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).

Tuesday, January 6, 2015

Sneaky success

For ages I have tried hard to relax and let go of whatever is coming next in this job search. Historically my reaction to a stressful situation is to give up completely or be so stressed and panicked that I avoid or do very destructive things (14 hours of a video game the day before something is due for example... is something that happened to a friend once... yes...). It's been a part of my daily meditation practice to let go of things I can't control and accept whatever is happening next.

I have felt like a total failure most of the time. I have tried to stop worrying about things and it just wasn't working. I fret. I worry. I have lists of lists so I have the illusion of control.

But. I'm in the process of applying for residencies and I'm not one bit nervous about it. Or maybe only a single tiny bit. I'm debating whether this means anything beyond that I am tired of explaining why I want someone to hire me but at the moment it seems like all that practice at letting go has worked.

I never expected there to be a day where I could say that I'm not nervous about the future. I hoped it might happen but I never really thought I'd be in a place where it was true. Today I was focused on today and nothing more. This focus didn't stop me from attempting to be organized and applying to a couple residencies, but it did mean that I'm not afraid of what happens now. I have zero worry about getting an interview for a residency. I'm only marginally concerned about getting a community job because a chain I interviewed with doesn't start hiring new grads until March so there is plenty of time, and my marginal concern mostly is inspiring me to apply for more jobs rather than panic or worry or be angry at someone for no reason.

It's very surprising to find my mental state so... sane and balanced for the most part. Usually I feel like I'm caught in a tornado of "what's next? how do I get there?"

Today really is a miracle.