The Real Meaning of Memorial Day

This political cartoon ran in my local newspaper last Memorial Day. I clipped it and saved it because I felt that it really summed up how out of hand Memorial Day has become in this country. It's no longer about the men and women who made the greatest sacrifice for our country, it's about the first weekend of summer. I think it's time that we start to remember what Memorial Day is. It's NOT about summer. It's NOT about the beach. It's NOT about cookouts. It's about remembering and honoring those individuals who have served our country. It's about the 58,178 names on The Wall in DC. It's about the 1,652 Americans who have died in Iraq since March 19, 2003. It's about the men and women who served in World War I, World War II, Korea, Vietnam, Somalia, Iraq, and Afghanistan.


To all those who have bravely served the US or are currently serving - Thank you.

A Funny Turn of Events...

I have to admit that this week was by far much better than last week. I have finally adjusted myself to the "DC way of life." This essentially is walking fast (even if you are not in a hurry), never riding an escalator - always walking up one, running to get in the Metro train as the recording says "Doors closing", and lining up at Gate A in Union Station at 4:36PM waiting for the track posting for my 4:55PM train. I should mention here that I adamantly stated that I would NEVER walk up an escalator, run onto Metro, or stand at Gate A waiting for a track assignment. Apparently my hypocrisy knows no bounds... Another funny twist is that I have gone from sitting in the DI room by myself, to spending the afternoons with the Director of Pharmacy Services for Washington Hospital Center. This turn of events occurred earlier this week when I got a call from a nurse in the stroke center. A patient was admitted with lower extremity weakness and inability to walk. The admitted her to rule out a CVA and it turns out she definitely was not having a stroke. This patient was experiencing atorvastatin-induced myopathy. This is an extremely rare side effect of the drug, and it can progress and be life-threatening. The director told me to find out why it happened. So...four articles later, I was ready to provide him with a hypothesis. He sent me to the floor to review her chart to see if she fit my hypothesis. She did. This patient's renal function and hepatic function were horrid. She was a totally uncontrolled diabetic with blood sugars hovering around 450. She was also quite elderly. Her decreased liver and kidney function caused her atorvastatin levels to sky-rocket. This caused her muscle damage. I was told to present my case at DI rounds on Thursday. I presented my case and answered all of the Director's questions - which were not easy. This man lives for pharmacology. I also had to present a case on why linezolid should not be used with gentamicin. I answered all of his questions - again. At this point, he stopped the conference and said, "Do you want a residency? Because if you do, I'm offering you one." I thought he was joking...but he wasn't. He came up to me after rounds and told me that he was thoroughly impressed and hoped I would consider being a resident at WHC. He then said, "I can do better than that. I'm offering you a full-time position at WHC after you complete your residency." WOW. I was speechless. The rotation from hell is turning into a great clinical experience. I have learned so much in the past two weeks and it's actually kind of fun. I still hate getting up at 4AM and getting home at 7PM...but I have to admit, it is growing on me. Only two more weeks...

Norwegian Scabies in DC

Last fall a call came into the Drug Information Center at Washington Hospital Center regarding a case of scabies on one of the patient care units in the hospital. The patient failed to mention upon admit that he was in fact infested with scabies. When the nurse did the admit, she noticed lots of red bumps over the man's entire body. She called the doctor and he ordered premethrin cream. Five days after the cream was administered, the scabies were still thriving. The doctor called the DI center in search of an alternative treatment and asked for an infectious disease consult. Low and behold the man had Norwegian Scabies. The same bug causes normal scabies and Norwegian Scabies, however with Norwegian Scabies there are an enormous amount of the little buggers. So - now the question was, how the hell do we get rid of these? Meanwhile, other patients on the unit developed scabie infections, even though the patient was in isolation. The entire unit was infected within a week - including the nurses and doctors. Even the clinical pharmacist working that floor contracted them. The original patient was also an AIDS patient - which was the reason premethrin cream did not work. This patient had to be given ivermectin by mouth to get rid of the scabies. The employees and non-immunocompromised patients were given premethrin 5% lotion. Two months after the orginial patient was discharged, WHC was still treating patients for the scabies outbreak.

So, now you can see that scabies are apparently a pretty common thing at WHC. I was quite surprised on Tuesday when the DI center received a question regarding scabies. One of the ICUs had a patient with scabies that was treated with premethrin 5% lotion. The nurse that called the DI center wanted to know if the patient should be in isolation...he'd be in the unit since Friday. So - guess what! The pharmacy was sending tubs of premethrin cream to the unit for patients that had been exposed to him. THANK GOD I LIVE IN THE BASEMENT NEAR THE MORGUE! Scabies aren't fond of dead bodies - it's hard for them to feed on the dead. Thank God for little favors, right? So...are you itching yet???? :)

DC = Disaster & Chaos

I write to you today from the DI lab in the basement of Washington Hospital Center. If you can't find it, just follow the dead bodies. That's right! I'm four doors down from the morgue. How's that for a cheery greeting every morning? Allow me to recap my first couple days on my first every clinical rotation. Monday started innocently enough. I rolled out of bed at 4:00AM and made it to the train by 5:10. The train ride was harmless. Then everything went slightly south for the rest of the day. Starting with Metro. My preceptor told me to exit the station to the left, which I did - only to find myself in an alleyway in NorthWest DC. Not a good place to be! So, I went back down the 100 steps I had just climbed and promptly exited to the right - and consequently back up another 100 stairs. I found my shuttle bus and made it to the hospital just fine. When I got on the elevator, I pressed the "B" button to head to the basement. Much to my surprise, I went to the second floor. Even more to my surprise, the doors didn't open. So I'm sitting on the second floor...doors not opening...sitting...doors not opening...sitting...doors not opening. Finally on the verge of a major panic attack, I start pressing the "B" button rapidly. The "B" button lit and I traveled the basement. Apparently the "B" button needs to be depressed forcefully to recognize that you are traveling to the basement. Otherwise, it returns to the second floor where it hovers until someone else wants on. I then sat in the DI room for an hour and a half by myself because my preceptor forgot I was starting my rotation on Monday and consequently took the day off. The receptionist, may that the TWO receptionists, failed to notify the assistant director that I was here. Finally at 9:30, I stepped back into the lobby and asked if anyone was ever coming to see me. You could've bought the receptionist for a nickel. The assistant director raced downstairs to find me. She apologized several times and then took me to her office to lay out the "game plan" for the rotation. Fun stuff. The best part is, she kept calling me Christie - which is not my name, nor is it anything close to my name. I'm sitting less than three feet from here with a name badge on that has my name in no less than 20 point font. I corrected her twice, and then just gave up. I find myself responding to the name Christie now. After a morning of hell, I dragged myself up to the cafeteria for lunch. It is surprisingly nice inside...and I get an employee discount! :) Cheap food is always good. After lunch, I left the cafeteria in search of the stairwell that would take me back to the basement. (This facility is 42 acres and some enormous amount of square footage). As I was walking the hall, I stumbled upon a dead body. It was laying on a gurney with the sheet pulled over it - but it was still a dead body. I took it as a sign of things to come. The rest of my first day was painfully uneventful. Tuesday was riddled with meetings, that I was not able to attend. I spent my morning lounging about in the medical library with the medical residents. They sure are a fun bunch. (note huge amounts of sarcasm) Then I met up with the assitant director again. She was no longer calling me Christie...I had now become Christine. Great. (Should this woman be allowed access to drugs??) Wednesday I went to Grand Rounds with the three pharmacy practice residents. Free food...and an hour with the fun-loving medical residents. The past two nights on the train home, I have discovered that people REALLY hate commuting to DC every day. They apparently cope with this by drinking heavily on the way home from work on the train. The drinking doesn't bother me (in fact, tonight I may join them) - however the loud screaming and yelping is bothersome. The one guy had his shirt off and his tie wrapped around his head. This lovely character took the train all the way back to my hometown, while the rest of his friends got off four stops before. He looked so lonely up there passed out on the seat, sleeping in his own drool (the train is a double-decker). So as you can tell, every day is a story. I have a ton - just not enough time to tell them all. Stay tuned for a post Friday or Saturday about the Scandanavian Scabies. :)

A Series of Unfortunate Events...

I watched "Lemony Snicket's A Series of Unfortunate Events" on Friday and I could have sworn the movie was my biography! On top of all the other crap occurring in my life, yesterday I received a notice from the US District Court that I have been selected for jury duty. *And the hits just keep on coming!* I contacted my advisor immediately and guess what! He's apparently vacationing in the Dominican Republic until May 23. Splendid. If I wait until May 23 to respond to my notice, I'll be in jail - not DC. I found another person to contact at school and he was so kind to inform me that if I didn't get exempted from jury duty (he has great hopes that I will) that my rotation schedule will have to change to accomodate it. Great... Currently I have a great rotation schedule - with the exception of this DC crap (which starts tomorrow). If they go moving stuff around, I could lose the rotations I asked for. I'm reallllllllllllllllllllly happy about that. It's 4:47 - I guess I should get to bed considering I have to get up tomorrow morning at 3:30. Normally, I'm going to bed at 3:30. I was born a night owl and will die a night owl - and my death may come in the next 4 weeks because I am being forced to be a morning sparrow. This rotation just may be the death of me...

Paraskevidekatriaphobia

"The unrational fear of Friday the 13th." How fitting that the Friday before I head to DC is Friday the 13th. Can I get anymore bad luck? Bah! Why is Friday the 13th considered so unlucky? Well, I did some research today - in between episodes of Judging Amy on TNT. According to the Phobia Center in Asheville, North Carolina, Eve gave Adam the dreaded apple of doom on a Friday. At the Last Supper, there were 13 people sitting at the table; and Jesus was crucified on a Friday. Ok - that's not why I would consider it unlucky. Is NC in the Bible belt now? I quickly moved on from the Phobia Center to other resources. I found some pretty amazing facts. For example, 90% of Otis elevators don't have a button for the 13th floor. So I take it if you are unlucky enough to work on the 13th floor, you are either screwed or you get your exercise. The US Navy will not launch a ship on Friday the 13th. Attention all enemies of the US - apparently our Navy is on vacation on Friday the 13th, do as you will. I found that fact a little unnerving. I hope we don't pass that tidbit along too often. A correctly tied hangman's noose has thirteen knots and executions used to be held on Fridays. Hmmm...Connecticut executed Michael Ross at 2am this morning. Coincidence? Probably - but it does add to the superstition of the day. Finally, one more fact that made me laugh. Air travel (actually all travel in general) decreases on Friday the 13th...unless you look at incoming flights to Las Vegas. It appears as though the number 13, while unlucky in other aspects of life, carries with it a sense of luck for gamblers. Travel to Las Vegas on Friday the 13th increases. Interesting...

Legalize It

I live in West Virginia. My state was once known for its beautiful mountains and wilderness. It's now known for its gray machines and titty bars. I have friends in college that call me and ask for directions to the titty bars. The sad thing is, I know the directions. It's not because I frequent these establishments - it's because I drive by them every day going into and out of town. How sad is that? The reason all of my college friends want directions to these establishments is because WV dancers wear NOTHING. (Ok, I misspoke, they do wear those platform stilleto heel things.) Last year a prostitution ring was discovered and busted here in my great hometown. The entire community was outraged. "NO! Not prostitution!" Why is everyone so outraged by prostitution? Especially when we accept the porn industry so readily? I can go into Sheetz and purchase a Penthouse. I can go to Blockbuster and rent a XXX movie. I can turn on cable TV at 11:00PM and see commercials for Girls Gone Wild. What is so wrong with prostitution? Personally, I'm more appalled by the aforementioned things than prostitution. I would like to be able to watch television at night and not have to watch a commercial for 18yo girls taking their shirts off for idiots - at least prostitution isn't occurring in my living room. I say - "legalize it and regulate it." Make the girls, or guys, get tested for STDs on a weekly basis. Put a tax on it - an expansion of the entertainment tax. If the titty bar market or the smut magazine market are any indications, I'm sure it will be a hell of a profitable industry.

A Change of Luck...

I worked out in the garden with Mom this afternoon. We planted three rows of onions, fourteen hills of cucumbers, a row of purple beans, four hills of banana melons, and three rows of sunflowers. It was refreshing to work outside. As I was planting the seeds, I couldn't help but think that Berlioz would've loved to play in the dirt. Tolousse (Berlioz's sister) came to the garden with us and frolicked in the sunshine. Our garden is surrounded by several fruit trees - two of which are cherry trees. I was taking a break and sitting in an adirondack chair under the cherry tree when I noticed a four-leaf clover by my foot. When I bent over to pick it up, I found another one and another one. When I was finished, I had picked 4 four-leaf clovers and 1 five-leaf. I sure hope this is a sign that my luck is changing - because I sure could use a push in the correct direction.

Magna Cum Laude??

School of Pharmacy grades were due today at 5:00PM. Due the technological advancements at my university, I am able to check my grades online rather than waiting for them to arrive via snail mail. I anxiously logged online at 5:25 to see how I finished my didatic career. Suprisingly, one of the professors still has not posted grades. I figured this would happen - but my money was on the professor that is currently residing in New Zealand. However, she actually posted my grade by the deadline. I am a person driven by academics. I am ecstatic to say that for only the second time in pharmacy school, I achieved a 4.0. This brings my cumulative GPA up to Magna Cum Laude level - the level my brother achieved at George Washington University. I have reached my goal. My entire life, my brother and sister have been making footsteps that I can only strive to try to follow in. My sister was Valedictorian of her graduating high school class. My brother graduated third in his class - robbed of Valedictorian by taking band rather than study hall. Me? I graduated seven in a class of 300. My brother was a National Merit Finalist - I didn't even make the quarter finals. Acheiving Magna Cum Laude - especially since my GPA after my first semester in pharmacy school was 3.4 - is a great honor for me. In my mind, I am now standing firmly in my siblings footsteps; and it's exactly where I want to be.

DC Ho'

I was watching "Judging Amy" on TNT this afternoon when it hit me - next week this time I'll be sitting in the basement of Washington Hospital Center. I think the rotation is going to be awesome - however my entire life is going to put on hold for four weeks. Due to the ever increasing price of gas and my concern for the environment, I have decided to not drive to DC every day. Lucky for me, my hometown is equipped with a train station...and a commuter train that goes to Union Station in DC. I talked to my preceptor and he thinks this is a great idea. The bad news - the train leaves my hometown at 5:25AM. I will be in DC by 7:30, where I will then catch the Metro. Finally I will board a Medstar bus and be transported to the hospital. My first day's assignment is this: Get from my hometown to DC in one piece. I am trying to catch the 4:55PM train out of DC to my hometown. This train arrives back at my train station at 6:55PM. Great...home with enough time to eat dinner, take a shower, and get to bed. There are people who live here that do this shit every day. I'm sorry, but no amount of money would be worth that. Since I'm only doing it for four weeks, I'm not too upset about it. I'm a little nervous, but I would be nervous no matter where I was going. The unknown always makes me a little aprehensive. I know I'll do fine. And, I'm actually looking forward to the experience. Now that I've accepted this, if I could just get my cat back...

Evolution Revolution

I see that Kansas is having "debates" over whether their children should be taught evolution or this creationism crap. I'm not really sure how creationism fits into science. I assume you would first have to accept that the Earth was created in literally six days (thanks ROMA for that clarification...I accidentally gave God an extra day in an earlier post). We've determined that the universe is billions of years old...and God formed it in six days. Sure... Next you have to assume that after God gave the earth light and water and animals, he decided to make "man" in his image. Then man needed a companion, so he took a rib out of man and made "woman." I'm pretty well versed in anatomy and physiology (being a pharmacy student will do that to you), and you may not believe this but men have 12 pairs of rib (that makes 24) and so do women! Amazingly, men don't have 23 ribs. The best part about this whole "theory" (and I use the word theory very loosely here), is that if you truly believe this - we're all inbred. I don't know about you, but I find that a bit unnerving. It sounds a bit like a WV joke. Personally, I think Genesis is a huge metaphor for the formation of the universe. I don't think God said, "Let there be light," and flipped a giant breaker in the sky and low and behold the sun appeared. I just don't buy that. Here's another part that trips me up...when you go into your typical Christian church and you see Jesus hanging on the cross - what color is his skin? My personal experience is that it's white - white as freaking snow. Um...the birth place of civilization is in Iran in a little valley between the Tigris and Euphrates rivers. Ever looked at those people? They're not white! Jesus, at best, had to have olive colored skin. Sorry Pat - Jesus didn't look like you! Creationism cannot account for the many different skin tones that exist in the world - but evolution can. Creationism is not science. Simply put, it has no place in a science class. Personally, I think placing it in a science class violates the priniciple of Church and State - which is nothing new, Republicans stomp all over this belief every day.

Law Knowledge?

I checked with the registrar's office online to see if any of my grades have been posted. Low and behold, three of my ICARE sequences, my ICARE lab, and my Pharmacy Law grades have all been posted. I knew the grades from my ICARE sequences (they are only 4 weeks long and most were completed long before final exam week). I also had a fairly good feeling about my ICARE lab grade. I was a little worried about pharmacy law. I took that exam on quite possibly the worst day of this semester. Apparently the road down hill had not begun when I took that final. I got an A in the course. I've been pretty down these past couple days. Finding the "A" brightened my day a bit. I also discovered something a little shocking yesterday...and a little bit unnerving. My first clinical rotation is in Washington, DC. For a month I have been asking if I need an intern license from the DC Board of Pharmacy to complete this rotation. The experiential coordinator continued to tell me no. I read over the handbook last night and apparently it states in the handbook that if you are practicing out of state, then you need to procure an intern license for that state. Great. I start the rotation in eight days. Definitely don't think that's time to get a license. Trying to calm myself, I went to the DC Board of Pharmacy website and checked the law regarding pharmacy interns. This is what I found: "6512.1 This section shall apply to pharmacy interns who are performing independent,pre-licensure professional practice in satisfaction of the internship required by § 6502.1(b)(2) and (3) under the supervision of a pharmacist in the District. 6512.2 A pharmacy intern shall be registered by the Board before starting an internship. 6512.3 A pharmacy intern shall apply to the Board for registration as an intern in accordance with § 4001.1 of chapter 40." Ummm...that sure does look like I need a license. That's just a section of the code - it gets worse as it continues on. I sent an email to the director of experiential education and to his new assistant (I assume that's this professor's position - personally I think it was created because the director is a weebit on the lazy side). The assistant wrote me back an email that said, "I'm deferring to Dr. soandso." Great. That tells me that he feels we're all up shit creek without a paddle. To be honest, I didn't expect anything less. This has been the absolute year from hell and I can't think of a more fitting end - Ahsirt can't go on rotations because the experiential coordinator dropped the ball. How fitting...

This is the end...

In the famous words of Jim Morrison - "this is the end." Today I took my last final exam ever. It was a 42 question test concentrating on special therapeutic considerations during pregnancy, labor & delivery, and lactation. I think I did decent on the exam. I'm proud of myself - because the only time I really looked at the notes was Saturday night. I thought I would walk away from school today with mixed feelings...however I didn't. I just simply walked away. I took the 2 hour exam in 20 minutes, turned it in, picked up my stuff, and just left. I didn't say goodbye to anyone. I just silently filed past my mailbox and out the door. I wasn't expecting a tinker tape parade...but I guess I was expecting a goodbye. I know of at least one person in that class that I will never see again. We used to be good friends. But, today, she walked to her car and pulled away without even so much as a wave goodbye. I guess she's been preparing for this moment for six months. I wonder if that is what she planned? I guess I'm just numb to the whole matter. I guess what makes the experience even worse is that my favorite cat disappeared yesterday. He came home for lunch and I haven't seen him since. This cat is so special to me. He sleeps every night on the foot of my bed...last night was my first night without him since September. I spend all yeserday evening and last night looking for him. I even rushed home from my final to canvass the neighborhood again...but alas, he is gone. I don't know what I'm going to do. I know he's just a cat...but my cats aren't just cats. My cats are my family. Each one is special...and Berlioz, he was just extra special. I got him when he was barely 6 weeks old and he fit in the palm of my hand. He would snuggle up against my tummy and sleep. He snored when he slept. He was fascinated with my dishwasher. And when I was upset or stressed out, he seemed to know. He'd put aside his craziness for a few minutes to rub around my ankles to let me know everything was going to be ok. I'm getting ready to start on a new journey in life - clinical rotations...and he won't be here to rub around my ankles to let me know it will be all right. I'm 23yo and my security blanket is a 10 month old cat...and now he's gone. I'm lost...