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...
3.27.2010
3.22.2010
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.
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.
3.16.2010
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!
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!
3.10.2010
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.
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.
3.08.2010
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.
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.
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