ICU Rotation

I'm currently on a rotation in the medical ICU and I've finished my first week. My attending physician was amazing, he's TOTALLY A.D.D. (making rounds last from 830-5 or 530 with 10 minutes for lunch), but he's brilliant...spouts results from a new england article from 1997 like he spouts off what he ate last night for dinner. Among the HD cath insertions, extubations and bedside trachs I got to observe, I've also seen people die. Some are old, some are young. Death sucks. So, outside from learning about medicine and medical procedures, I've learned some other things

1. Make sure your loved ones know your wishes about how you do and do not want to live. It makes it a lot easier on them if the worst were to happen.
2. Make sure your loved ones know you want to be an organ donor
3. You want to be an organ donor, it can make a really crappy situation into a less crappy situation.

Conversation of the Day

MD: When do we need to check vancomycin troughs?
Me: 30 minutes before the 4th or 5th dose

MD: Can you write for the level to be drawn for my patient in room X? They're being discharged today to the rehab facility
Me: Of course, how many doses of vanc have they had?

MD: I'm not sure
Me: OK, I'll see where they are in their therapy and write for the trough

MD: Thank you
Me: No problem.

The patient received one dose of vanc in the ED 2 days ago
Estimated trough: undetectable
Time wasted: 45 minutes

I'm overwhelmed

I currently have 14 things on my to-do list, and not things I can easily mark off, like eat cereal for dinner. There are things like MUE lit review, colon cancer topic discussion, etc. Most of the things on my list are just the beginning of something else. Once I get done with the lit review, I have to collect at least a years worth of data, analyze the data, formulate a plan for how to make things better then present it. Granted, this isn't an overnight project but it will mostly likely be on my to-do list for at least 9 months.
I'm currently on my oncology rotation, which is stressful for a number of reasons
1. I think I want to do a second year in oncology which puts an enormous amount of pressure on me to perform well this month.
2. My handouts for my topic discussion are in excess of 8 pages each and I typically have 2 a week. It takes me at least 6-8 hours to prepare for each discussion
3. I'm checking chemo... I could possibly be the last person that looks at a bag filled with chemo before it gets to the patient. I was nervous the first time I check baby aspirin; checking a chemo for the first time was almost enough to through me into a full blown panic attack and it hasn't gotten better...
4. I have cancer conferences 2-3 days a week, starting at 6:45am..this makes for very long days

On top of this rotation, I still have obligations back at the main hospital. I staff until 7:30 once a week. I have research meetings, P&T, med safety, among others. This means I have to leave the Cancer Center, drive 20minutes, find a parking spot, attend said meeting, leave the main hospital, drive back to the Cancer Center, find a parking spot, catch up on what I missed, what questions were asked then check more chemo....

On top of rotation and regular obligations, I have my dog...who has begun barking in the middle of the day and my neighbors have been complaining...awesome... Now I get to worry about whatever it is my complex does with obnoxious barking dogs. I now get up 20 minutes earlier so I can take ollie on an even longer walk so he might be a little tired during the day. I also leave a box fan on as well as my iPod to drown out some of the sounds ollie might hear and respond to.

Then there's the fact that I'm still 8 hours away from home. I miss Ryan and my family terribly and I try to balance keeping up with them with work I need to get done in the evenings. I'm going home next weekend, which will be lovely BUT I'll still have to leave, which already makes me sad.

So you think you can dance is on...

Frick-update

Today after work I went to the outpatient pharmacy and bought 42 days worth of omeprazole. Why? Because I'm pretty sure my stomach ulcer is back. It's totally related to stress and this would be the 3rd time, probably in about 5 years that I've had this. The first go round included H. pylori testing (negative) followed by Nexium daily and sucralfate 30 minutes before meals. For those who have never had the privilege to take sucralfate tablets...let me let you in on how awesome it is.
1- it's a freaking horse pill
2- the moment it comes into contact with your saliva it begins to disintegrate (think chalk dust)
3- you have to know when your going to eat and take it 30-45 minutes before so it has adequate time to fully coat the ulcer so it wont feel like you've been punched in the stomach and swallowed a ball of fire.
The second ulcer happened in pharmacy school- I just got an Rx for the sucralfate
This time...I don't have the luxury of a doc in Greensboro so I'm going the OTC route. I'm gonna give it 2 weeks, if I'm not 100% better or it gets worse, I'll find a doc ASAP.

Stress sucks

Oliver

Oliver is probably one of the best things that has ever happened to me. When I got into pharmacy school I knew I wanted to get a dog but definitely not a puppy. When mom helped me move into my very first apartment in Savannah we went and looked at the Savannah Humane Society and an adoption fair at Petsmart but to no avail...I didn't fall in love with any of them. After mom left I spent the night on my couch with the TV on. The next day I drove back to Jacksonville to look at the dogs at Animal Care and Control with my brother and they rest, as they say....is history. Oliver and I have been inseparable ever since.

Great things about Oliver
- ALWAYS happy to see me
- Lets me put sweaters on him (even if they have poinsettias on them)
- Good snuggler
- If he lays at the other end of the couch, I simply pull him next to me to snuggle and he stays!
- When I cry he gives me kisses
- He gives AWESOME looks/glares

OK, so he may not be great at following commands or acknowledging personal space but his face is so adorable that I forgive him almost immediately. I mean, seriously....look at that face!!!

Frick

I thought I would get used to stress. I've juggled projects, commitments, studying, traveling, maintaining relationships for years now...residency is a whole new kind of stress. I don't sleep well, I am almost terrified of become a licensed pharmacist for fear of having to do the final check of meds that will go to a patient right afterwords, I don't have schedule. I need a schedule. I need deadlines, due dates, consistency. Residency thus far, has not afforded me these luxuries. (I do get to stay at the Venetian for FREE in December though) I haven't had any real time off until today since, well... I don't know...during rotation, I'm sure I had a week off. We've gotten some projects lined up but so much of them is still unknown and it drives me crazy! I need to know specifics people , or at least ideas!
I've finished taking my exams and I'll find out if I passed the NC law on Tuesday or Wednesday. I could be a licensed pharmacist in the state of North Carolina on Friday...holy crap!!!!!
Relationships are crazy hard to maintain over distances too. I've mentioned Ryan...we've been together for a whopping 3 months but I'm pretty sure I'm going to spend the rest of my life with him; even my sis thinks so. This week has been hard. I miss him like crazy and I just wish he was here to give me a hug when I get home from work. I still talk to my mom every day, which is amazing. I love my mom. I don't get to talk to my sis everyday though. She's has two kids and it's hard to align our schedules now. I miss her and my nephews terribly. I fear I'm going to miss so much over the next year and that makes me sad. On top of all this, I'm a bridesmaid in one of my best friends, Kyrie's, wedding. They are having her bachelorrette shower next weekend in Amelia Island and I had planned on going until I realized it would cost me between $500-600 for the weekend between plan tickets, boarding ollie and chipping in for the house. I'm crazy sad about it.
So with all this said/ written...any coping ideas? Also...anybody got an extra $600 laying around?

It's been a while

It's been a while since my last blog and here's why...
1. I've met an amazing man, whom I've fallen madly in love with
2. I finished my advanced rotations ( I hate retail)
3. I moved to Greensboro, NC
4. I graduated from pharmacy school
5. I started my pharmacy practice residency...kinda