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.

CXXI : Disney

Growing up Mufasa was my father, Bambi's mother was my mother, Ariel was my sister, Peter pan was my younger brother, Hercules was my older brother, Esmeralda was my aunt, The Genie was my weird uncle, Woody & Buzz were my best friends, Baloo & Bagheera were my babysitters, The Dalmatians were my pets, Growing up Disney was my family. I'm proud to say I am a 90's kid.

Someone commented this on a youtube video, and I can completely relate to it. Hoping the future will be as sweet and leave great memories as the past.

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?