I Wanna Be a Pharmacist When I Grow Up

Today marked the "official" last day of my cardiology rotation. Technically it was supposed to end last Wednesday, however my preceptor's 2 sons got sick (1 with tonsilitis and 1 with a severe ear infection) thus prolonging my rotation by 1 extra day. Last Wednesday was my last day to go on rounds, and today I only had to appear to give my presentation. My presentation went very well - with the exception of one evaluator stating that placing my left hand in my pocket was "unprofessional" and consequently docked me 2 points on "professionalism." That begs the question - what the hell is unprofessional about putting a hand in your pocket? I wasn't picking my nose...or worse, my ass. I wasn't gesturing rudely at the peanut gallery. I have a tendency to talk with my hands, which some people find funny. To avoid this when giving presentations, I place them in my pockets. Apparently, I have been an unprofessional fool for the past 4 rotations. Silly me. Aside from that, I did very well. And even Mr. Professionalism's docking of 2 points couldn't cost me an A. I averaged a 9.8/10 on the presentation. After my presentation, one of my classmates informed me that I should be a professor. she noted that my cool demeanor and ease of explanation would make me an awesome professor. Teaching is in my blood - my mother taught for 33 years and my grandmother for over 40. It isn't like I haven't given it thought. However, I never thought of myself as having the gift my mother and grandmother had. Perhaps I was wrong... So now I'm thinking...Dr. Ahsirt, professor of pharmacy practice...sounds nice. We'll see where I land. For now I'm just going to enjoy my 5 week break. I have residency applications to complete, a research project to finish, and Christmas cookies to bake. :) 5 of 7 rotations completed...home stretch, here I come!

Heights, Sights, and Twinkling Lights

I've come to realize that Thanksgiving isn't so much about giving thanks as it is about kick starting the Christmas season. My turkey hadn't even settled in my stomach before the Christmas shows started popping up on my television. And the sales...sheesh. Everything 99% off!!! I avoided retail establishments like the plague on Black Friday. Instead, I spent the day putting up decorations outside. I wrapped all my shrubs in little twinkle lights and inflated my Homer Simpson santa. Darkness fell before I could plug everything in. Today I went back out to plug in everything. I felt like the house was missing something...then I realized it. It would look so much better with lights outlining my roof. :) I drug out the ladder and set to work. The ground level roof wasn't so bad...but then when I got to the second story roof... I have never been on my roof. Truth be told, I'm scared to death of heights. I kept telling myself how bare the house looked and pushed myself onto the roof. I even got the extension ladder out and put lights on the second story gutters. After house was outlined, I plugged in all the lights around the house. I felt like Clark Griswald. I almost did the drum roll with my tongue when I plugged the master plug in. And true to Griswold form, half the twinkle lights were out...as were 2 strings of icicle lights on the roof. Luckily, the strands were on the ground level roof, not the second story roof. I dug through the box of Christmas lights and found 2 brand new icicle strands. Then I had to put gutter clips on them...and then it started to rain. A nice cold rain... But I got the lights up and the house looks very festive. Mission accomplished...now onto the inside.

The Goblet of Fire...a First Row Perspective

Disclaimer: Do not read if you have not read the 4th book or have not seen the movie!

I saw the fourth Harry Potter movie on Saturday night. We arrived at the theater at 6:30 for a 7:00 movie...and had to sit in the very front row. Let me just say, Voldemort was HUGE. The 2.5 hour movie left my back in a knots (not my wand Roma)...and my mind reeling. Let me just say that the movie is pretty awesome. It's a great action movie. However...as with the third movie, it does deviate from the book several times. For example, Winky and Dobby are not in the movie at all. That may not seem too important; however Winky appears in every book after the fourth one. Also, Winky leads you to discover Barty Crouch, Jr. In the book, Barty Crouch Jr is at the Quidditch World cup, but is invisible due to the fact that he is wrapped in an invisibility cloak. During the Death Eater scare, Crouch Jr steals Harry's want and conjours the Dark Mark. In the movie, Crouch appears at the camp site after the Death Eaters have burned the place to the ground and conjours the Dark Mark with his own wand. Another important point that is twisted in the book is in reference to the final 2 tasks in the Triwizard Tournament. The second task requires Harry to hold his breath underwater for over an hour. He can't figure it out. Moody gives Longbottom the book on underwater plants, however Longbottom doesn't put two and two together. Dobby steals Gillyweed from Snape's potion's closet. In the movie, Longbottom steals the Gillyweed. Finally, in the maze at the end of the movie, Krum acts very odd. In the book, you learn that he is under the imperius curse; however this is not even addressed in the movie. They state that the maze changes people - not true. Also, there are no monsters in the maze. The book has monsters and a sphynx; however Harry never encounters them because Crouch wants to ensure he touches the port key. I will say this...once the port key is touched in the maze, the movie follows the book almost to a "T." It is pretty incredible. Voldemort looks exactly as he did in my mind when I was reading the book. Ralph Fienes was an excellent selection for the part. Also, there is quite a bit of humor thrown in this movie. I laughed quite a bit. All in all it was a great movie; however if you're really into the books, it will be disappointing (just as the third movie was). I enjoyed the movie...in fact I'm going back tomorrow for a second showing. :)

Let Them Eat Cake!

Hearts, Birthdays, and Potter...Harry Potter

My "heart" is slowly recovering. He was moved out of the CVSICU on Monday afternoon. He's been fighting kidney and lung problems since the operation. He is so weak that he can't walk. But, he keeps his motivation and his determination to get better. Every day, when I go in his room, he motions me to his bedside and grabs my hand. He tells me how much he appreciates my dedication to him. His son gave me a hug in the hallway the other day. It's been a humbling experience. Who could've guessed that a pharmacy student could have such an impact on a patient? Not only have I been something of "cheerleader" for my heart, but I've also been monitoring his drug therapy. I've made 4 recommendations for changes in his drug therapy, all of which were accepted by his physicians and implemented. It's reaffirmed my faith in the future of pharmacy...as well as my desire to pursue a residency and solidify my future as a clinical pharmacist. My preceptor told me that I will make an excellent resident. She also recommended that I don't stop at a general residency. She thinks I would make an excellent cardiology or intensive care specialist. Intensive care has become my new love. I find the ICU extremely challenging and exciting. When my heart was in there, I'd work with his nurse for hours on end. It was awesome. In the ICU life is maintained with medications. My heart was receiving infusions to maintain his blood pressure and heart rate. It was quite amazing to see pharmacology from that aspect. So now, I'm thinking...intensive care specialty...2 years of residency...I like the sound of it. :)

Finally ~ my birthday. Ah, to be a year older...does it really matter after 21? Not really, with the exception of car insurance discounts and ability to rent cars (as Roma pointed out). I've now reached that age where birthdays simply mean "another year older" instead of "a right of passage." It's hell getting old... To maintain my youth, I had my mom buy me a birthday cake. I haven't had one in at least 5 years. The best part - it was Harry Potter! My brother's mother-in-law baked it. She had to call my mom to reaffirm my age. I'm sure it's the first Harry Potter cake she's made that she wrote "Happy 24th Birthday" on. :) I'm going to post a picture of it, because I won't be able to describe it correctly. Tonight, I'm going to see the 4th movie. Am I excited? Hell yes! I'm sure my brother and I will be the oldest people in the theater...and the only ones who can go out for a beer afterwards. Hey, they say you're only as old as you feel. Is it ok to feel like a 10 year old and drink a beer???? :)

Happy Birthday

Happy birthday to me,
Happy birthday to me,
Happy birthday dear ahsirt,
Happy birthday to me! :)

The Long and Winding Recovery

My heart's surgery did not go so well. He has hyperparathyroidism, and secondary to that his calcium levels are extremely high. The calcium deposited in his coronaries. He was on the table from 0930 to 1447 - and on the heart and lung machine for 91 minutes. That's a very long surgery and a very long time to be on the pump. I was in the CVSICU when he came out of surgery. His chest tube was draining an extremely large amount of blood. He had already received 3 units of blood and 2 infusions of platelets. He wouldn't stabilize and kept bleeding no matter how much protamine, aprotinin, and blood products he received. I stayed in the CVSICU until after 5 to be with him. He was pretty volume depleted and was actively bleeding. To make matters worse, the hospital ran out of platelets and required an emergency shipment of them. My heart didn't have that kind of time so he went back to the OR. When they opened him back up, his heart was covered in clots, so they cleaned him up and cauterized all the bleeding areas. He was on the table the second time for almost 3 hours. That's a lot of anesthesia for an almost-80yo man. He had a very bad night. By 0730 this morning, he had received 8 units of blood meaning that he had not one ounce of his own blood left him in him. Apparently when someone receives this much blood, they're factors can change and they need to be retyped before further transfusions. To make matters worse, his BP was 186/104 and HR was 114 when I got to the unit. They ordered an emergency x-ray and discovered a large effusion in the left chest. I watched the doctor place a chest tube in the room. Immediately 800mL of blood ran out of it. My heart started to stabilize. The rest of the morning was spent trying to get the heart to hold his pressures without pharmacological help. This did not occur until after 1300. When I came back from lunch, my heart's eye's were open and he had a little color in his cheeks. I walked up to him and touched his arm and told him who I was. He turned his eyes to mine and held contact for a while. He's still vented so he can't talk. The nurse told me they were going to try to wean the vent off tonight, so he may be on his own tomorrow. That would be great. Taking the vent off is one more step to recovery. The next hurdle that the medical team has to address is whether or not he has long term brain damage due to the operation and pressure fluctuations. However, we'll cross that bridge when we get there...for now, he's alive and finally stable. (Yes!!!)

When I left the CVSICU today, my heart's son waved at me. I walked into the waiting room where the whole family was. My heart introduced me to all of them before his surgery, so they all know me. His son thanked me for being so dedicated to his father and told me that I would do great in whatever field of pharmacy I enter. That was so rewarding. When I left, his sister told me that it meant a lot to my heart and a lot to his family that I was so dedicated to him. This is the reason I went into health care. To know that I am helping someone is tremendously rewarding for me. I love my field...I love it more every day. :)

My Heart...

My cardiovascular rotation is going really well...a lot of work but good nonetheless. Part of my responsibility on this rotation is to follow several patients from admit to discharge. Since I'm on the cardiology unit, most of the patients are post-surgery or post-MI. Anyone who undergoes CABG (coronary artery bypass graph) is affectionately called a "heart." I had a heart last week - a really nice guy whose daughter is a pharmacist (read - totally open to pharmacy intervention). Yesterday, I got a 79 year old chest pain patient in the CCU. Since he was having a heart catherization, I was allowed to watch his procedure. I rode down in the elevator with him, talking to him. When we got in the cath lab, I had to go behind a window for protection from the x-rays. He couldn't find me, so he started yelling, "Where's my student? Where's my student?" The lab technician talked into a microphone and told him that I was behind the glass. He calmed down. During the procedure they discovered 4 blocked vessels. He was not receptive to CABG at all and wanted stents placed; however the cardiologist didn't think stent placement was a good idea. After the procedure, I went to his bedside and talked with him. He grabbed my hand and said he was scared of surgery. His eyes got all teary...and so did mine. It was heart breaking because I knew I couldn't change that. I went with him back to his room and stayed with him until he was settled. After lunch, I went back to him and he told me he was going to have the CABG because he still had a few more things he wanted to do before he died. I almost cried right there. I told him that he would be in my prayers and he thanked me. He undergoes the surgery tomorrow at 9:00am. From that point on, he'll officially be my new "heart." Unbeknownst to him, he's already become my heart.

Beast of the Big East

My cardiology rotation is going well. I particularly like the part where I get to leave around 1:00 every day. I can handle a 5 hour day. This week I followed a CABG x 3 patient from recovery to discharge. It was pretty awesome - and my patient was hilarious. The day after surgery, we were sitting in his CVSICU room discussing his surgery and the discomfort of the chest tube when he says to me, "So can I go home today?" This guy was incredible. Less than 24 hours before, he had his rib cage sawed open and his heart stopped. He was ready to go - he was up walking around dragging his IV pole and chest tube bucket all through the CVSICU. The nurses were finally like - Get out! Ha! He was discharged to the cardiac floor for 4 more days of recovery. I saw him 2 days post-op and he was kind of glad he didn't go home. His epidural had faded away and he was feeling some pain - but nothing a little Lortab 7.5/500 couldn't handle. I was pretty impressed that he was comfortable with ketorolac IV (an NSAID like ibuprofen) and Lortab po as needed. After surgery, all CABG patients get a huge red, heart shaped pillow to put on their rib cage when they cough. When they are impressed with someone's care for them, they ask them to sign the pillow - I was the first to sign his. I was quite honored. He's going home Sunday, so I had to say my goodbyes today. He's doing great - and wouldn't be surprised to see him back to normal in a few weeks. So enough about my rotation...

HOW ABOUT THEM MOUNTAINEERS!!! I left my rotation early (or should I say earlier than normal) on Wednesday to head to Morgantown one final time this season. As always - Morgantown was awesome. It was 41 degrees and quite chilly - but nothing a few beers and shots of schnapps couldn't fix. I also accomplished something that I have been promising to do for two years - watch Brandon Barrett play at WVU. Brandon went to my high school and was quite the football star. A two time Kennedy Award winner, he finally got his first playing time at WVU. His dad and I worked together at the cement plant a couple summers ago. (Kevin Pittsnogle, the center for the WVU basketball team, is also from my hometown - his sister and I played basketball together in high school) WVU moves to 5-0 in conference play and 7-1 on the season. We got back Wednesday night, or I should probably say Thursday, at 1:45am. I was on cardiology rounds at 8:00am - 4 hours of sleep is painful. But it was totally worth it. :) Let's go Mountaineers!

And Now I Introduce Murphy....again

Yesterday I started my cardiology selective rotation. This is the one rotation that I have been looking forward to since I got my rotation schedule. From the looks of it, it is going to be pretty good - a lot of work, but good nonetheless. On the way home for my rotation yesterday, I started to smell what I thought was burning rubber. I looked in the fields along the interstate to see if someone was burning something. I didn't see anything. Then my car started to act odd. I made it home (the mechanic doesn't know how) and found my rear wheels to be EXTREMELY hot. I mean the heat was just emanating from them. Come to find out, the rear brake calipers locked up. Very nice...does it sound expensive? Because it is! $800 later, I still don't have a car. The mechanic did not have the parts in stock but promised me he would have them this afternoon. I borrow my dad's Avalanche for the day - not even thinking about the height restrictions in the parking garage. When I got to the hospital this morning, I saw a sign that said, "Clearance 7'7"" Hmmm...is the car that tall??? I had no idea, so I figured what the hell and pulled in. I was doing fine until I came around the corner and met a light hanging from the ceiling. I didn't hit it...but I had to just barely clear it. I am supposed to park on the fifth level, so I wound my way up through garage in pursuit of the fifth level. The sign for the fifth floor reads "Clearance 6'6"" I was pretty sure I wasn't going to clear that one. I didn't want to try it and get the truck stuck on the ramp, so I parked on the far end of the garage. Thanks Murphy for another swell start to a rotation!