Musings of a Pharmacy Student

A Conundrum...

2009-09-16T14:50:00.000-07:00

Someone riddle me this - why are some students so stuck-up? Yes, I realize that you getting a doctorate is amazing, but that doesn't mean you get to treat people like crap. We're going to be future colleagues and you're already stepping on people's toes. You stick with your MD course, I'll stick with my PharmD course (and possibly future MD).

We're on the same side of the battlefield. Don't make me an enemy.

The Title Difference

2009-07-16T12:29:00.001-07:00

To preface, read this.

Take every "fact" with a grain of salt. Oh yeah, try not to laugh when reading the original poster's responses.

So, people seem to be mistaken when it comes to the title of "Doctor".

Doctor, in modern times, mainly refers to medical doctors, or ones who hold the Doctor of Medicine (MD) degrees. Now, the title of "Doctor" does not only go towards MD holders. There are many other non-medical degrees that hold the title of "Doctor", like Ed.D (Education) or JD (Law).

Classically, however, Doctors of Philosophy (PhD) in any subject matter (of course, from an accredited college) are the original Doctors.

If everything goes as planned, I'll hold a Doctor of Pharmacy degree, and perhaps go to med school and be the bastard child of pharmacy and medicine. Then the world shall tremble! Or not. Oh well, it's good to dream, right?

PS: Anyone with a doctorate degree has the title doctor. Yoink.

Oddities of the Day

2009-07-02T16:41:00.000-07:00

One long and weird day in the hospital. I review medication reconciliation forms and see if it's complete, matches the patient, and to see if it makes any sense at all. Here are some gems from today:

Lumigan Eye Drops 100 mg OU Daily
Since when did the strength of Lumigan come in 100 mg?

Ritalin 40 mg PO Daily
I haven't seen that much Ritalin used in a single day in a while. Funny thing is, the script filled at the retail pharmacy said: Ritalin 10 mg PO 1-2 tabs up to 3 times daily. A possible 60 mg daily? Really?!

Vicodin user
I backed out of this room quick. Cold turkey with vicodin after taking it for a while (and happened to drink alcohol during the cold turkey process). Don't you people see what happened to House?! He went cold turkey and couldn't do it, and he's a badass.

Levitra 10 mg PO PRN
The man winked at me and gave a creepy smile when I asked. End of story.

A patient that takes 39 *different* medications
I didn't think this one was possible. I spent 1/2 an hour to an hour making sure everything was correct for this patient. This one beat my last record by a solid 15 medications.

I'm sure I'll see more funky stuff tomorrow, considering our ED and ED Lobby was packed today.

Undergrads and the Fresh Meat

2009-06-15T14:52:00.000-07:00

I almost forgot what an undergrad looked like. So hopeful of their futures, bragging about their degrees. Not in this economy. In this economy, people are LUCKY to get jobs.

Walking around the Student Union (not because I wanted to, I dropped off a couple undergrad class books for a friend), I overheard many conversations. One was of this guy talking to a chick, trying to impress her.

Dude: "Yeah, I'm going into med school."

Chick: "Oh, so you're going to be a doctor! How cool is that?!"

Dude, you're not getting into med school, you still have another 4 years to go before people will even consider you. And at the rate you're talking and impressing the ladies, it will be a cold day in hell before you ever get in. I hope admission standards are still high. The ditzy chick was no better. She was pretty much clueless as to what college was for. DURRRRRRRRRRRRRRRRRRRR SORORITY!!!!!!!!!!! I lost several brain cells standing there listening to her babble on about what sorority she was going to join.

Another one I overheard was a new kid trying for pharmacy. Now this guy was a lot worse than Mr. Impressive up there.

Kid: "I'm going to pharm school, but not here. I only came here because I wanted to get away from the parents."

Hey jackass, the university you're at has one of the Top 10 pharmacy programs in the nation. Dickweed didn't even do a tiny bit of research before he mouthed off my precious College of Pharmacy.

So naive...so clueless...

Bitchy Eunuch

2009-06-05T23:12:00.000-07:00

There's a nurse on the Med-Surg ICU that looks like a eunuch. No joke. But that's not the point of this. I just got off my shift (the pharmacy was still getting hammered by orders), and I am mighty annoyed at him...or her.

Maybe he was lacking some testosterone and had to make it up by venting (I would like to call the term "bitching") at me about an order. Eunuch here called our handy-dandy cell-phones from hell and immediately starting ranting about not being able to get Methadone out of the machine for his patient. I check the computer, find that the old dose (35 mg) of Methadone was discontinued, and a new dose (30 mg) was put in. Problem was, Dr. G had written for the patient to take the last dose before d/c'ing starting the new dose. Now, consider this: we only stock the 10 mg flavor of Methadone, and Eunuch is still able to pull up the Methadone for this patient. How hard would it be to pull out #4 of the 10 mg Methadone and break one in half to fulfill the 35 mg dose? He could have easily done it under the 30 mg Methadone order. But NO! Eunuch insists on re-entering the order. The common sense train needs to hit Eunuch at full speed.

While still holding the phone, I print the order to have our overnight RPh look at it, and I hear him...or her say in the background "these stupid pharmacists...".

Oh snap! You said stupid pharmacists to the pharmacy intern! Not the brightest idea, mate. You can raise your voice at me for all I care, it's not going to change what our department thinks of you. Next time you start bitching, the game is on, and it's hardball now. Oh yes...that means you're going to be frustrated when dealing with me, because I'm not taking any more shit from you Ms. Eunuch. You also better take your blood pressure meds before you start your shift, because at your age (damn old), your blood pressure is going to spike when dealing with this 20 year old. I will make your 2.5 hours with me a living hell.

I should point out a couple facts and opinions here:
1) The order was to finish the last dose of 35 mg Methadone at 2200. Eunuch called at 2130.
2) It's not going to kill your patient if he or she doesn't get Methadone at 2130.
3) Eunuch treats himself like a king. If it doesn't go the way he wants it to, he turns into a bitch. Eunuch bitches are not fun to deal with. He already lost his manhood, now he's bitchy. Yuck.
4)Since our pharmacists are so stupid, Eunuch should never EVER call down to clarify an order or ask what a drug is, if it can go down a PEG tube, or if it's compatible with another drug.
5) Quit the nursing profession. You're making nurses look terrible.

To the stupid lady-nurse that cut me off when explaining how our phone times work: Clean the sand out of your vagina. I was just reminding you the times for calling my phone (if the other intern/tech can't be reached, or if it's past 2200). If you actually paid attention or knew that, we wouldn't have this problem. Did you really have to just hang up on me in the middle of speaking? A simple "I understand" would have been fine. Next time, no, I won't find the med you're looking for, and no, I won't look at the patient's orders for you. I'll simply redirect you to the other intern/tech. You waste my time, I waste yours. Done deal.

I swear, all the incompetence in the hospital gathered tonight. Is it a full moon? Is it show your stupidity night?

Code Blue and a Shoutout

2009-05-26T21:47:00.000-07:00

I attended my first code yesterday, and it was something that I'll remember, however odd it seemed.

So a code blue was called overhead, and be being an intern had to attend the code alongside the ICU pharmacist (he kicks ass). Luckily, the ICU pharmacist was back at central, so we grabbed the code box and immediately headed straight up to the room. It was a giant jumble in there. ICU nurses, ER Physicians, ER nurses, nurse techs (?), and us two from the pharmacy department. I broke the lock in our code box, ready to hand over any meds to the pharmacist and the nurses. The nurses were already doing CPR on the patient and the ER Physician was doing all the checks and asking about prior history. Our pharmacist called out for 1mg/mL of epinephrine to be administered and told me to get the syringe of atropine ready. An intensivist and hospitalist were called overhead to the room stat, but didn't arrive until the end of the party.

The patient was fine, and transported to the CVICU. However, two important things were missed. Documentation: every health professional should know to document anything that's going on with a patient, including what has been administered (and time), what each person was doing at the time, and the condition of the patient. CPR: the CPR was going fine, however the patient probably has bruised (or cracked) ribs due to the compression. We noticed on our way out that there wasn't a backboard under the patient. Yikes. Well, at least she's alive.

The cool thing about this was that since the ER Physician was preoccupied with the patient, the pharmacist was calling the shots and telling people what to do. That's how much our physicians trust the man. He's awesome.

Anddddd here's a shoutout to the ER nurses at the hospital:

...Except for the one who had no idea why I was sitting there typing away, looking at a patient's profile and the H & P. You totally could have asked me who I was, but you chose to ask another nurse. Luckily, she knew who I was, and she liked having me around in the ER. So there!

Anyways...

You guys and gals have a job that's hard as hell, especially when there is a total jerk of a patient (or in my case the other day, one that had to be restrained AND held down and injected with some sedative). You all do an excellent job with patient care and are highly coordinated.

She had it coming...

2009-04-20T23:37:00.000-07:00

Oh man. Worst day to go into work. Our Acudose was going nuts, not working at all. I thought I could handle it - but only barely. Everyone called about their patients not being entered in, and they couldn't get the meds out from the machine.

Ok, send down a request form. Surprisingly, almost all of them did that, which was a first.

Five hours into the shift, I get a phone call from an irate nurse. Now, I'm usually a nice guy, and will help out with what I can. This bitch starts yelling at me.

My blood starts to boil.

Carefully, I told her to give me the patient's last name, room number, and missing meds.

She starts yelling again, wanting to know why the patient's meds weren't up there.

"I NEED NEURONTIN AND LOVENOX FOR MY PATIENT RIGHT NOW."

She was treading on thin ice at this point. I had a tinge of controlled anger in my voice.

"The Acudose machines aren't working correctly tonight, no one is crossing over into the system. The whole hospital is affected. The thing is, we have it set so you can access the whole Acudose inventory."

"IT'S NOT IN HERE, I'VE ALREADY CHECKED, THERE ISN'T ANY NEURONTIN OR LOVENOX IN THIS ACUDOSE."

Like hell there isn't. I know for a fact it's there.

"Well, what did you look under?"

"NEURONTIN AND LOVENOX."

"..."

My sarcasm meter rose.

"Have you tried looking for it under generic names?"

"..."

"Oh, what are they?"

At this point, I could've given two shits about what she needed, she pissed me off.

"The nursing drug handbook would know, but they're gabapentin and enoxaparin."

"Ok."

*click*

No word of thanks, but I didn't expect any.

I go up there and you turn your back to me. You can't even stand to look me in the eyes anymore. Your ass got handed to you on a silver platter. Yes, the lowly pharmacy intern just said some generic names, and you're ashamed that you yelled at me. That's all it took? Weak shit.

I go back to the pharmacy, still angered.

"Why the FUCK can't the nurses FUCKING move their asses five FUCKING feet over and look at the nursing drug book?"

That was the loudest I ever dropped f-bombs in the pharmacy.

The overnight pharmacist just looked at me and starting laughing.

Rx Scripts

2009-04-19T00:08:00.000-07:00

So here's the deal. Physicians usually have their own Rx sheets, right? Those little rectangle deals with their name, title, address, DEA crap, the whole shebang, right? So I'm pretty sure they have them in their offices with them.

Someone tell my why they can't carry their own Rx sheets to the hospital when they come for a consult or a patient visit? Ok, nothing wrong with that, they're busy people. I'm ok with bringing up a couple of sheets for you, provided you aren't being a dick to me. However, me bringing you up a couple Rx sheets is ME doing YOU a favor, because you "FORGOT" to bring your Rx pad with you. When you YOU start getting pissy at me because YOU have to sign for them (hospital policy), then you get ME angry too. You know why? Because you're being a dick, and no one likes dicks. Being rude and inconsiderate to the pharmacy technician or intern isn't going to get you anywhere, especially when you're speaking through a nurse to talk to me. What, can't even spare 1/2 a minute to talk to a lowly pharmacy intern? Have to retain the tough-guy image? Well, doctor, grow a pair, let them drop, and TALK TO ME. Our numbers are posted CLEARLY on EVERY board, so ANY staff can contact us. Your bitchy attitude may intimidate the pharm techs, but you're not going to get shit from me. I'll take my damn time in getting the scripts to you if you're bitchy. "BUT I'M THE GODLY MD THAT HAS COME TO SAVE THE WORLD!!!!!!" Yeah, and I'm the one you have to get past in order for you to save the world. Go ahead, complain to my director if you want to. I'll give you my full name and position. I'll simply say that you were extremely rude and inconsiderate of my position, and how you have the worst attitude. EVER. Who will my director side with? Me. You know why? Because my director isn't intimidated by physicians either, and my director knows the shit that our department gets as a whole.

What irks me more is that I know you can talk to me. I can hear the nurse dictating my response to you, and you replying to her. Afraid to talk to me? Afraid to ask me why we have to get you to sign for the Rx sheets? Well, here's my answer to you. We get you to sign for them, so that the hospital and pharmacy are both covered when you decide to leave them around, and some non-medical personnel decides to write a script for Norco for themselves. Oh no, it won't come back to you, of course. They won't screw with YOUR DEA number because the scripts came from pharmacy! It's all the pharmacy's fault, even though you signed for them!

Here's a tip for you. ORDER SOME SCRIPT PADS FOR YOURSELF. I know you can afford them, you're the guy who pimps around his Mercedes like a jackass. You play nice, and I'll play nice. You be a dick, and well, you can piss your precious time goodbye.

Pre-Meds

2009-04-14T09:35:00.000-07:00

Yep, I have a major problem with ~~all~~ some of you.

The brown-noser who sits in the front of the class who has an air of superiority around him: you suck. We get it, you're a Pre-Med. You don't need to make a "forum" saying that it's to "help" people. We can study physiology perfectly on our own without staring at a screen the whole day. You are so ridiculously snobby, I would hate it when you actually become a physician, if that ever happens; you're the type that will get so held up on getting people to do what you want that you won't care about anything else. You probably only do it so you can have the oh-so-prestigious title of MD. You are no better than the person who sits next to you. Oh wait! No one sits next to you. No one likes you.

The two girls who sat right behind me talking the whole time: Your Alpha Epsilon Delta shirts will not get you into medical school. Just because you wear them doesn't mean you're automatically accepted. For the love of god, shut your mouths for a couple seconds when in class, you might benefit from and, and I sure as hell will benefit from it. I don't care about what you did last night. No, seriously, I really don't care about what you did last night. SHUT UP.

To the girl who has a "College of Medicine" bag: You are a pretty bad offender. You're not in the college yet. Your MCAT score wasn't great either. If I were you, I would stop talking, because I could hear you...from the BACK of the room. I don't want to know how much you studied for the MCAT, much less hear you talk about how hard it was (cry me a river, you chose it). I don't go around flaunting my status as a pharmacy student, a PRE-MED really shouldn't because you have no status to speak of. Don't hate on other majors because you're not in it. You know that smirk on your face when you talk about yourself? Lose it, it makes you look like a total bitch. You think you're better than your friends who support you in your endeavors - keep on going like that, and they'll be your enemies.

To the guy who comes in to class late everyday and makes a big commotion: Douchebag from the "honors" section. Nuff said.

And to all the other Pre-Meds that aren't like these people, THANK YOU. I hope you all become excellent physicians, and look forward to working with you in the future in the healthcare team.

D-Bags and Dicks

2009-04-14T00:12:00.000-07:00

As with every occupation, there are d-bags and dicks. So, someone tell me why people have to be such asshats and treat other people like crap? Oh no, it's not only physicians (:D); it's everyone: pharmacists, nurses, anyone working the health system (oh, especially insurance, you suck!). Given, if you screw up, you probably deserve to be ripped a new one.

Besides god-complexes, egos, and shiny new licenses getting in the way, can someone answer that question for me? Why can't people work with each other?

Lookie here! http://www.youtube.com/watch?v=sGip7x-sIuo

I hate people. I am angry.

2009-04-12T17:25:00.001-07:00

You know what annoys me the most? People giving out medical/drug advice without even knowing WHAT THE FUCK THEY'RE TALKING ABOUT.

So one of my previous teachers back in my high school has some problem. Ok, fine with that, so I list out stuff to take (it was a cold...thank you differential diagnosis), and was done with it. Then I told him that he a) could take them together (no major interactions), or b) wait before taking the drugs (I recommended the latter choice, since I didn't know what the whole PMH was and there wasn't a med rec available).

Then this fucktard (now known as FT) comes in and says that it's ok to take them all together. For fuck's sake, you're a fucking math and physics major, stay within your god damn field. I bloody know it's ok to take them all together, but I gave him two different fucking choices. It's up to him to decide what HE (our teacher) WANTS to do. I bet FT is the type of person that urges a person to down a bottle of Tylenol with a vodka chaser (don't do that at home, kids). I bet FT is the type of person that goes onto WebMD and tries to diagnose himself and ends up with a GYN problem, starting with vaginal discharge.

Please, NEVER give out medical/medication advice without being properly educated. "But I looked it up on Google/WebMD/My mom's a nurse, she knows everything (hah!)/Wikipedia!!!!!!!!!". Well shit, why not the fuck you just replace the whole health field with your infinite source of wisdom!!

Sooner or later, you're going to kill somebody, and I will have absolutely no sympathy for you.

Stupid questions should get stupid answers...

2009-02-28T21:48:00.000-08:00

So today I had a nurses ask me some stupid questions...

Nurse #1 (Seemed like a new guy)

Nurse: Is Zocor simvastatin?
Me: Umm...yeah it is.

N: Well, the doctor ordered Lipitor 10mg, and it was substituted by Zocor 20mg.
Me: Ok...

N: So, my question is, if the doctor changed the dose to Lipitor 20mg, do I give the patient 40mg of Zocor?
Me: (...Are you kidding me?) Well, if the doctor ordered it, and it was substituted that way, and you see it under the MAR, then yes, you give 40mg of Zocor.

Nurse #2 (Nice nurse, but confused at times...but this is about the dialysis nurse)

N: The dialysis nurse needs a vial of Heparin 1000U/mL for pt. X.
Me: Ok, let me get onto a computer...Hold on, it's entered in as 10,000U/mL, in a 5mL vial, and it's been administered that way for the last couple days...

N: Oh, okay, if it's like that in the computer, then send up the 10,000U/mL vial.
Me: Will do.

(Later on in the day)

N: Oh, I sent back the vial of Heparin.
Me: Why? I thought that's the one you needed?

N: Well...the dialysis nurse said it was the incorrect one, so she got it from somewhere else.
Me: Wait, what? Where did she get it from?

N: I don't know where she got it from, but she said she found some.

At this point, I was even more confused. Where exactly did this nurse get this heparin, and what was the dose? Gah, I just hate when this happens. Well, at least tomorrow I won't have to deal with nurses...as much.

PS: For those not in the know, Lipitor = Atorvastatin.

Nurses hate me.

2009-02-28T21:42:00.000-08:00

[REPOST FROM MY OLD ONE...WHICH WAS 2 DAYS OLD]

Note to nurses: I respect your contribution to the healthcare system and respect your profession, but some nurses are just...ugh.

Okay, so I know several nurses at the hospital hate me. How? They glare the fuck at me. Why? No idea at all. I get their meds to their patients in a timely manner, AND I put up with their bullshit about needing a stat med (when I know for sure it's not). They call me on my phone (when it should be used for stat calls) to ask me to get them something as trivial as more saline flushes to refill the machine. Something tells me that if you call for a bloody saline flush, that you have a problem. Call me for a levophed drip? Sure, I'll get that to you straightaway. Call me for a fucking antibiotic when you could have scanned down a med request? You have got to be shitting me. There's a reason why we HAVE THE FORMS RIGHT THERE FOR YOU. It's not that hard to get off your fat ass and walk over, grab a form, and fill it out, is it? Don't even say that all nurses are busy - I see some lounging around, gossiping, reading magazines and the like. Why the hell should I bust my ass getting the nurse a patient's med if the nurse doesn't even make a conscious effort to write a couple words on a sheet of paper and scan it? Is it that hard to write down the patient's name and room number, and Levaquin 500mg IV?

Oh yeah, and I hate the nurses who let their drips run until there's 5 minutes left in the bag. Why the hell did you let it run dry in the first place?! Now you need a drip stat because you fucked up? I'll get to it when I can, because there's most likely a shit ton of other things that I need to do. I'm positive there was a memo sent out to every nurse telling them to scan a request (hah!) down to us an HOUR beforehand so we can get the drip to them in time. Guess they all just glazed over that one...

And to all the nurses who, for some reason, call me asking what the brand name is for a generic drug...I know you all have drug information hand books at your unit stations. I've seen them there. I've seen the good nurses use them. Get off your lazy ass, walk over to the counter, and look the fucking drug up. And if you handily "forgot" that Tylenol #3 was the same as "APAP c Codeine", I will punch you.