Monday, April 30, 2012

On Worry

It's finals (final 2 of 7 today), worrying is to some degree needed to survive.  Then of course there's life to induce worry.  Oh life.

I get that I need to live in today and quit worrying about it all.  I know and understand it totally on an intellectual level.  Then there's the gut reaction when you get possibly worrying news and that's out of my hands, that knee-jerk bit.

The trick is not letting my knee-jerk get me into walking somewhere I don't want to tread.  Today is all there is and when tomorrow gets here, we face it.

My faith teaches me that there's a plan for this life (the good stuff) and that if you screw up once, you might get a second chance, or maybe a third, but there's no way to know if this is the last chance.  This inspires me personally to use my life do-over to good effect.  My faith also teaches me that the bad stuff is done by us and it isn't in the plan.  We do bad stuff despite the Higher Power I understand to be running the show (maybe directing is a better way to put it).

So if this is the plan, Higher Power, keep me strong and sane and whole and ready to face whatever happens next.

and as an aside, why must the best place to use a computer at the library be behind the newspaper rack so I have to listen to all the crinkling? I do enjoy that it isn't shouting little kids but SHEESH!  Is it necessary to loudly move every single newspaper in the place?


It is clear I am in a pseudo-funk and that's life.  I'll move on soon and get back to embracing opportunities rather than hunkering in self-pity.  Maybe in about 10 minutes.

Thursday, April 26, 2012

Oh innovation...

New Walgreens Facebook Plugin Allows Users to See What Prescriptions Friends Are Picking Up

This may be an article from The Onion, meaning it's meant to be farce, but it brings up a good point.  Why is it that people care so much about what their "friends" are doing?  I suppose it's the mediated experience of life these days.  We put media and devices in place to make interactions as much as possible like there's no technology, but to make the experience less noticeably tech-involved, we add another layer of technology, which in the end makes us farther away from the original tech-free interaction.  Example: Talking to a friend on skype.  Yes, it's almost like talking in person, but we both need to have computers with video cameras and microphones and high speed internet (and electricity) for it to work at all.  That's several layers of technology.  At the root of it, we are both sitting behind glowing screens.

If you use facebook as much as I do (and shouldn't but it happens), you may have noticed lately that facebook is adding features like "Bill is currently listening to..." feeds using some app or whatever, and the location check in has been around for quite some time, so when you're out somewhere you use facebook to announce it.  Facebook is telling you in real time what your "friends" are doing - exercising, listening to, etc.

It adds levels of interaction for sure, but it also means that we have to spend more time at our computer/mobile device screens to do so.  Last week I went to a record store and I browsed through albums for a few minutes.  In years gone by, my friends would have lived in the same town as me, and we might have run into each other in that record shop on occasion, and asked each other what we were listening to these days, then gone and touched physical copies of albums (in whatever format - CD, LP, cassette) before buying anything.  My friends would have seen me out in the community at a restaurant because we'd have frequented the same relatively small number of places.  We'd have bumped into each other in the grocery store and said hello and caught up on things like who's gotten a new job or had a baby or whatever.

None of those in person interactions happen these days because of the screens we plant ourselves behind.  I can order groceries online, I shop for music online, I say hello to friends online via email or facebook (or twitter or foursquare or pinterest if you're into that), and I don't live anywhere near a great many friends so I wouldn't run into them in a restaurant no matter how hard I tried.  Because we no longer practice actually catching up with people in person, we don't do it very often at all.  When I see someone I haven't seen in a long time out in the community, I often go hide and pretend I didn't see them because I have no idea how to have that "Hey! How are you? I haven't seen you in years but what have you been up to?" conversation.  Or I'm afraid I'd screw it up and be honest about what I've been up to and overshare.  But I don't think I'm alone in this. I don't see people under 40 or so having the same chats in the grocery store that you see people older having, where they go on about kids or job promotions or retirements.

I don't know what it means, but it's a change in our lives we all need to start addressing and probably in person rather than through screens if we can manage it.

Sunday, April 22, 2012

The Home Stretch

It's now just about 3 weeks until the semester is over. It will be over. It is finite.

Right now it seems like the longest 3 weeks in the world and it will never ever end.  It's pretty scary since my grades are still towing the line of passing or not in at least one if not more classes (but improving!) and one has a cumulative final (eeeeeeeep) that has a minimum grade to pass the class.

I'm moving forward with getting ready for summer however. I've bought a hideous carry-on to take to Utah when I go to the School on Alcoholism and Addiction in... whenever it is.  I'm plotting rotations I'd like to pursue and have started pursuing at least one, and I'm about to finish the stuff to do my summer mini-rotation in a hospital (which I'm absolutely terrified about, just in case you were wondering).  Well actually, I'm excited and scared because I know nothing or nearly nothing about hospital pharmacy and what I do know, I'm not a big fan of and I'd rather spend my time saying no to vicodin refills and chatting with old people than have that extra pressure (that I imagine is there with people dying every which way, since it is a hospital).

On the upside, after my last final I get to celebrate with friends and family and I'm excited about that.  It's been a big bad year and to celebrate (at least I really hope so, G-d willing I get that far) is pretty amazing.  Plus the rascally kittens will be a year old then too, so I imagine we will have a cat birthday party too.  I may order egg free cupcakes just for me.

Today at the grocery store I saw a guy I went to high school with at the grocery store with wife and baby and it reminded me that this isn't out of the ordinary any more.  It's about time everyone else got hitched and had babies.

I'm still sad about being lapped by friends (but somehow not family, go figure; lookin at you here, family who isn't having any babies at all for me to goo over).  One friend just celebrated her 4th wedding anniversary and is expecting baby 3 in the fall, meaning she's had 3 (well, 2.5) in the time since my kid was born... oh life. How mysterious and surprising it is.  I've decided to just let myself be hurt a little bit when there's another baby coming into my life who isn't mine and then move on with gooing and insisting on holding the baby and soforth.  I am so sad that my infertility buddy classmate won't be around next year in the same way for me to commiserate with about the abundance of babies in our class who we don't get to keep, but I'm hopeful that things go well for her and that in a year or less I get to see pictures of her baby (biological or otherwise).  I've also decided to box up and give away all the horded baby stuff because whatever.  It's likely that even if we get pregnant (ahahahahah! as if!) sometime soon we'd move at least once between now and baby's arrive, and how much is it worth to haul all that stuff around anyway? Not enough that it's worth it.

And now, back to the regularly scheduled slaving away at studying and tossing the cats off the computer.

Wednesday, April 18, 2012

Parenting philosophy described

Here's a blog post about letting go of your control as a parent, and I fully concur.  I read too many Mormon mommy blogs (well, too many mommy blogs in total, and a high proportion happen to be Mormon, but it isn't a thing I don't think, just a fact) and this is the best of the bunch most days.  Her discussions of waiting for a baby are probably my favorite inspirational pieces for when things are, well, as they are and baby-free.  So read some of Nat the Fat Rat and enjoy.

The F Word


Hah. Is that the F word you were expecting out of me? Bwah ha ha ha ha.

This is a multi-part discussion that will happen over the next months, I'm sure.

Today, part 1: feminism and the sexual revolution
Other planned parts:
What happened to feminism anyway, and where on Earth are we going?
Who stole feminism?
Where's the line between empowering women and tromping on men?
How do we create a new world with equality?
It starts with an article: Republicans, "Girls," and Sexual Freedom in The New Yorker

In short, the article talks about why republicans are so darn interested in controlling women's sexuality with all this "how dare birth control be required to be covered by all insurance?" and "all abortions ever are evil and should be illegal" stuff that's been so prominent lately.

If we consider all the things that have happened since the start of feminism in earnest in the mid-19th century, first it was the end of the world if women got to vote, then the end of the world if they worked outside the home (and for equal pay, which women still don't get for a whole host of reasons), and then the end of the world if contraception and then abortion became legal.

Society as a whole (in the U.S) is now completely unfazed that women vote.  We are big fans of women worldwide voting.  Very few people really bat an eye at women working outside the home (yes, still some object, but generally this is a minority that gets scoffed at by most people). 

Working outside the home is still a hotly contested issue among women themselves (see: mommy wars over every darn parenting choice that exists) but it isn't something women feel the need to fight to do at all anymore.  The fight is now about the moral high ground of working exclusively at home versus working outside the home.

But sex. Sex is where it gets sticky... (did I just write that? oh my filthy mind)  It intrigues me that the things that were a part of the package (voting, family planning rights, autonomy to have a job of one's own) of early women's liberation have been split out so that sex is somehow its own issue.  While men no longer ought to have any say over whether a woman has a job or if she can vote, men still get to control women's sex lives? Isn't that strange to have such a double standard?  Men are more masculine if they have many sex partners (serially, not necessarily several women at a time) while women are defiled and depreciated if they have many sex partners.  So weird.  I suppose it's because men are somehow less responsible if a baby turns up as a result of sex, since they can't immediately be identified as the father and therefore can skulk off and pretend they have no idea how she got pregnant!

Since I like to fix things, I fully support requiring paternity testing before a baby leaves the hospital for all babies unless you jump through some big hoops.  If men were as tied to their babies as women, there would be much less fuss about women getting to limit their fertility (in my view, at least) because the commitment would be increased legally. 

It just baffles me that women are capable of deciding what job to pursue and what person to marry, but women are not capable of deciding when and if to have babies.  Really now.  If women are people, and people are as a rule autonomous and capable of making decisions about their bodies, WHY ON EARTH  shouldn't women get to make these choices for themselves?

When I was young and still in on politics, I was door-knocking for a pro-choice (woman) congressional candidate.  I wound up talking to this guy, maybe early 40s but with small children, about how frustrating the abortion=legal debate is.  He argued that children are a gift from G-d and we need to embrace them when they get here because we may only have a few precious chances to be parents, and when I was older and if I experienced infertility, I would totally change my mind.  I've thought of that guy often since then, and I am now totally convinced that argument is bogus. 

There was a pregnancy in my life that I considered terminating. I actually made the appointment.  I changed my mind, but my body didn't get the pro-baby memo, and that was that, decision made for me.  Yes, it was selfish to consider. So is deciding to bring any child into this overpopulated world.  After struggling to get pregnant again, and then failing to stay pregnant AGAIN I considered that choice again, and I wouldn't change a thing because I'm now pretty sure that I could never have an abortion.  But I also had the heart-wrenching "what do we do now?" talk with my OB after the last miscarriage, the one where we decided whether to wait and see what my body did, or do surgery, or try some drugs to speed things along.  My proto-baby was dead already at this point, but I can very easily the extra anguish and heart break to know the baby you are carrying is going to die no matter what, and to consider terminating the pregnancy rather than waiting and letting the baby suffer for a few brief moments after delivery.  That heartache of choosing to end a pregnancy so the mother can live.  Nobody but that woman and her higher power can decide what's right or moral in her situation (and hopefully her partner, but in a supporting role, because it's her body and she lives or dies in it) and nobody ought to try.  Although I think there are a great many immoral abortions that happen, it isn't my job to enforce my morality on anyone.  You make your own moral choices, I'll make mine.  I think lots of things are immoral that other people seem to find no fault with, so good for them.  Infertility hasn't convinced me that my younger self should have tried to carry that pregnancy that failed to term and figure out what would happen to that baby with no dad in the picture.  It was my personal sense of when life begins and what my higher power is up to in my life that convinced me not to go for the termination. I chose for myself because I'm a fully human person, capable of deciding something like that.

It will probably always baffle me that women shouldn't have sex but men should have lots.  Does that mean men should be having more sex with each other? or...?

So if thinking that women ought to get to decide what is moral for themselves makes me a feminist, then there I am.

Monday, April 16, 2012

Friday, April 13, 2012

Community versus hospital versus grab bag pharmacy

One of my professional mentors was asking me the other week about whether I want to keep working in community pharmacy when I'm the pharmacist.  My response was that I have no idea.  This is actually not totally true.

First, for you non-pharmacists in the audience, pharmacists are the medication experts in your healthcare team.  Doctors are the diagnosis experts in the healthcare team. Nurses are the people management experts in your healthcare team. Physical and occupational therapists are the muscle experts, and so forth.  In a good system, everyone works together and does a good job and no patient falls through the cracks.  No system is perfect, and there are some big gaps in the U.S. healthcare system (obviously, hence the "healthcare reform" law and subsequent shenanigans in the legal system). 

The very short of what pharmacists do: check what a doctor prescribes and make sure it's all right for the patient to take.

You've probably seen a pharmacist fetching your antibiotic when you have strep throat or something at a community pharmacy (think Walgreens or CVS or grocery store chain).  Pharmacists in community practice are kind of like islands in the healthcare island chain, with patients going by boat from one island to another (hospital, nursing home, various doctors who may or may not talk to/know about one another).  That well-defined healthcare team is not so plain in community pharmacy as it is in a hospital.  The island nature means the patient-prescriber-pharmacist triad is less stable as well with patients seeing many doctors but also maybe using several pharmacies depending on their mood or discounts or what have you.  More gaps in community pharmacy in patient care as well because information from one place to another isn't so smooth.

You probably never considered who checks all the medications people get in hospitals, but it's still the pharmacist.  Many hospital pharmacies are located in the basement so there's almost no chance of running into a pharmacist if you visit a hospital, and you probably missed that there was a pharmacist there at all.  Hospital pharmacists are moving toward a stronger role as a part of the healthcare team, strolling around with doctors on rounds to visit patients in person and assess their medications or assigning specific patients to the pharmacist to tweak doses based on labs following a diagnosis.  Here you've usually got pretty decent continuity of care (meaning you know a reasonably complete patient history, and the patient's doctors probably are available to answer questions easily and without playing phone tag) and if the hospital is part of a health system that includes clinics as well, you might have all kinds of helpful information.

The post title talks about "grab bag pharmacy" and I lump together everything else and all the interesting and strange places pharmacists get paid to work in this category.  There are jobs working for insurance plans or their pharmacy-specific branches, there are jobs working in universities teaching future pharmacists, there are jobs running employee wellness programs for corporations, all kinds of interesting and very unique settings. There are places where you see the pharmacist first, then the doctor (or the two together) when you're sick.

So me and career plans: I know I like the big picture, I prefer words and research to experiments, I like talking to old people well enough, I like systems and how they work, and I'm a super big information technology dork and I'm still geeking out about getting to watch a new electronic health record system work the other day.  I want to do something where I get to use these skills, but I can see where this stuff would be useful in any practice setting.  The numbers say that 60-65% of pharmacist graduates get jobs in community pharmacy, and 20-30% get jobs in hospitals, with everyone else ending up in the grab bag jobs.  I presume therefore that I'll get a job working in a community pharmacy.  I'm not so worried about it.  I like it well enough to do it for the rest of my career.  My life is boring, so I can just get rid of my sweatpants and be "on duty" all of the time.  I think one reason why in the profession it's more desirable to work in a hospital is that because nobody sees you working as a pharmacist (since you're either in your office or the depths of the hospital sending techs out to deliver stuff) you don't have that same level of public scrutiny.

But I also think I'm cautious about deciding I know what I want from life since up to this point I've been absolutely wrong about what is good for me.  If I got to pick a perfect job, I'd want to do clinical and IT stuff for a hospital system, or drug information (basically a librarian but looking at the literature and making sense out of it for somebody else).  I just try to remember that some years ago when picking a major I was almost this certain that I wanted to teach English to high schoolers, and I was extremely wrong then.  I could be just as wrong now about where I'm meant to end up, so I'm trusting that I'll get there when I get there.

I always liked that Shaker hymn "Tis the gift to be simple" and I think the part that means the most to me is "Tis the gift to come down where we ought to be."  My idea of my higher power (you can say G-d if it makes you happy, as I do sometimes) includes some bigger plan for me and my life, and I'm just bumbling around to figure out what that plan is, so it's very comforting to know that somewhere I have a place and when it presents itself, it will be where I ought to be.

Monday, April 9, 2012

Fun times and fun adventures

I'm off on a two to three day adventure alone here in a minute or two.  It's going to be exciting but I'm driving 7 hours down to stay with a friend, do a school thing, and then drive 7 hours back to stay with my sibling a night.  I spent a lot of my early adulthood driving 10-14 hours to visit the spouse at college.  In those days I drove and the spouse didn't, so I gave driving lessons and made the long trip at least once or twice a semester.  But it's been a few years now since I did something like plot my rest stops and stock up my car with caffeine and junk food.  I had planned to sleep late, and I did a little bit, in a nod to the crazy thing I'm about to do, but not as late as I'd planned to.  Nerves get the best of me.

Since I'm being honest, I am prone to doing crazy things like this: working an evening shift and then driving 7 hours to spend about 18 hours in town, then drive 7 back after a study group for an hour or two mid-drive.  I have this inclination to do crazy things like work myself to bits or be tired enough to watch the world glow while I drink more caffeine.  I have this inclination to test my limits and see if I break.  In the past I have found my limit and broken so completely that I'm still picking up pieces but that's for the best.  I'm in this introspective mode at the moment and I'm contemplating my life and how I order it.  How we order things as a family. How I order my career and where it's going or whether I should try to shape it or just let it roll.

I think that I must have healed wrong at some point, like some arm that didn't get set right the first time and needed re-breaking.  Looking at the pieces of my old life, I'm glad to have had them but I'm also glad that I got the chance to fix things now instead of later.  And now, song time! I listen to this song a lot and think about how life smashes you up sometimes, and it hurts, but the light shines through the cracks at the end, and maybe that's for the best.  At least it makes you a person who's more interesting and illuminated.