Residency!

I may have put this blogpost off until, oh, 11:15, because I was scrambling for a topic that wouldn't totally embarrass me. So I won't be detailing here exactly what happened when I played Fatal Frame alone in the dark a few nights ago.

Instead, I'm going to give you guys the rundown on applying for residencies! Or, what I'm planning on doing for the next two years in attempt to get a better background for the time when I'm solely responsible for people's lives.

I want to be an infectious disease pharmacist. To do this, I have to do two additional years of training after I graduate. One year of an intensive pharmacy practice residency - basically a more advanced version of this last year of rotations; one year of intensive infectious disease work.

I'm working on applying to a bunch of places across the country right now, and it's been simultaneously the most demoralizing and exciting experience I've yet had. You see, when applying to pharmacy school, I had one option (due to an ill-fated run in with a poisoned chicken salad sandwich the night before I took the PCATS). I didn't have the anxiety of having to choose between programs, or the fear of not getting in. Or the soul-crushing experience of rejection letters.

Now, I've applied to nine places. One of my top choices turned me down before I even got to interview. Another one did the same (in a hilarious two-sentence form e-mail that didn't even include my name). Four places have given me interviews so far, and I'm waiting to hear back from three more. The fact that there's no way I'll be living in Seattle next year is pretty well countered by the awesome point that the first interview I scheduled was my top choice. I may have spent an hour running around the apartment yelling when I got the e-mail, before calling everybody I know and generally freaking out.

These interviews typically take hours. I'll have to impress the current residents, the residency director, a host of pharmacists and preceptors with my ability to answer questions and whatever clinical stuff they want to throw at me. I'll have to give presentations, analyze journal articles, and solve case reports.

I go on my first interview in less than a week. It's in Ohio. Weather permitting, I'll get there on time (at this point my biggest concern) and then I'll proceed to destroy all of my jitters by blowing the interview out of the water.

Remember Jaws? It'll be like that.

Except maybe with less raining of sharky bits.

Gratitude

I've been thinking a lot lately about gratitude, and expressing it. I'm on my critical care rotation, and I'm getting accustomed to watching patients die. That doesn't bother me as you'd expect - I'm learning that to a point there's only so much we can do for a person, and past the best we can do is a realm where they either live or they don't. It's not up to us.

I don't feel guilt for those lives because I know we've done everything we can. I'm sad, and I regret that they die, but I understand that it was not because of something we did or didn't do. On my first day my preceptor told me that I would have to get used to watching patients die, and that I would have to be able to handle it. I'm glad he gave me that warning, and I think I've been handling it well so far.


I've watched an organ harvest, and absorbed the fact that five people minimum will lead new lives because a 22 year old died (admittedly, there was a lot of crying and some alcohol involved in coming to terms with this). I've watched patients die, surrounded by family members who had the chance to say goodbye. I've watched patients die without lasting long enough for family to reach them to say their farewells. I've watched patients everyone was sure were done for recover, and leave the ICU. This has been the most intense, fast-paced experience I've yet had.

It's been an especially hard rotation emotionally for me. I'm learning a great deal and I'm grateful every day for the opportunities I've been given. I'm able to see critically ill patients and I'm able to help them get better. But I'm also encountering situations where nothing we can do will help. It's been difficult to come to terms with this, but I'm learning.

All I can feel at this point is an overwhelming gratitude for everything I have. For parents willing to sacrifice enough to give me the opportunity to get out of school debt free. For the fantastic friends I have, and the friends I've made here in Reno. For the chance to become friends with musicians I admire and respect, and for the chance to be helped through a vulnerable place by these same friends.

I'm grateful for the opportunities I've gotten for coming here for this last year of school, and for the fact that I'm happier now than I have been in three years. It's been a real struggle up to this point, because of the overwhelming pressure and depression I've been pushing through for the last three years. I feel like this is where I'm supposed to be at this point in my life and I'm truly, honestly, happy.

I'm grateful for the help and guidance of my professors and mentors, who spent countless hours helping me prepare for my residency applications - and for the burgeoning results of those applications. I have a decent shot at my dream job next year, and it's thanks to the efforts of those who support me.

I know this isn't a fun or funny post, but I've had this on my mind for a while, and wanted to get it out there. More accordion madness will be forthcoming.

Adventures in Compounding (and other things)

Today was another one of the compounding Saturdays of doom. I went into work (running on very few hours of sleep, thanks to the inane urge to watch Watchmen at midnight last night) and was presented with twelve IVs, 50 syringes to put 0.1 mL of a drug into, and a stack of things that needed to be made. I spent two hours in the hood -which is pleasant enough at first, but soon it becomes a sweltering nightmare in which you're focusing so hard on tiny details that you start to forget big picture things. Like the fact that I still have one more exam coming up, or that you should probably remove surgical booties when out of the hood so you don't walk around looking like an escaped mental patient the rest of the day.

It wouldn't have been such a bad day except that we finally got the H1N1 vaccine in and another shipment of the seasonal flu vaccine. The other intern essentially had to spend the entire day in the blood draw room sticking needles in people while I ran back and forth from the compounding room to help the pharmacist out during rushes, usually whilst covered in whatever cream I'd just spilled. An observation of note: wearing a surgical mask, even if it's just to prevent yourself from breathing in hormone dust, freaks patients out. Moreso when you burst flailing from the room and trip over the rug while trying to wipe a concoction of testosterone off your arm before it absorbs enough to cause some rather unpleasant changes.

I ended up making something like 600 mL of a stock cream and filled well over fifty syringes with the stuff. The true trial of the day, though, came in the form of a thyroid capsule that for some unfathomable reason contains olive oil. I have no idea why anyone would put olive oil in a gelatin capsule, but I valiantly attempted it with the assurances of the lead compounding tech that she'd done it before and it works pretty well.

I don't know to which dark gods she has been sacrificing sheep to be able to make that work, because I spent two hours trying to coax the oil/pig thyroid/silica gel mess into those capsules. It smelled terribly, looked like death, and refused to cooperate. I gave up when the syringe I was using exploded the vile mixture all over the window and wall, and vowed to steal the dark secrets from her on Monday.





Also, I recently gave in to a two-year wish and bought myself a squishable. It's amazing. That's him above. I dubbed it Worthington and promptly spent the afternoon taking pictures of him attacking various things and being quite the intellectual. The afternoon would probably have been better spent studying for the dosage form and design final I had Friday, but everybody needs a break, right? And that particular final turned out to be ridiculously easy.



The aforementioned projects are still in the works - one of them involves setting up a program that would allow a group of people to see what their friends are reading and connect to other people who read the same things. I can't do it by myself, so the ever-awesome Cody will hopefully be helping me iron it out when we both have some actual time. I got the idea from him, as he has been talking about keeping track of everything he reads, and I think it'd be a neat way to connect with your friends and with other people.

There may be another post up tomorrow. I, in a lapse of judgment, agreed to let the techs take me out to the bars tonight for a few hours. If some other less-than-suave "gentleman" tries to shove his hand in my drink his time, he's going down.

It's About Time

I have here, for your listening enjoyment, the first recording of me playing the accordion. I did have a video, but my internet connection is currently the butt of a terrible joke and thus cannot handle the 30 second webcam vid. Typical. Everyone should laud much praise upon my friend Cody for fixing the video into a workable format for me. He's amazing.

The song is Du, Du Liegst Mir Im Herzen, which I'm assuming means something about love in German. According to my lovely book, it's a German folk song. My phrasing is less than perfect and there are a few mistakes in here, but this was probably close to the thirtieth attempt at recording it and my patience was wearing thin . . .



I'm hoping to post a video each week, to both force myself to practice and to see if I'm actually improving. I do feel rather awkward as there's not much in the way of volume control on accordions and this apartment complex has walls that are best politely described as 'thin'. There haven't yet been any angry stompings or agitated people trying to bash my door down, so I'm going to keep assuming my fellow apartmentians are connoisseurs of fine accordion music.

Hey, it's possible.


In other news, pharmacy fair was yesterday and today. It went off well, and I'm excited to chair the committee for next year. I had two interviews today, one with Shopko and the other with CVS. They were marginally awkward as I've got a job I adore and am not really looking for a summer internship, but the interviewers were polite and I made some decent contacts.

Swag from the pharmacy fair was also awesome this year. Shopko was giving out their brochures on 2 gig flash drives, and entering all of us in for a laptop drawing. Big Box Retail, my opinion of you is shifting slightly upward. The rest of it was the standard pens, first aid kits, and the like, but I did manage to snag an epic post-it organizer and five decks of cards - the Walgreens reps kept dumping stuff in my bag as I walked by.

Albertson's took us all out to one of the local bars last night to relax and interact with the recruiters in an informal setting. I enjoyed a gin & tonic, vodka cranberry, and a lemon drop, then stuck with water for the rest of the evening (in the interest of self-preservation).

It was great fun until some random bar-goer decided I was grade-A meat and needed to be picked up. Let me paint a picture of this positively delightful example of why I need to get the hell out of SE Idaho: long greasy hair, scruffy beard, filthy jeans, a grey sweater, and a mardi gras necklace. Yes. In October. Somehow I doubt he was celebrating Fat Tuesday. This less-than-appealing example of masculinity came sauntering over and put his hand in my drink.

Slimeball: Heeeeey, what're you drinking? (as his filthy hands violate the sanctity of my delicious hangover-preventing H2O)
Me: Water . . . (as I stare in abject horror at the dirt now floating in my once pure refreshing beverage)
Sleazy McJerkFace: Hey, that won't get you drunk, let me buy you a beer! (while removing his grimy hands from the plastic cup now holding only despair and broken dreams)
Me: (more abject horror)
Wonderful Fellow Female Students: Objection! Interception! Rejection!

I am eternally grateful to them for getting rid of the water defiler, and for getting me a new cup. The rest of the evening was fun, until Phil decided he hadn't had enough and spilled beer all over my nice boots.

Conclusion: I need to find out some way to make myself completely unattractive so I can go to the bar and enjoy drinks with friends without needing to bathe in lye afterward.

Also, accordions are awesome.

- SqueezeBox

Pressure

I currently work in a family owned community pharmacy that does a few extra things like compounding on the side. On Saturdays I'm the compounder and thus get to spend an enjoyable eight hour shift making capsules, creams, IVs, and whatever else anyone needs. If there are no current prescriptions, I make an endless supply of Domperidone capsules. And I truly mean endless waves upon waves of orange capsule shells and powder that needs to be mixed and packed into each one perfectly . . . I have nightmares about the stuff, honestly.

Today I spent a few hours making eighteen ceftazidime (an antibiotic) IVs. When making an IV, the powdered medicine needs to be reconstituted, mixed, and then put into a bag to be put into the patient. It sounds simple enough, but I found out the hard way that too much positive pressure is a bad thing. In order to be able to get the mixed up medicine back into a needle from the vial, there needs to be higher pressure inside the bottle than outside. Usually it's easiest to squeeze some air into the vial and allow the fluid to fill the needle because of the pressure.

Unfortunately, ceftazidime produces gases of its own when mixed, and needs to be vented before putting the liquid in the needle. I thought I would be clever and put more air into the vial before withdrawing the fluid . . . which ended up being a mistake. Turns out fluid under pressure can and will squirt through holes in vial lids made by needles.

It also turns out that ceftazidime looks and smells very much like cat urine.

I managed to remove most of the smell from my lab coat, and then went about making some solutions for dogs. We use beef flavoring to get the dogs to think the medicine is a treat, but it's kept on a relatively high shelf along with every other kind of flavor oil we possess. (Side note: Graceful is not an adjective that will ever be used to describe me.) I reached up for the beef oil and pulled it down, catching the bottle of bacon flavor on the way. The syringe fell out of the top of the bacon vial, thus allowing the concentrated oil to cover the counter, me, the capsule machine I'd just emptied of Domperidone, and the tools I had just set to dry.

Concentrated bacon oil does not clean up well.

Now smelling of cat urine and bacon, I went on a hunt for our bottle of odor neutralizer (which we picked up after the unfortunate tuna incident). The bottle had gone missing, and the only thing I could find was a test bottle of candy cane scented spray. I didn't think the combination of smells could get any worse, so I used it on the bacon affected area.

Minty bacon and cat urine is, surprisingly, not an appealing scent combination.

The smell may have also seeped out of the compounding room and may be sinking into the carpet.

I might be needing to make and bring in cheesecake to appease the head compounding tech for this one.

- SqueezeBox