Wednesday, March 25, 2015

Check your privilege

It's easy to get lost in the shuffle of daily life and forget just how much you have.

This rotation I'm in a very rural area with a very high poverty rate. It hits me over the head pretty often that I am incredibly fortunate.

For example: I own an iDevice. Usually I make my grocery list on it. This week I opted to copy it onto a piece of paper because it is incredibly rude (in my view) to flaunt that wealth here. Half of people don't have cars and people live very spread out, sometimes an hour from town (where there's a grocery store, one restaurant, a gas station, post office, and two churches). The post office here is the trailer that has a blue mailbox in front of it, and it's in slightly better shape than almost everywhere people live around here. This is not saying all that much. I spent $30 on supplementary groceries (milk, meat, cheese, frozen green beans, hand soap) and got about half what I would at home. No wonder everyone is broke. There is a wall of canned meat. 10 feet across the bottom and at least 12 feet up. I couldn't find any plain chicken breasts in the store, but I saw the price tag and it was double what I'd pay at home. Chicken thighs with the fattiest skin I've ever seen were on sale for a nearly affordable price.

There is no internet at my place but I can go visit some neighbors and plug into their internet. It's patchy and reasonably slow (no streaming video is possible) but it connects. It's the fastest around here by far, probably double what most people have access to. I have a computer and it works and I get to use it to connect to the world and apply for jobs.

I have this incredibly huge floppy sun hat that I wear when I walk to work. It's objectively hideous in olive green and I love it because it keeps the sun off of my face and I can skip the sunblock since it's UV protective. It blocks my peripheral vision almost totally though. I can see only what's in front of me when I wear it. Then I get to work and take the thing off and I get it. The blinders are off and I see the pack of stray dogs and the spirit behind the people who have a hard time keeping hope.

It's beautiful and raw and painful and hopeful all in a single glance. The blinders are off and my vision has expanded. Privilege checked.

Wednesday, March 4, 2015

The Waiting Place

On my first day of high school, our principal sat us all down in the gym for some various "rah rah welcome to high school" announcements and such. Then our principal read us the Dr. Seuss book Oh The Places You'll Go. It was a nice reminder that we were in charge of our destiny based on what we did with each day.

I also have fond memories of our principal announcing it was time for classes in the morning 5 minutes before the first bell, first yelling to everyone lounging in the cafeteria and then to everyone just off campus lurking while smoking. Ah to be young and idiotic with few consequences...

But I digress. Ever since then, I have loved Oh The Places You'll Go. If anyone had read it to me or I'd read it before that first day of high school, I don't remember it. I'm sure someone got me a copy when I finished high school (maybe even my parents) and I have it somewhere or other in physical form. I also have the audio book and I've pulled that out to listen to it a few times lately. The part that strikes me now is so different from what I'd caught reading it before.

The Waiting Place.

I'm actively (mostly) looking for jobs and applying to things and have an upcoming interview. I miraculously got several residency interviews and am about to submit my ranking for the match. This match business is a complex way of ensuring that as many people as possible fill residencies and get offers. You might have heard about medical school residency matches and it's the same deal but their match day is the week before ours. First the applications happen, then the interviews (long interviews, some with several panels of interviewers, most with at least one presentation and sometimes multiple presentations, some with pop quizzes even), then everyone ranks (places you interviewed and people you interviewed, depending on if you're a candidate or a program), then there's some magic behind the scenes, and on March 20th the results are released. Hopefully I get a third miracle and match, but if I don't, I'm honestly not that stressed out about what will happen after that. (The first miracle was a single interview, the second was MULTIPLE interviews, at about half the places I applied, because WHOA that really happened and I am so fortunate to have this chance to seize.)

It is such a strange place, to be waiting. I look forward to the Boom Bands at the end of the Waiting Place. I am trusting that this is a moment in time and on the other side is whatever awesomeness comes next. Because this is certainly Another Chance and I am going to seize it.

To quote The Seuss:

The Waiting Place...

...for people just waiting.
Waiting for a train to go
or a bus to come, or a plane to go
or the mail to come, or the rain to go
or the phone to ring, or the snow to snow
or the waiting around for a Yes or No
or waiting for their hair to grow.
Everyone is just waiting.

Waiting for the fish to bite
or waiting for the wind to fly a kite
or waiting around for Friday night
or waiting, perhaps, for their Uncle Jake
or a pot to boil, or a Better Break
or a string of pearls, or a pair of pants
or a wig with curls, or Another Chance.
Everyone is just waiting.

NO!
That's not for you!

Somehow you'll escape
all that waiting and staying
You'll find the bright places
where Boom Bands are playing.


For all of you out there who find yourself waiting, I hope you discover the bright places soon and get to enjoy whatever you discover in the newfound light.

Thursday, February 26, 2015

Two and two

I can't believe it was two years ago that I was noticing my maternity clothes were suddenly much looser and that Little Monster would make her appearance so soon! That sneaky baby, turning up ahead of schedule. She has flouted all schedules ever since. She waited forever to get teeth, finally cutting her first, second, and third teeth within a week at 9 months old. At 5.5 months she stole a pizza crust from my hand so we let her eat food. She started walking very deliberately to get her favorite book from across the room.

She is using more and more words all the time. Tonight she was showing me the dried pinto bean she has been hauling around for a few days and told me "Look mommy! I have a peanut bean." Then my spouse took the bean from her to show me up close via web cam, and when she took it back, she pinched it perfectly between index finger and thumb. Her favorite things are equal parts adolescent turtles and princesses (sparkly dresses and skirts and brushing everyone's hair, even her fluff). When we read a flap book last weekend while I was home, she pointed to each animal and said, "Look mommy! This is the mouse, he's hiding in the flower (or tree or rock or whatever). What a nice mouse. Squeak!"

Little Monster, you're a pretty excellent toddler. Keep up the good work.

The other thing of note is how long we've now had two children. They get along really well sometimes and fight other times. The biggest struggle is keeping the Kid from over-parenting and over-helping with Little Monster. Once the Kid helpfully took Little Monster's diaper off to help her potty train... and after 5 seconds in the bathroom, Little Monster ran off and the Kid got distracted and forgot all about her. Often the Kid is very concerned with keeping Little Monster in line, usually to the point that she ignores taking care of herself, like when she demands Little Monster sit down while she eats breakfast but won't do the same and is reminded to stop dancing while eating.

The pair of them are super cute too. When we are in a parking lot, Little Monster is good about holding someone's hand better than 90% of the time (and she gets scooped up and carried if she won't). She gets to choose whose hand to hold and she nearly always reaches for her sister's hand first. It's amazing.

Tuesday, February 3, 2015

A moment of classic sassy toddler

One of the other kids at daycare who is a bit older than Little Monster is potty training. They have similar verbal skills despite close to a year in age difference (I think?) so she has been inspired to want to potty train too. Due to a laundry emergency where some fool (aka me) went to bed without restarting the dryer to ensure the cloth diapers would be dry in the morning, she got to wear undies for a bit. There was so much excitement about the undies. She did a little stamping-in-a-circle dance while chanting "undies!" over and over for maybe a minute or so. They are actually really training pants that are highly absorbent, but she doesn't know anything else is an option. Then after a couple of hours, it was time to change out of the now wet undies. Little Monster had a full blown tantrum and tried very hard to prevent them from being pulled off of her.

Then we put another pair of undies on her (pesky dryer only running on low heat), and she immediately stopped crying and yelling and said "I told you so!" and then attempted to run away with no pants on.

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).