Monday, May 21, 2012


At present I am enjoying my very short summer break.  I start interning in a hospital shortly and am scared to death about it, and I'm really excited, and mostly I'm trying not to fret.

During my mini-summer break I have done the following: loafed around, watched some Warehouse 13 episodes, been excited about going to Utah in about a month and made some vague plans for the trip, snacked excessively rather than cooked a proper meal, and I've caught up on reading blogs.  I also had coffee with a friend this morning WHICH WAS AMAZING.  Coffee! Friend! Catching up!

This past weekend the spouse and I celebrated 7 years of whatever we call marriage, which is pretty amazing.  It's been a doozy of a relationship experience for the both of us and I like to think we're both better for it.  At the very least we had a relaxing celebratory weekend with dinner and a movie Saturday (Avengers in 3D probably not worth the extra cost) and dinner at the restaurant we went to before the wedding and a movie on our couch Sunday.

Being married is a strange thing and I often wonder what possessed us to go through with it.  And then I remember my grandmother who was SO EXCITED to see one of her grandchildren get married, and I realize that even if being married and official and in front of G-d and this congregation and all that jazz changed nothing about our relationship, it made her so happy that it was worth it.  My other grandmother was pretty excited about it too, although she passed away before we actually got married, but I did enjoy how excited she was that last time we visited (and went to dinner to celebrate my grandparents' 59th anniversary).

What are you doing with your upcoming summer? Any awesome vacation plans? Boring vacation plans?

Thursday, May 17, 2012

Amazingly cool research in progress

I read a really neat article (that you need a subscriptions to read, although I think it's a free subscription) about research in MN about how having people with high blood pressure measure their blood pressure at home can lower their blood pressure even more than just medications, and how pharmacists' interacting with patients based on that data works and is probably cost-effective.

The short summary of what they're doing is: patients newly diagnosed with high blood pressure in the study group get a home BP monitor and it digitally records readings and syncs them with a secure health record online.  Pharmacists can see that record and followed-up with patients by a phone call every 2-4 weeks to see how things are going and are authorized by a collaborative practice agreement to prescribe if med changes are needed.  After the first 6 months of the study, 72% of those getting pharmacist interventions had their blood pressure down to goal while only 45% of those getting usual care (doctor visit about every 6 months, first follow-up at 1 or 2 months after starting a med).

That's pretty amazing when you think about it.  An extra 27% of people getting their blood pressure under control within 6 months of starting treatment is pretty stellar.

While this study doesn't split out whether it's the charting of blood pressure electronically or the chatting with the pharmacist that improve outcomes, I like to think it's talking to someone more often.  Those in the pharmacist intervention group were on an average of 2.3 meds at 6 months compared to 1.6 meds in the usual care group, suggesting that pharmacists knew when to give up the first treatment and increase to a second med while doctors either didn't see patients often enough to make this intervention, or they didn't realize it was time to do it so soon.  The study is continuing to a year and maybe beyond that, so the final results are something to wait to check out, but it's still neat.  #pharmacygeek

How awesome is this research?  Chatting with a pharmacist for just 10-15 minutes every 2-4 weeks while monitoring blood pressure at home helps a lot for patients with high blood pressure.  While it's preliminary research, it's also very promising.  There's a good deal of other research that supports similar conclusions: talking to someone pretty often about fixing your health helps people improve it.

I have a piece of artwork that I'll put on my desk when I have one (or on my counter, depending on where I end up working) that says the following:

If a pretty picture and a cute saying are all it takes to motivate you, you have a very easy job. The kind robots will be doing soon.

Nobody but a real person can talk to another real person about their health, and nobody but a real person can coach another person to improve their lifestyle.  My future job is secure!

Tuesday, May 15, 2012


If you haven't spent much time around the Future PharmD household, you may not know about my recliner.  When I was approaching 18 I was getting ready for a fundraiser at my family's place of worship, where the youth would get people to sponsor them to rock all night in rocking chairs.  For some reason (probably that I didn't have a place to sit in the family living room anymore after the demise of the couch) I decided that what I really wanted was a reclining rocking chair of my own.  I have no idea why anyone took this request seriously (I'm not entirely sure that I took it seriously) but I eventually was drafted to go shopping for it, and a purple-ish burgundy one was selected.  It was delivered for the rock-a-thon (gasp the weekend before my birthday!), and a great time was had by all staying up all night watching movies and pretending we were continuously rocking.

It probably would never have been a big thing in my life if it weren't one of two times I spent with a friend before he killed himself.  Just some piece of furniture that I could claim as mine when I moved out (as soon as humanly possible was the plan).

The entire rock-a-thon, he (well, let's give him a name.  How's Joe?) wanted to borrow my rocking chair, to try it out.  Joe had never been what I'd call a stable guy and at just 17, he was a friend, yes, but not a close one.  He'd always acted kind of strangely, and I figured it was because he got knocked around at home and it broke him somehow (and based on the hand-shaped bruises I noticed more than once, this was a reasonable guess).  Being also 17 and pretty focused on things besides my platonic friends, I didn't think it was a big deal that I knew he got hurt at home (everyone knew he got teased constantly at school, by teachers and students alike) and I didn't mention it to anyone else.

I'd like to say that I let him borrow my chair, but I don't know that I did.  I was probably selfish and didn't let him use it.  I haven't asked anyone else who was there about it, and I don't think I ever will, because I'd hate to know for sure that I was mean to him that second-to-last time we were together.

The last time he and I were in the same place, at the same time, was a McDonalds in some small town after a youth retreat weekend with our youth group, maybe 3 weeks after the recliner incident and 2 before his death.  The weekend had been about addressing addiction in our lives.  We were sitting with some friends from somewhere else, enjoying a few last minutes of freedom from our parents before the drive home and back to life as normal.  The toy in my Happy Meal (or his? or someone else's?) was a green goblin number, and the head popped off via a trigger on the back.  I have this image of him sort of strangling the thing, until the head popped off and it got lost in the shuffle of the restaurant.  Joe looked, or attempted to look like he was looking, and I attempted to be upset by the lost part of a toy, but I was really upset by the look in his eyes. It was strange and scary and I didn't know what to make of it.

Then when he hung himself, I understood and it hurt.

I didn't sit in that recliner for at least a year, maybe almost 2.  I hauled it around when I moved twice, and then I stacked things on it.  It wasn't until about 2 years after his death that I realized what I'd been doing.  It was his chair.  He'd been with me all along, hanging around that chair.

Since I started pharmacy school, I sit in that chair every day and study.  Sometimes I migrate around the house studying, but that recliner has been my desk chair, my way to stay awake late at night.  I fed my baby girl in this chair.  I knew for sure I'd lost a long-awaited baby in this chair.  Hey, I'm writing this blog post from my chair.

And within the week it is going away.  After years and years, it's worn out. It's starting to be uncomfortable and stabby in places.  Its replacement is ordered and will be here soon.

I'm trying not to be too emotional about letting it go.  It's a chair. Really.  But it's complicated too because it's got some mileage.  It's probably (ok, certainly) time to let go of the chair, and to let go of the guilt of all of that too.  Yes, I could have told someone, and maybe they would have believed me, but maybe it would have changed nothing.  Life happens whether I like it or not, and it isn't my job to obsess about decisions I made wrongly once upon a time.  It's my job to live today to its fullest (and get the lawn mowed for pete's sake).  As the musical RENT puts it, "No day but today."

But honestly, I'll still miss my chair when it leaves.  It's a dear old friend after all these years.

Saturday, May 12, 2012


I don't do grief very well. I'm not sure anyone does, but it's a particular area that I'm no good at (not that I would like to improve with practice or anything).

There's a lot to grieve right now in my life.  Lots to celebrate too, yeah, but the grief.  A friend died today after a long battle with cancer.  Another friend is in the hospital with pneumonia and maybe cancer back again (one or both could easily be fatal, and fast). 

The grieving for people is complicated by a pet that died, my last childhood pet, and she died of something that could maybe have been prevented.  It makes me kick myself for not being more on top of things.  It's all tied up with a complicated family mess that I'm not sure how to handle yet, but I'll keep working on it.  The short of it is that my expectations exceeded someone's capacity to meet them, and it makes me very unhappy.

I presumably failed a class (grade still in limbo, which is my least favorite thing ever), so that sets me back a year in school, and at least at first I played that game of what did I do wrong.  I know I did plenty of things wrong, and I know how to study differently to do better next time.  It's a lot to grieve though, losing that dream and losing the fight.  It's been a rough time and it's miraculous really, for me to be here at all, let alone having magically pulled off not awful grades in almost all of my classes.  Now I think I'm at a place where I accept that I did the best I could with what I had to work with, and I'm lucky to get to give it another shot.

It's a great cycle, grieving.  I just have to be mindful not to get sucked into the "it's all my fault/why didn't I.../if only I had..." circuit that goes with it.  Historically I've wound up there and sometimes festered there imagining ways things would be better and different "if only I had..."  BUT this is clearly a dead end, because I'm not the only person involved and I can't control other people and their choices.

So I'm trying to do grief differently.  Go to the funeral, don't pretend things are all right when they aren't, make things right with people as soon as possible, cry and cry as often as needed because you can't heal all hunched up and not communicating.  I don't know if my new, stronger idea of a higher power is really inclusive enough for me to totally have the strength to trust it works out as it's meant to be, at least all of the time.  It makes me mad that life is unfair and that I can't fix it all myself... but I can fix myself with help, and that's something.  Letting go of the idea that I can control my life is a challenge and I think it will stay a challenge for quite some time to come BUT that won't stop me from continuing to try. A little bit more letting go and trusting every day...

I think I'm just going to be sad for a week or two and then get back to whatever comes next.  In the meantime, sappy movies, chick lit, and mowing the lawn. Probably also key lime pie.  (see, health nuts? Improvement! I'm going to grieve in a pseudo-unhealthy way by primarily non-food gluttony)

Friday, May 11, 2012


During my first semester of pharmacy school things were rough for us as a family because we lost a pregnancy/proto baby (and because of pharmacy school and moving and me being very ill while pregnant).  During a particularly bad moment in all of that, the spouse and the kid got me a lovely miniature rose (from the grocery store, on clearance, but still) in an effort to cheer me up.  I really like gardening, but I don't get to it often enough. I do have a rather large collection of house plants (complete with fortifications to keep out the cats).  My house plant collection includes my very first, independent, grown-up, pet plant named Phil. Phil the philodendron is now almost 9 years old, in his second pot, and still doing very well. 

Anyway, things didn't go so well in the cheering up department and I struggled an awful lot for a big chunk of that first year with being really angry at everyone and everything.  I got so caught up in being angry that I lost sight of a lot of things, including that lovely little shrub, and it died. Or really, it dried. I left it sitting on my desk until the cats murdered it, a perfectly preserved specimen of blooms that just died at their peak.

Then in a couple of weeks during midterms or a bad week of exams, they came home with another miniature rose bush for me.

I kinda feel like that was a tipping point in things, the chance to start over and do the right things one after another, starting with caring for the mini-rose bush.

Being not really sure how to care for it, I bumbled along and it quit blooming for several months (maybe that's normal, what do I really know anyway?).  Then for finals last year it managed a lone bloom, and nothing since then until now.

Last week the kid was all excited because the rose was blooming, and I was shocked to see that it had TWO blossoms, but in a spot where I wouldn't have seen it without the kid mentioning it.

Since then I've observed it putting out no less than another 10 buds, but none are open quite yet.  The first will probably open yet today.

It's amazing how much can change in a year, isn't it?

Wednesday, May 9, 2012

Political moment

This is not a political blog. I try to stay out of politics whenever possible.

I grew up with politics in a way that I don't think many people do.  Example: my first "elevator speech" for a political candidate I wrote when I was 5, and I think I pitched it to other kids at Vacation Bible School (having not yet started school).  I door knocked at 7 and talked to people about taxes and pro-life versus pro-choice.

That little preface there, that's to explain that now, when I say that I like to stay out of politics, I do so because I have been so far into politics that there was little else.  This does not mean that I ignore politics.  I follow reasonably closely things on the state level and vaguely on the national level.

So this issue is near and dear to my heart, and I'm so sad that North Carolina voted in favor of a constitutional amendment that  bans same-gender civil unions and doubly bans same-gender marriage (note: no gender versus sex discussion today, thanks).

In my neck of the woods this is hotly under discussion, and I haven't written why marriage matters to me, so here it is, parts 1 and 2.

Part 1: I grew up in a little farm town where the adopted Korean kids were picked on mercilessly for being different (to give you a sense of the level of outsider fear) and being gay was the absolute worst insult. Worse than being an atheist.  One of my good friends was the least popular kid in school and therefore bore the brunt of the taunting, mostly about being gay.  He wasn't, but it didn't matter anyway, since hardly anyone looked at him like he was a human being, let alone gay or straight.  The endless bullying made him sad and eventually he hung himself, and I think a big part of that was having internalized the sub-human status given to gays and on some level worrying it might have been true.  Nobody deserves that, and laws like this one make it easy for adults to model that gays are not fully human unless celibate/castrated/whatever weird rules folk come up with.  When adults model hatred, kids learn it well and practice it on each other, and other kids die or are scarred as a result.  Equal legal rights and protections pave the way for no right to publicly hate, which means safer kids.

Part 2: As a kid growing up in a little farm town, I knew I was different (and not just because I had parents who weren't locals).  My first crush was on a boy, my second on a girl, and then many afterward on girls.  I figured this made me gay, and over a few months of obsessing about it, I was sad but accepted that I was whomever my Higher Power made me to be.  But why was I sad?  Because all those dreams you dream up as a little kid about your life as an adult, they all include getting married.  It broke my heart into a pile of little pieces that I could never get married if I fell in love with a woman.  After a couple of years, Vermont had civil unions, and it dawned on me that maybe this "marriage" thing was bigger than what I'd learned from my peers.  I joined a faith community that marries same-gender couples in just the same way it marries opposite-gender couples.  No kid deserves to have their every dream about their future crushed because they are gay.  Marriage and the partnership that goes with it ought to be available to everyone [on a legal level. You keep your faith off my laws, I'll do the same, thanks.].

Today I'm happily married, something I didn't think was possible then, and it's miraculous.  Every loving couple deserves equal legal protection, every family deserves to have a public recognition of their loving relationship, so yes, marriage matters.  It's not all about the law, it's about being able to take part in a public commitment to each other and have that commitment simply understood by those around you.  Just try explaining a "commitment ceremony" to someone over 50, I dare you.  You get blank stares and bewilderment.  If you name that very same ceremony a marriage, even if you have to explain that the people getting married are Adam and Steve instead of Adam and Eva, they get it.

So NC, along with other states with such amendments, I look forward to when hatred gets written out of constitutions and these are overturned.  It's only a matter of time.

Sunday, May 6, 2012

On coffee

Once upon a time, 16 year old me did not drink coffee. Ever.  I did consume plenty of caffeinated beverages, being a busy student who did dumb things like work 30-40+ hours a week supporting her family (oh codependency, we meet again. Or appropriate dependency? That's for another post.) while in school all day.

Then I decided to drink way too much soda in a 24 hour period (I probably was out with friends until midnight, slept a little, then went to work to start a 5am shift) and I burned my throat drinking all that acidic soda.  This required a switch in caffeine source to something that wouldn't make my throat hurt more (and recall, this is pre-energy drinks, thank Heaven or I would have ODed on them).

So I had a crappy cappuccino.  Since I worked at a fast food joint, and could buy these half priced, I gagged one down.  The first one was awful but it kept me awake.

The second was really awful and I hated it, so I added some more sugar to it.  It was still awful but I needed to stay awake so I guzzled it.

I have the feeling that after 2 I knew I was hooked.  I would drink another one, and it would be awful, but I would be awake and getting things done, and that was the most important thing, right?

Fast-forward through a week of awful cappuccinos (at school for breakfast, at work for an afternoon snack) and my budget is shot.  BUT at work, coffee is free (as was soda, but throat still hurt like mad drinking one) so I mixed coffee with about 50% milk and sugar and suffered through it.  Tasted like road tar.  Ick.  But also, that coffee came with a euphoric sense that I could handle things better afterward.  I would be awake! A coherent, awake, rockstar who could conquer the world!

And to this day, I loathe the taste of coffee and yet crave it all the same.  Mmmm... delicious addiction...

Today I had my weekly cup of coffee after my faith community met.  Well, "cup" is a misnomer. I generally have a half cup of coffee, 1/4 cup cream, and 1/4 cup water with some sugar for good measure.

Then there was lunch with friends, which was great.

And then I studied at the library until it closed.  Then... there's only one really good place to study left... a coffee shop!  So being indecisive about what to get, I just got a large coffee... and then a refill because I was thirsty... and now I will be up all night, reliving the disgusting yet wonderful coffee even after I've brushed all the sugar off of my teeth and out of my mouth.

At least it was really good coffee today, not just desperation coffee.

Tuesday, May 1, 2012

Finals dreams

It's still finals (9 more days, 1 quiz, 5 exams) and I am having crazy dreams that usually indicate I'm stressed and tired and soforth.

Last night's memorable incidents:

A dream of counseling a patient about taking Plavix that was all in Spanish that moved into discussing an anti-hypertensive drug (maybe losartan) as well.  I don't really speak Spanish (restaurant Spanish only at best) so this is especially great, because the parts of dialogue that I remember were in perfect Spanish (thanks Google!). So weird.  Recently I've been dreaming in German (which I do/did speak well enough to get by, possibly even actually counseling a patient on Plavix) but not yet American Sign Language (very limited vocab but more often I dream in ASL than any other language).

Being lost in the pharmacy looking for a drug that just wasn't on the shelf, probably fludrocortisone or prednisone in a strength that doesn't exist.

Making a dozen vancomycin IV bags.  This is really amazing because today I compounded a vanco oral solution, and that involved doing exactly the first part from the dream (adding water to the powder to rehydrate the vanco).

The usual "oh no I forgot about the exam! I'm late!" dream.

Something about getting my next tattoo, although I missed what the tattoo was going to be.  I'm still on the fence about the next tattoo, when to get it, where to get it, all that jazz.  Currently toying with a pair for the current tattoo on the other leg, upper half sleeve (that would be a long-term tattoo project rather than just the next tattoo), or something else. 

Clearly tattoos are like potato chips and you can never have just one... although it's taken me 9 years to get to where I'm really serious about this next one actually happening soon.