasn't been the most outgoing and generally made me feel like I was in her way and that she didn't have time for me. I'm still not super excited about this rotation in the ICU, but at least my real preceptor has a general interest in me being there.

A new year, a new month...

I moved back to Asheville tonight, along with 5 of my classmates. Our January rotations (#5 of 8) start tomorrow morning. I will be in the medical/surgical ICU (med/surg distinguishes it from neuro or trauma or burn, etc). I'm not really looking forward to it.

December was a nice month off from rotations. I had a very lovely Thanksgiving with grandparents, aunt, uncles, cousins, and friends, and a very nice Christmas as well. Lots of family parties, lots of football, and lots of time working at the hospital. It has been great to go back every Christmas and make money, I just wish I didn't need the money so much so I had more time with friends (I know, welcome to the real world - yeah yeah yeah). Santa brought several of my presents early for my trip to Vegas so not everything was a surprise Christmas morning, but it was all greatly appreciated.

For New Year's Eve, Thomas and I went to see Jeff Dunham in Uptown Charlotte. It was a really entertaining show. It was all new material and Jeff kept cracking himself up during the show which was a little funny to see. He does a great job creating his characters. After the show we went to a party at one of my friends from Queens' house. All in all, a good night.

So for the new year, I'm back in Asheville as I've said. As I drove back today, there were still snow remnants along the highway and in our backyard. The heat is apparently broken downstairs so there's a 20 (maybe 40) degree difference between floors. They did some repairs to the house over break and we have a new shower downstairs! It isn't any bigger, but it is nice and shiney and clean. Between the no heat downstairs, fighting with a book shelf for an hour, and realizing I left ALL my pants minus my suit and some jeans in Charlotte -- it has already been "one of those days." I'm looking forward to May and yet praying I learn a LOT between then and now.

Oh, I took WAY too many pictures in the last few months and haven't posted them all. Here is a photo album I made on fb to see them.