November's almost over

My November rotation that is.

This month has been fast paced, challenging, and a learning experience in more ways than I thought it would be. I know I've learned things, I've certainly spent enough time every night looking up things I didn't know that I must have learned something, but if I had to list them, I couldn't.

Let's see, I'll try:
Zosyn covers Psuedomonas
Cefepime covers practically all gram (-) bacteria
Doctors think about and/or find cancer way more than ever I thought about
Communication issues can kill people
Despite your advice, the doctor's going to dose the drugs however they want to

Anywho, although I can't remember the things I've learned about medicine this month, I think I've learned more about myself. In the two mornings out of this month that I've gone on walking rounds, I have confirmed that I should be a pharmacist and not a doctor. At least not a doctor in a hospital. And maybe not even a pharmacist in a hosptial.

Our Attending physician this week was not very pharmacy friendly. Despite recommendations that "Hey, this guy's kidneys aren't working really well, can we decrease the dose of this antibiotic so it doesn't kill his kidneys, please?" or "This little old 92 year old woman got a dose of digoxin that can get toxic really fast, can we please not load her up on this heart rhythm drug that can increase the toxcity?" Nope, just do it, do it the way I want it or the way consulting physicians want it. They know better. (P.S. the consulting physicians went back and forth on the dosing of the antibiotic based on his kidney function; and the lady's digoxin level got more toxic and her kidney function got worse the next day)

I guess my biggest issue with this rotation is I just don't know how what I've done for 3 weeks really translates into a job. The morning stuff, reviewing the patients and then rounds, makes sense, but our afternoons have been time for projects or topic discussions, that I don't know what a "real" pharmacist would do for that time. I know I learned stuff and would continue to, I know sometimes we might make a difference for the patients, but overall, I don't think this is the job in pharmacy I want. Only 1.5 rotation days left, then home for Thanksgiving and Christmas :)

Traditional Rounds

An update on my November...

This month is internal medicine at Mission Hospital. I am with another pharmacy student this month and its nice to share the work. She and I arrive at the hospital around 0800 and spend a couple hours looking up patients in the computer. We check their labs, read their history, check their meds, make sure things are dosed properly, make sure their using the right antibiotics, make sure they didn't forget something the patient was on at home, etc.

At 1000 we normally go to Rounds with the Family Medicine Team. There are several first year interns and a third year senior resident plus their attending physician for the week. They each present their patients and we discuss what to do for them. As pharmacy representatives, we're there to bring up any issues we saw when we were looking up patients, and address any questions they have during their discussion. After rounds, most days we go to lunch and then maybe have a topic discussion with our preceptor. Usually though, by the end of the day we have discovered 6 more things we didn't know we didn't know about from rounds and have to go look them up. I'm living in a state of overwhelmed and stressed this month!

Anywho, this morning our attending wanted to do full team, traditional, walk rounds. So we all met at 0700, no one had looked at their patients, and we proceeded to walk all over the hospital and talk about (and examine) all 14 of our patients. 0700 - 1300 (6 HOURS!) of rounding on people. Oh it was awful. I don't think I learned anything, I didn't have a chance to look at the patients before hand so I was totally unprepared, grr. Not my favorite format, and I discovered once again why I don't want to be a doctor. No touching people for me, thank you.

The Pumpkins

Ok, I know I'm a few days late with this but this new rotation is a whirlwind (which I'll try to write about in a new post this weekend...maybe).

Anywho, throughout the month of October, I heard about this pharmacist that carved pumpkins. He took time off at the end of October and carved and carved and carved and the whole neighborhood comes to see. Well he did carve, and there were certainly more than I would ever do, but there weren't the hundreds I was thinking of. The neighborhood does come, but mostly because they close off the street to auto traffic so its a pretty safe place for kids to go running on a sugar high.

I, and a few of my fellow future pharmacists, volunteered to hand out candy. He makes this little tunnel/walled pathway with trees and vines and had people stand in cloaks in little alcoves. Most people could see me as they came through, but the girl on the other side had a suburb time reaching out and tapping adults on the shoulder when they had no idea another person was around. I got home just in time for the rain to hit and watched the UT/USC game and listened to my roommates scream at a horror movie downstairs. All in all it was a fun night, and the Vols won in their cute black and orange -- yay for halloween themed sports uniforms. Enjoy the pictures!

Oh wait, almost forgot. Part of the reason I wanted to check out the pumpkins and volunteer is because Mr. Pumkin-carver-Pharmacist takes donations all night for the Eblen Foundation. Its a charity here in Asheville that does a little of everything: helps people get healthcare, vision, dental, travel to other hosptials out of the area, communications, rehab, electricity, heating, college scholarships... really everything. OK, now enjoy pictures :)

and of course his lab...