CXVII : Limits

I've never really been good at placing limits from the beginning. Instead, I would go through things, and then realize if I could or could not handle it. I'd give it a chance, a test, first. Mix that with the sometimes unreasonable desire to finish what I started, and you get over-stress and end results that hit far from potential. This is what I think about now when I imagine any position involved in the medical world in general.

It is ideal and best to practice/work imagining the one you are caring for is your own family, or whomever is an important person in your world. It's true that this mindset works to provide the best care for patients, but it is only possible in a select few environments. For example, if you make the medications for people, think that the med is for yourself or someone important to you. You would be extra careful to make it safe and correct. However, imagine you're working for people who are mistaken about the importance of your job, who are irritable because of their long stay in the hospital, who are already stressed out from their health endeavors, and who have the feeling of gratefulness far in the back of their minds, it is difficult to treat every patient name you see as someone important to you because when they come, you question, "why do I go through all this work for you when you come to demand selfishly for everything to go your way, regardless of the consequences?"

I had the opportunity to work in Infusion Care for a few weeks, and although I did not have to actually see patients come pick up their medications and supplies, I had to call and receive calls about them. It really felt like they were ordering food from us and we would deliver. Some were knowledgeable about the system, but others were not. In Infusion Care, I dealt mostly with enterals-- the supplies and nutritional content (aka milk formula) needed for patients who could not swallow and had to be fed through tubes, or for premature infants who needed that extra nutrition to grow. We try to work with the patients, but if they call us when the're already completely out of the 'milk,' it makes it difficult for us because we order as needed. This means that our inventory is only stocked with the most common, cheaper formulas. Anything more special is ordered specifically for that individual and takes at least a day to come in. It's hard to want to give the best care when patients have this idea that whenever and whatever they ask for, they'll get.

This leads me to separate myself from patients. I'll try to take care of you the best I can, but their life and their problems are not my worries and not personal to me. So, even though I am going to work with their best interest in mind, I am also going to keep myself distanced enough to not be affected and overwhelmed. It seems harsh to be in the health profession and be detached from the patients you care for, but there has to be limits to how much care to give or else you end up giving only subpar care to everyone.

CXXIV : Where do you see a pharmacist?

Think of a pharmacist as the last line of defense to make sure the right drug is going to the right patient at the right time.

Think of a pharmacist as the developer of the right properties for a drug to pass the FDA trials before entering the market.

Think of a pharmacist as the point of care provider for patients with lifetime health issues that need to be maintained such as diabetes, obesity, hypertension, and osteoporosis.

Think of a pharmacist as the manager of the drug inventory to control costs and maximize benefits, adjusting the formulary based on the frequency of need and the market price.

Think of a pharmacist as the knowledge house for questions about starting a drug, various interactions, administration, usage, monitoring, cost, stability, dosing, mechanism of action, and maybe to the point of identification based on color, size, and whatever is carved onto the capsule/tablet.

Think of a pharmacist as the health care provider you can approach and ask about your health issues at any time, no appointment needed. Ask about your supplements, your Tylenol and other over-the-counter medications, your prescriptions, your health habits, your daily lifestyle, and any of your health concerns.

Think of a pharmacist as the personal health coach who wants to work with you to make sure the medicine is appropriate for your lifestyle and improves (or maintains, in some cases) your health condition.

Pharmacists can work alone, but ideally, all the health professions should combine their expertise to manage a patient case. That way you have each focus doing what they do best and giving the best care possible. Medical doctors diagnose the patient, nurses take care of the patients, pharmacists check the medications and monitor that they're given properly, and various specialties may be involved as well: physical therapists, occupational therapists, psychologists, nutritionists, etc. Of course, even more people are involved to manage the costs, be the liaison between health practitioner and family, do the labs (blood work is extra important in many cases), and keep the supplies in stock. Right now, a lot of these linked professions are separated and communication is too easily lost between them. A person's health problem can already be complicated to deal with (because people are all different and it might take multiple tries before finding the right therapy for one person), why make it more complicated with any chance of miscommunication?

CXXIII : Health Fairs

One particular aspect I absolutely enjoy about being a pharmacy student is attending health fairs. I like being able to translate those medical connections into terms that other people can understand. I want people to understand their own health and how to take care of themselves. What can they do for themselves. Because ultimately, it is the patient who is in charge of how their health will progress. Will they get better? Will they stay the same? Will they get worse? Participants who come to the health fairs are people who need to understand in order to prevent developing health problems such as hypertension (high blood pressure), diabetes (high blood glucose), dyslipidemia (high cholesterol and/or triglycerides), osteoporosis (low bone density); people who are interested in learning more about certain diseases such as heartburn, sexually transmitted infections, and asthma; people who want to take advantage of getting a free flu shot and find that they learn about vaccines as well; people who know they have health problems or are at risk of developing health problems and want to know how to combat it.

This is what I am Director of...

I want to tell people all that I can about over-the-counter medications, but what do people want to know? What do people know? What have they tried? What are their experiences? Some people don't feel comfortable revealing any of this, which makes it difficult to talk to them.

I participated in a health fair yesterday in a primarily Chinese community, so I was forced to use my limited Mandarin skills to counsel participants on body fat. We used a machine that measures a person's BMI and % body fat. It's called a BIA and it sends electric signals through your body as you hold its two metal sides, and it detects the conductance of these electric signals. Muscles conduct electricity more than fat does, so a slower conductance registers as increased fat content. Since water and food could potentially make the measurement inaccurate, it is best to measure your body fat in the morning before you eat. The BMI is calculated using your height and weight, so it sees whether your weight is acceptable/healthy for your given height. It does not tell you if your body is composed more of fat or of muscle. BMI should not be 25 or greater, as that is generally indicative of being overweight. At the health fair yesterday, most of the participants were Asian and had good BMI. However, their fat % reached as much as 40%, which is obviously too high. The recommended body fat % for women is 22-25% and for men is 15-18%.

So how does it make sense to have a normal, good BMI, but have a high body fat percentage? This is because high weight does not always correlate to fat, and normal weight does not always correlate to less fat. Fat may not be evenly distributed in the body, so when you lose weight, you may not be losing fat, you might be converting muscle into fat instead. It is important to know that just because you see your BMI is 24.9 doesn't mean you should go on a diet or you should immediately think you have to lose weight. What you should be doing is modifying your lifestyle. Exercise, again, is a key factor. Consuming less glucose foods (because excess glucose to your body means more conversion to fat to store energy for later) doesn't mean avoiding fruits. It is better to consume mono and polyunsaturated fatty acids than saturated. Completely avoid trans fats.

So I had to say this and more in Chinese to the participants, who kept coming nonstop for a good 4.5 hours. It was the busiest health fair I've been to, which was a good experience, though it did have it's negative aspects. I wasn't able to rest so sometimes I'd feel compelled to say less to a participant just to get them over with. Usually, we hope to get to know the participant's lifestyle to help them make beneficial small changes that can help with their health, but at health fairs that are nonstop busy, it gets impossible to do so. This makes me want to open a clinic to provide these services to people. Have them feel comfortable talking about themselves, their lifestyles, their concerns with a health care professional who wants to help them control their health to the best they can. This is just one possible future I can have...

CXXII : Dear Nurse,

I understand how anxious and frustrated you can get when you're trying to find a medication to give your patient on time. And I understand that it makes sense for you to call the pharmacy to request your medication in that urgent tone of yours, but do you really need to emphasize how you looked everywhere for the medication just now-- the patient's cassette, the patient's room, and by the tube station? and when I say I'm sure I just tubed it to you 5 minutes ago, you doubt me and retort "I just checked 5 minutes ago and it's not there." I know you're waiting for me to say "ok, I'll fill it and send it to you" because of course, it's not your fault the patient is going to get the medication late. Although I really want our professions to work well together, to have a mutual understanding and respect for each others positions and responsibilities, I was irritated with your response and so I adamantly did not want to fill a medication I clearly remember sending to you already. When I said, "can you check the tube station again and call back if you don't find the medication?" couldn't you trust the one who sends you the medications? What is pharmacy to you? I do remember most of what I fill and send out. But I know you didn't think it was there when you said "okay-y" in a doubtful tone. But hey, you didn't call back. Now can you trust the pharmacy when we say we sent it to you?

Seriously though, I want all the health professions to respect each other, to understand how important each one is in the treatment of patients. Some nurses give off that "my profession is better than yours" air when they call pharmacy wondering "where's my medication?" [I'm glad that most nurses do understand the importance of pharmacy though] One satellite pharmacy covers the whole FLOOR of patients (and sometimes it's multiple floors and at night, one central pharmacy covers the whole hospital), while nurses have a few (maybe around 5) specific rooms to look after.

At the hospital I'm interning at, they separate inpatient pharmacists into two types: dispensing and clinical. The dispensing pharmacist is in charge of verifying medications, making sure that the active orders are still necessary, and answering a lot of phone calls from nurses and physicians. On the other side, the clinical pharmacist is in charge of monitoring TPNs (liquid food that is given intravenously [IV] for patients who can't take in foods by mouth), drug levels for dose adjustments of IVs (something I just learned called pharmacokinetics [PK]), and pharmacy-controlled medications like warfarin. There's a bunch of duties I'm missing, but overall, pharmacy's impact can be seen on cost. Regulate the meds, regulate how much is spent on them.

There are a bunch of other types of pharmacists involved in the hospital (administrative positions and outpatient), but I haven't really been exposed to those yet. I have a vague idea, but not much, and now I'm not sure if I want to stay in inpatient. I like it because I'm seeing so much of what I learn from class, but I don't know... It's starting to seem like I can't really be picky about where I end up in. As long as I get a job, I'll adapt to its environment and enjoy it as much as I can.

I want people to understand what each other's responsibilities are. More trust among professions would be nice.

CXX : Pharmacy Decisions

One of the USC faculty professors, Dr. Steve Chen, never fails to reassure me that I chose a great profession. That I am being trained to become an integral part of health care in the US, filling in a place that is much needed especially during this time of reform for our problematic health care system. He has started projects that have expanded all over the nation to involve clinical pharmacists as an important factor in reducing health care costs. Just in the LA area, he has impacted many of the underserved populations through his implementation of safety net clinics. However, one important detail he emphasized to us was how important it is for pharmacy to reach out to the other professions. Many of our professors have told us pharmacy students that "you know you belong in pharmacy when you talk to yourself." It doesn't help the nation, and it doesn't help the pharmacy profession. What it means is pharmacists do so much to reduce the potential of hospitalization, to reduce the risk of exacerbating chronic illnesses, to help patients control their illnesses, to educate people on their own and their family's health issues, and to implement plans that ultimately reduce cost all over the spectrum. But, the pharmacy profession frequently does not publicly show these efforts, and we keep these to ourselves. If it doesn't get known, if it doesn't get a chance to spread outside of pharmacy, how will these beneficial ideas be able to improve the state of everyone's health?

I've been hearing over and over again how pharmacy is changing, how the purpose of pharmacy is still unclear now that there are new demands in health care, and how current pharmacists and leaders in pharmacy are dealing with this. In my mind, I see myself collaborating with a physician in an independent clinic. We work together to care for patients--- pinpoint their health problems and control them. And it's not only me who has these ideas. Apparently, it is one of the directions that pharmacy is going toward--- interdisciplinary care. This means pharmacy, medicine, occupational therapy, physical therapy, dietetics, nursing, etc. as well as the patient and family members are involved in the care given. All the other health professions have a long, historic, and definite role in providing health care. Physicians diagnose and start a plan and OT, PT, nursing, etc. continue monitoring and improving different aspects of the patient's overall health condition. Afterall, a diagnosis of one disease does not mean just one part of the body is affected. The whole body is put off balance. So, where does pharmacy come in? Pharmacy has always been associated with medications, but to what extent do pharmacists deal with medications? What responsibility are pharmacists going to take and what results are pharmacists aiming for? Clinical practice. Clinical skills.

As I become more involved in these pharmacy services set up by pharmacy students and advisors, I hope to share these experiences with everyone, not just within the pharmacy profession. The question is, for me, in which direction within pharmacy do I want to go?

CXI : Things Seen in a Pharmacy?

Not quite sure why the Emergency Department wanted all of the pharmacies in the hospital to know. So... the patient ran away without taking the med? "Thanks though," but we weren't the ones who filled it. Anyway, whoever taped this to the dumbwaiter really wanted as many people in the pharmacy department to know. Did a splendid job too.

CX : Work and Not

I wish my phone's camera were just a bit better.

So, picture from July 4. I want to set off one of these fireworks some day! They are exciting to watch, even though they last for about 15 seconds?


I got injured at work last week.

So silly. I was trying to close our dumbwaiter, and my hand slipped and scraped on the crisscrosses of the mini elevator. Good thing skin is quick-healing! It's almost completely gone now.

On Tuesday, I went to Trio House to eat a dinner while waiting for traffic to loosen up a bit on the 10. I ordered a wonton noodle soup with BBQ pork pieces, which I found I don't like this kind of pork. It's so strange tasting-- sweet and porky. haha It's the kind with pink fringes. Other than that, it wasn't too bad. Finally went to the new Gateway complex at USC!


Back at work two days ago and yesterday. Saw some crystallization going on.

I hate working evening shift, especially if it's from 3:30pm-midnight. I can't imagine doing graveyard (10pm-7am). Ever. Unfortunately, it's a possibility in the future. My sleep cycle and body hormone schedule are all confused just by working evenings. I had an extremely wimpy, late period. I won't complain too much because at least I didn't get cramps or a bloody mess, but it's worrisome if this happens next month.

No work today. Back to work tomorrow. I understand this kind of working schedule, so why can't my mom?

CVI : The Price of More Time

How much are you willing to pay to live just a while longer, say, 4-5 months? Recently, the FDA approved two new prostate cancer drugs. This article presents the high cost of both Zytiga ($5,000/month) and Provenge ($93,000/treatment). I remember my professors talking about USC's Norris Cancer center providing Provenge to patients with advanced prostate cancer. It's effective and an option after hormone therapy begins to fail, but how many are able to pay the 93k? Men with prostate cancer are usually well over age 60, so chances are high that they're on Medicare. By accepting such costly treatment, you have the chance to live a few more months (a few people live some years more). Afterwards, however, what condition is your family in? You won't know exactly how long you have left, how will you spend each moment while you wait for that time to come? As your condition inevitably worsens, will you be able to face the reality that you can't extend your time anymore? Is dragging on life with the disease worth it?

I respect you medical doctors who must handle such issues when prescribing medications to patients.

CIV : Malibu

During the weekend, I went to Malibu for a board retreat with APSA (American Pharmacy Student Alliance). I drove on Friday night (6/3) and safely reached the beach house by 9pm. The executive board members were already there because their meeting was Friday afternoon, and the partying was just beginning even though we had the long meeting on Saturday with the rest of the board. It was crazy and loud, but I was able to hang out with people I normally didn't at school. I wonder why it is that I don't try harder to know these nice people. What is there to talk about? What is there to say? Why do I just sit in silence?

Anyway, Saturday was gorgeous.

We had our super long meeting from 9:30am to 5pm. During one of the many breaks, we saw dolphins swim by the shore. It was magnificent. After everyone left, only 9 of us stayed behind for one more bonding night together. It was relaxing, and I took a bubble bath by myself. I don't remember how long it's been since I had a bubble bath, but it was just as soothing and fun as I remembered. The day had made us all tired, and there was no energy left for any more partying like the night before. We gathered on the couch in front of the big screen tv and watched movies. I went to sleep before we finished Jurassic Park.

Sunday was a blast. It was my first time at the beautiful Getty Villa.

Somehow, I remember the name Getty from the Spain trip with band way back in sophomore year of high school. I doubt this is the same man, but it could quite possibly be. I didn't really pay attention to the tour in Spain. We took hilarious pictures and normal ones, and I really felt a good connection was established among us. I really can see myself working with these people and having a good time getting things done, I thought.


The peacefulness of this moment was beautiful. Unfortunately, there are other obligations in life that are calling. It's great to gaze at beauty and peace from time to time.

I am looking forward to my second year at pharmacy school.

CII : Breathe

Interviewers want to know what makes you unique from other candidates, what makes you stand out as a candidate, what your strengths are. When I get asked, "what makes you unique from other candidates?" I want to tell them exactly what makes me, well, ME.

I love dinosaurs. I am creative when I am allowed to be. I love the imagination and what can become real as a result of it. I am easily inspired by others, easily motivated by others, easily brought back to happiness by others. However, I am just as easily unmotivated and depressed by my own thoughts. It's not exact to say I'm easily influenced by others, although I tend to go along with things when I don't know much about what's going on. But it's also not exact to say I know what I want because I prefer to see everything as a whole before deciding or forming my own opinion. The more experiences I gain, the more confident I become, but also, the more I question that confidence, and as a result, the more I strive to learn and improve myself.

I welcome the thought of trying new things, but I try not to put myself in a position that will make me go through hardships. If it's avoidable, why set oneself up to be the current that passes through high resistance? I can be unpredictable and spontaneous at times, but I can also be shy and withdrawn. All this adds up to my being able to relate to many people through feelings, but not necessarily through experience.

So, as you can see, I am an all-over-the-place kind of person. However, can I really say what makes me stand out when I have no idea who the other candidates are?

Anyway, I tried different colors of nail polish earlier this week because my friend has a large supply and we were bored.


I like the dark purple one that's on my middle finger of my left hand. I can't tell from the picture, but it's dark purple. And very pretty.

I went to Costco to look for a GPS since mine broke. The screen has a crack and the touch-screen function doesn't work at all. Costco here didn't have good selections, but I did find a gigantic teddy bear! At first glance, I thought it was Spencer by Wongfu Productions, but it ended up to be some other kind.

It was soft and squishy, but heavy and shed all over my clothes like a dog, or more like my carpet. My eyes make me look like a crazy weirdo.

I also finally opened my emergency survival kit I won from CPhA (California Pharmacist's Association) Outlook earlier this year. The packed food bars don't look appetizing at all and are as hard as a rock. The blanket looks cool; it supposedly is suited for all and any kind of weather. It reminds me of the screens you put against the front window for cars to block out the sunlight.


Well, what's done is done. What's passed has passed. I can only wait and make the most of the time I have, and hope that I can simultaneously earn some income and knowledge and not put my family through even deeper financial hardships.

XCIX : IPPE Hospital

Today was the last day I was at my hospital rotation for IPPE (Introductory Pharmacy Practice and Experience). It was my first exposure to what pharmacists (and the pharmacy) do in the hospital setting, so everything was new and something to learn about. I'll leave that to another day because there's just so much I got out of it, yet there's so much more I want to know about.

Because today was the last day, my preceptor had to fill out an evaluation of our skills as externs. He commented, "You're kind of shy. But not in the way that you don't speak with people or ask questions when you want to. Give your opinions and get other people's opinions more."

hmm, I guess that's what I've been missing? I never could identify it until someone said it clearly to me, even though in the past, I remember saying to myself to be objective and fair. That's why I've kind of lost my own opinions of things. But, as a pharmacist, ethics plays a significant role, and my opinions will have to be well-defined with the best interest of the patient in mind. It's scary, but I'll work on it. Two interviews to prepare for.

XCVIII : A Changing Profession

It's not just USC that is pushing for the pharmacy profession to move forward from its traditional role of dispensing and compounding based on a physician's recommendation. This article talks about the changing profession. As the older generation of pharmacists is being replaced by the newer generation of PharmD-carrying pharmacists, the profession is shifting toward a more patient-centered care. This means that pharmacists are actively participating in the treatment of an ill patient. This means that pharmacists can do what they are expected to do best: know about drugs. This means that pharmacists can provide the insight and knowledge about drugs to monitor how the patients respond to therapy. What am I getting at? Pharmacists play an important role in patient treatment, just as physicians, nurses, and all other health professions do.

"The primary care physician shortage is acute and growing," Schommer continued. "Nursing and pharmacy are being called upon to take a lot of the load that physicians once carried. Physician groups are saying this is a good time to let go and focus on what they do best, which is diagnose and treat. When it comes to nonmedical care, nursing is very well positioned to take on the load. When it comes to medication therapy management, you think of us [pharmacists] as the best-trained experts."

In the end, it doesn't matter if the physician makes the perfect diagnosis if the patient doesn't get the right medication, or the physician also writes the prescription but the patient doesn't even believe the medication works. Each person in the health care team is specialized in a certain aspect of patient care, and because there are some overlaps, the team can make the best decisions about the treatment that a patient receives.

As a specific example, consider the roles in a hospital. Everyone knows that doctors go on rounds to check up on patients in their sick beds. Everyone knows that nurses take over caring for the patient after the doctors do their rounds. But, what do pharmacists do in a hospital? I may not know everything that the pharmacist does, but ever wonder where the medications that nurses give come from? Where do the IV bags that nurses infuse come from? Where do the emergency medications come from? Who checks that these supplies are always available? Who prepares everything so that nurses and physicians don't need to look for them? Who knows all the medications that the patients are on and how they interact? Who monitors that the medication is actually given to and taken by the patient?

It's true pharmacists are still mainly in dispensing and distribution, but it's changing. Pharmacy is a profession, and I'm proud to be going into part of the health care team.

I think I'm more suited for the hospital than the community because I'm feeling more strongly about being in the hospital setting right now. This rotation is really getting to me. I want to see more. I want to know more. I want to experience more.

XCVI : Quality

I want to have a job knowing that I'm doing it for others and benefiting from their happiness. I don't want to work just because it supports my life, and I especially don't want to go to work to just work routinely. I want quality in my future. I watched the first season of Code Blue (Japanese drama again), and it touched upon many themes that make working in a hospital difficult. How do you deal with emergency care patients? What happens when you must face the death of a patient? One that stuck out was physicians should know patients not by what they have (for instance, the guy with the seizures, the woman who needs brain surgery), but by their names. It's important for anyone working in a hospital, and hopefully everywhere else, to do that.

“Ask not what disease the person has, but rather what person the disease has.” –William Osler

I might turn out to be a workaholic...

XCV : Clinics

I went to a clinic for the very first time to help out (and see what the pharmacist does there). Apparently, the clinic was started by a physician, but she left in the past year and it was taken over by a pharmacist (recent grad too!) somewhat. She kind of just manages the educational and clinical opportunities for the patients. Today, she gave a talk on diabetes, hypertension, and cholesterol, and afterward, us student pharmacists were able to talk to the people who showed up for the talk. They were mostly diabetics and had some time managing their medication, so it was the first time I really talked to a patient about their specific medications. It was awesome. They were intrigued by the information that was presented (quite unlike some students who find going to lecture super laborious) and had many questions afterward. I was able to talk to three people and even applied a bit of what little information I had learned in class or at a health fair. Now, I hope that I can pull out more information from people to get a stronger idea of what could be causing their discomfort or inconsistent control over their disease states. I'll let the knowledge come to me little by little (uhh, though I know it really gets overwhelmingly thrown at you during 3rd year). First year will be to work on my interpersonal skills.

On a side note, I like clinics. I like the idea of providing a learning and medication-al experience to people who are really interested and focused on their own health. Without cost to them, except for maybe the few minutes or hours they have to put in to come to a clinic. I like seeing people taking care of their health and finding ways to improve and maintain it. Thus, I want to be able to provide those services to the people who are interested. I like the idea of a health care team taking care of a patient, monitoring a patient's medication and health, following up on the patient, basically revolving their work around the patient's health. It's all about the patient in health care.

XCIV : Coincidences

I went to a Pharmacy Conference called Outlook 2011 for CPhA. There was this one talk about "new drugs of 2010," but I didn't go to it because I didn't feel comfortable walking into the room in the middle of the talk (but apparently it's ok to walk in or leave during the talk). So, when my friends came out of the room, I read their notes. I skimmed the names and a bit of their indications, but that was it. Later in the day, there was a quiz bowl for just the pharmacy students there (there were 8 pharmacy schools that attended: USC, UOP, UCSF, UCSD, Loma Linda, Northstate, Western, Touro). One of the questions was about Pradaxa, which is a new drug that is supposed to replace coumadin for the treatment of stroke and other blood clotting diseases. I thought, "whoa! Cool! I recognize that from the list that my friend had written from the talk earlier today!" I like that feeling.

Then, just a moment ago, I read Sus' post about absinthe and how the wine has become Pernod, and then decided to start this new j-dorama called "Bartender." In one of the scenes of the first episode, the main character holds a wine bottle with the words PERNOD Paris, and immediately I go "whoa, I recognize that!" Something I had no idea about before just popped up twice in the span of 20 or so minutes! So amazing!

Anyway, I hope to log about the conference tomorrow. It was my first pharmacy conference, and it was quite an experience. Quite tired now.

XCIII : Exciting

What makes you excited? What makes you feel accomplished? What makes you like you've really learned something?

When you watch a drama and one of the characters is on an antidepressant, and the husband wants to drink wine together to cheer his wife up, but you know that there is an adverse reaction with alcohol and antidepressants, so you talk to the computer screen and say, "NO!! That will exacerbate her condition!" And later on in the episode, the wife is in the hospital for attempting suicide by slitting her wrist and the doctor tells the husband that wine will make her mental state more depressed. It's nothing to smile about, but I felt excited for knowing this little detail. Alcohol is one of the substances that can have an adverse reaction with many drugs.

One would think that dramas or tv shows are full of lies and make-believe, but when there is some sort of scientific basis that goes into the story (for example, in Juui Dolittle, a J-dorama about a veterinarian), it's amazing how much you actually know and can see pop up in entertainment. This is what I love about learning. This is what makes me feel my education is worth it.

It's exciting to be able to apply knowledge to life. But I have to keep in mind that these can be serious cases, and that is not exciting.

XC : 11111 one more day

What is the significance of 1/11/11 other than it's a whole bunch of 1's (just wait until november this year)? Is there some superstitious story to it? about luck?

Anyway, it was the second day of class today, and I found it tough to sit through it with my utmost attention. It was only the second day of class, and I fell asleep during break immediately, which left me feeling very groggy throughout the lecture afterward. guah

I want to list some kinds of pharmacists there are out there that I can go into (but I have absolutely no idea where I want to end up) because sometimes I get myself confused with "what does a pharmacist do?" Here goes, a (short) list:
Academia
Alternative Therapeutics
Anticoagulation Therapy
Army
Chemical Dependency
Clinical Transplantation
Community Pharmacy (Chain, Independent)
Compounding
Consultant
Distribution
Geriatrics
Health Systems Pharmacy
Home Health Care
Hospice
Hospital (Inpatient, Outpatient, Ambulatory)
Immune Disorders (AIDS)
Industry
Infectious Disease
Nuclear Pharmacy
Nutrition Support
OB/GYN
Oncology
Pain Management
Pediatric Oncology
Pediatrics
Pharmacology
Pharmacy Benefit Management (PBM)
Poison Control
Psychiatric Pharmacy
Sleep
Surgery
Regulatory
Veterinary

Doesn't it look like a MD can go into many of those various fields as well? Well, we are dealing with medications, which is where doctors and pharmacists overlap. The one day I went to yoga class back home, I met an older lady who was a nurse at Kaiser, and she told me that Kaiser is changing the some of work the medical team is doing. Pharmacists rather than nurses are taking over the role of giving screenings to patients and talking to patients about their health, so what will nurses be in charge of doing? Interdisciplinary medicine is complicated because of how the professions were built up in the past. What are we striving toward?

LXXXI : Good Questions

After finishing my externship, we had a take-home final. More like homework, which I totally forgot about until today, when it was due. So, I quickly went home after the first pledge meeting and completed my final in 2 hours. It really took 2 hours. Why? The questions really made me think, and there were 16 of them. And while I was answering each one, I kept thinking, "these are good interview questions." They are also good questions to ask people and get to know them better. :) A few:

How do you define success?
Success is the feeling I get when I overcome some intangible barrier, such as memorizing a piano piece, and see the people around me smiling.

I've done this one before: What makes you happy?
Many small occurrences make me happy. For example, hugging clean, straight-from-the-dryer laundry, receiving a smile back from someone I walk passed, getting postal mail, and cooking for other people. Seeing other people happy makes me happy, too.


Why did you decide to study pharmacy?
Growing up, I was intrigued by Chinese medicine, especially when I wrote a report about the Chinese physician, Hua Tuo. He made his own medicine and walked around China, curing people of their illnesses, and he was the first Chinese surgeon. What appealed to me was how he dealt with the patients after his diagnoses and procedures—the herbs and mixtures he gave them. I entered undergrad as a pre-pharmacy student not really certain what exactly was pharmacy. The more I learned about modern pharmacy, however, the more I became interested in it as well as Chinese medicine.

Do you want to be a leader? If so, in what capacity do you want to lead?
I want to build trust and equality among the health professions, starting with the perception people have of pharmacists. I also want to develop ways for the concepts of Chinese and Western medicine to be combined to maximize therapeutic potential.

And lastly, something I haven't really been able to talk about to anyone else, but I'm starting to feel like I learned the most about life from it.
A crucible is a moment or event in your life that was extremely challenging and altered your perspective on life and leadership. What and when was your crucible?
I have always felt I was a late sprout. I was generally carefree all through elementary school and just went with the flow of things in life. In high school, I felt I was in charge of how happy I can be with my life, but I was lost as to how to go about doing that. Unfortunately, because I did not have a clear mindset of what I was looking for, I encountered an emotionally extremely challenging situation in undergrad, when someone I met had a clear vision of his principles, and it clashed with mine. Through this episode, I learned that I needed to be more firm with my own principles and that I cannot be accommodating all the time. Whenever I became firm, I felt uncaring, so I would back down again. As a result, what could have been solved in a few days dragged to a few weeks. From this moment, I learned that someone must be resolved and clear when it comes to one’s values and beliefs. Leaders, to persuade others to understand their principles, must be determined and, at times, resolute.

LXXVII : Pharmacy Jot 2

So, three weeks have passed since the first day of class, and I am officially DONE with one class' lectures. No more new material for my Pharmacy Practice and Experience I class, but there's a final to look forward to after this midterm I have on Monday. It's going to be crazy. I'm nervous and scared, but what else can I do beside study, memorize, stuff my brain, and enjoy some good healthy food this weekend? Anyway, recap of what else I have learned about being a pharmacist (the professors really drill into you how drastically the profession has shifted).

Screenings. Pharmacists can provide these services to the public that are beneficial to updating them on their health. Assuming that I pass my first exam, I'll be able to give diabetes screening (measure blood glucose levels), hypertension screening (measure blood pressure), dyslipidemia screening (measure various lipid levels), obesity screening (measure body fat percentage), and maybe some other less common ones like osteoporosis screening. It's important for the people we screen to understand that pharmacists DO NOT diagnose. We leave that to physicians to do. They may (and most likely will) use the same procedures we use, but they have other techniques to further speculate and diagnose. Also, given that physicians have a patient profile of whatever illnesses or problems (like fractures) the patient has had recently or before, physicians have more information about the patient to be able to pinpoint what exactly is wrong with the patient. Pharmacists have no patient profile like that. Pharmacists have information about the patient's drug history and allergies, but not enough to truly diagnose. Therefore, pharmacists assess. We can tell the patient that they are at risk of having diabetes (or they may have it) and refer them to a physician to get a true diagnosis as soon as possible. This is one reason why I feel like "why aren't there pharmacist+physician clinics around?" Pharmacists have to be vague about illnesses and disease states when screening. People should know that pharmacists do not diagnose.

Ok, the pharmacy profession is so young! compared to the medical profession. This is because pharmacy wasn't called "pharmacy" until somewhere in the 1800s, I believe. Pharmacists went through being called "apothecaries" (which some places still do), "chemists," "druggists," and "pharmaceutists" before becoming "pharmacists." I don't know how true this is, but Professor Goad said today in lecture, as an example of how pharmacists and physicians diverged, that physicians went the way of patient care using leeches to suck out blood while pharmacists used snake oil. Anyway, to think that just 50 years ago, pharmacists would never think about questioning a physician's prescription and that even many of the pharmacist associations in the US are relatively new (Academy of Managed Care Pharmacy is 20 years!), pharmacy is truly a developing and changing profession. I believe it will continue to be so long as the US health care system is a mess, which it will be for quite some years. People want to provide health services to those who need it and those who seek it. And as health professionals, what we can do for the public, we should do. If we can provide basic health services such as the above-mentioned screenings to people, who knows how much better educated the public can get about staying healthy. We can't assume that they will always follow what they're told to do, but we can provide recommendations and access to follow-ups so that they monitor their progress.

I hope that I will be able to work with the medical students some time this year because I really want to know what medical students are able to do. My image of doctors is a fee for every visit, no matter how long the visit and what it's for. Just to talk to the doctor for consultation probably costs you some amount. There are probably doctors out there who also provide free consultation services (and maybe diagnosis for the easier-to-diagnose diseases?), but I haven't heard of it before. I'm hoping to find out. By the way, did I mention that I can give shots now? Sticking a half-inch needle into someone's arm is so crazy! The skin is quite resistant. I am amazed.

One more thing, "retail pharmacy" is an old term. It's "community pharmacy" because pharmacists aren't like they used to be-- more about business than about patient care. Nowadays, pharmacists are more about patient care, but sometimes, especially for independent pharmacies, the businessman takes over. I hope that I'll be able to find what kind of pharmacist I want to be soon. I want to work with both physicians and patients... so maybe an in-patient hospital? Who knows. I start my community pharmacy externship on Tuesday. We'll see how that goes. But first, got to get over this Monday exam from 5:30-8:30pm!! *cries*

LXXVI : Pharmacy Jot

It's been one week of class! During the week, it got harder and harder to get up at 6:45am to get to class before 8am. But, finally it's Saturday, and I am recharging my energy for the week. Anyway, highlights about the first week, which I am glad I learned even more about what being a pharmacist entails. I still don't know exactly what I want to do yet though.

So, patients get prescriptions from their PHYSICIANS. Because pharmacists are also "doctors" in the sense that their degree is the doctoral degree, just as PhD, MD, DD, and all other D's are doctors. But, doctor, physician, same thing in lay. And there have been changes in the responsibilities and practices of the pharmacy profession to make it even more critical to the medical therapy of the patient. For instance, though USC was the first to have the PharmD program in 1950, pharmacy programs in the US were all changed to PharmD in 2000. So many of the older pharmacists aren't used to being addressed "Doctor (blah)." Also, only in 1993 were pharmacists required to provide patient consults on new medications. This is important for patients to completely follow the steps to fix/maintain whatever health problems they have. But so many studies find that people don't follow through with their medications, and they end up going back to their physicians because their problems come back or persist longer than expected. Why does this happen?

Pharmacists took up the responsibility to be the one to guide patients properly through their drug therapy. That is why we are required to know everything about every drug out there. We want patients to have the best outcome from their medication regime at the lowest cost. This is where consultations come in to help. Though we can ask questions to determine what medication would help the patient (like detective work!), we don't diagnose (job for physicians). This means that we are at our best when we know the patient's complete medical history (what are they taking now? What have they taken before?), any supplemental drugs, any allergies, health conditions, etc. But there's usually missing information and we can only trust the patient to tell us everything (being honest about not taking a drug as indicated). Most physicians don't find out that patients may be taking blood pressure medication every other day instead of every day as prescribed. They may think that it doesn't work, so they prescribe a higher dose (which could lead to adverse effects). So, as health care professionals, we should work together (like detectives in different departments!!!) to find out what is going on with a patient. It makes sense to be a health profession for a patient right?

Anyway, on top of all the "how are pharmacists involved with patient care" stuff, I have to memorize drug names, dosages, indications, and classifications for the Top 100 drugs. It's crazy because they feel like random words and numbers, which most of them are (brand names...). And I have to learn at what age people get what shots at what dosage. Oh yeah, pharmacists can give shots, and one of my professors predicts that pharmacists will take up the responsibility to provide shots for people. We'll see. The profession is so heavily regulated and feels so "new" compared to the medical profession. As one of my professors said, medical doctors have distinguished themselves very well from each other... say if one family doctor gets sued, the surgeon in local hospital isn't affected. But say if a pharmacist in local pharmacy gets sued, all pharmacists get a bad reputation.

I'll leave this with an awesome quote by my professor: "Patients don't care how much you know until they know how much you care." Can't force patients to take their meds properly, go to check-ups and follow-ups, and return to you for future problems if you don't care if they recover or not.

In other news, I hiked up to the Hollywood sign with a bunch of other pharm students (mostly P1, some P2)!