Letter to US News

My mother cut an article out of her US News & World Report which addressed Plan B and pharmacists. It was written by a medical doctor - and it couldn't have been more correct. The article is entitled "Ask and You Shall Receive." Here's my response:

It was very refreshing to read the "Ask and You Shall Receive" article by Dr. Bernadine Healy. Having just graduated from pharmacy school, I have debated this topic heavily with fellow students and colleagues. It is my impression that most of the fury over Plan B comes from misconceptions about the medication. As Dr. Healy correctly points out, Plan B will not affect an established pregnancy. It acts just as regular birth control pills would - it thickens cervical mucus, prevents ovulation, and prevents implantation of the fertilized egg into the wall of the uterus. It is not RU-486 - as it does not initiate an abortion. In response to the "pharmacist conscience" clause, it unfortunately does not end with Plan B. It has been extended to encompass regular birth control pills as well. It is not unrealistic to envision a pharmacist refusing to sell a package of condoms. I'm not sure where members of my profession obtained the misconception that they could impose their beliefs on patients. It is ethically wrong in my opinion. If we permit a Catholic pharmacist to deny a FDA approved medication based on their belief system, where do we draw the line? The Islamic faith does not permit individuals to use alcohol - whether it is for medicinal purposes or not. Many medications in liquid form do contain alcohol. These are not just cough syrups, but life-saving medications such as phenobarbital for seizures and digoxin for heart failure/atrial fibrillation. This could be a very slippery slope indeed. It's time pharmacists stop pushing their beliefs and start respecting their patients.

Ashirt, PharmD

(It feels great to put the PharmD after my name) :) :) :)

Law Exam Anticipation

The Meaning of Memorial Day

This is one of my all time favorite political cartoons - in fact, I ran it on the blog last year at Memorial Day. While many Americans believe Memorial Day is the gateway to summer, there are a few of us who still remember what Memorial Day really represents. I think this cartoon pretty much hits those sentiments. Lest we forget that freedom is never free.

After spending 6 weeks at a Veterans Affairs Medical Center, I know what Memorial Day means to me. The vet population is amazing. When I reflect back on my rotation experiences, those that stand out the most are from the VA Center. One of my most vivid memories occurred while I was working in their Coumadin clinic. An elderly veteran in a wheel chair came in to have his blood evaluated. He was quite spunky - a real character. But, I saw tears in his eyes when he showed me a picture in his wallet. It was taken at Pearl Harbor on December 6, 1941. It was a picture of his platoon, all smiles, with a sign that had their platoon number on it. As we all know, the next day, the Japanese attacked Pearl Harbor. He was one of the few survivors of his platoon. In his wallet beside this picture was a card issued by the US Government declaring him an official survivor of Pearl Harbor. Chills ran down my spine when I looked from the picture to the survivor card. They still do when I think about this experience.

When I selected this facility as the site for my residency, I caught a lot of resistance from many people. There apparently is this misconception out there that sub-standard doctors, nurses, and pharmacists work at VA Centers. That just simply isn't true. To those who questioned my choice, I say - it is an honor and a pleasure to serve our vets as a pharmacist. :)

Healthcare Crisis Victim

For the past year I have been sans health insurance. When I turned 21, my parents' insurance companies decided it was time for me to go - regardless if I was pursuing a degree or not. I lost my insurance through my previous employer last July because I "didn't work enough" - which is pretty hard to do when you're "volunteering" 40 hours a week for pharmacy rotations. My retaliation consisted of me quitting my job and giving a very pissy exit interview (probably should've heeded that 'pharmacy is a closed community' advice, but I was pist). All this being said, I have been extremely lucky to not require healthcare. Sure, I get a prescription filled every 3 months and dish out $150 - but beyond that, I'm a pretty healthcare-less person. Unfortunately, I am now nursing an injured knee. I'm still not sure what is wrong - RICE appears to help, but only temporarily. The swelling is reduced but still is limiting my range of motion. My mother insists that I see the doctor. This sounds great - except I'm pretty sure $100 won't even touch the diagnosis part of the visit. My mom recently injured her knee and the MRI alone cost $1500. $1500?!?! How about I give them $1.50 and they run a bar magnet around my knee? I honestly don't know how individuals without health insurance survive. God help you if you are in need of emergency care. My grandfather recently went to the ER for shoulder pain, $5000 (not including x-rays) later he has a bruise. It cost them $5000 to tell him he has a bruise? Of course it doesn't.

From working in community pharmacy, I know how the health care system works. And now, I'm going to sell them all out. Sit down for this one. Insurance company reimbursement is significantly less than what the pharmacy (I'm sure this holds true for physicians, dentists, hosptials, etc) would like. This is especially true with institutions such as Medicare and Medicaid. Often times with Medicaid, we actually lost money on prescriptions. The pharmacy has to make up this slack somewhere - and they make it up on the non-insured person. Newsflash - 20 tablets of generic ciprofloxacin does not cost the pharmacy $75. The entire bottle of 100 tablets costs the pharmacy somewhere between $5-15 (depending on the warehouse purchased from). Granted, the pharmacy has to collect a dispensing fee, but it doesn't have to be with 500% profit. So, the person who really needs the price break doesn't get it - because they are the "cash cow" for the pharmacy. The most sickening thing I remember from retail pharmacy was the "switch the patient from brand to generic drug" speech. At first, I was all for it. I hate drug companies. But then my manager showed me the real reason for switching patients from brand to generic - profit margin. Our profit margin on brand name Cipro was something like $5. Our profit margin on generic ciprofloxacin was $70. Yes, the patient saved some money by switching to generic, but the pharmacy made money switching the patient. Very sickening. I'm still an advocate for community pharmacy, but after being a "cash cow", this advocate is losing her zest.

Not a Carpenter

Today I realized that I'm blessed to be knowledgable about drugs, because my carpentry skills leave a lot to be desired. In all actuality, they're probably not that bad, but by my OCD standards they are horrible. Many of my graduation gifts were in the form of things that hang on the wall. A family friend provided me with the requisite diploma frame. My sister and her family purchased 2 awesome signs (side note - she purchased them in New Orleans pre-Katrina and feared they washed to sea with the rest of New Orleans after Katrina hit. By a stroke of luck, the store had a flagship store in Missouri which was able to send them.) The first is a history of pharmacy bejewelled with every stamp commemerating medicine since the early 1800s. My name is on a gold plate at the bottom. The second sign is just amazing. It's a solid wood sign with "Registered Druggist" painted on it and several products are depicted (example - cathartics and liquor cures). Below the sign hangs another wooden sign with my name. I also had to hang my awards from the hooding. Needless to say, I spent the entire afternoon with a level, drill, hammer, and several different sized screws. In three hours, not only did I manage to hang all of the gifts, I also managed to fall off the ladder (further injurying my knee), mismeasure the distance between two hangers (resulting in the need to drill 3 holes in the wall rather than 2), and place an unknown substance on my diploma frame. All problems were remedied.

As for other awesome gifts (which get a bonus for not requiring the use of a drill or a hammer), include a laudanum bottle from the mid-1800s and a book entitled Gray's Elements of Pharmacy 1889. Both very cool - and much easier to display. Those who know me well will understand the significance of the laudanum bottle - which is now the most prized bottle in my collection. It even has the cork stopper in it! My narcotic collection is growing nicely, for I am now the proud owner of Tincture of Opium, Glyco-Heroin, and Laudanum (all empty of course). Now I'm going to cook up some Acetum Opii (a recipe from Gray's) - 10 parts powdered opium, 3 parts powdered nutmeg, 20 parts sugar, and QS 100 dilute acetic acid.

Thou Shalt Not Drink and...

Saturday amid all the graduation celebration, I found myself slightly inebriated. I would say "buzzed" is the buzz word for this condition. After leaving the restaurant on Saturday, I stepped of the curb onto main street and stumbled. It has become apparent to me over the past couple days that when I stumbled into main street, I twisted my knee. It is now the size of a cantaloupe and the swelling is inhibiting my ability to straighten it fully. I fell asleep last night with and ice bag on it only to be awakened at 3AM drenched in ice cold water. Something popped a hole in it in the middle of the night - I have a feeling it was probably my cat's claws. First post-graduation lesson - do not drink and stumble into main street. This lesson, I feel, will come in handy all throughout my life.

Fate Hates Me

Three months ago, my parents and I planned a trip to Boston for my graduation. It consisted of 2 1/2 days in Salem and 2 1/2 days in Plymouth. Yesterday I was watching the Weather Channel and was astounded to find that it's been raining quite a lot in New England. Yesterday the tally was something like 17" in Massachusetts. Then I saw a breaking news session in which the governor of Massachusetts declared a state of emergency due to the flooding. Apparently they haven't seen rain and flooding like this since 1936. Today I called and canceled the reservations out our two hotels. We have decided to take a two day tour of Lancaster and check out what the Amish are doing (which according to my sister is pretty much what they were doing 200 years ago). Murphy rears his ugly head again!

Is There a Doctor in the House?

The title of this post was repeated several times this past weekend as my family and I celebrated the culmination of the past 6 years - the earning of my Doctor of Pharmacy degree. This is apparently the new buzz word (if you would've attended the hooding ceremony, you would understand this). My name was called by a woman who looked like she escaped from the England section of Busch Gardens. Her robes rivaled only those of William Shakespeare. Her hat was slightly askew as if to say, "I've had one gin too many this morning." Nonetheless her dislike of pharmacy was evident. To her I say, kiss my doctor ass and it was I who screwed up your processional. Whoever thought of having the graduation ceremony outside should be shot. Under my gown and pharmacy hood, it was about 90 degrees. I decided after sitting in the sun from 11AM to 2:00PM, it was time for me to exit. I figured it was fitting for the Doctor of Pharmacy to follow the professors out of the ceremony. This apparently was not her design. Oops! For dinner, my entire family went to a chic place downtown. We ordered drinks for a toast, but forgot to toast. Then we ordered shots of "chocolate cake" (an interesting combination of Frangelica, Absolut Citron, and a lemon wedge). You know you're putting away drinks when the bar runs out of shot glasses. After dinner we had another round of shots, and at this point we did have a toast. We all then returned to my house for homemade sangria and more "chocolate cake." It was a great evening. It's been a long time since we all got together and laughed that hard. Very fun - and now I need a couple days to recouperate.

As far as my feelings about graduating and the "goodbyes" - I'm still a little torn. I'm not much for goodbyes, I usually run from them - but I didn't really get to say goodbye after graduation. Everyone just kind of disappeared. I met Ryan at the top of the steps and we hugged, but I'm not sure we said goodbye (he's pretty clear on my policy about goodbyes). Grafs and I found each other for one final cap & gown portrait. But everyone else just vanished. I'm still having a recurring dream, which I thought would finally end. Maybe with time it will eventually vanish as well. We'll see... But for now, the doctor is in - as are her allergies (again, the person who decided to have graduation outside under trees and in grass pollen should be shot). Pass the Sudafed.

In Da Hood

Today was my pharmacy hooding ceremony. Reality didn't hit until I entered to auditorium to Pomp and Circumstance being played on a violin. The violin player was awesome, but it did make it sound a bit more like a funeral procession than a graduation procession. It was one of the honors of my life to have two members of the faculty drape the pharmacy hood over my shoulders. As I sat on the stage listening to our keynote speaker, I found myself transforming from student to pharmacist. After I was hooded, the Dean of Students handed out awards. I am proud to say I was awarded the APhA Mortar and Pestle Professionalism Award. The award consisted of a hand-turned oak mortar and pestle and a chance at $2,000. Being that I'm the poorest I have ever been in my life, $2,000 sounds mighty nice. I was sitting whispering to my neighbor when I realized my name was being called as the recipient of the 2006 pharmacy senior of the year. It consisted of a very nice certificate matted and framed. It was presented by the alumni association. Very cool. After a couple more recognitions, I stood to take my Oath of a Pharmacist. I walked onto the stage a student, and walked off a professional.

I received an email this afternoon from a professor who is currently undergoing chemotherapy and was unable to attend our ceremony. He addressed me as his colleague and congratulated me on my accomplishments. It was very moving. His wife was at the ceremony today and gave me a hug. She said that she came because he asked her to be there for him. He sent his congratulations for me with her. She made me cry. The entire ordeal that their family is living pains me so much. The fact that he was sitting in a room, having poisons pumped through his veins while we were all celebrating saddened me - and yet through it all, he only is thinking of accomplishments of our class. He's an amazing man. I honestly hope I can have his drive and dedication to the profession after practicing for 10 years.

Graduation countdown: 12 hours. So - here's to graduating and being a pharmacist. The next time I post, I'll have a few extra letters after my name. :)

Graduation Countdown: 2 Days

Today I completed the final day of my NAPLEX review session, which led me to conclude that I wasted $500. We totally skipped psychiatric drugs and the review of chemotherapeutic agents consisted of "They are listed in Table 1,250 for your reference." Thanks for that. I could've read that for myself. This evening was the rehearsal for my hooding ceremony. I've been waiting for this for six years, yet even as I sat on the stage listening to the agenda, I really couldn't grasp that in two days I will have some extra letters at the end of my name. Being cursed with a last name that starts with "W", I have earned myself a seat in the seventh row of students. I am sitting beside a very smell individual, who also is an honor code violator. Now, what did he do? Oh yea, he alledgedly traded sexual favors for test question answers. I find this quite amazing because the smell wafting my direction from his body was atrocious. No passing grade would ever be worth that. I'm swabbing Vicks Vaporub in my nostrils before the ceremony tomorrow. It wouldn't be fitting if I didn't stick my foot in my mouth one more time before the end of my academic career. As the dean was lining up students alphabetically, the student in the post below wasn't paying attention (surprised? I'm not). When he didn't get in line (I didn't know he actually was present), I said very loudly, "Surprise, he's not here." I was then informed that he was...at which point I made eye contact long enough to show my disgust and discover that he's still as clueless as ever - at least I don't have to stand beside him. However, I'm pretty sure he doesn't smell.

All in all, I think I'm finally mentally prepared for tomorrow and Saturday. I was stressing out about a couple things, but have settled them and decided that it is time to walk away. Closure is a good thing.

More on Honor...or Lack Thereof

As I said in an earlier post, yesterday I presented my practicum project. Half of the class presented theirs in December and the other half presented yesterday. At each of these sessions, members of the faculty selected the top 5 practicums, for a grand total of 10. Today they announced the final top 5 winners. To the surprise of pretty much the entire graduating class, a student who isn't even graduating with us due to an honor code violation received one of the top five. To me, this is an insult. He's an individual who has lied and cheated and been caught at it at least twice. My point - if you lie and cheat your way through pharmacy school, you will lie and cheat your way through the profession. It's people with his ethics and morals that have caused pharmacists to no longer be the most trusted profession. My anger is less with him than it is with the university. They won't let me wear my Rho Chi honor cords at graduation because "wearing the hood is honor enough." Well, I beg to differ. Standing on the stage with people like him is NOT an honor. It's embarassing. He won't even be receiving a diploma on Saturday because he failed a clinical rotation due to his lying. They're letting him walk in the ceremony and recognizing him at our doctoral hooding for his accomplishment. And what an accomplishment it is - lying and cheating his way to a PharmD.

Pleasure and Honor

I rolled out of bed this morning at a little before 6AM so that I could stop to vote on my way to my NAPLEX review. The polling place had a few individuals, but since all of them were scared of technology, I was able to vote right away. Our county just received electronic voting machines. For those afraid of the technology, there are still the old paper ballots. I was the first person to use the electronic voting machine at my precint. The right to vote is a freedom I take very seriously. Since turning 18 six years ago, I haven't missed an election yet - whether it be primary, general, or special. Today I took great pride and pleasure in touching the box beside Senator Robert Byrd's name for his historical 9th term in office. Yes, I know he still has to win the general election in November, but I think he's shoe in. :) It will be a great honor to select Senator Byrd's name in the general election this November. With Bush's approval rating at an all time low and non-existant Republican ethics, 2006 just very well may be the year the Dems retake Congress, both the House and the Senate. Now, to place that Byrd for Senator sign in my front yard...

Graduation Countdown: 5 Days

My checklist of things to do prior to graduation is slowly getting smaller. I ticked off law review and class party on Friday and Saturday, respectively. Today I ticked off practicum, laptop exchange, exit interview, and progression exams. Practicum went well. After no less than 3 presentations of my findings and at least 3 pictures, I was allowed to pack up my board and cross it off my list. Laptop exchange was painless - simply signed the dotted line. Exit interview allowed me to express my disdain with our school's teeth-lacking honor code policy. Progressions weren't bad. Increased my confidence with kinetics and my pharmacy math skills - and alerted me that cardiology truly is my forte and I should probably spend less time studying that and more on other topics for the boards. Tomorrow I start my official Kaplan NAPLEX review. Kaplan called my house this evening to inform me that I had been emailed directions to the center providing the review as well as information on hotels and restaraunts in the area - which helps since the review center is my pharmacy school (snicker).

This week also marks the influx of graduation presents, which is always fun! So far I've added cash, diamonds, electronics, and memorabilia to my collection - and it's only Monday! :)

Senate Bill 1955

Turncoating on Genocide

During his first term in office, President Bush said about the Rawandan Genocide, "Not on my watch." This pledge apparently was just as half-hearted as his pledge to fire anyone in his office affiliated with the CIA leak and his pledge to investigate price gouging in the oil industry. Two years into his second term, genocide is occurring - not in Rawanda, but in the Sudanese region of Darfur. It is on his watch, and he's not doing anything about it. This is not a recent occurrence. War erupted in this region in 2003 and conditions have been seriously declining since late 2004. Now 2006, it is a humanitarian crisis. According to SaveDarfur.org, "Not since the Rwanda genocide of 1994 has the world seen such a calculated campaign of slaughter, rape, starvation and displacement." The World Food Program, the UN, and the Coalition for Internation Justice report that 3.5 million people are now hungry, 2.5 million have been displaced due to violence, and 400,000 people have died in Darfur thus far. It's time to hold President Bush to his word. To sign a postcard denouncing the genocide and asking President Bush to stand strong in his pledge, go to this link: SafeDarfur.org.

Damned Liberal

This past Tuesday marked the final "Lenten" bible study with my neighbor. (Yes, I realize Lent ended 2 weeks ago - but we missed a couple weeks) Let me just say this - had this been the first bible study, it would've been the last. This event brought out everything that has driven me away from religion - hate, name calling, and damnation. Worst of all, by the end of the evening, the fingers were pointed at me and I was being called a liberal *gasp*. I, being a liberal, was not offended by this. I think it was the part about "liberals ruining this country" that really got under my skin...that and the "men are morally superior to women" sermon. Apparently, women are weak creatures who must depend on men to show them faith. It was at this point that I reminded the group that when Jesus was crucified, the men fled. They got out of dodge while the getting was good. It was the women who stayed. It was women at the foot of the cross and it was Mary Magdelene whom Jesus first appeared to after the resurrection. Sounds like the men in that story could've used a little more faith. They didn't have an answer to my response. Then I had to listen to emails from the American Family Association (read - extremely right-wing conservative think tank). I replied to those by saying that I watch the real "fair and balanced" new - CNN. This went over the Fox News watching ninnies' heads. I stormed out of the house listening to my consceince tell me not to lose my faith. Those who know me well, know it's events like this that push me away from religion. But then I was reminded by my brother that Jesus himself was a liberal. He recommended that I tell my neighbor this the next time I see her - we both know she'd drop dead in the driveway. Liberal is one of those dirty words. But the more I thought about it, the more I realized my brother is right. Jesus crossed social barriers. In a time when the lower-class of society was cast aside, he was there entering into fellowship with them. In a time when women were viewed more like property than equals, he was standing side-by-side with them. He rebuked the system. He was a liberal. Damned liberals...we're everywhere. HA! :)