notageek

“So, where are you in your educational life cycle?”

“Oh, I’m a pupating pharmacist.”

Working on a hematology/oncology service has confirmed, like nothing else, my suspicions on the state of natural justice. Namely: there is none.

Most of my patients are going to die of their cancers, somewhere between tomorrow and about forty-six months from now. I realise that because this month is inpatient oncology at a major teaching hospital/research institution, I see some unusually grave cases, but I think the issue remains. Cancer is not dealt out fairly; if there were not these patients on service we would have someone else’s teenage marine biology major; someone else’s beloved young papa, someone else’s Anabaptist father of nine.

Neither is there justice in the cures. The patients who achieve and maintain remission are not consistently those who wanted it more, who kept up a smile and good spirits, whose chemotherapy was brutal and almost killed them. There is no rule of exclusion for the thin ones, the pretty ones, the young ones, the ones who had better support, the ones whose families needed them more. The patients the medical team is pulling extra hard for may, actually, be the ones who had a graver prognosis in the first place.
There are only the mechanisms of the malignant cells, and how well they die under the broad killing waves of chemotherapy.

We—I—will do the best I can, and it may well not be good enough. It’s not fair, and I’m sorry.

Preceptin: ur doin it rong.

And that’s really all I have to add at this point.

This is my second inpatient rotation, and the second inpatient rotation that has made me want to cry every day.
Seriously, every day so far. Learning new things in new environments necessitates some discomfort and unfamiliarity, but not abject panic and impenetrable piles of data.
My rotations since January have convinced me I’ll be an excellent community pharmacist, and a shitty inpatient pharmacist. I am so very glad I did not try for a residency—there is no way I could have succeeded at this for an entire year. I am done playing this more-clinical-than-thou pharmacist game, in which the desirability of your job is proportional to the time you spend reading chart notes. I am done looking down my nose at retail pharmacists, and sneering about “wasting all that training” and “counting by fives”.

I think I am going to take the $Chain_Pharmacy job. I am ready for income, for stability, for feeling competent. I can deal, albeit grudgingly, with the pressures of retail. I cannot deal with the hospital—with the urgency, the complexity, or this constant need to stay a step ahead of doctors and guess what they might possibly need, keeping a ready drug answer. This shit is whack, yo.

Someone may invite you to attend “pathology rounds” or “the pathology seminar”, or some such event, emphasizing how few pharmacy students are ever interested and what a great learning experience it is. You may overhear that they only review cases of patients who have expired. This is because, after the case review, the associate professor who heads up the pathology department is going to lug out a large stainless-steel tray full of the fixed and sliced organs of the recently-decreased.

I would suggest that you get the pale/flushed episodes, dry heaves and meditations on the horror of the dead body out of the way before you go, because you are going to have to stand on a chair to see anything over the heads of all those tall medical interns.