Summer vacation!

This summer, instead of having a vacation, I'm doing a research project (that I got a grant for, wahoo!) and working in the usual "refill too soon, your insurance won't pay for that, let me tell you about your antibiotic, no vicodin for you!" retail setting.  It's a good time and I'm busy with it all.  The spouse had surgery on Tuesday and is healing nicely but being sole breadwinner with two stinking nearly full-time jobs PLUS sole house maintenance person is a lot.  I'm clearly not cut out for this.  I'll sling pills any day, but ask me to do laundry and cook and clean and monitor the kid too? Oof.

And it sounds like someone needs more vicodin after waking up from another pain-induced nap (aka the spouse, poor thing).

Oh. Did I mention that somehow in all of this, we're also moving? HOLY WOW we're moving and soon. Yipes!

No idea how we'll get through this, but we will manage one way or another.  Eventually the movers will arrive, our things will move onto a truck, and eventually they will be unloaded in our new house.  It will work out somehow or other.

Summer Reading Challenge Update

Progress, not perfection!

Since Danielle is updating (and I have no sense of when I set my summer reading goal), here's my update too.

At this point, I've almost finished "reading" Timeline, I'm somewhere in the first 100 pages of Alcoholics Anonymous, and I'm loafing about getting ready to read some more.  I do plan to be sure my reading list books get packed last so I can read until the very end. 

I did finish reading The Blessing Way by Tony Hillerman and it was awesome.  I'm a big sucker for anthropology-type books and the most interesting part of this story is what it's like to live and work on the Navajo reservation in Arizona/New Mexico.

I am adding to my list of things I want to read, though, so suggestions welcome.

In the meantime, PANIC! We're moving and soon! Yipes!

Confession

I read lots of blogs, and some I've been reading for a few years, others a few weeks.  In reality, it's become my substitute for watching TV, and honestly it takes less time than the TV used to.

However I've noticed a perhaps not so good thing happen.  I start reading a blog, I enjoy it a lot, it's lovely, and then the author gets knocked up, and I quit reading. It's not a conscious "oh now I'm done reading this blog entirely" sort of deal.  It's a slow process where I decide it's too much for me to cry over every update about whatever is going on with the pregnant blogger that starts with me forgetting to wander over and read the blog in the first place.  I look at most blogs I follow about once a day or so, and no, I don't use one of those reader things.  I'm old fashioned and type in the addresses in my browser.

When the author gets pregnant, the daily check-ins stop because "I just forgot" and maybe I did.  I'm not totally convinced of that though.

And that's probably the sum total of it for the moment.  I think I'll just deal with grief as it happens and life as it happens and that will be all right.

Sustainable rural healthcare

I've been thinking a lot about rural healthcare and how we make it work.  Rural parts of the country have few primary care providers.  Near me a critical access hospital just stopped delivering babies because they couldn't find a second OB to join the practice and the one doc can't be on call all of the time.  (why on earth they aren't hiring another non-OB provider who could deliver babies is beyond my pay grade. I'm just a future pharmacist and a potential pregnant person who would far prefer NOT to see an OB but that's a post for another time.)

Anyway, I read an interesting article at this Washington Post blog about one rural, solo practice doctor, who's giving it up in favor of a city job with humane hours.  It makes me wonder if this solo practice model would be sustainable if it were combined with a pharmacist in the practice.  If the doctor is stuck doing prior authorization paperwork, maybe a pharmacist in a collaborative practice could speed that along or suggest something else that might cost less or be covered from the get-go.

I'll have to see if anyone is doing that and if it's sustainable.  A pharmacist doesn't really fix the "on call all the time" problem of the rural doctor, but the doc in that blog post was actually fed up with 4 hours a night of paperwork with a weekend on call at the hospital once a month (which i don't think is unreasonable myself, the weekend on call).  But a pharmacist could help manage medications, do some chronic med education, help with billing and paperwork for prescriptions, save the doctor spending so much time hearing about medication regimes and let the doc focus on diagnosing.

The other big chunk is that specialists get reimbursed more than primary care docs from Medicare and a huge swath of rural dwellers are on Medicare.  We have to fix this or there will be no doctors left in rural places and people will have to travel more than 40 miles to find a doctor, and will have to schedule appointments weeks ahead because of a shortage.

We're moving to a rural area, so I've been looking at new doctors, and over half aren't taking new patients.  Plus although we're moving somewhere with a higher population than our current town, there are fewer doctors on staff, so it's going to be a struggle to find a doctor we like because there are just fewer doctors available.

Summer Reading Challenge

One of the hard parts of being a mom/student/spouse is finding time for myself.  Lately my big indulgence is reading (or listening to audio books actually).  Danielle is sponsoring a summer reading challenge to read 10 books, so here's my list in progress.

1. Alcoholics Anonymous, because I'm taking that elective this summer on alcoholism and addiction and maybe another in the fall. Relevant reading yall.
2. Timeline by Michael Crichton, because it's great and a good summer re-read.  Audio book this time.
3. The Spirit Catches You and You Fall Down by Anne Fadiman, because I had no idea I'd be in healthcare the last time I read it. Cross-cultural healthcare is a much more complicated thing than I ever imagined.
4. 50 Shades of Grey, since it's the hip thing to do. It's part of a trilogy, so that accounts for books 5 and 6 as well.
7. Science Ink by Carl Zimmer, because nom nom nom, new tattoo ideas! I'm saving up for my next one and debating what it will be, so maybe this book will have some ideas that inspire me. Plus it's beautiful.
8. The Spark: The Revolutionary Science of Exercise and the Brain, to gear up for another elective AND getting my butt in shape already.
9. Suggestions welcome! I'm sure I'll think of more things to add.

EDIT:
9. Why Your Prescription Takes So D*** Long to Fill by the Drug Monkey because any profession that can't laugh at itself is doing it wrong.  This book makes me laugh incredibly hard because it is true, and if you miss the humor in a day at the pharmacy, you get stuck in the sad/miserable/awful/mind-numbing stuff.  I'm somewhere in the middle of this book and reading it slowly so I can savor it.

On nerves and stuff

I'll be honest (and I try to always be honest, but perhaps obfuscate some of the real details because it's easier and stuff0.

I am totally freaked out, and I've been fretting a moderate amount for the last 4 or 5 days.

Why you may ask?  Moving far away, farther from family and away from a job I like lots?  To a new place where we know nobody?

Nope. Moving doesn't phase me anymore.  We scoped out housing this weekend and found a really great place and a pretty awesome place, so we are set.

I am panicked about flying on Saturday.

I mean, after all this time, having flown a number of times to a number of places, I shouldn't be freaked out.  It's just a faster way to get from here to there and about as interesting as a bus ride, right?

HA.

I've been laying out my trip, mapping out airports, figuring alternate routes, how am I getting to the airport and back, all that jazz.

Have I planned what I'm packing? No.
Have I figured out how I get from the airport to wherever I'm going once I'm there? No.
Have I called to see about food during the week and if I can have a fridge since I need to cook my own food? Of course not.

I hate flying, and I have to do it twice in the next 2 weeks for a total of 4 flights.

So freaked.

Knowing it's irrational doesn't actually help me one bit. or it helps that I know it's irrational, in that I know I will get through it and be fine.  But I am certainly no less scared despite knowing that I'm much safer on a plane than on the highway (especially since this would take me about 35 hours to drive, which is too long I think).

I'll just keep taking deep breaths and knowing that it will be all right. Eventually.  And if it isn't all right, it will be over eventually.

Oh my!

So the spouse has been our income for some years now while I've been in school full time and working very little if at all.  The job that the spouse has had hasn't been all that ideal, being about an hour's drive away and at a place that has lousy benefits and relatively low pay.

This means that looking for a better job has been a big thing of late, with about 25 applications out there (maybe more, I quit counting after the first dozen or so).  After 3 interviews, we got an offer, and decided to take the leap and accept it.  It means moving about 150 miles away, and this is not my favorite, but it is life.

The great part (if you ask me, and since this is my blog, OF COURSE you asked me) is that it's a nice career-minded move for me into a region with a lot of really awesome healthcare happening.  And we're closer to out of town friends in two different directions which rocks.

It does change my commute but not as much as you'd imagine since the distance is largely to the other side of our metro area.

so.

Terrifying though it is to move, I'm excited mostly. Still not sure how actually getting ready to move will work, but it will in the end work one way or another.  Moving is an adventure and hopefully we don't have to move to another place after this one.  They have my favorite restaurant, and my other criteria for a place to live have been met.

In case you were curious, my criteria are:
1. Must have a hospital with more than 50 beds, preferably more than 75 beds.
2. Must have pizza delivery.
3. Must have a grocery store and a community pharmacy.
4. Must have a public library open more than 10 hours per week.

Where we live now only meets 2 of those criteria (#3 was added after the first month at our current residence, where we are 3 miles from a town, but since #1 is also lacking in addition to #3, we are realistically 12 miles from town).  I'm excited about a "big city" and stuff.  Maybe more than one place will have pizza delivery!

A conversation between me and my blog

Ms. Future PharmD: hey there, blog!
Blog: Oh it's you, is it?
M: What's all that about? That sass!
B: You've been ignoring me. You know it. Don't patronize me.
M: ...
B: Oh yes. You know I'm right.
M: Well I've been busy and stuff.
B: Have you? Really? WHAT IS MORE IMPORTANT THAN ME?!?!?!? Huh? ::pout::
M:... well I mowed the lawn once. It took a couple of hours, and I fell off the mower once but thankfully it turned off and stopped just like it's supposed to do.  Let's not talk about how tall the grass was or where the mower is currently parked.
B: Are you saying you've been neglecting me so you can stop neglecting your lawn? Who are your neighbors that they weren't up in arms about it not being mowed?
M: Jeepers Blog. I can't say who my neighbors are.  This is an anonymous blog and...
B: YOU'RE BEING EVASIVE!
M: All right! I admit it. I was wrong to ignore you for so long. I'd say I won't let it happen again, but life happens and sometimes that means no blog posting. But two posts in two days! Isn't that something?
B: Well at least you admitted you were wrong. But I'm still grouchy.
M: Aren't you always grouchy?
B: I blame you.
M: If you keep blaming others, you'll never grow and change and what have you.
B: It's still all your fault.
M: Well all right then. I have a nap to take and stuff.
B: Harumph.

Interning part 1

I'm interning at a community hospital that has about 150 average daily census (that would be the number of people in it on an average day across the year).  It's part of a health system with a bunch of hospitals ranging from a 50 bed rural hospital to a 500 bed urban tertiary hospital that has a level 1 trauma rating (that would be the most severe trauma cases).  Random terminology: "tertiary" means that somebody who started out at a very small hospital (also called critical access hospitals where patients only stay a few days at most, generally in rural areas), then was transferred to the regional hospital, would have to make another transfer to reach this hospital. Tertiary hospitals handle every procedure imaginable, and some states don't have one at all.  The pharmacists and techs I have talked to have nearly all talked about it being "only a small hospital" which entertains me.  I figure this is my chance to be in a "big" hospital.

I'm having a good but busy time.  I'm learning lots and lots (no shocker there).  One of the cool things is the fancy electronic health record.  It has almost all the bells and whistles you could ask for, so it's been fun to get exposed to how it all works.

Other fun stuff I've done: I got to visit in the operating room pharmacy and go over what they do (at 6am no less), I spent 3 or 4 hours in the emergency room with the pharmacist who works as part of the interdisciplinary care team there (amazing, and I was surprised to be really interested in it), and I've gone on interdisciplinary rounds in the ICU.  When they say interdisciplinary at this hospital, they really mean it.  The doctor, nurses for each patient (each nurse steps in for his/her patients then steps out, the charge nurse is there for all patients), pharmacist, and social worker have been there all three days, and 2 of 3 have included a social worker, a physical or occupational therapist, a respiratory therapist, and a dietician.  The hospital chaplain was also there one day, and 2 days there was another person whose job isn't really clear to me (I should ask about that).

Interdisciplinary teams are a pretty big deal and pretty new as a formal thing in hospitals, so I was really excited to see this.  It works really well and has been neat to see in action.

On the agenda are two more sets of interdisciplinary rounds that are still new to the hospital.  One is discharge care conferences (where everyone, including the patient and maybe their family/caregiver) goes over what happens when the patient leaves the hospital - where they're going (home, nursing home, somewhere in between), what medications they'll take, what pharmacy they'll use, if they'll have physical or occupational therapy (PT and OT, respectively), and any questions they have get answered.  I'm not really sure how this is going to work out because pharmacists' time is pretty limited and this is a long process, so to do it for the 10ish patients on this unit who leave each day is going to be a big job and take a lot of time.

The other set of new rounds is the one with the pain management team (not sure who all is on that team exactly).  I'm not totally sure why a pharmacist is needed to manage pain, but I'm interested to see how it all works.

In the realm of "what do I want to be when I grow up?" I think that if it works out, I'd like working in a hospital well enough.  I kind of think that ambulatory care (that would be where you see the pharmacist, then the doctor, or maybe the other way around if you don't have any chronic meds to manage) might be neat.  In the long run I have a rotation in that, so that's something to look forward to in another couple of years.  I had been pretty sure I wasn't interested in working in the ER, but now I'm pretty sure that it does interest me some or moderately.  The trick about working in a hospital is that (at least right now) to get a job in a hospital larger than about 75 beds (ie those in cities/urban-ish areas) in my region [TRI STATE AREA!], you need a residency.  My grades just aren't pretty enough for a residency (I think, but I could be wrong) so it's kind of out as a result.  BUT who knows what happens next?

In my dream world, I still have a job doing something informatics/computer/database-related in mind as "perfect" but my idea of "pretty amazingly awesome" has expanded considerably.  It's nice to keep my options wide open, I think.