notageek

Suckeando.

persimmon — Wed, 12 Aug 2009 00:05:44 +0000

Because I am getting SO OLD, it’s been about 10 years since I was last in a Spanish language class. I took a year of Japanese, a year of German, and a medical Spanish class, but since then my language skills have been mostly atrophying.

Then my husband wanted to go to Ecuador. So here I am, a pharmacist who supposedly speaks Spanish, in the middle of a pharmacy, and I can barely get a Ventolin inhaler. I picked up a novel that looks fairly interesting, and after several intense hours of frowning at it, I’ve gotten through the prologue. I downloaded an audio version of Tales of the Brothers Grimm last year, thinking it might be a good brush-up for my receptive language skills.

HA. Maybe if I slowed it by a factor of 4. I have to fix this. This is crap.

restaurant names

persimmon — Sun, 07 Jun 2009 05:19:06 +0000

Someone should start a depressingly bad American-style Chinese restaurant chain, and name it “Sad Panda.”

I’m just sayin’.

Parenting WIN

persimmon — Tue, 02 Jun 2009 03:03:17 +0000

I had a delightful encounter while I was stuck in the pharmacy by myself the other day.

Young gentleman and his mother came up to my counter with a new prescription. Mother realized she didn’t have the insurance card and ducked off to call the dad to ask him to fax it in. Young gentleman and I filled out his patient profile, including allergies, current medications and insurance carrier, and then his dad’s fax came in. I verified the profile information with his mom, and everything was correct. And he spoke clearly and he was patient and polite.

And he was 13. I have 21-year-olds who can’t do that. Hell, I have 35-year-old patients who can’t do that.

I have to p

persimmon — Thu, 14 May 2009 04:10:46 +0000

I’m forming a theory on culinary similarities between Southern China and the Southern US. I’ve covered the Chinese obsession with some of the pork products before, but tonight I made a very traditional Cantonese sweet-potato dessert soup. It contained sweet potatoes, jujube fruits, ginger and brown sugar.

It tasted like sweet potato pie.

Also, Cantonese-style mooncakes taste an awful lot like pecan pie. And why do we also make sweet-sauced roasted pork?

Some of the similarities are undoubtedly due to economy—mom’s parents are from some kind of Toi San hicksville—and climate. But still, it’s kind of weird. Maybe I need to eat more Southern food.

paranoid antimicrobial wasters

persimmon — Thu, 30 Apr 2009 04:30:01 +0000

I worked slightly over half of today’s pharmacist-hours. Of the pitifully small number of scripts processed in that time, I dispensed half our Relenza and all of our Tamiflu, and I sold a bajillion boxes of surgical-style masks. Oh, and some lady freaked out because the cheapo off-brand surgical-style masks don’t have a particle micron-size filter label but the 3M ones do.

What the hell, people? We are nowhere near any of the documented swine flu cases. It is not a bad idea to have surgical-style facemasks around. It is not even a bad idea to read up on the situations in which an antiviral would be of use. But it is really, really dumb to go freaking out because somebody else already snapped up the last available box of Tamiflu in this neighbourhood. There is a supplier shortage of Tamiflu precisely because so many people are inappropriately panicking and filling scripts inappropriately when they will be of no anti-infective benefit.

YOU DON’T NEED IT, people in my patient population. And by taking it now, you are ensuring that, should this swine flu actually go pandemic, someone who needs it will go without; moreover, if you even do have flu of some kind, you are almost certainly not taking the antiviral in a manner which will reduce your symtomatic illness at all. Take your multivit, get enough sleep, eat un-crappy food and for fuck’s sake wash your hands and don’t pick at your nose. Take vitamin C, if you want. And quit listening to the “news coverage” on the “not-a-pandemic-YET!” because it will just make you stressed, paranoid, and ready to waste antivirals.

Wish I had known: medical education and team structure

persimmon — Tue, 21 Apr 2009 02:35:47 +0000

I wish someone had told me how medical teams at hospitals are structured, given that they are the units in which most pharmacy students end up on hospital rotations. Well, and as a corollary, I now wish I’d known how physicians are educated, because they call the shots on most hospital rotations.

From what I’ve gleaned, MDs have two academic years followed by two years of rotations, which are roughly homologous with pharmacy APPEs; graduation from medical school yields licensed but inexperienced physicians, who are seasoned with several years of residency before being unleashed upon an unsuspecting public.

Medical students are termed M1 through M4 and residents R1 through R3 and up, though first-year residents are usually called “interns”, and being a drug slug I didn’t meet anyone claiming a designation of R4. At that point of specialization, doctors may have taken monastic vows and withdrawn from public view, or acquired new titles that don’t indicate how long they’ve been plugging at this ridiculous endeavor. Readers in the pharmacy field may recall being called P1s our first year of pharmacy school and then not caring because we spend so little time in clinical environments that we don’t have the same clear labelling requirements.
The hierarchy of the medical team at teaching hospitals is arranged by who has the most clinical experience, which is logical. What I found so baffling is how much each person shits on the people below them in the hierarchy. Not all teams engage in this behaviour, and it varies by institution, but as the pharmacy student, your entire team has carte blanche to shit on you. You might be able to shit on a couple of the nurses or healthcare assistants, but I don’t recommend it, because your allies are pretty sparse.

This is the basic structure I saw in my inpatient rotations:

Attending physician (“the attending”). The medical analogue of our preceptors. Has been working in the field several years, and often an unfathomably long time.
- Medical resident, who looks after things while the attending isn’t around; seems like usually an R3.
  - Interns; it seems like there’s usually two of them so they can take turns staying up all night looking after patients.
    - 1 or more medical students, either third-year or fourth-year
- Your pharmacist preceptor
  - Pharmacy resident, if a resident is not occupying the pharmacist role on the team
    - You. Ha. All the way down here. Seriously, don’t piss off the nurses.

Things I wish I had known before 4th-year pharmacy rotations

persimmon — Sat, 18 Apr 2009 21:39:53 +0000

I now have a license, students and completed preceptor CE credits, which means that once I’ve been licensed for a year, I’ll also be a pharmacy preceptor.

I think this—in conjunction with other signifiers like the house, car and spouse—qualifies me as an adult, and true to adult form I cannot stop mining my past to try and figure out what actually happened, that my fifteen-year-old fuckup self ended up a “skilled professional”. The retrospective analysis is never enough, but it’s also all we have.

So this is something new for me and my weblog: a series. I had originally begun a list of “things I wish I’d known before rotations” as its own entry, but it was too long and too scattershot to be an entry, or even a FAQ. These aren’t the answers to frequently asked questions, anyway; they’re the answers to questions I didn’t know needed to be asked before I was a student extern, or a pharmacist. I want to tell you the material we should have learned in dispensing lab; the real complement to the PK/PD and medchem and therapeutics.

Also, I promise this series will still be about how I hate everything.

dear body: knock it off

persimmon — Mon, 23 Mar 2009 22:38:27 +0000

I have a touch of the lung-gunk (a technical term), which is ordinarily no trouble for me to fight off in a weekend, except that earlier this week I sneezed while bending over to grab a stock bottle and stretched something unstretchable in the vicinity of my sacrum. So if I use the nice, vigorous cough to bring up all this lung-gunk the way I usually do, then I throw my back out more.

Also, because I do not have enough yarn in my life, I’m taking a wheel-spinning class from one of the local purveyors of fiber crack yarn shops. I got to sign out one of their shop-owned wheels on which to do my homework, momentarily terrifying my husband, who has only recently resigned himself to the eventual appearance of yarn-related furniture. At least I can spin without throwing my back out.

oh, you have no idea

persimmon — Mon, 09 Mar 2009 23:20:02 +0000

In the midst of vacation—because I am now a yuppie and can do things like take vacations—I picked up some books on local flora. It bothers me to walk down the street and not know names or uses for any of the plants I see.
Anyway, Bookstore Gal was impressed by my signature. “You must be an artist,” she said. “Most people don’t sign things enough to make a fancy signature.” A ha ha ha no. Most people are not uptight anal-retentive killjoy drug-pushers, either.

I haz a patient

persimmon — Thu, 05 Feb 2009 08:37:55 +0000

Mr. See calls the pharmacy several times a week, whether he needs a prescription filled or not. He called me about the peanut butter salmonella recall. He called to ask me about whether his previous pharmacy was engaging in fraudulent Medicare billing practices. He also asked me if he should continue to take his Parkinson’s medications, and if sexual activity is ok for someone who has Parkinson’s. While I appreciate the trust he places in me, it would be nicer if he had another, more non-me person he could trust with his questions. My hearing is kind of crappy and due in part to his condition he mumbles like crazy, so I ask him to repeat everything a bajeelion times. The first time I tried to fill a prescription for him, his insurance wouldn’t go through and he wasn’t sure if it was because he hadn’t paid his premium on time. He is someone who, in a more restrained time, might have been referred to as an eccentric gentleman.

My pharmacy does “environmentally friendly medication disposal” (i.e. we take unwanted medications and put them in a bin to be incinerated at a later date; this is less hazardous than letting them leach into the water table from a landfill). Right now the meds disposal bin has a great deal of expired OTCs the front end pawned off on us, a lot of mail-order cardiac meds, someone’s bottle of Viagra with only one tablet gone, and some Epipens. Last week Mr. See brought in his last fill of meds from his previous pharmacy, and tried to have me dispose of them. I pointed out that they were the same ones he was currently taking and put them back in his bag.

This afternoon I got a call from a local ER. “Oh no,” I said. “Is this about Mr. S?”
“Oh dear,” said the doctor. “It is. And it can’t bode well that you guessed that.” Mr. See had presented to the ER with acute delirium after driving himself there. I read off all the prescribers and a complete fill history for the ER doc, and he promised to get Mr. See all better so he could come back and bother me with irrelevant questions again. I hope, I hope. Sometimes it is rather shitty to be right.