Ah, it’s nice to be in Rocky Mount-March 3-19 2003

I have made it to rotation number 7 out of 8, and it is nice to be in Rocky Mount. I never thought I would utter that sentence let alone write it down, but it is the truth. I am glad to be here. The end of these rotations is so near that I can feel the low-level panic I have been living with start to escalate with each passing day, as well as the warm South Carolina sun on my face. Balance. It is all about balance. I have not reached it yet, but I try every single day. I cannot coast yet but I can certainly enjoy the fact that I am back in familiar territory. It was wonderful to see my former preceptor again and to work with him. It is also nice to be working and living with Julie again. We are in the same pharmacy school class, and we used to live together in the real world too not just on these wacky rotation vacations. It will be the perfect setting to finish (also start) my seminar presentation. The TV is broken. Thank God. The rotation is off to a good and familiar start, and I am looking forward to a focused, academic, structured, TV free month. With no boys, at least not on weekdays.

It is time for me to express my fears now. Ready or not. I am scared to death that I won’t pass the boards or know enough to be a good pharmacist. At this point what these rotations have taught me is that I have so much more to learn. I feel like I need to start pharmacy school over and to REALLY focus this time. So, I am currently in the vicious cycle of feeling like I don’t know anything so then I lack the confidence for the things that I do know. It feels like the only thing I know right now is that it is time to stop living in fear and panic and start focusing on learning. That is the only way to solve this problem.

But where is my motivation? I have no motivation to do what I need to do but a ton of motivation to do other things I wouldn’t normally do like e-mail friends and talk on the phone and read random books I got at Nice Price Books. I started this tradition in high school that I would walk into Nice Price and buy one book I never heard of plus one CD from an artist I never heard of if I had extra money. I am reading a book now called Candy and Me: A Love Story. The cover got me. I was trying to distract you, but I need to come clean and confess that in a moment of weakness I e-mailed Mister Ghost. I hate the evil draw and convenience of e-mail and I was doing so well. Maybe someday there will be a pill for this, so I don’t keep relapsing. The outcome can only be bad given our history and yet, I e-mail. I am the one that never learns. Why do I want to be loved so much? This has really been a mystery to me. It was never important before. I hate the feelings of wanting it so bad that I can’t deny these feelings around nine o’clock on a Monday evening in Rocky Mount. Tomorrow is another day and I will conquer schizophrenia for my seminar presentation or at least start to learn all about it…

Well, the neediness continues and I decided to reach out to Brett, Thomas, and of course I already confessed to you about Mister Ghost as a test to see if they would still respond and yes, they all passed my stupid test. It won’t always be this way I suppose. Also, it wasn’t just a test, I will admit to you that I felt like I wanted to make sure they were still there if I needed them and also because I really missed talking to them. I miss them in the role of my actual friends until I made them something else in my head. Ok, I have been really procrastinating here, so I also reached out to Sailash, Dave, and Peter to make myself feel less desperate because I knew they would respond. I am lucky to have them as friends and part-time mentors and really, they have never ever even come close to letting me down. They mostly exceed my expectations, and yet I still test them. I know, I have issues.

Back to my ongoing education which has taken a turn recently into being a sort of blood pressure detective. I was sent to talk to Ms. Joan because her blood pressure medication was being increased and her blood pressure also began to increase along with her dosage. Strange. Why? Pain and detoxing from alcohol are all valid and applicable reasons but then we stumble across a recent EKG, and it is abnormal so that is when I am officially sent into investigate. I ask how she is, “sleepy”. This is also understandable but aren’t we all sleepy? I go through her med list in my head we walk to her room. This is when she starts at the beginning. Her husband got a blood transfusion which have him hepatitis. Her husband also had diabetes and was put on a drug he shouldn’t have been on and three months later he is dead. Ms. Joan wants to sue the doctor. It all comes together now as his death occurred in January. Ms. Joan was married to him for 50 plus years and worked side by side with him for most of her adult life. They were in NY. She is now by the beach for her retirement in NC. Alone. She starts to drink heavily because she said that she doesn’t want to live anymore. She can’t stop crying. She tells me she has 17 grandchildren who need a grandmother. More crying. She tells me she shouldn’t be there in this facility. She tells me that she isn’t an alcoholic but that she was just trying to deal with her loss, anger, bitterness, and loneliness. Will an SSRI fix her? No SSRI will fix this. Right? I think she needs to go back to NY, see her grandkids, and get some daily hugs in and find someone to talk to. The plan starts with getting her the hell out of North Carolina. This is my recommendation.

Mr. Melvin is up next with a string of elevated blood pressures, and I was asked to investigate why with a history of hypertension he isn’t currently taking anything to control it. We sit down and talk, and I am able to find out what medication he had been on, and he doesn’t give me a reason as to why he isn’t still taking it. So, I casually ask him if it is ok if we put him back on it. He says no. I ask him why. Then he tells me he has been using 1 teaspoon of vinegar, and it has worked great, but he can’t get his hands on any vinegar in the facility so that is why his blood pressure is elevated. Duh. Apparently, he has been telling everybody this, but I don’t see it documented and I certainly didn’t see that coming. So, after talking to various people who work in and around the kitchen, I finally find some vinegar packets and with the packets still in my hand I tell Mr. Melvin that he can have a packet with supper. I am still holding the packets in my hand as he snatches one out of my hand and sucks it down. There, he glares at me, it should be lower when they check it again. I have no choice but to say OK. Wonderful. Will continue to monitor.

I know you know this already, but real life never goes the way we were taught it would go in school. You know the drill, they ask you a question, and you have to pick the best scenario with the best medication and best dosage to treat your patient, well, in real life maybe those three best scenarios aren’t possible for reasons and variables you could never imagine. There are no best-case scenarios, and you just have to make due with what you have. I am wondering now and possibly too late why no one mentioned all the detective work involved in the practice of pharmacy. As soon as I sit down with a patient, I get way too involved, plus Detective Gulla has no ring to it, at all.