The Long, Hard Fight

My patient passed away at 2:15 this morning. Yes - that's right, 11 hours after life support was turned off. It just makes me wonder. It seems as though he fought it to the very end. My only wish for him is that he didn't suffer. We tried to keep him comfortable with morphine and lorazepam. How comfortable could he honestly have been? I don't know. Everyone was subdued in the ICU this morning. I walked in at 8:00 and the janitor was scrubing the room. The nurses who had come on shift were just standing and staring at him. It was eeriely quiet. I took a moment to reflect on him and hope that he really was in a better place. His granddaughter's hand drawn pictures were still hanging on the wall in the room. They wished him a speedy recovery and told him how much she loved him. I got a little emotional thinking about it.

The highlight of my day occurred at 9:45 this morning. I was returning to my office from the inpatient pharmacy, when a crippled African American man asked me to hold the elevator for him. When he got in the elevator, he asked me where 1A-171 was located. I told him I wasn't sure, but that I'd help him find it. I escorted him around the first floor until we found his location. When I departed him, he thanked me repeatedly and said, "God bless you." He made my day. :)

Emotional Week Thus Far

Today at 3:16PM we removed the ventilator from my patient in the ICU. I've been with him since he was admitted on 1/5/07. I sat in my office and blinked back tears. My only hope for him is that he can finally have some peace. I went in to see him this morning. He looked so ill - his eyes were glazed and rolled back in his head. His skin was puffy and yellowed. He looked so miserable. Whenever someone touched him, his oxygen saturations would drop in the 70s and his heart rate would jump up to the 140s. It was as if he was saying, "Please leave me alone." At 6:00 this evening, he was still alive - breathing on his own, but his oxygen sat was 61%.

I went out this evening with several of the pharmacy team members. We christened the new BW3s as an official VA hangout. The B shift pharmacist came in at 7:00 and updated us all on my patient's status. A fellow pharmacist's son kept hitting on me throughout dinner - problem here would be that he is 16. HA! Other highlights of the evening - waiter forgetting to place my order and waiter losing my credit card. At the end of the day, the beer was good and the wings were great. It was a much needed unwinding after a very emotional day.

Not An EMT...

Today was rather eventful - and very, very busy. This morning I learned a very valuable lesson - I am not EMT caliber. While in the ICU this morning, one of my patients went into respiratory distress. He's on a ventilator and his oxygen sats dropped to 75%. The physicians and I entered the patients room. I was horrified. The man has a trach in place, so the ventilator hooks to that instead of the endotracheal tube. He's been off sedation for roughly 2 days so, his eyes were open. His head was moving side to side rapidly, which indicated extreme distress to me. His eyes were wide open with a pleading look. His respiratory rate was 35-40, with no improvement in his sats. I found my heart beating extremely fast and I started to hyperventilate a little. The physician increased the man's ventilator support and gave him some nebs. Over a course of about 5 minutes (which seemed like an eternity to me), his sats came up to mid-90s and his respiratory rate dropped to the low 20s. At this point, I glanced around the room and found the pictures his granddaughter drew him. I became a little emotional. I felt tears welling in my eyes. I backed up against the wall and tried to compose myself. I slowed my breathing and blinked back the tears. It was a little overwhelming. I don't think I am EMT material...being as they'd probably have to transport me via ambulance from the scene. I'm sure that would go over well. HA!

On a more positive note, I did ace my BCLS recertification today. It took me all of 5 minutes to take the written test - which I scored a 100% on. :) Fortunately for me, there wasn't a "must keep composure" section to the test. Otherwise I would've flat out flunked it.

Ahsirt - Director of Pharmacy Services

So, Mr. Tramadol came looking for me at the outpatient pharmacy. He was looking for Ahsirt, Director of Pharmacy Services. *snicker* You gotta love this guy. I'm just a lowly resident and he thinks I'm the director of pharmacy. I guess it's not entirely his fault - if someone denied me medicine, I'd think they were pretty powerful. Alas, I'm just a lowly resident who gets to recommend denial. I suppose to idiot doctor forgot that important word.

Today I staffed the outpatient pharmacy. I actually have grown to like staffing on the weekends. There's something almost relaxing about running the pharmacy. Today flew by - between answering the 15 non-formularies pending from yesterday (was everyone on vacation yesterday, or what?), completing all the pending mailers for 2 of our clinics, and checking at least 100 prescriptions to be mailed, I didn't have much time to think about anything else. I guess I've even found staffing to be therapeutic for my mind which tends to want to dwell on the past...

My insatiable desire to be part of the critical care arena has led me to consider becoming an EMT. I'd love to be a critical care pharmacist; however another year of residency just does NOT interest me. I figure I might be able to feed this desire by becoming an EMT. This will be the third time I've considered making this move - but the first time that I actually looked up when the classes are offered. It appears as though I just missed one. Go figure. Next step is to stop at the volunteer fire department I'm thinking of joining. A little birdy told me if I join, they'll pay for my class. Very nice. This should also help feed my desire to be near firemen. HA! Kill 2 birds with one stone. ;)

Absurd moment of the day: Old Veteran - "I used to have my blood monitored at that clinic with Diane." Me - "She was a really nice lady." Old Veteran - "Yea she was, but you know what? She finally got my blood stable and then she went and died." Me - "..." Old Veteran - "I really don't know why she had to do that to me." Me - "I really don't think she died on purpose. She was very ill." Old Veteran - "Well my blood just hasn't been right since. Don't know why she had to go and die.."

My Week Thus Far

I'm sure glad my funk has gone, because this week + my funk could've been lethal. HA! Here's the low down...

Monday ~ Fireman called again. We rehashed our entire relationship. It felt good to finally get some of the stuff out into the open. This was culminated by a telephone call at 12:30 from a friend that I haven't been entirely close with for a couple years. I'm just emotionally rung out over him and the whole situation. After all of this, I felt slightly numb...but I didn't hurt. I think I really have pulled out of the funk. I went to bed at 2:00am and got up at 5:45am.

Tuesday ~ Day from hell in the ICU. Completed no less than 20 non-formulary requests... I pulled the door shut to my office at 4:45 and realized that I left the keys to get into the office lying on my desk.

Wednesday ~ HA! The diamond of the week. After roudns in the ICU this morning, I was greeted with several messages from a patient. He apparently was given my name and telephone number by one of the idiot docs. I answered his non-formulary consult for excessive tramadol yesterday - I recommended denial. The chief of mental health agreed with my assessment and denied the request. This apparently made the patient not so happy. He wanted to know why I wouldn't let him have his pills. The last thing I needed today was a guy with a substance abuse problem yelling at me about his lack of opioid receptor activation! So, I passed it on to my supervisor, who passed it on to the chief of mental health. Taken care of. Then I had P&T this evening which was made oh so very special by a especially lovely nurse. I just wanted to get up and point at her badge and say, "See, that says R.N. - as in registered nurse; not medical doctor." But I played nicely..and bitched afterwards. Now I think I'm gonna have a beer and put this day to rest!

**Song of the Week: Teddybears - Punkrocker**

Forecast 2007 - Better

Ok - so Roma informed me that not only were my wishes weak, and self-serving, they also lacked creativity. He's harsh these days. So, I turned up some music, and really sat down and thought about what would make 2007 better. Hope this is up to snuff Roma...

1. Exit strategy from Iraq. Sorry, but this still stays #1. The answer is NOT more troops or more money - the answer is to get the hell out now.

2. Peace in Darfur.

3. Lift on stem cell research ban.

4. Access to health care for women with out JUDGMENT. Case in point - I called my pharmacy to find out if they could order Giardasil for me (the HPV vaccine). CF, the religious zealot pharmacist, asked me if I was promiscuous. I proceeded to educate him on the importance of all WOMEN and young girls to be vaccinated againt the virus that can cause cervical cancer. WTF?

5. Plan B OTC access to be granted to those under 18. I mean, honestly, I'd rather the 15yo get the pills than a 25yo. Who thinks up these rules?

6. Pharmacists to leave their religious convictions at the door. Behind the counter is not a place to preach. Contrary to popular belief, the counseling booth is NOT an altar. Get over it or get out of the profession - PERIOD.

7. Democrats to grow a backbone. For God's sake, we got Congress, now let's do something with it! For example - get out of Iraq; ban drilling in Alaska; block conservative judges; put ethics back in politics; etc, etc etc.

8. Abolishment of the PATRIOT Act. There is nothing patriotic about suspending civil liberties.

9. Trash "No Child Left Behind." Kids are getting dumber - now instead of teaching subjects, we're teaching tests. Why? Because now teachers are judged based on standardized test scores.

10. Increase benefits to our veterans. We're sending them to a war that is sending them back broken physically, emotionally, and mentally. To add insult to injury, we keep cutting veteran benefits. It's time to take care of these guys.

Wishes for 2007

Roma suggested that I stop focusing on the past and start planning for the future (or something like that - I think I added a few words to what he said, but you have to admit I put it more eloquently). This past week was a step in the right direction. I'm starting to pull out of my funk and starting to realize that I am satisfied. I started in the ICU this week...and it was awesome to say the least. I didn't run any codes, and I didn't have any life threatening cases - but it was exciting nonetheless. In between medication reconciliation and drug presentations, I started to think about what I want from 2007. Some of these wishes are altruistic, and some are just plain selfish - but they're my wishes so I'm ok with that. :)

1. An Exit Strategy
~This definitely leads the list this year. I think working with JW has made me want this even more. I see a shattered 22yo guy who will never be the same - all for a political war. I see lots of these guys on a daily basis. It's time to get out - period.

2. Employment
~The first of many selfish wishes. My residency ends in June 2007, and now that I can see the light at the end of the tunnel, I'm starting to get a little jittery about my future. Should I stay at the VA? Can I stay at the VA? Where else can I go? My wish is that it all just falls together and I reap the rewards. :)

3. Happiness
~The most childish wish on the list. After a tumultuous 2 months, I'm ready for some happiness. I'm starting to get there. I think this past week opened some big doors. I don't gain happiness from material things - which makes me different from a lot of people. Don't get me wrong, money is nice - but personal interactions are more enriching. So I guess I'm hoping 2007 is full of more smiles than frowns - and more people who give in return rather than take and take and take.

4. Concerts
~HA! 2006 was filled with only 1 concert - which is extremely weak for me. My dream list for this year includes Buckcherry (always #1), AFI, Green Day, U2, My Chemical Romance, Poison, Cinderella, and anyone else who can make me scream. :)

Goodbye 2006 - Hello 2007

2007 rang in this morning with the usual fireworks and hoopla. As with most things, today felt no different than yesterday. I'm not into the whole "resolution" thing, so I figured instead of planning for the future, I'd reflect on the past today. Below is my list of the top 10 things in my life for 2006.

10. Poison-Cinderella 20th Anniversary Tour
~Concerts are always the highlight of my life. I try to see these guys every time they come around. I've been a fan since I was just a youngin'. Also, it's the one thing that my brother, sister, and I can all do together. We all have different interests and different priorities, but we put them aside when it comes to Poison. HA!

9. Lyme Disease
~I never thought I'd find myself wishing I had Lyme Disease; however when faced with being diagnosed with rheumatoid arthritis, Lupus, or Lyme disease - Lyme was definitely the pick of the litter. After 28 days of doxycycline, I was "cured" and have been pretty healthy since. All in all, Lyme disease gave me an appreciation for those that are crippled.

8. WVU vs. Marshall
~I was only able to attend one WVU game this season, and I'm glad it was this one. It was the season opener. And even though we didn't become national champs, the thoughts were in the air at this game. It was exciting and energizing.

7. Church
~2006 truly was the year that reaffirmed my faith. It started during Lent season with my neighbor. She held a women's Bible study once a week to discuss important women in the Bible. It was awesome. The feminist in me loved it. My faith truly blossomed, however, when I finally listened to Roma (and Axis) and went to SPC. It's a church filled with love and tolerance and understanding - all the things I value as much as life itself.

6. Democrats Retake Congress
~I looked back on my wishes for 2006 and I believe this headed the list. I guess some wishes really do come true. It was an honor to click the box beside Senator Robert C. Byrd's name (not the WV had any contested Senate seats). It was exciting to watch the news on election night and watch the Dems retake the country state by state.

5. Acceptance to the VA Residency
~It was pretty much VA or bust for my residency choices. I left it up to God and fate. If the VA didn't pick me, I was going to be a retail pharmacist. The day the matches were announced, I was in tears with joy. I'm half way through and I must say, I love the VA. I love working with the vets - it's the joy of my life. Whenever I'm having a bad day or feeling down, all I need to do is walk down the main hallway. I'm greeted by no less than 5 veterans - all of which wish me a good morning. Occassionally, I even get a "you're beautiful." The best is when they say thank you - it melts my heart.

4. Meeting JW
~JW is a 22yo Iraq veteran. I have posted about him several times on here. He truly touched my life when he landed in my counseling booth at the VA. It was the most humbling experience of my life.

3. Meeting Senator Byrd
~If I hadn't ended my academic career this year, this most definitely would've been number 1. It was truly the honor of my life to shake Senator Byrd's hand. He personally autographed his autobiography and addressed it to me. It was awesome.

2. Passing the Pharmacy Boards
~This was definitely a close second. Becoming a licensed pharmacist was the last milestone in my education career. It truly closed the one chapter in my book and opened another.

1. Graduation
~It truly was the highlight of the year to accept my Doctor of Pharmacy degree. To quote the Indigo Girls, "I spent 4 years prostrate to the higher mind, got my paper and I was free." Ok...so it was actually six - and it felt like 12.