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.