Sunday, January 25, 2015

Out of the old

Over at Not A Wasted Word, Noemi is working on moving toward minimalism. It's pretty awesome to behold. Around the Future PharmD household we are in a similar place where we have too many things and want to ditch most of them so we have enough room to be a family. There are plans to rent a dumpster when it's spring so we can easily dispose of the trash/junk/things nobody else wants. It's amazing to consider how much stuff we have in surplus. I'm looking forward to ditching it all and having more space.

It's been interesting how many experiences I've had with hospice or nearly hospice care this year. I didn't intend for that to happen but it has. There has been a case of a very medically complicated patient who is now in hospice after months in the hospital and the doctor in charge who has few hospice patients and maybe never any as complex as this one. The way things happen in hospice is very different than if the focus is healing for a patient and it worries the doctor a lot to be managing this level of suffering and pain, the patient's and the family members'.

A lot of the work that needs to happen in order to let someone who is ready die is about those around her. We need to get used to our mortality and accept that some day we will be at the end of our lives. It makes people panicky at first to see so much of the end of life. A rookie hospice nurse called the pharmacist on call at 3am  on one of my rotations with a rather simple medication question that any less rookie nurse in this practice would have handled according to protocol with no need of a pharmacist to reassure her.

I think a lot of the work of dying is about moving out of the old and into whatever is after this life. It puts things into a stark perspective to serve dying patients. At the end of life, before the sharp decline just before death anyway, the dying get to work clearing away the things that don't matter and reconnecting with those people and things that do matter.

I decided recently to get to work on doing that very thing, because we are all dying. There's no sense waiting for some mystery "future" when things will be different to get rid of things and people that are meaningless and reconnect with the ones who do matter. No day but today is guaranteed so I'm attempting to seize now and get to doing the things I really want - spend time with friends and family and less time managing the mess.

When I worked in a library once, we had a big donation that came with these stickers for us to put in the front in honor of the donor who died young. They had this Mary Oliver quote on them: "Tell me, what is it you plan to do with your one wild and precious life?" I got really tired of reading it over and over for weeks as we got those heaps of new books, but now I like it again. I try to live with that outlook, that this is my one shot at life and I'm going to quit doing the things that don't matter and get busy doing those things that do. Nobody knows how much time they have left and I at least plan to get busy living well. No more junk crowding out life.

Saturday, January 17, 2015

Infertile ambassador

This rotation I'm at a rural community pharmacy. It's a lovely place. Nobody has yelled at me or any employee while I've been there. I mean, once the family member of a young hospice patient got kind of loud when worrying about making sure the patient got enough pain medications and that nobody was diverting them. We were taking a list of exactly who may pick up medications and making sure every person in the pharmacy knows to check IDs every time for this patient so I get it. That's a really hard thing to handle and I think the family member was doing a very admirable job. Aside from consulting for the local hospice agencies, this pharmacy does a variety of things including filling any and just about every prescription that comes through the door.

This week that meant a prescription for 5 days of an antibiotic prescribed by a doc at a fertility clinic a few hundred miles away. We had some trouble with billing it and didn't have the drug in stock and it cost a lot so we called the doc to see if we could switch it. By "we" that means me, of course. It's a lot of fun most of the time, calling for lots of transfer prescriptions. This kicked me in the gut. Nobody else had a clue what those antibiotics were for, but I knew. The rest of the medication profile reminded me that few people land right on IVF and it kicked me again. Infertility stinks.

So I practiced what I would say in my message for the doctor in my head and made the call. Later I got the call back from the nurse and then I got the patient herself to talk about the new medication. This pharmacy counsels everyone on a new medication and often otherwise. This was one time for sure I didn't need the pharmacist to help me with what to say about the medication or its use. I wish I were less familiar with the ins and outs of infertility treatments.

After I finished my charting on talking to the patient and wished her all the best this time and that I hoped I wouldn't see her again getting this medication, the pharmacist said, "I wish I knew more about fertility treatments." I gave her the 5 minute run-down on what medications get used in a typical cycle since we had a complete med list for this patient in front of us to look at, pointed out that I'm super lucky to not have personal experience with treatments but that I have a number of friends who have gone through different treatments, and that goo.gling "IVF regimen" would net her a selection of blogs with a great listing of the different regimens.

I forget how different things have been for me and us sometimes. It's the new normal, knowing about icing your progesterone injection site before the shot so it hurts less and that sesame oil is supposedly less burning than peanut. It's the new normal to know that birth control pills are used sometimes not at all to avoid pregnancy but to induce a period for a medicated cycle in hope of a baby. I didn't giggle at the note in the chart where the pharmacy student before me talked about how she discussed using a back up method of contraception if this patient missed a pill, not very much, I just smiled to myself.

It's nice now, that I can use my knowledge for good. It helps to do something for others. Even though it's a small something to be a sympathetic ear to a patient, to help someone learn how to be a little less clueless for the next patient, I'm glad I can do it. Sometimes I wish things had been different and I hope nobody in the world ever goes through infertility because it is awful, but yesterday I was glad to have the knowledge so I wasn't another clueless person on the journey for someone. I'm glad I could be a reluctant ambassador from the lands of infertility to the realms of the fertile. I guess there really is a silver lining in every stinking nasty cloud, even in the hurricanes.

Sunday, January 11, 2015

My life in jars

Now that I am at long last out in the world working (even if I pay for the privilege of working) I bring my lunch to work. At every rotation, very nearly every person I've had lunch with has remarked on my lunches for the same reason. I pack lunch in jars. Since its been such a conversation starter, I thought I'd write a little bit about how I wound up with so many jars and why I love them.

First, I would like to mention that I'm not opposed to plastic at all. I have a lovely plastic water bottle and popcorn bowl and so forth. Some people who choose jars do so because they worry about plastic, and that's fine for them but not me (yet). I don't have the enthusiasm to read the literature on the subject to form an opinion so I remain silent on that subject. Reviewing that literature is on my to-do list for the next mystery amount of time.

In the beginning, it was left overs that got lost in the fridge too long that started the debate. Cleaning out the containers was miserable so for a time we only bought cheap plastic food storage and tossed it often but it was expensive. There was also the risk that the container would break before the food had been eaten. It was the pits to save and store something delicious to only end up with a mess.

Then we opted to invest in better quality containers and swore we would quit abandoning left overs in the fridge. It lasted a few months at most... and then they all ended up in the fridge festering. Some we salvaged and others we gave up on and then followed a phase where we tried not to have any left overs. It didn't work super well. We decided to just buy one kind of plastic container so we would have a smaller selection of lids and they'd all be interchangeable and accepted that we'd need to replace them maybe once a year.

A couple of years ago I got this bug to make apple pies in little half pint jars because they were cute (and turned out to be delicious too). Then we had this lovely set of half pint jars around the place and I started putting snacks in them. Eventually it dawned on me to put crackers in jars for lunches and I started dishing out the entire packet of orange fish all at once into snack sized portions.

Maybe 18 months ago we were due to get some new storage stuff and I priced out half pint jars as compared to new plasticware. It only cost a little bit more to buy jars than to buy middle quality storage stuff and it was actually less than to buy nice stuff. We decided to get jars instead of more plastic stuff.

The advantages have been that it's easy to package up lunches. I like that it's simple and I can load up each jar easily to match so I only have to measure once (depending on what it is, obviously some meals are too lumpy and need individual servings measured out). I like that I can put them on either rack in the dishwasher. This meant that on the rotation I drove at least 3 hours for every day that I could load up an entire dishwasher's worth of jars Friday night and reload them all Saturday when I got around to it. I can freeze things with no worry that it will taste like icky freezer when I open it later, and I can even take a jar from the freezer and pop it into an oven without worrying that I will destroy it. I can label the jars in permanent marker and use a dab of alcohol on a cotton ball to clean it off later with no damage to the jar and no left behind label gunk. The stacking well thing is a bonus that saves on fridge space and jars happen to be a great size to go in fridge doors so I don't lose lunches somewhere in the depths.

The biggest benefit is probably how food tastes out of jars. It doesn't wind up tasting vaguely of fridge and it keeps its textures better than food stored in plastic containers, probably because the seal is extra tight. The cheap replacement lids are fantastic and that the lids for all the wide mouth jars are interchangeable is even better. No more attempting to keep lids with containers or to sort and stack them for ease in finding the lids or fitting everything into a drawer.

Overall: jars make me happy. Less waste! I can cook a big meal once or twice a week and stash away left overs for lunches and then not worry about it! If I get fed up eating the same thing 7 days in a row, I can just pop some into the freezer for later! Decent conversation starter for shy people who would rather write a blog post during a lunch break than chat.

EDITED TO ADD: I have half pint wide mouth jars for snacks and pint jars for leftovers. Most casserole dishes or rice with some topping are in the 1-2 cup meal size so it works well. These are my favorites for snacks and side dishes (lots of applesauce for lunches).

Tuesday, January 6, 2015

Sneaky success

For ages I have tried hard to relax and let go of whatever is coming next in this job search. Historically my reaction to a stressful situation is to give up completely or be so stressed and panicked that I avoid or do very destructive things (14 hours of a video game the day before something is due for example... is something that happened to a friend once... yes...). It's been a part of my daily meditation practice to let go of things I can't control and accept whatever is happening next.

I have felt like a total failure most of the time. I have tried to stop worrying about things and it just wasn't working. I fret. I worry. I have lists of lists so I have the illusion of control.

But. I'm in the process of applying for residencies and I'm not one bit nervous about it. Or maybe only a single tiny bit. I'm debating whether this means anything beyond that I am tired of explaining why I want someone to hire me but at the moment it seems like all that practice at letting go has worked.

I never expected there to be a day where I could say that I'm not nervous about the future. I hoped it might happen but I never really thought I'd be in a place where it was true. Today I was focused on today and nothing more. This focus didn't stop me from attempting to be organized and applying to a couple residencies, but it did mean that I'm not afraid of what happens now. I have zero worry about getting an interview for a residency. I'm only marginally concerned about getting a community job because a chain I interviewed with doesn't start hiring new grads until March so there is plenty of time, and my marginal concern mostly is inspiring me to apply for more jobs rather than panic or worry or be angry at someone for no reason.

It's very surprising to find my mental state so... sane and balanced for the most part. Usually I feel like I'm caught in a tornado of "what's next? how do I get there?"

Today really is a miracle.

Monday, December 15, 2014

On deaths and dying

I've had more time to think lately and I've been reminded of the time 3 years ago when we went through that third miscarriage. I also think more about it because we so clearly have a toddler now and not a baby anymore. (Later I think I may discuss my adventure attempting to get to the airport in morning traffic in LA and the hours spent contemplating a very different world, but for now, just the grief.)

The dying part is hard too. My friend who has been dying for some time is now at the end of hospice care waiting to die. She's in so much pain and not really eating any more and it's hard. Obviously not so hard for me as it is for her and her family but it's had me pretty frozen. It's a really good thing I'm not keeping track of how many brain candy books I've read in the past few weeks. I'd say it's about 50% escaping reality and 50% trying to fill the time with more cheerful thoughts rather than the gloom and doom and death hanging around everywhere. Happy Festive Winter Holiday to me?

I guess the two events, aside from both occurring in December, really bring up a lot of survivor's guilt for me. I never feel worthy to be on this side of things with a toddler and no cancer. My friend has the most perfect spouse and four awesome children and I wonder why her and not me. I never feel like I'm enough. It matters that I get these second chances and I'm trying to seize them and do some good in the world but it's a struggle to kick the feelings of unworthiness. I haven't descended into feeling worthless but it's hard to avoid that pitfall. I suppose I might say that grief has me standing at the edge of the pit of worthlessness and I can see how it would be easy to fall but also that the way to whatever is next in life is walking along the edge of the pit and not falling in or going across.

Anyway, the most intriguing thing happened last week. I was feeling mopey about life and how many of my favorite Festive Holiday ornaments have been ruined when yanked off the tree by Little Monster (and/or Fluffinella and/or the Kid) and then I was checking FB yet again (nervous habit I suppose?) and ran into a friend posting about the Mental Illness Happy Hour. It turned out to be the day a new weekly podcast came out and it was the above linked episode... about miscarriage.

I figured that I'd better share it with you all. The guest in that episode is a fellow infertile with multiple miscarriages and she talks about her experience with a full-spectrum doula. So much of what she says is so familiar and wonderfully put. You should go listen. Then maybe if you need it, read what she wrote about the closure ceremony part here as well.

So I feel better now. Still freaked and unworthy of all the amazing things happening in my life and totally unworthy to be applying for residencies but I'm trying to psych myself up and stop putting anything off. Today has awesome parts even if the transition to whatever happens after life is circling in close. On the whole, just getting to breathe is pretty awesome, let alone getting to snuggle a grumpy toddler for 5 hours while she watches the yellow hat dude and some critter wander around a city. Bonus!

Wednesday, December 3, 2014

Baby shower blues

I still hate baby showers. They are a great kick in the guts every time, a reminder of everything that didn't work in our attempt at family building. I've kind of resolved that I will excuse myself from as many of them as possible because there's no sense in me attending and being a glum bunny. It's just a thing and I'm stuck feeling the way I feel until it gets better maybe some day. For special people I am willing to put on a happy face and stuff my feelings briefly. Some people are worth celebrating.

So here we are (I am, actually), with the most recent baby shower invite to an event happening this weekend. This one is for a family friend who's the closest thing to my spouse's sister that exists (closer than my sister-in-law, that's for sure). Based on family relation alone this is one I'm pretty obligated to attend. Then there's the infertile club membership we share. It took a couple years for her to get pregnant with her first (two)and the twins were born at 22 weeks just about a year ago. This baby happened remarkably soon after that and is expected in late January. It hasn't been an easy pregnancy as you might imagine so I feel bad there too. I get it, at least more than the perfectly fertile folks. I want to be there in solidarity.

But. Oh I hate baby showers. I'm also flying to the ASHP meeting (that giant pharmacy conference which is in California this year) that same afternoon so I get to leave the baby shower early at least. But I hate flying so much. Usually I get to the airport 4ish hours early so I have plenty of time to panic before I get on the plane. Attending the baby shower cuts my pre-flight airport loitering time down to only 90 minutes.

I'm debating the merits of skipping the thing so I can go hide at the airport. I asked weeks ago if it was ok for the girls to come so I can pawn them off on my MIL while the spouse drops me off at the airport. This week the sister of mom-to-be has been discouraging everyone else from bringing kids and their mom was doing the same. If the answer was no children, why on earth did you say they could come? I hate passive aggressive baloney. Ugh.

I don't know what to make of my selfish motivations. I suppose that means I make an appearance and pretend I hate it less than I am likely to. It's possible it might not be awful. Maybe my motivations will straighten out and I'll figure out whether I can go or whether it's better to send my regrets.

Monday, December 1, 2014

The Relocation Shuffle


I'm in a place where I mostly think I am totally capable of not only getting an interview but getting a residency and yet I wake up from dreams where I am counting by 5 and the phone is ringing and the printer is beeping about a paper jam and someone is yelling at my tech about something that the tech has no control over and it is 2pm and I haven't had a break and I won't get one. So I guess I could say my confidence is not high all the time but is high enough that I'm getting along with applying to residencies.

And jobs. Also applying for jobs. I have had 7 interviews so far and one "forget this, we aren't hiring you" response, so overall not bad.

In all things, we are free to relocate if my job dictates. I think we can move the kid to one new city between now and when she's grown so this is actually a very big choice. There's some consideration that I will go during the week for a job and the family will stay here so we can move after a residency. One of the local pharmacies (we had 1 in a grocery store, 3 at big box stores, 1 chain, 2 independents, 2 at the hospital) just closed and another shrank its hours so I worry that working in town won't be an option.

When I'm not debating which of the zillion residencies to focus on applying for, I'm considering how on earth we could leap and move for a job. One of the considerations is that we have a lot of great things in place for the kid now and that's hard to find. She has a tiny class (that is 25% Caucasian, a bit less than our neighborhood but not too far out from the under 12 population demographics) and a small school that supports her with all the quirky services she needs to thrive. I don't think it would be impossible to find this again but we got really lucky to live in a neighborhood that has an elementary that exactly meets her particular needs.

The other big thing on my mind is respite care. It's hard to manage a kid who is challenging all of the time. It's hard to find anyone willing to take care of her for any length of time if her label is known. We aren't stupid so we haven't told our usual respite care friends around town her diagnosis and they are still happy to have her for a few hours. She behaves like a saint at someone else's house right now so that's helpful. I don't expect it to last. Overnights we have mostly been relying on family but they live far enough away that we can only do that maybe 3 times a year. If we move farther away we lose that help. Maybe. We could move closer to a big chunk of family too. Maybe. There's some discussion that my in-laws would visit us more if we lived somewhere more interesting/near their vacation home, even if it were the same distance from their vacation home that we live at now where they come down twice a year at best.

We've also been discussing if we really want to move for good reasons or if we want to move because we just aren't used to staying put this long. This is our third year here and the longest we've lived anywhere since we got married. I really found this video over at Rage Against The Minivan an interesting discussion. Does where you live shape your life? Tremendously so, yes. In my experience it does. Are there communities around you can join or are they all closed (or nonexistent)? [By communities, I mean things like churches or book groups or scouts or community service groups or the PTA.] Are there things you want to do nearby? What about shopping and restaurants? Do you want to do either of those in town or would you rather take a weekend trip somewhere?

My criteria for a place to live is as follows:
  • Must have pizza restaurant, preferably delivery
  • Must have a community of faith I'm comfortable being a part of
  • Must have a job for me and accessibility to a job for the spouse
  • Must have schools with support for the kid or that are willing to figure out how to support her
  • Must have childcare available
  • Strongly prefer a red big box store be within 90 minutes
  • Strongly prefer it is possible to get package delivery beyond the mail
  • Strongly prefer interesting outdoor recreational opportunities be readily available
  • Prefer limited constant wind
That doesn't actually narrow things down one bit. I'm feeling like caution is warranted rather than jumping at the perfect job, but at the same time, I'd rather go somewhere and have a great job than stay here with ho-hum options and no real reason to be here aside from "we already are" and pretty good schools.