Bag Burpin'

Ahsirt the Super Tech strikes again!!! Actually, I have been "super tech" in the IV room since Thursday. I like being IV Super Tech. There's just something about sitting in the hood and knowing that you can't screw up. Prior to Friday, I had made vancomycin in NS and Rocephin in NS piggy backs. On Friday, I graduated to narcotics. Narcotics used in PCA pumps are different than your typical vanc bag. There can't be any air in a PCA bag. Friday we got a new cancer patient referred through hospice. Her pain was being unsuccesfully controlled by fentanyl patches, so the doctor ordered a PCA with Dilaudid. They ordered 0.5mg of Dilaudid per 1mL of NS. We decided to make it 1mg of Dilaudid per 1mL of NS so as to cut down on the risk of calculation errors. This way when the nurse goes to program the pump, it's simply 1mL for every milligram of Dilaudid. I got in the hood and pulled 50mL out of the 500mL NS bag. Then I injected 50mL of Dilaudid into the bag. Now comes the fun part. I had to burp the bag to get all of the air out. This is a bit frustrating - especially when you can't get the champagne bubbles to congeal. But 20 minutes after getting in the hood, I had succesfully removed all air bubbles from the bag. My preceptor was much pleased. I was rather pleased with myself. Ahsirt is THE bag burpin' super tech. :)

Ahsirt the Super Tech

Tonight I am sewing a large "S" in the back of my white coat. With the official firing of the "no call, no show" technician, I have stepped up to the plate to bring the team home. Today I taught myself how to use QS/1 software. Anyone who has had the pleasure, or displeasure, of working with this horrid software realizes that this is no small feat. My saving grace is that the sig codes are exactly the same as Martin's software. Once again I have tricked my preceptor into believing that I am phenomenal. Today I inputted, filled, and checked prescriptions. Ladies and gentlemen, I am a full service pharmacy. I haven't used the cash register yet...and am conveniently keeping a safe distance from it. Today I learned that apparently my employer pharmacy is the "soup Nazi" in regards to narcotics. These people hand the shit out like candy. They even bypass DUR rejects and cough up excuses such as, "It probably has different directions" and "Oh, they're only 8 days early." Did I mention they only sell brand name narcs? A sure sign that shit isn't right. I tried to explain this to JW - the student from WVU. He guffawed at me. Look, when the medical assistance patient is requesting brand name Percocet and throwing down 100s of dollars, that's a sign that something isn't kosher. He didn't believe me. This store even has brand name Dilaudid. I have never seen brand name Dilaudid. When I told them the generic equivalent was available for all Oxycontin strengths, they just glared at me. They don't even have generic Oxycontin 80s! I did their narc inventory yesterday and was just totally amazed at the amount of brand name drugs on the shelves and the cost of their narcs!

Today's Highlight: Explaining to JW the reason he couldn't find a diaphragm on the pill shelves. He had filled the prescription for 65 diaphragms as opposed to a size 65 diaphragm. He also wondered if that was a 65 day supply. I walked away from our conversation convinced that he had no idea what a diaphragm was until he talked with me today.

A Liberal Among Conservatives

"Behold, I send you out a sheep among the wolves" - Matthew 10:16.

Every day that I am at my second rotation it becomes more apparent that I am indeed the lone liberal in the establishment. Today it became apparent when a lady at the counter whom could not speak English presented our cashier with her medical assistance card. Good lord, you would've thought she condemned the entire staff to Hell for eternity. They bitched for 30 freaking minutes about the injustice of her having medical assistance. I, on the other hand, would've preferred to bitch for 30 minutes about the injustice of one of the workers not showing up for work and condemning me to counting pills for eight hours straight. Apparently that didn't hold a candle stick to being an immigrant. If these people had there way, we would shut and bar the door to everyone trying to enter the states. God forbid we allow those less fortunate than us an opportunity to better themselves. Everyone was bitching except for me and one other tech. This tech told me last week that her grandfather is an American Indian. Let's see...I wonder why she wasn't bitching. Could it be that our forefathers took the Indian's land and gave them syphilis, gonorrhea, and firewater in return? Hmmm...maybe. But we did give them those nice little reservations to build casinos on. That makes it all better, doesn't it? Whatever the case, she was shaking her head at them in disgust, just as I was. Last week I found out they were all "W" fans. Before I could catch myself, I told them that I wouldn't hold it against them. Whoops! That sent up the "liberal flag" like you can't believe. In light of these recent findings, I think the Matthew verse would be more appropriate if it read "Behold, I send you out a liberal among the conservatives." HA! :)

Lessons from the DME Aisle

Having worked in retail for over two years, I thought I knew what durable medical equipment (DME) was. The pharmacy that I work at does not sell DME and we refer all of our patients to an outfit in town that sells these objects. The questions I usually get at my pharmacy are from people seeking walkers, wheelchairs, shower chairs, or canes. What I have learned at my second rotation site is that these objects are just the tip of the iceberg when it comes to DME. Below are ten things I have learned from the DME aisle at my rotation site.

1. DME does not begin or end with walkers and crutches.
2. The DME section at my rotation site not only knows what AKTON is, but they actually sell the products my sister's company has been making for over 30 years at Action Products.
3. You can rent a wheelchair but not a walker.
4. For many DME products, you actually have to have a "prescription" from a doctor before your insurance will pay for them.
5. You can get canes in every color and print imaginable - including leopard print.
6. There is a company that makes shoes specifically for diabetic patients.
7. For people who cannot wipe themselves due to diability, they make a product that helps you reach your butt...and it's called "Self Wipe." You don't need a prescription for it.
8. People who are paraplegics or quadraplegics have difficulty regulating their bowels - and there is a product to help with this. It is a bullet shaped insert that is placed inside the rectum to "stimulate" bowel movement. You don't need a prescription for this - and I think "The Locked Door" (an adult toy store in the same town as my rotation site) sells this product as well!
9. Men with enlarged prostates have trouble with dribbling after peeing. They make a clamp that is placed over the penis that squeezes the urethra shut. I think they sell this at "The Locked Door" as well, but I'm pretty sure it isn't called a clamp.
10. There are a lot of products that patients need to be fitted for. The DME section at my rotation site does not fit patients for penis clamps.

The Compulsive Liar

Have you ever encountered someone who lies just to lie? I work with one...and it's a pharmacist! This woman must think that I, as well as the rest of her co-workers, are complete idiots. On Tuesday she tried to convince me that she had Calculus 3 in high school, as well as biochemistry, microbiology, and organic chemistry. Biochem?? Biochem was a pain in my ass - and I took it in my first year of pharmacy school. Calculus 3??? Isn't that was engineering majors take in college? What a dunce. The best story by far comes from our conversation yesterday in the IV room. I was in the hood making 10 IV bags - 4 vancomycin 1500mg in NS and 6 Rocephin 1g in NS. I had to stop making IVs because the bullshit was getting so deep I was afraid of contamination! She told me that she had her daughter by C-section (pretty believable). Her nurse anesthesist couldn't place the epidural and wasted half her dose on "test doses" (whatever the hell those are). Finally an orthopedic surgeon came up and gave her an epidural. Ok - my first question was, why would an ORTHOPEDIC surgeon be giving epidurals to women in labor?! The story only gets better from this point - and by the end, you may think that an orthopedic surgeon giving an epidural is plausible. (HA!) So the doctor wouldn't order any more medicine and she didn't get the full dose. Consequently, she could feel her C-section and move her legs (totally not possible). When I asked her if she could feel the pressure, she said, "Oh no, I could feel everything. I even moved my legs for him during the procedure." Right... The next miracle is that she was only in recovery for 10 minutes because she could lift her legs at a 45 degree angle with no problem. Well let's see - abdominal muscles have been cut and sutured. I'm sure doing abdominal activators is cake with sutures in place! Finally, she told me in 4 days post-surgery she was walking around Target shopping. Personally, I have never had a C-section, but my sister and sister-in-law both have had them. My sister is possibly the toughest person I know. She can tolerate some serious pain and she wasn't walking around Target 4 days post-surgery. I don't know how I kept a straight face during her conversation. Not only does this woman lie, but she's horrible at time management. I'm pretty sure she has ADHD. There were 20 prescriptions to be checked and the waiting area was full and she was running around telling everyone that she bumped her toe on the shelf. She's wearing thin on my patience. I don't like people who lie and I despise pharmacists that can't manage their time!!!!

Pride of WV???

As a fellow Mountaineer, I truly have blue and gold running through my veins. I grew up with a sister in the marching band at WVU. For those of you not from WV, the WVU marching band is "the pride of WV." People go to the football games just to see the band. So as a small child, I recall rooting for the Mountaineers in football and occassionally going up on weekends to watch my sister to march. My brother did not attend WVU (he's a George Washington University graduate), but he and his friends used to frequent WVU football games quite often. At this point, I should also alert you readers that you have not been to a college football game until you have walked into Mountaineer Stadium. We take our football pretty damn serious here in WV - especially when we're playing Virginia Tech. I swore that when I grew up, I was going to be a Mountaineer as well. A hard lesson in life to learn is that things don't always go as planned. My senior year, I applied to WVU and was accepted into their pre-pharmacy program. I was going to live in Towers dormitory with my best friend of 17 years. Everything was going to be awesome... Then reality hit. My grandmother entered the late stages of Alzheimer's Disease. It was a horrid time. To watch her and my mother grieving was almost more than I could bear. In the meantime, the guy I had dated exclusively all through high school informed me that my "depression" was more than he could handle, and apparently he coped with this by sleeping with a good friend of mine. Three weeks before my first day at WVU, I withdrew from college. By a stroke of luck, I had applied to Shenandoah University in February. I contacted SU and was immediately enrolled in classes. $9000 later, I was a SU student - much to my sister's disappointment. It's funny how fate pushes you in a certain direction. I had some GREAT times at SU. I loved undergrad there. Pharmacy school as been awesome. I have met my best friends at pharmacy school. So I guess at this point, you are wondering what exactly the point of this post is...

Well, I'm sitting here in my room listening to my sister's marching band tape from 1987 and wondering - did I make the right decision? At times I don't doubt myself at all. I would've got lost in the shuffle at a large university. I don't do the bar scene. I'm more of a "let's sit around, shoot the shit, and drink" person rather than a "let's go bar hopping" person. My preceptor informed me today that I'm the best Shenandoah student she has ever had. Several of the techs at the pharmacy commented on how "slow" the other students were. Christ, I hope I made the right decision! My personal experience with some SU graduates is that they are nasty pharmacists. Why enter retail if you don't like people? Oh yea...there's that $95,000 thing. (I hate people in the profession for money.) So every once in a while, I get a pain in my gut that tells me that I should've sucked it up 5 years ago and went to WVU. And other days I'm glad I'm not in Morgantown. However, if I would've went to WVU I definitely wouldn't owe the federal government $60,000!

PS - You haven't lived until you have heard the WVU marching band play "Simple Gifts"

PSS - Proof that WVU's marching band is The Pride of WV: Rational Drug Therapy's music for customers on hold is none other than the WVU marching band playing "Simple Gifts." :)

Rotation #2 Synopsis

Rotation #2 started Monday morning with the alarm clock sounding at 6AM. Now to most of you, this may seem extremely early; however since for the past 4 weeks I had been rising at 4AM, this is cake! The new site is a retail pharmacy/home infusion/doctor office supply hodgepodge place. My first day was boring as hell. The head pharmacist told me that she was going to give me an "important task" that apparently many students have a problem with. Hell I figured I was going to be ordering narcotics or something. No...she wanted me to put the stock bottles away. I asked her if their bays were arranged alaphabetical by brand name and she goes, "Oh no, that's too confusing." So my next question was, "Then why the hell is putting the stock bottles away so damn hard????" Actually, I asked myself that question and put all her stupid bottles away in like 3 minutes. She was amazed. The rest of the day was filled with similar incidents. Tuesday she even let me take a message from a doctor's office because "it's time I learn to do that!" (That's a direct quote.) Ok - I've been working at a pharmacy for over two years and I've been taking doctor calls for um...let's see...oh yea 2 YEARS! So I took that doctor call and she practically peed herself because I got all the "pertinent" information. This woman must be surrounded by pure idiots. The women that work there aren't idiots. They are some of the best technicians I have encountered. I guess she's just a flake. Today I actually worked with my preceptor. I made KOH 10% solution for the women's health center to burn genital warts off with. That was fun. KOH melts when it sits at room temperature in light and it will eat your hands. Fun stuff to play with - wouldn't want it anywhere near the genital area though. So in the end, rotation #2 is pretty painless and I'm home by 5:40 every day - which, after living 4 weeks as a DC commuter, feels pretty damn good. :)

Achilles Heel

I have a weak spot - an extremely weak spot. Basically, if you want me to do something and I'm reluctant - guilt me into it. I think it comes from growing up with a grandmother (whom I loved very much) who would prey upon this weakness. I can still hear her now, "You'll be sorry when I'm gone." And by damn, I am. I guess that's why I can now be guilted into about anything. I certainly don't fall to peer pressure. I never have done anything in direct opposition of my morals to satisfy another person. Beg and plead all you wish, I won't do it if it underminds my moral fibers. It's probably these same moral fibers that allow me to be guilted. I will add to this a disclaimer - I cannot be guilted into doing something that I feel is inherently wrong. In high school, I had lots of friends that played with Mary Jane on occassion; however I never imbibed. I don't think it is inherently wrong. Smoking in any form has never appealed to me. I just never wanted to try it. I had a couple friends who tried to get me to smoke with them. In the end, I just stopped going around them. It was annoying to have to constantly tell them "no."

Disappointment really bothers me. The odd thing is, I constantly set these goals that can never be achieved. People hardly live up to my expectations. I plan shit out to the "T" and if it doesn't occur that way, then I get disappointed. Is that self-destructive? Perhaps I should set the bar lower? Maybe if I stopped being so damn obsessed with disappointment I would learn to stop being guilted into things.

Ahsirt meets Murphy...

On Sunday night, I proudly announced to everyone that this was my last week in DC and nothing could hurt me now. Then Monday morning at 6:30 I met Murphy...the inventor of Murphy's Law. You may know him. I was sleeping nicely for once on the train when I was startled awake by the conductor. We were parked on the tracks just past the Point of Rocks stop. Apparently the carnival was coming to town and was blocking the tracks heading to DC. From Point of Rocks to Rockville there was one track. Mind you there were about 20 trains coming and going from DC Monday morning. Passenger and freight lines share the tracks. So we sat in Point of Rocks until 7:30. This means I got to Union Station at 8:30. I usually get there at 7:30. You can see where this is going. I was 45 minutes late for work. When I got to work I realized that my shirt was ripped. The sleeve was ripped from my elbow to my shoulder. I looked like a street walker. Thank God I had my ID badge for WHC, otherwise the cop who stands outside probably would've mistaken me for a hooker. For lunch I selected a personal pizza from the cafeteria - only to get to back to the dungeon to realize it was cheeze bread. When I finally got to go home, things went from bad to worse. I get underground at the Brookland/CUA Metro station and the power goes out. I'm stuck underground in DC in the dark. I was a little freaked - but more freaked that I might miss my train. The security guard pushed open the turnstiles and let us all enter the station. I boarded the train and went to Union - where the turnstile would not accept my ticket because I had never swiped it in Brookland. I explained my plight to the station manager who looked at me with a "yea freaking right" look. Apparently he was as tired as me, because he didn't argue, he just opened the gate and let me go. I reached Gate A to find out that CSX had placed heat restrictions on all MARC trains. Apparently when the mercury tops 90, the rails expand and deform. Therefore trains must travel at 20% speed through some areas and only 1 train can leave the station at a time. GREAT! To add insult to injury, Union Station lost power at 4:30 thus halting all rail travel to and from the great city of DC. My 4:55 train departed the station at 5:55. It was 8 before I stepped of the train in my hometown. Thanks Murphy!

Side note - today my preceptor let me leave WHC at 2:30. I promptly caught the 3:35 train to Brunswick where I had a ride waiting to bring me back to wild, wonderful WV. I was sitting in my air conditioned house at 5:30. That sure was nice. :) C'mon Friday!!!

Shocked back to reality

I awoke at 10:30 this morning to the sound of my smoke alarm blaring. I sat straight up in bed and froze. I didn't see any flames, I didn't see any smoke, hell I didn't even smell any smoke. I fumbled for my glasses and instead of running to see if the house was on fire, I mumbled a few curse words, climbed up on the bed and ripped the battery out of the alarm. Only after stopping the noise did I investigate to see if my house was ablaze. No fire anywhere. There was no way I was getting back to bed at this point. My heart was pounding, adrenaline was at full force. I even was experiencing slight chest pains. My anxiety was in full swing. I stomped to the kitchen to calm myself down. Thirty minutes later, I was finally feeling normal. I hate being startled awake. I feel like shit the rest of the day. This was the second "shock" in two days. I really don't think I can take anymore. The chest pain thing is a bit worry-some as well. On Thursday, I was briskly walking to the train and about halfway down the platform I started experiencing chest pain. It was sharp, piercing pain substernally. I had no radiating pain. I didn't feel like an elephant was on my chest. Every time I took a breath, it hurt. I slowed my walking pace and tried to slow my breathing and increase the volume of my breaths. The pain disapated. I was scared. I never had anything like this happen before. As a student in a health professional field, you would think that I would've went to the Urgent Care or ER when I got home. No - I went home. I thought nothing more of it until this morning, when my anxiety brought the chest pains back. I guess I should probably discuss this with my doctor. I think it's just stress-induced. There's a lot going on in my life right now and I think the stress may be finally catching up. Perhaps now is a good time to take up Yoga???

Lessons from Metro...

Last Friday, I reached the Metro platform at Brookland/CUA just in time to hear the woman announce, "Doors closing." So, I ran in between the two metro doors and cleared them just in time. It really pissed off the electronic voice because she promptly told everyone, "Please stand clear of the doors.....Thank you." In the mist of celebrating my good luck, I failed to realize the hornet's nest that I had stepped into. Apparently some white kid did exactly what I did and hit an old Armenian man in the process. When I say hit, I really mean bumped. And in the stupid white kid's defense, the silly old man was standing directly in front of the doors. However he was not entering or exiting the train. He simply enjoyed the view from the doors. So as I quickly became aware of my surroundings, I realized I should step back because the old man had now lifted his cane from the floor and was swinging it around. He finally calmed down and after much coaxing from another Metro rider, he sat down in the seats reserved for the handicap and elderly - conveniently located BESIDE the doors. Usually my Metro ride goes by fairly quickly. There are only three stops between Brookland and Union Station. Last Friday, I swear it felt like I was on the train for an eternity. From the moment he sat down, the old man went on and on about how ignorant Americans are and how we don't respect anything. At first his rant was annoying me - it was loud and half incoherent. Then as he continued, he generally just pissed me off. As I stepped of the train in Union, I almost turned and said, "Look old man, if you hate America so much...GO HOME!" But, I just let him make an ass out of himself and calmly exited the train.

Today when I was on Metro, I happened to think of the silly old man - partly because I had the same great luck of reaching the platform just in time to hear the announcement that the doors were closing. The more I thought of the old man, the more I couldn't help but think he was right. Last summer, I went to DC with my mom to do some site seeing. Whenever I'm in DC, I try to visit The Wall. We got to DC rather early, so we decided to head to The Wall first, and then hit the museums on the way back up the mall. Huge mistake - every freaking elementary, middle, and high school in the tri-state area had dropped their pupils off at the memorials. If you've never been to The Wall in DC, there is a HUGE sign before you start down the pathway that says "Quiet." Apparently these pupils were illiterate, because they were yelling at each other and singing stupid songs - just generally acting like idiots. I couldn't even get up to The Wall for the mobs of students filing past. The worst part is - yes, they were walking down the pathway, but they weren't looking at The Wall. They were blowing bubble gum bubbles and talking about prom and talking about football and pushing each other and listening to walkmen. The Wall is like a cemetary. It's not a place for ignorance and disrespect. It's actually more sacred than a cemetary. Americans weren't exactly accepting of the young men and women who fought in Vietnam. To many, this is all they've got. The students weren't respectful and quite honestly, the teachers accompanying these students weren't respectful. This disregard for respect spilled over to the Korean War Memorial where the high school students were playing in the fountain and running among the statues. They were posing with their friends with their arms around the soldier statues. I got so mad, I had to leave the area. I walked away from this trip thinking that you should have to be 21 to go to these memorials. And, I couldn't help but wish that a Vietnam veteran would've been at The Wall to put them all in their place. Unfortunately, they probably would've rolled their eyes at him and carried on with their bubblegum blowing.

I think the silly old man was right - Americans are ignorant and we don't respect anything. We don't respect our elderly, we don't respect our neighbors...hell, I don't even think we respect ourselves. The moral of this week's Metro lesson is "respect thyself and others." I think I saw this on Sesame Street about 20 years ago...am I the only person who watched that episode???

Is that hotdogs I smell???

I officially have six days left in DC and I can't tell you how happy I am. :) The rotation is going a lot smoother than it was three weeks ago. Today I had to bid farewell to one of the girls I work with. She is a clinical pharmacist at WHC and will be on vacation next week (my last week). Today, she showed me the morgue. I didn't venture inside - but I have to admit, I was intrigued. Surprisingly, it's not in the basement! The place I found during my first week was in fact the department of pathology. It's where they study tissue samples. They don't store bodies there. The real morgue...you're not going to believe where it's located. It's located BESIDE the cafeteria. This is why I saw the dead body on my first day. The "viewing room" is located directly across from the cafeteria entrance. Isn't that great? The critical care pharmacy is located on the other side of the morgue. Jenny informed me that you can tell when the freezer is on the outs. The entire ground level smells oddly of hotdogs - and it ain't the Nathans hotdogs cooking in the cafe. I don't think I'll ever eat a hotdog again!

As the end of my rotation draws nearer, I have to sit and reflect on where I want to go in pharmacy as opposed to where I thought I would go. This has been my first clinical rotation experience and I must say, I'm totally hooked. It challenges me. It makes me think. It is something different every day. I like it...and I don't think there will be any looking back from here. Every day I go, I become more determined to do a residency and work in a clinical field. I have worked in retail for two years and I have used my education more in the past 3 weeks than I did in the last two years at work. And...there are NO insurance companies! No assholes in India telling me that my patients can't have their blood pressure medicine filled at my pharmacy. No prior authorizations. No fighting over copays. Best of all - no monotony. I haven't sworn off retail, but I must say that I'm seriously considering not entering the retail field. It's a shame that WHC is in DC, because I would definitely take my preceptor up on his offer of job. It's this damn commute that's killing me...