Monday, June 30, 2014

Side effects

One of the interesting things about being on rotation is the strange things that are happening that are unrelated to my current actual day to day working experiences. In other words, rotations are supposed to teach me pharmacy things and other things I learn or skills I develop are mere side effects.

Since I am clearly procrastinating, here's a short list of my side effect lessons.

1. I do not especially like having a dog. I'm staying in a place with 2 big dumb dogs who are very sweet but also a nuisance. Compared to Fluffinella (our superior resident feline who is probably napping on a pedestal at home right now), these dogs are far too much trouble. One gets so excited to go outside that zie jumps 5 or 6 feet straight into the air. It is ridiculous.

2. Birds are weird. I dodge the chickens leaving my parking space in the very large driveway, then the ducks paddling in the ditch near the road before I leave the driveway, then the pheasant who likes to dart across to the other swamp at the first corner, and THEN there's a family of wild turkies a block away. The tom turkey likes to strut ever so slowly across the road while the hen and chicks just hover in the bushes JUST TO MAKE ME NERVOUS. I also commute passed a pond with 2 pairs of geese nesting in it that take their combined chicks for a stroll along the shoulder of the road every morning JUST as I drive by. Fools are just begging to be smashed and yet they appear to have at least 4 communal chicks. I'm unclear if they are actually aware of which chicks belong to which parents as they even have adjoining nests that I noticed on a walk last week.

3. I still don't like driving in city traffic. It is infuriating to just sit in the car on the road waiting. I don't mind the drive when the traffic moves but gridlock is too much. It is a shame that I can't arrange a carpool or take some kind of transit to this specific rotation.

4. It's very weird being a "grown up." I'm staying with a friend who's in her 50s and there's a resident child of hers who is not that much younger than me, say 5 years or so, yet I'm an "adult" and I feel compelled to do things like empty the dish washer and pretend/avoid knowledge of a variety of things (did I see that when my friend was out of town, there was an extra guest overnight? No, I have no knowledge of that per se because a whole group of folk was here when I went to bed and I saw nothing about any extra cars in the morning, it's a mystery!).

5. I still forget where I put my car all the time. I have learned to accept that I just need to park in the same place every time and not fret about it because I can only remember so many things. When I am in a strange parking ramp, I just take the reminder slip about where I parked with no shame anymore. Getting lost is silly if I can avoid it.

6. It will be important in the future to remember to keep a change of clothes either in the car or in the office in case of coffee-related difficulties that necessitate a change of attire.

7. I am pretty happy with my "right sized" lunches and I may translate that into unit dosing my dinners as well. (Aside: "unit dosing" is something that happens often in a hospital pharmacy, where a large bottle gets purchased and then each dose gets put into its own packaging so it is ready to be given OR where a special single dose package gets purchased.) Once a week or so I make something for lunches and portion it out into 400-600 calorie servings in a variety of jars. I'm finding that now that I'm a few weeks in, I am happy enough and survive the commute home with my stomach rumbling. I keep reminding myself that being hungry isn't a bad thing, just a part of life, and that I should adapt and that I WILL adapt in time. I haven't ventured onto the scale yet but I think I've lost maybe an inch at my waist thus far so that's something.

8. I am really lazy after work and will need to plan my daily exercise to happen BEFORE work if it is going to happen at all.

9. Sleeping remains crucial and I am going to go attempt to do some more of it. I still fail miserably at a sensible bed time but I am doing all right at getting up on time despite not enough sleep.

Monday, June 23, 2014

Living the lies

So let's talk about the truth. Clearly there are lots of truths and lots of levels of truth, and since we are here on my blog, you're stuck with the truth that matters to me right now, as much of it as I've figured out.

The obsession (or whatever it is) that I have with figuring out what truths I'm hiding and from whom is over a decade old now and in all honesty, it started with a crazy guy asking me a question that I had never considered before. What's something you think about but don't tell anyone else?

So here and now, the levels of lies in my life are multiple. I don't find this necessarily all bad but mostly a part of being a person. If we were capable of being totally honest the world would be remarkably different. All people can't handle the whole truth, whatever that might be. I think we catch glimpses of the truth about ourselves and about the world and maybe about divinity but we are incapable of grasping the whole truth.

Right now there are a few levels of lies that are playing out sharply in my life: the lies of omission where I fail to correct people's assumptions about me and the lies I tell myself that materialize as excuses are most notable. There's also the obvious set of lies that underpin this blog, the ones that hide my identity, obscure my location and my spouse's identity, the pictures I'm not posting, the significant but identifying things in my life I'm omitting, but I feel like these are among the lesser sins at the moment.

So the lies of omission. What's the first thing every single person in a pharmacy asks a pharmacy student they've just met? "What do you want to do when you graduate? Do you want to work in a hospital or...?" I'm still working on a good answer beyond "well, I don't really know." I have some ideas but I'm not sure enough to narrow it down to one of three very different paths. Later on, maybe a half hour into the conversation at most but sometimes less if the other person is lobbying for a residency as the best way to go, we come to the "oh I' sure you'll match somewhere" point. (Aside: pharmacy residencies are the hot new thing what with the crunch in the market where there are not nearly enough hospital jobs to go around for new grads who want them so extra credentials are required to get those entry-level jobs. There's an application process in the fall, interviews lasting a day in January and February, and the Match happens afterward. Last year 2/3 of people who applied actually matched and a small chunk of residencies didn't match so some of those who didn't match likely scrambled to get those spots filled.) The problem is much more complex than that of course. While technically I have limitless options to apply to the perfect residency anywhere, I am cautious and want to avoid moving if it's at all possible. It might be possible but it would mean a long commute and maybe taking a less than perfect residency position (if I could get it at all). I'm then at the corner where I could mention that I'm not applying everywhere or just anywhere because of my family and omitting it.

The assumption made by everyone in the pharmacy is that, like most pharmacy students, I have no children and probably no spouse either. Furthermore the assumption is that I'm young and immature and pretty innocent. For the most part I let this slide because I am pretty private and would prefer to be remembered for my work and not for my non-traditional student status. I have been joking about how I appreciate being called a kid and could my superiors please try to work that in a few more times, especially when giving me verbal feedback so I can bask in being a kid just a tiny bit longer? It's only a little bit of a joke though. I  am reveling in the last bit of youth I have left before being a professional. There is also a little bit of ribbing of my superiors who are only a year or two older than me to remind them that not all pharmacy students are such babes in the woods. Obviously many are lost little sheep but not everyone and perhaps they should watch the lumping of us all into the "silly little kids who know nothing" heap.

I also am wary of making plans because I know exactly how well my plans have worked in the past: hahahahahahahahahahah no. My plans were wrong, sometimes exactly opposite of what has turned out to be the right direction.

One of the books I have been assigned to read so far (aside from a vast swath of things on a certain pharmacy association's website, to the tune of 175 printed pages of very dense text) is about adapting to constant change and being ready to change when the time comes (and it was pretty hokey and I don't even know how to make sense of its combination of hokey and useful). One of the main characters reluctantly and eventually changes to take a new path and starts writing messages on the wall for the other anti-change character in the hopes he'll follow, and one of the things shocked me.

"What would you do if you weren't afraid?"

I realized that maybe my hemming and hawing and not committing to applying for a residency might be because I'm afraid I'll fail. Then I had this moment of clarity where I realized I have already failed so spectacularly that there is no failure that will top that. If I apply for residencies and I get zero interviews, there is no public failure at all unless I let on that I applied. If I apply and interview for a residency but don't get it, that's not a failure. Getting the interview is huge! If I manage to interview and then match, that's a few levels of spectacular. There is no failure at all except if I fail to try. If I weren't afraid, I would go for it with no hesitation at all. I would dig in, research thoroughly and find a good fit and then apply.

So now that I recognize the lie that's been playing out in my life, I will squash it.

The other big omission that keeps playing out is mentioning my family. They aren't around right now so it feels monumental to me to avoid talking about them because I've already set up a situation where I am away, probably for the best but it's HARD to be away. I sat in on an interview and one of the candidate's reasons for wanting the new job is to have a shorter commute and therefore more time with the kids. At the time, I sort of went, "Aww how sweet, more time with kids..." and didn't look further. Then I considered what would happen if I was the person being interviewed looking for a change for that reason. Would I be that candid? Would I have a different answer? What would my response have been if the candidate looked different (more masculine, more feminine or pregnant)? And what does it say about me that I don't know for sure if I would treat a job candidate of a different gender identity the same when exactly the same words were spoken? Big questions that I'm sure I will consider at more length later.

So this brings me to the second significant category of lies that's been influencing my life lately: the lies I tell myself. I turn these lies into excuses and the excuses fuel my laziness. Example: I am tired after I get home from rotation, the traffic psyches me out, I really just want to eat pizza and relax afterward. I use being tired as an excuse to avoid a whole host of things, from eating healthier (takes more time) to exercising (too tired and sore) to being social (too tired, too hungry to wait to see if anyone else is around for dinner, etc). Sometimes I make excuses for why I can't get groceries after work so I can justify getting a fast food breakfast.

Today I did pretty well for the first part of the day. I was tired when I got home and hungry on the way but I resisted getting a snack and then went for a walk after dinner. Then I walked an extra 5 minutes beyond my goal (one way, I'm just timing the walk out for now and hoping to make it back in rather than timing the whole walk) and made it back. Of course then I had an ice cream bar while surveying the freezer for tomorrow's lunch prospects, but up to that point I was really good! I squashed all my excuses and did it anyway. I chose to think about the things I don't have to do (have a second ice cream bar, eat a snack before dinner, take a nap or watch TV ) and to skip the excuses and get to doing what needs to happen.

The lie I tell myself the most often is "tomorrow things will be different" and a close second is "just this one (or once) won't hurt that much so it isn't a big deal." But I know that now and today I have the chance to change things. I will not change my rocking out to a song from a musical in the car reminding myself "there's only this, forget regret, for life is yours to miss... there's no day but today." I can change things now, today. I can stop buying the lie that tomorrow will cure everything and that once is harmless. Once is only in the moment - in retrospect, all those "just once" events pile up.

Today I get to choose to keep living the lies or to move beyond the lies I've discovered into uncharted territory, and I get to keep making that choice all day long and I get to start over again when I inevitably am human and imperfect.

Tuesday, June 10, 2014


Now that I'm on rotations, I imagine I will either post more because it's lonely or less because it's exhausting and busy. Or maybe more in conjunction with this next thing I'm up to.

After "what's your name?" and "where do you go to school?" the next question every person I've met so far on rotations asks is "what do you want to do when you graduate?" I know I've written about this before but I'm too lazy at the moment to go hunt up old posts. If you're a long-time reader or have bothered with my archive, this is not new ground just a new time.

There are three major pathways to very different sorts of careers after pharmacy school. One is a community pharmacist job, at one of those chain pharmacies would be typical. The upside is lots of interacting with patients and caregivers. The downside is lots of standing all day long and night and weekend shifts. The other most common is a hospital pharmacist job. It's rare that anyone in public sees a hospital pharmacist but every patient in a hospital who gets a medication has it double checked by a pharmacist. Instead of interacting with patients, most hospital pharmacists interact with doctors and nurses. The third route is what I'll describe as "other" and it includes managed care pharmacists who work for insurers or other entities that manage healthcare somehow, nuclear pharmacists who prepare the medications used to do radioactive imaging among other things, and ambulatory care pharmacists who operate in a clinic setting. When I started pharmacy school I had no idea what an ambulatory care pharmacist did and here's how I understand it now in a little example. Say Harry Potter goes to see his doctor and discovers he has diabetes and high blood pressure. His doctor orders some labs, schedules him an appointment to see a dietician, and a follow up visit in a few weeks after he sees the diabetes educator. In some practices (say that national one that's had long wait times in the news recently) at that follow-up visit, Mr. Potter would see a pharmacist to talk about his medications first and then the doctor after that, both in the clinic, often in the very same exam room with a hand-off between providers or sometimes (rarely) both with some overlap. Then the pharmacist would schedule a follow up visit sooner or later than the next doctor visit. In some practices, patients see the doctor once a year and the pharmacist changes medications at any point in between those annual visits with follow ups based on patient needs.

The job market for pharmacists is tight. After finishing a PharmD there is the option to do a year or two of residency. These are competitive to get (mostly) and are almost all focused on hospital pharmacy. Most people who do a year of residency stop there but a few go on to the second year or do two year combined programs. Jobs are split 60-65% community, 20-30% hospital, 5-10% other. In cities with a population over 200,000 people a residency is required to be considered for a hospital job in most cases and depending on the area it may be required in smaller cities too.

Of course it isn't so bleak as "there are no jobs unless you do a residency and only 75% of people who apply get one" overall. There are jobs in community pharmacies but not always immediately nice positions with a fixed home store or not without willingness to relocate. Ambulatory care is expanding as medical homes start to be a thing. Managing healthcare costs is similarly a growing area where more and more pharmacists are employed.

The areas I feel I have the most skills in are informatics and patient care of the sort that happens in an ambulatory setting. Informatics is the computer stuff that happens to make a pharmacy work so there are informatics pharmacists in all realms of pharmacy but mostly in hospitals since it's so complex to manage the wide range of patients in a hospital. To work in a hospital in particular would require both a first year general residency and a second year informatics residency (probably). Similarly ambulatory care would require either a residency for a year or two, or waiting a few years to start applying for jobs in that specialty area.

So then there's the residency debate. If my life were different and there were zero children involved, we would find the best residency program and move wherever to complete it. I think that if I had the whole nation to search and apply, I could find a program that would be a good fit and that I might match with (or be able to scramble for). But that isn't my life and I don't have unlimited flexibility. Given the kid's very poor adjustment the last time we moved, I think we can move one more time to a new school and that's it. So that doesn't exactly prevent me from looking at residencies outside driving distance of where I live now but it does mean we would need to be really sure about accepting a position that requires moving.

At the moment I'm getting ready to structure a period of discernment for myself so I can consider the options and figure out what's the right or most right path for now. The cool thing about pharmacy is that it's very possible to change specialties if you want at any point. Although it's rare for a community pharmacist to switch to being a hospital pharmacist, it happens occasionally. Discernment is something I've done before and I'm looking forward to planning it out. I'm going to do more prayer and meditation, read some sacred texts and some sacrilegious ones and probably some self-help books too, and make some lists. Then I will deliberate and consider the merits of each path and then reflect on them. At the end is some prayerful consideration and listening for cues and clues to point me in the right direction and then accepting whatever my heart and gut point me to.

Monday, May 26, 2014

Memorial day

Today was a nice day. I went to the lake with some friends for a picnic. There was bocce and Frisbee and iced beverages in coolers and all that jazz.

As usual in my doom and gloom way I thought a lot about a friend who wasn't there today. A guy I went to high school with was killed in the war in Iraq. His brother put up pictures today of his tombstone with some flowers and such. I think about his longtime love who he never even got up the courage to ask to marry him, let alone actually got married. He died too young. Another friend had a stop loss baby to get her out of the military before a second deployment overseas to a war. Her spouse has been on 5 combat deployments. That's huge when you think about it. It's horrific really. In the Vietnam War one tour oversees was considered enough and going back for a second was rare and discouraged.

My spouse and I were talking the other day about how different things are now than they were once when most young men served in the military if there was a war. Today it's the broke, the directionless, those desperate for college who can think of no other way to pay for it who serve. It is so unfair that we benefit from their sacrifices. It is so unfair that anyone should ask young people to make such a sacrifice.

So as usual, as I do every day, I pray for peace. I pray for peace for veterans who come home broken and wind up homeless. I pray for peace among peoples. I pray for peace for the families of the soldiers who have died in or because of wars.

Here's my sound track for the day too.

The Field
"When you joined the war we were so proud of you
You seemed so grown up, living life the way we taught you
Then your first letter came, it sounded nothing like you
It took all my strength to keep myself from running to you
I don't want no victory, I just want you back."

Penny Evans "They say the war is over, but I think it's just begun."

It haunts me that I live in a time where we send young people to die and for what? It's hard for me to say it has been a just war or that anyone wanted liberating. When my girls are old enough to ask, I won't have even a few words of "they did their duty by serving their country" for them because there's no good that's come from these wars that I can see. I tell the kid that her friend's daddy is a soldier and we pray he stays safe and never has to go to war again because wars hurt everyone.

So in all the joy of a long weekend, remember that we are still losing our young people to wars. Work for peace because it matters.

Sunday, May 25, 2014

Cloth diapers at 15 months

Can you believe Little Monster is now 15 months old? It's just insane how fast she is getting big. Tonight she said "uh-oh" after she had been crying and I about died laughing. When she is crying we say "uh oh! Did you fall?" and I guess she learned that's what you way when you cry.

So. Many bloggers I read have mentioned cloth diapering. Here's a really nice summary post (that links to other posts on the topic) if you haven't read a similar post. Actually I really found this one helpful too. Over the years I've read many other cloth diaper posts in this vein all over the place.

Brief disclaimer: I do not care one bit whether you use cloth diapers or not, it's all good. Life happens and we do what works for us. I do not expect anyone to be insane and do things my way because it often feels like an eternally uphill battle in many respects. We chose cloth diapers because we are broke most of the time and overall the cost is much lower to do cloth (in dollars and because we are failures at taking out the trash so we need to reduce our trash production wherever possible).

The thing other people haven't written about is using prefolds instead of all in one or pocket diapers. That's something we are doing that is pretty unusual (maybe?) so I thought I'd talk about it (plus I'm in a gloomy mood so I'm hoping it will at least be a break from my grumbling gloom that I hope will go away soon).

Here are the questions I have heard or not heard but seem implied from folks and our answers (along with some pictures because why not?).

How are prefolds different from diapers my grandma used?

What makes them prefolded is the number of layers of cotton. Back in the day, diapers were one thickness (and all cloth obviously) and you needed to fold a bunch to get more bulk where you needed it. Now the diapers are made with a middle third that is double the thickness of the edges so fewer folds are needed or none depending on how you attach them to the baby.

Why would you pick prefolds instead of all in one diapers?

For us the reasoning was twofold. One, it's easier for us to not add a step to the end of laundry like stuffing pocket diapers or even putting away all in one diapers. We get busy, laundry gets left in a basket for a week, and prefolds are easy to grab from the basket, fold in thirds, and stick into a cover. Two is the advantage of each part wearing separately and being able to be laundered in a way that makes it last the longest. We wash diapers in a warm short cycle (this is mostly a rinse) and then a hot wash while the covers only get washed warm with other baby clothes (and the liners too, then they go for another hot wash after the other clothes and covers are removed). This means covers last longer and diapers that wear out or are damaged can be tossed out while we keep the cover. A bonus we discovered is the cleaning power of a cloth diaper. We use them for spills on the carpet, as burp rags for tiny humans, to dust, for potty training incidents, all over the house. It's really handy to know that we have that level of absorbency handy for cleaning up.

Don't all those diapers stink? I don't think I could handle the smell.

I gag every time I wash diapers and throw up on occasion. I gag a lot when I change a poopy diaper so I am not representative of someone who tolerates stink very well. However, we do a few things to cut down the smell. We have soiled diapers in a trash can with a foot pedal, soiled baby clothes and diaper liners and used wipes in a mesh wire basket on the counter because they smell very little. We add baking soda to the diaper pail when it gets smelly and it gets washed out periodically too. When we leave home we use wet bags and the smell is pretty well contained in them.

How do you get them clean? Aren't they really icky?
We use Rockin Green laundry soap and never bleach them, warm rinse with a dash of soap and hot wash with a full dose of soap, and they either go on the line or in the dryer. Our dryer is geriatric so they get dried on low because anything hotter and it overheats and won't work for a week and the repair human who fixed it up last time it quit heating said it's at a high risk of starting on fire at any moment if we use the high heat. Sometimes we dry the diapers twice on low so they are really dry. The covers we turn inside out (well, flip inside out) and put into the warm wash and they generally come clean in only one load.

When it's sunny we dry the diapers on the line. One drying rack holds about 2 dozen large size prefolds or 3 dozen of the small ones. In the winter it took 3-5 sunny days to whiten the diapers but in the summer one afternoon gets out most stains. I discovered recently that clothespins fit right over the rods on the drying racks so that saves some time hanging them up. Here's my laundry assistant demonstrating that her big sister's mini golf set needs to have a hole inside the drying rack.

You can see we have another very short drying rack in silver in addition to the main white one. That's the one we got when the kid was a baby and after umpteen moves, its legs vanished. When stretched it holds 3 dozen large prefolds if it has its legs. Now it holds about a dozen at most but it's my overflow. I think we have between 3 and 4 dozen diapers in circulation. We bought 1 dozen new and 2 dozen used ones retired from the local cloth diaper service and there are some strays from the kid's babyhood around but not nearly as many as I'd thought. I assume I'll discover a box of cloth diapers about the time Little Monster is potty trained since so many things are missing and have yet to be found. 3 dozen would be plenty and it's kind of risky to have so many diapers because we can go too long between washes and still have diapers.

I tried cloth diapers, those all in one things with all the snaps, and I hated them so I sold the lot.

Aside from the diaper portion being a factor in choosing prefolds, the closure for the diapers was a major factor as well. One of us adults has moderate limitations to manual dexterity which makes snaps very difficult. I don't think an all in one diaper exists that comes with the loop and hook closure (ve.lcro is a trade name for this stuff). Combining a hard time getting snaps to work with a squirmy kicking baby just seemed like a bad idea to us so we didn't.

Isn't it a pain in the neck having all those parts to keep track of?

Maybe yes, mostly no. We do covers, trifold the diaper to fit in the cover, add a fleece liner, and attach the diaper to the baby. If we used all in ones, we'd only lose one piece to that trio. It isn't that much effort and only nominally less than if we did all in ones, plus we don't need to worry about doublers or adding special pieces to the all in one.

What about diaper creams? How does that work?

Little Monster has mild eczema and she needs lotion or creams of some sort about 3 weeks a month to keep it in check and stop her from scratching until she bleeds. We started off thinking rashes would be rare and we could just put her in disposables for a day or two while we used the cream but now we've gotten some fleece from a craft store and chopped it into liners that we use with each diaper change.

Wait... what do you use for wipes?

Washcloths. Specifically we bought a big pack of them meant for washing your car at a price of about 40 cents apiece. As they get destroyed by being laundered often we just toss them. I think we started with about 6 dozen and we're down to maybe 4 dozen now (some barely lasted 1 wash though). We also have some plain white washcloths in the mix too but most were the kid's during her diaper years. Many people get all excited about some fancy wipes solution but we don't do that at all. Just plain water for us and so far it works well. Both girls get a rash from aloe so we are cautious about products we put on their skin and try to keep it to a minimum. We have an insulated water pump deal like this except in a really amazing plaid pattern for when the diaper station isn't in the laundry room with a sink like it is now so water is always handy.

What about bleaching or yeast infections?

Some all in ones have in their cleaning directions to bleach them sometimes but that's more because the cover makes it hard or impossible to get the sewn-in liner clean all the way. That's a benefit to prefolds. Unless you do something awful to them like forget to wash them before a week long vacation, there's no need to bleach them probably. If Little Monster is having trouble with a yeast infection we iron the diapers with a very hot iron and lots of steam and that helps quiet things down. Heat kills the nasty yeasts so some folks also use really hot wash water. Our diapers already get washed in water hot enough to kill most yeast so the iron seals the deal (plus obviously the dryer never gets all that hot).

What kind of covers do you like?

We have a variety of covers. Little Monster is a long body baby and relatively narrow as babies go, plus she's in the 25th percentile so she's a petite baby. I imagine some covers that don't work wonderfully for us would be better on a differently shaped baby. We mostly have Thirsties (no affiliate links, I'm much too lazy for that) and Flip covers. We had intended to just get Thirsties but the cloth diaper store was out and some Flips were on clearance so we got some and I think I like them better. Thirsties have the double leg gusset that my spouse likes but I find the inner elastic is worn out now. They also come in size 1 and size 2 so higher cost overall than the Flip that in theory fits all along. We got our first Flip cover about 6 months ago so I can't speak to how it would fit a newborn but my bet is not as well as the Thirsties size 1 did. Despite weighing not much more than 20 lbs Little Monster needs the tallest size in both covers now so I'm unsure they will last her tall body to potty training, but then maybe they will. She's still pretty near the narrowest on all her covers as well. We also have a Sweet Pea all in one cover that is just not at all the right cut for Little Monster so we rarely use it, and a single all in one diaper that I like pretty well and would consider having more of despite the snaps. In the legacy diaper cover category we have a few Bummis covers that are much less awesome than the current models but that got the job done well enough. They were the small size and are outgrown now and we didn't buy any more but not for any special reason beyond sales and easy availability. Somewhere we have the full set of barely-used mediums from the kid's toddlerhood but due to need those may just stay lost.

If you had unlimited money and were just starting out with cloth diapers, what would you suggest?

I really like the multipurpose prefolds so I'd say go with those and pick some cute covers. We've convinced 5 different in-home daycares to use them if they have the hook and loop closure. I prefer the hook and loop closure but I bet the snaps last longer so might be better if you are planning for many children. I would suggest a few different covers to start with (say 4 but maybe 4 different varieties or brands), 3 dozen of the small prefold diapers plus 1 dozen large ones and you can add the other 2 dozen larges and another 2-6 covers over the first few months of babyhood as the budget allows. We have to have at least 8 covers because at daycare each cover is used once and that gives us 2 days' worth of covers if we are behind on laundry. I'd suggest either a big wet bag or a cheap foot pedal trashcan to store soiled diapers and a little one for soiled covers.

Monday, May 19, 2014


I had a skin biopsy a few weeks or months or something ago. In pharmacy school time, it is recent enough that I don't have a scar yet but not so distant as to have been last semester or even before midterms and that's as close as I can pinpoint the event.


Since the stitches went in, a scar has been forming. I have had this same size biopsy a few times now on various patches of skin and I somehow hadn't noticed the time from stitches to scar so acutely as I have now. This scar has been taking way too long to form, I thought.

In the first week while I waited for the stitches to come out I was sure it was infected. It burned, it ached, it bugged me, it woke me up (or other things woke me up and once I was awake I was very bothered by it).  I was sure something must be wrong in how long it was taking to heal. It oozed and all that stuff. I was out of sorts. I went in to have it inspected and it was deemed perfect. The creepy unhealed mess that it was, that was perfect and exactly how it was meant to be at that stage of healing, according to someone who knows what's what after having seen oodles of these.

Lately I've been thinking about where I expected to be now and where I am and if it matters that my expectations were wildly wrong. One of my professors has mentioned to me or us several times about "over the last 3 years" in pharmacy school and stuff about how I finished a requirement (that requires reflection afterward of course) in my first two years so I didn't do anything to meet it this year and it is bugging me. It just grated on my last nerve so much that my bonus year gets glossed over. I didn't finish that requirement in my first two years of school, it took me the full three but here I am at the end of the third year of school after four years. It's also that it isn't just me that it grates when people gloss over the extra time. I think it's about 15% of my class who started with me and is starting rotations soon. It feels rude to me that we get ignored as a group. The dean's pep talk included a "did you imagine you'd be here 3 years ago? Did you think you'd make it? It all goes so fast!" section and I was tempted to walk out. 3 years ago? I thought I'd be somewhere very different than this. I thought I'd get lucky and have the perfectly timed after 2nd year baby and then graduate and have a job and a 2 year old and a 6 year old. Here and now? No job, no 2 year old, no graduation, just a funk where I feel like a screw up.

Anyway, I think that most of what's broken in me is my expectations and that I'm disappointed that life isn't meeting them. I get gut punched when I see someone with the middle child we don't have. It stings a lot when my classmates are having second children during pharmacy school or just after. One classmate has the almost 2 year old we'd have if pregnancy 4 had gone well (perfectly timed for summer break of course) and will have another in the next couple of months, that elusive 2 year spacing I always thought would be ideal. I had thought that I'd have a job now and be studying for board exams and going somewhere. Instead I'm getting ready for my rotations and spending a lot of time away from home. I suppose I just have the itch for change since such big changes were in the plan originally but are delayed some more now. Limbo is a lonely place to be and the bonus year of school has in many ways been one of limbo.

But that pesky new scar that's slowly forming on my arm reminds me that just because I think things should move at some speed doesn't mean they will or that they ought to. I bet if someone had seen thousands of cases of expectations and plans dashed they'd say that sometimes it works out better to have the delay. It is entirely possible that I am impatient and things are moving along at just the right speed. It might even be probable that everything is fine in the big picture and I will get where I ought to be only this way. I'm really looking forward to the scars of pharmacy school healing completely so I can get back to my life or I settle down enough to realize there is no destination to life, that it's all a journey to somewhere we will probably never recognize. Hopefully this year of rotations is that opportunity.

Tuesday, April 22, 2014

Ends yet again

I realized today that it's been a week since Little Monster nursed and that means we are done. If I'd realized it at the time I imagine I'd have been nostalgic a little bit but since it was 30 seconds of chomping and then giggling, I was mostly just DONE. On the one hand, given how much I disliked the whole thing, whoa making it to 14 months was pretty spectacular. I had so much frozen milk that I stopped pumping in January for daycare and she didn't switch to store-bought milk until 13 months so that was incredibly freeing. Up until that last time I decided that with the biting/yanking/causing bleeding I'd stop offering and if she wanted to request to nurse, she could bring me her nursing pillow (ok, so it's a polar bear stuffed animal). I turned her down once since then and she was grouchy but she's also getting like 5 teeth all at once. It's so sweet of her to save teething for when I have high stakes school stuff coming up, isn't it? (extreme sarcasm)

My first final is within the week (they are strung out to torture us this semester). Life as we have known it for so many years is really going to end.

It's a very weird set of emotions that's all wandering around my head these past few days, part relief that at long last there will be no more "I'm going to the library for the night" or "No I can't play right now, I have a test tomorrow" and part terror that I have no idea how we will cope with the new world. It of course doesn't help that we are buffering school and real world with a year of extreme wackiness where I'm gone lots and terrible twos (pre-twos?) and new label management that comes with getting an appropriate IEP and so far with one special ed teacher I'd like to fire. Seriously it's been a week with the label and we aren't going to disclose everything to you in an email because we aren't stupid. No need to be rude and disparaging and suggest that the kid won't even qualify for an IEP (and how could you know that anyway, fool?).

The time left in school and with a baby who really is more toddler every hour is so short it is mind-boggling. It has seemed through all of pharmacy school as if it were never-ending and with the bonus year, that's certainly felt more and more true up until just this week. Now there is hardly enough time to get everything ready. I've ordered my work clothes to fill in my wardrobe. I've bought myself a rice cooker and will probably buy some jars for lunches tonight. My travel plans for the first two rotations are reasonably firmed up. Since it works out that I go straight from school Friday until noon (drive for hours between) to my sibling's wedding (SQUEE!) and my first rotation the day after the wedding, my time to prepare is really short. Startlingly short.

My very first na.plex review book came yesterday (that's one of the two exams we take to get licensed, the other one being the state-specific law exam). I was cheap and bought last year's edition since I'll want the newest information to study for the real thing next year. I haven't actually gotten it out of the packaging yet. So far it's sitting where I can kick it around but studying for my exit exams starts Friday afternoon (and the exam is way too soon so I'm counting on being able to fail once so I get to study for it before the retake).

I think for now I'm going to make a list of everything that is left in the semester and another that's everything to get ready for rotations. Hopefully they are similar in length and not terrifying. After I finish the assignment due at midnight and the very last freaking paper I'm ever writing in pharmacy school that's due tomorrow. And maybe after I sleep some since I have a quiz and a zillion doctor appointments tomorrow with big things the rest of the week too. Siiiiiigh.