Today was long and surprisingly not as exhausting as some of the other long days I've had lately. I'm still pretty wired even though I've been up since 6:15am, got to Memorial at 7:30am, left at 3:30 and went to real work at 4:30. We close at 9pm but I ended up staying till almost 10 because we were so backed up and the pharmacist I was working with was having the shittiest day he has probably ever worked. In addition to that, he mentioned he was having some problems back at home, so I really felt like it was my duty to stay and finish all that I could so the pharmacy manager wouldn't get pissed off coming in tomorrow with so much crap that still needed to be done.

Anyway, I still can't believe how many months have already gone by and how fast our graduation date is approaching (April 30, 2010 at 9:30am!). At this point, I still don't feel comfortable being let out on my own but I guess I never will until I'm finally "The Pharmacist" and will have to experience the mistakes before I grow into my independence.

I've learned a few things within the past few months that they don't teach you in pharmacy school. One thing I've observed is that the higher you climb professionally, the harder it is to read people. In other words, it's harder to tell if someone is being genuine, or if the person simply understands the "right" or "professional" thing to say or do in the situation and does not genuinely feel that way at all. Be wary of the people who say one thing to patients, but turn around and confess their completely opposite feelings to you. If they do that often enough with people who you may think don't warrant those types of comments, then think about what they may be saying about you. I try not to get too close to people like that.

Another thing I've learned is how far your reputation precedes you. Reputations are important because it's what maintains your position and it's what can create opportunities for networking, which in turn can provide you with a better position at a better facility for whatever goal in life you're trying to achieve. I've been told again and again how small of a world pharmacy is, and it has been confirmed through my experiences on multiple occasions, so burning bridges means a lot more than just blowing off someone you don't like. It's possible you may never see them again, but if you really fucked something up, the repercussions of your actions will continue to haunt you a pretty long time. What if 2 years down the road, you find another position that you think is a fit for you, but turns out the person you blew off is good friends with the hiring pharmacist? Shit like that happens all the time.  Corporate politics is very much alive and is influenced by many things that aren't morally right. This goes back to reputations: If you decide to give someone a nasty piece of your mind, if you decide to be late to work and leave early every day, if you decide to never return favors -- people watch you and these actions can tell mountains about a person's genuine behavior and immediately label it as "unprofessional," which could cost you a job. If you do believe it's ever worth it to unleash emotional build up or do anything that can potentially cause huge consequences to your career, do it when you're close to retiring. Don't do it if you're about to quit and want to get a job somewhere else doing the same type of work.

Anywho, I really shouldn't be up at this hour. Goodnight everyone!

I know this is really late but... man, if the president calls you a jackass and is applauded for it, that's pretty bad.

Since I haven't done this in a while, I'll go ahead and give you all another update of my life.

So for July and August, my rotation is in Gainesville for Ambulatory Care. Basically it's just your regular primary care clinic, except we have a clinical pharmacy service available. If the doctor thinks a patient needs management of their medications or chronic conditions like diabetes, high blood pressure or high cholesterol, the doctor refers the patient to us and we help them optimize their drug treatments, help get them meds they can afford, and just help them become more aware of their health and improve it overall. Our demographic consists mostly of low-income patients who don't really have more education than just high school.

I actually enjoy it, although it can be hectic at times. I think the reason I kinda like it over retail is that I actually sit there and have time to talk to patients in a room for an hour or more about their medications, get to know them as people, and get them to trust me so that they help us help themselves with their health. Because this rotation is 2 months long, we can actually follow up with patients and have enough time to see changes in their health because of what we talked about in the previous visit. It's really all about how well you can communicate with them because if you're a shitty communicator, you probably won't see much of a difference at the next visit or maybe they won't even show up for their next appointment.

Last week, I had this one patient tell me that he really had time to go in-depth about his health with me and that he feels comfortable talking to me about his situations. I think he was in his mid-40s or 50s and he seemed "with it" enough to understand the concepts I was telling him about. I explained to him what an HbA1c meant, why it's important, what the numbers in your blood pressure mean, what his goals were, etc. He's a smoker, he drinks, and he was even comfortable enough to tell me he smokes pot and snorts coke occasionally. Everyone knows you "shouldn't" be doing that stuff, so there's no point in telling them they shouldn't be doing it, so one question you gotta ask is how ready they are to quit. If you ask them every time how ready they are, then they feel more comfortable being open with you about that stuff. I dunno, but personally, marijuana isn't that big of a deal to me... lol. I think it's probably worse to be using tobacco anyway. But yeah, it felt good to know that someone trusts me to help them out.

Yesterday, there was a lady who didn't have any prescription insurance and needed to be on like 5 meds for her health and back pain, and she was also going through a rough time in her life because I think her husband died recently. The doctor, the pharmacy resident, and I talked over her meds and optimized them so that she barely had to pay for anything. I was the one who actually had to talk to her about it and when she was leaving, her eyes started watering because she was so grateful that we could help her.

About 3 weeks ago, there was a 22 year old girl who came in for management of her diabetes. The last pharmacy resident tried to start this self-titration project thing with her insulin so basically she doesn't have to go to the doctor every time we need to change her insulin dose -- she could just do it herself at home. Well anyway, when I saw her for the first time, she had been doing it all wrong and so we printed out this worksheet thing that shows step-by-step what to do to titrate her insulin. I even did an example in front of her to show her what to do. So she came back in about a week and we FINALLY got her to do it right, and we could visibly see her blood sugar go down over the course of the week. My resident was excited that we finally got it to work for somebody because that was the first success we've had since we started the program. So the whole point of the self-titration is to get the patient's blood glucose under enough control so that they're stable on a set dose of insulin and they don't have to titrate it anymore. So yesterday, I called this girl for a follow-up phone consultation and she finally got it down to where she didn't have to titrate anymore!!!! I was so excited!! LOL. I told my resident and he gave me a huge high five and he even told the attending physician. The attending was considering getting this published if we got enough successful patients on this system. =D

There's another patient whom we put on the insulin self-titration with the resident from last year that we were about to give up on, but I educated her with the worksheet and stuff also, and my resident went in and talked to her and he told me she said that she was comfortable with my explanations and she understood it. He said that if we get her to do it right when she comes back for follow-up that I should consider this residency..... =D =D =D

Anyway, I know this was a really long blog, but it just feels so good to know that I'm in the position to be helping people with a big part of their lives and seeing the successful results of that. In retail, yes, you can still help people, but you just kind of see them come and go and I feel like you really don't have that much of an impact on their lives as you do in this kind of clinical setting. Like if I get really good at this, I'm even considering trying to do some kind of pharmacy service with the Peace Corps later on down the road in my life. After I become financially stable and start a family and all that first... hehe.

Aaaaaanyway. That's enough from me today. Have a good weekend, biatches!