Cynicism

Sometimes I wonder what happened to the girl who started this blog: the enthusiastic, overachieving chick who was almost done with rotations, fired up to do two years of residency, and ready to conquer the world.

Maybe it's the stress, maybe it's the short days and cold weather, but I'm not her anymore. Residency is sucking the life out of me. I'm tired all the time, I never see my friends, my paycheck sucks, and I can't shake the feeling that this is not going to help my career. Finishing residency will gives me a piece of paper that says I'm smart... or rather, it'll give me a piece of paper that says Sacred Spleen thinks I'm smart. This isn't exactly Johns Hopkins, and from talking to my resident friends, I know other residencies are way more demanding. (And yet, I'm still worn out. Draw your own conclusions about what that says about me.)

I'm at Sacred Spleen till June 30 and the thought of looking for a job for after that has me terrified beyond measure.

I have got to get out of this funk... get back into my project, try to get some publishable data, figure out where the hell my ambition went, find the original Pharmgirl and bring her back to life.

There is no point to this post other than for me to complain. Sorry.

Midyear Recap

I've been talking about it all year and I couldn't just let it pass without letting you know how it went.

Saturday: Hop off the plane at LAS with a poster and my cardigan. You can tell you're in Vegas when you see slot machines at the airport. My co-resident and I check into the hotel and we can barely contain our excitement. We are FINALLY in Vegas! We go out that night with some friends and a good time is had by all.

Sunday: We intended to get some CE in today, but we were out till 4 AM. Well, this is what I get for waking up in Vegas. (Incidentally, that song was in my head all week. If I ran into Katy Perry, I probably would have slapped her.) A networking dinner with the boss is all we can handle... but we go out again that night anyway.

Monday: We haul our keisters out of bed just in time to see Dennis Quaid talk. He has an interesting speech, but it could've been about 20 minutes shorter. A little CE, then the RESIDENCY SHOWCASE!!! Chug an energy drink prior to our session so that I can be Perky McCheerful when potential residents show up. Get everybody's name and contact info, and finally distribute some of the 1000 or so business cards I got back in July. Monday night, I'm out with my pharm school friends again. A good time is had by all... and we are once again out entirely too late.

Tuesday: CE, again. License renewal, here I come! Between the time change and the last few days' antics, my co-resident and I are still tired, so we skip afternoon CEs and shop. In the evening, it's out for dinner with the Sacred Spleen crew. My boss is a pretty cool guy... but maybe I only think that because he bought me an expensive dinner and a bottle of wine. :)

Wednesday: POSTER SESSION!!! If the last 6 months were a Christmas tree, this would be the star. I put my poster up and answer questions from all passersby. I get some good feedback, and nobody's come by and told me I'm an idiot. Boss Man declares it a success. We're so exhausted after the posters that we go back to the hotel room, nap, get dinner, then nap some more.

Thursday: I miss HusBot 5000. I miss Pinky and the Brain. Hell, I even miss Sacred Spleen. Let's get out of here!

Moral of the story: When Midyear is in Vegas, don't expect to do anything constructive.

Typical Day: Staffing

Every resident has to staff. What's staffing, you say? I'm in the main pharmacy in front of a computer with two monitors. One has the list of orders that have been scanned, and one has the software where I enter said orders. I type whatever's on the scan into the computer, and if there's anything wrong/illegible/incomplete, I put it on hold so the floor pharmacists can deal with it. When I'm not entering orders, I check the techs' work and answer the phones.

0900: Arrive at the pharmacy. The list of orders to be done is, as always, long. The other two pharmacists and I type furiously, and since Sacred Spleen operates with a skeleton crew on weekends, there aren't any pharmacists up on the floors to do things like check doses, adjust things for patients with kidney failure, and clarify stuff with docs. The mountains are rough and the going is slow.

0932: Crap, another order without a name. I call the unit.

Me: Hey, this is Pharmgirl down in the pharmacy. I have a question about these alcohol withdrawal orders you guys just scanned down.

Nurse Ratched: Who are they for?

Me: Well, that's why I called. There's no name on them.

Nurse Ratched: So what do you want me to do?

Me: Um... ask around and see if anybody's scanned down orders?

Nurse Ratched: Fine. [click]

Nurses, I know it's frustrating when you've been waiting an hour for your stuff, but you really throw a wrench in the works when you scan down orders with no name on them. I am a pharmacist, not Miss Cleo. Recognize.

1145: This scan has 5 drug orders on it. I enter the first order and the phone rings. Resolve whatever's going on with that patient.

Enter the second order.

The phone rings. ICU wants to know where their drugs are. Be patient, Betty; there are about 50 orders ahead of yours.

Get halfway through order #3. Tech pops in and asks me to check an IV bag for the ED. Finish the second half of order #3.

The phone rings. 5th floor is out of insulin. "Please, Pharmgirl, can we have some more?" Thanks for asking so nicely! Yes, it's on the way.

Where was I? Oh yeah, order #4. Get it entered, click through umpty kajillion lame warnings (Ambien causes drowsiness? Get outta here!!!) and then I realize... it's already in the damn computer. A few nurses have gotten fed up with us and are now double-scanning things. Great. Order #5 is in the computer too. Orders 1-3 are in twice. Way to go, Pharmgirl, wasting 30 minutes on crap that was already done.

1300: The Neonatal Intensive Care Unit (NICU) calls.

Cruella de Nurse: I scanned down a STAT order for fluids for Ike Broflovski fifteen minutes ago! Where are they?

Oh, shit! I missed a STAT order! When nurses have a STAT order, they scan it down in a red sleeve and it shows up on my screen in red so that it gets our attention. I scan down the queue and... yes, there's a NICU order, but it's not red. Since that's the only NICU order I see, I click on it, and sure enough, it's Ike's fluids.

Me: Sorry about that, ma'am. It looks like the order wasn't scanned in a STAT sleeve, so we didn't know it was a STAT.

Cruella de Nurse: I shouldn't have to do that! NICU should take priority over everybody else in this hospital! Now get me those fluids STAT!!! [click]

Here's the thing, folks: Nine out of ten NICU orders are for things like diaper rash cream. As we've established, I'm not a mind-reader, so if you don't tell me you need something STAT, I'll make you wait your turn like everybody else. Yes, the NICU is important. So is the guy in the ED who's having a heart attack, the guy on 4th floor who just got out of surgery, and the lady in ICU who has pneumonia.

1330: It's time for my lunch break... wait, I don't get one. That's OK, because the techs have decided to order out. I have become an expert at entering orders with one hand and holding my pizza with the other.

1600: It's TPN time! TPN stands for Total Parenteral Nutrition, which means that the patient's guts don't work and we have to inject his food into a vein. Fo' realz, yo. Sacred Spleen does not make TPNs on-site; we send the orders to an outside pharmacy. The outside pharmacy starts making TPNs at 1700 because the TPNs have to be in the patients' rooms by 2100.

1745: An order to discontinue a TPN comes down. Sweet mother of crap, how many times do we have to tell you docs that TPN orders must be in before 1700?!? If I call the outside pharmacy at 1745 to ask for a change, the hospital must pay for both the correct TPN and the incorrect one. If I call at 1745 for a discontinue, the hospital pays for a TPN that no one will use. This is why health care in America is so expensive: people don't follow directions!

1900: For the next two hours, I am the only pharmacist in the entire hospital. Which means... I am in charge. When I was a student, I thought that would be fun. After my first night alone, I realized what being in charge really means. Every med that goes out must be checked by me, every order is entered by me, and if things go bad, there is no one to blame except... me. If the tech screws up, I am the one who will be held accountable. The two hours I spend alone are the most stressful two hours of my month. Uneasy lies the head that wears a crown.

1943: Rihanna comes on the radio. Since the techs are out delivering meds, I start singing along.

1945: The techs return just as I get to the "umbrella, ella, ella, eh" part. The techs laugh. I blush.

2030: At this point, all the nurses in the hospital are probably thinking, "Man, Pharmgirl is a doofus!" Every call I've taken for the last 30 minutes has been about another thing I screwed up. This insulin's wrong, the fluids were supposed to be at 100 mL/h instead of 75, you put in these antibiotics without a stop date... I swear, I can't do anything right! Thirty more minutes on this shift. I think I can, I think I can...

2100: Hi Overnight RPh! Bye Overnight RPh!

7 Quick Takes - Things I Have Learned Edition

Today's 7 Quick Takes are all things I've learned during residency/rotations.

1. Laying out your clothes the night before is an excellent timesaver. I went to Catholic school K-12, so I never had to think about what to wear each day. In undergrad and pharm school, I pretty much threw on a pair of jeans and whatever T-shirt reeked the least and called it good. That didn't work at any hospital where I did a rotation and it certainly doesn't work at Sacred Spleen. I was faced with a dilemma: I like to look good (slobby dress for class notwithstanding), and I can't function before my first cup of coffee. During rotations I started laying out my clothes the night before, meaning that I plan my outfits when my brain actually functions. This made a huge increase in the number of days where my socks match. :)

2. Always be prepared. Prepare for the questions patients and preceptors are going to ask you. Prepare for the AV equipment to malfunction at your presentation. Prepare for rain. Prepare to spill spaghetti sauce on your pristine white coat. Prepare to look like a dumbass despite all your preparation.

3. Your heroes are overrated. Your mentors have struggles and insecurities too. Putting them on a pedestal will disappoint you and make them feel inadequate. It's fine to admire people, but realize there are aspects of their life that you may not want to emulate.

4. You may find yourself wondering, "What could go wrong?" The answer to that question is: everything. Give Mr. Murphy some respect, and don't tempt fate.

5. Never be afraid to say "I don't know." A person who says, "I don't know, let me get back to you" looks a lot smarter than someone who just makes stuff up. Patients are not stupid; if you don't know what you're talking about, they'll catch on. Besides, even after you've practiced for decades, there will still be things you don't know. Get used to admitting that now.

6. Never miss a chance to have a good time. I've mentioned before that we're in a stressful field. Any opportunity to blow off steam - whether it's a night of debauchery or merely a good joke during rounds - is to be seized and throttled.

7. You can look like a million bucks on the outside and still be a mess inside.

For more Quick Takes from Jen and others, go here!

Inpatient Means... INpatient

I work in the inpatient pharmacy. That means we provide meds to patients who are in the hospital. This is a surprisingly difficult concept for some people to grasp.

No, sir, we will not fill those scripts your doctor gave you when you were discharged. You see, we don't have a cash register and we can't bill your insurance, so we would have to give the drugs away for free. If we did that for everyone, Sacred Spleen would be broke in a New York minute. Lest you think me hard-hearted, we often give free take-home meds to patients who are indigent. However, sir, since you are brandishing both an insurance card and a $100 bill, I very much doubt that you are indigent.

No, we will not fill the scripts just because it's a holiday and your regular pharmacy is closed. Go to PWLTH. They don't even close on Christmas.

No, we will not fill your script just because you're an employee. You say you desperately need your antibiotics tonight? Hey, guess what? If you're sick, you should not be at work! Put on a mask, go to a retail pharmacy to get your drugs, and then go home! Our elderly patients with heart and lung problems do not need your germs, nor do the people who care for them. (BTW, this applies to those of you who work in cube farms too. The world will not fall apart if you take a day off. Stay home and keep your vile contagion to yourself.)

7 Quick Takes - Short and Sweet Edition

1. I apologize if any of the following Quick Takes are incoherent/unfunny. I wrote these after an 11-hour shift, which means I was a tad punchy.

2. The Price is Right must have some sort of magical healing powers. It's always on at my hospital.

3. I do not check my e-mail nearly enough, mainly because I never expect there to be anything in it. Sorry, folks. I'll try to get better.

4. This is partly because some days I forget that I have a blog. Yes, I am working a lot. Why do you ask?

5. 29 days till Midyear!!!! AUUUUGGHHHH!!!!

6. I have a goal for today: spend less than 10 hours at work so I have the energy to do all the household stuff I've been neglecting for the last week.

7. I also have a goal for tomorrow: get finished with project stuff by 5 PM so I can relax on Sunday.

For more Quick Takes from Jen and others, go here!

The Most Wonderful Time of the Year

I'm not talking about Christmas (yet), I'm talking about the ASHP Midyear Clinical Meeting, or Midyear for short. Midyear is trade show, job fair, continuing ed, and networking all rolled together. And since it's in Las Vegas again this year, it'll be big fun too.

I assume that if you're reading this, you are a student and this is your first Midyear. If you're a practicing pharmacist, I'm not sure if anything I say will apply, since this is my first Midyear as a practicing pharmacist too. I'll try to break down useful (and not-so-useful) parts of Midyear and what they'll mean for students.

ASHP Student Programming: I haven't looked at what's on deck for this year, but the last two years the programming's been worthwhile. Attend at least a few of the workshops. The Clinical Skills Competition Finalist Presentations are usually pretty interesting (and you don't have to stay for all of them).

CE Sessions: Go to some of these if you can. There's some pretty interesting stuff. I like "Clinical Pearls" - it's easier to come and go if you have a crazy schedule.

Exhibits: I'm not sure how much swag you'll be able to get this year, but the last two years - holy cow! I got tons of pens, tote bags, Post-Its, even a few books. Must-see exhibits: anything with food, the major drug companies (better swag, sometimes fun games), and your fraternity - you'll get a sticker or ribbon with the fraternity's logo which can help other fraternity members find you.

Opening Session: The keynote speaker is usually worth a listen. The last two speakers (Maya Angelou and Elizabeth Edwards) were both interesting, and I have high hopes for Dennis Quaid.

Personnel Placement Service (PPS): PPS is useful for residents (and other job seekers), but not for students. Skip it.

Posters: Residents all exhibit posters of our year-long research projects. Stop by to get some ideas for next year and network.

Residency Showcase: The big kahuna. The bad mama-jama. The reason we're all here: to get trampled by other residency seekers, sweat all over our nice clothes, and walk up and down the aisles in shoes that pinch. (Why no, I don't take my own advice, why do you ask?) The residency showcase is overwhelming, but if I survived it, you can too. Here's how.

1. Have a plan. Before you go to Midyear, look at the list of programs that are exhibiting and figure out which ones you want to talk to. The programs only exhibit at one session and each session is only 3 hours, so try to keep the list short.
2. Come prepared. If you're graduating in the spring, bring copies of your CV - some places will take them. Be sure you have a pen and a notepad, so you can take notes on all these programs. You'll find that they all run together after awhile.
3. Smile! A huge crowd of people can be intimidating even for a real people person. Shy folks may want to run for the hills. Don't! If you only learn one thing from this post, let it be this: residency directors need residents as badly as you need a residency. They want to put their best foot forward, so anyone they send to Midyear will be a friendly person who LOVES talking about their job. If you run out of questions to ask, make sure you have their application materials and then tell them that you need to go talk to some more people, but you're glad to meet them. They've done this before, so they understand.
4. There will be space to sit down. Use it. Make your notes more legible, or just get a drink and rub those aching feet.

What should you wear to the Showcase? In 2007, I wore business casual - I was just getting info and didn't want anyone to get the idea that I was a residency seeker. In 2008, I was actually looking for a residency, so I wore a suit. First impressions are everything!

Social Events: There will be lots of less-formal social events during Midyear. For example, most schools of pharmacy have one for alumni/current students. Attend your school's event and any others you're invited to. It's OK to drink if you're of age, but don't overdo it. Again, pharmacy is a small world and someone is always watching you.

And finally, have some fun! Don't do anything too crazy, but it's OK to skip a workshop and go shopping with your pals or spend some time at the slot machine or in the bar (take off your nametag and change clothes first).