Ramblings from the Psych Ward

I’m finishing up my second week working on a psych ward. Before I began I had spoken with my therapist and asked him if he had any recommendations. He asked me only to do one thing, “look at them as if they are real people with real issues. Remember that how they act makes sense, at least to them..” I’ve tried to do just that and in the process I’ve learned a few things about myself.

I’ve learned that it’s a very thin line between ‘normal’ and ‘crazy’. I’ve met people who still have dreams but life has thrown a bunch of garbage at them.

I’ve met a young man who, for no fault of his own, cannot stop moving his mouth. He has tardive dyskenesia along with some catelepsy. It’s not fair that he can’t use one of the drugs we’d like him to have because he’d have no way to pay for it out of the hospital.

There’s a lady who rather than embracing her upcoming retirement has decided that life just isn’t worth living, or at least bothering with. She barely eats, barely sleeps, and just lies in bed all day, despite being on several medicines that should be helping her by now. We keep hoping she’ll try ECT but so far she refuses. She doesn’t believe she is depressed, just that she’s a realist.

Another lady, who is so similar to myself that it scares me, is manic. She doesn’t remember the difficulty the police had bringing her in, nor the way she behaved in the ED. She doesn’t understand why she’s still being held ‘hostage’. When asked about it she has changed the story so much that it makes me wonder why she’s still there. The reality, though, is quite a bit different when you talk to those who met her that first day. Still, some of her story is true. She really has lived several places, really has suffered tragedy, really has had life turn upside down on her. I look at her and I see just how close I came to being there as a patient with her. Instead, though, I discovered ways to handle my stress, ways to grow my way out, and continue to grow. I have to remind myself that she is not me and does not have the skills I’ve learned, despite our similar circumstances.

The truth is all of these people could be you, or me, or someone we walk by. They are no different than we are, not special, not broken. They have just become overwhelmed and need someone to help guide them out of their own caves. Today, I nearly broke down in tears listening to a man who had to move back in with his mother because of an unexplained seizure that then turned his life upside down. He’s my age. I think how my parents would be if I lost my ability to take care of myself, and I think of how I would be if my own children found themselves in a similar place. I feel for them all.

And then, there is a man, who if he could only control his anger could provide such beauty to the world. He’s an artist who has covered his walls with drawings he’s done while waiting. He is also a gifted musician and can provide so much more to this world. Smart, well-kept, handsome, young, and strong… all the qualities a man his age would love to have. He’s there trying to explain to us that his problem is that he can’t sleep, that is the reason, he says, that he sees so many strange things. Visions when he closes his eyes, radio waves in the air, dots on our bodies… He believes there are aliens and he is worried there will be war because of them. He may be right, he might not; it’s not my place to say. There’s a lot of perfectly ‘normal’ people walking around who believe in aliens so that isn’t something worth arguing about.

So what do I say to myself? What do I think? I think it’d be best if when we talk to those who are in the ward that despite how crazy they sound, despite how far-fetched their stories may be, that we should give them the benefit of the doubt. So, yes, I choose to believe my patient when she says she swallowed a bunch of flexeril as well as oxycodone, mobic, and citalopram with vodka. I believe her when she says she doesn’t know why she started feeling suicidal, that it doesn’t make sense to her. I believe her when she says she really wants to live, despite being alive only because someone else found her. I believe her. And? If my patient says he believes in telepathy, why not? Who are we to say what another has experienced? We aren’t them. If they say they lived in Europe, or DC, or wherever, then who are we to say they didn’t?

These are good people, not liars, nor embellishers. They are telling us exactly what they think to be true. They are only being honest with no filters…. if everyone was as honest as these, we’d all be in the psych ward…

thank you for reading,

me

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Geriatrics Rotation… A much better fit

I have to say, being in Pharmacy school is hard. Doing the studying, the exams, the science, the math… all of that is part of it. But the hardest part? All of the exams, math, and science are useless during rotations. When you see a new drug that came out you think it’s great! You’re like, it’s about time, let’s get some people well. And then, then you realize that your guy wouldn’t have qualified for the trial. He’s too old, too fat, too young, too sick… they only use mostly healthy individuals for trials… people who only have the one disease they are trying to fix, or no disease because they’re trying to prevent it.  This is true for all of the trials and has an effect on all patients differently.

Geriatrics… I’ve been working with a population of men (because they’re veterans) who are between the ages of 74 and 95. 95?! Wow. Do you expect to be able to live to 95? What a ride that will be! But, back to my patients. When they aren’t in their youthful ages anymore, when they are just trying to stay alive another day but still loving their lives… then the rules of the medicines doesn’t really apply. There are almost no trials in elderly people. No one has any idea how the medicines will act in their bodies. AND! every single one of them act differently. In one man, if he takes a statin he won’t be able to walk. In another, it has no effect on him. Another can’t take anything like aspirin or ibuprofen, but can take Tylenol. Another only needs 15 micrograms per week of warfarin and the one next to him uses 30 micrograms per week…

For these, and really for all of us, age is just a number and has no bearing on the amount of medicine a person needs. The most important factor on whether you live to 95 or 102 is how old you feel, not how old you are. Over the last few months I’ve met people who are older than me but technically a lesser age. And I’ve met those who are 95 and look, act and feel, like they’re just in their 50s and 60s.

I ask them what they do? What they did to get to where they are? One man told me, age 95, that I had to go to war. He said it doesn’t work unless I go to WWII and then Korea, and learn to jump out of airplanes for 30 years. I could have listened to him for hours. I had to ask him if his birthday was right, I just couldn’t believe he was 95.

So, yeah, I love geriatrics. Here I deal with people who have lived full lives, who have had their chance already to make mistakes and to make dreams come true, or not. I love listening to them and getting to know them. They are a treasure trove of information and advice. This community is growing exponentially and needs people who specialize in their medicines. The wrong drug could destroy an otherwise healthy individual, but the right one can help. I look forward to being done with school… only three more months!

thanks for reading,

me

Another Week in my Pediatric Rotation

This past week has been hard. We’ve lost two little ones (ages 2 and 8), told bad news to another set of parents, and tried hard to prove nothing was wrong with yet another. Every time I see these kids I see my own and wonder if I am being helpful or just in the way. My heart breaks seeing their parents’ hearts being torn in two. I hate sickness and death. I want to take away their pain and take it on myself. But I can’t, I’m not strong enough. When I see them hurt or crying it’s as if I am the one hurt or crying. The emotions I feel are so intense. I’m trying to learn how to protect myself. I asked another pharmacist how she does it every day. “I learn to compartmentalize.” I understand it, but I’m not very good at it. I can feel all of the emotions all at once and it’s overwhelming! How can I even think clearly when I care so much? How do I be the best pharmacist I can possibly be? How can I continue on my path without giving up?

Yesterday I was allowed to be present at a delivery. This one gave me hope. The baby was delivered via cesarean and was a healthy 8 pounds 1 ounce (about 4 kg), screaming, gorgeous baby girl. I wanted to cry for joy along with the parents. When I left the operating room I went directly back to my team to find them in a room with a baby born at 23 weeks and only now weighing 0.7 kg. So tiny! All the other babies I saw on my shift were premies or high risk infants. I was in the neonatal ICU all day. One baby was discharged home and the mother broke down in tears, a great day for one mother. And yet another was still wondering if her’s was ever going to go home.

I have the heart for these children. I am a fantastic, caring person, but in order to survive these emotions I have to get away. I’m grateful that I bought the boat I bought. My timing may be a little off, money-wise, but exactly when I need it time-wise. I come home every day and hug my kids tight. I’m more aware of them and how much they mean to me than I’ve ever been. Life is too short for pettiness.

Life is short, don’t let it slide by unnoticed.

thank you for reading,

me

Pediatric Rotations

Many think that pharmacy isn’t like the rest. We, as pharmacists, are often thought of as lesser, unnecessary individuals, at least until they need us. When they need us though, they love the knowledge that we have. I’m in the midst of one of my rotations and this one is with pediatrics at a large hospital. Yes, pharmacists are necessary and needed here. Below is what I wrote after the first day there.

“Day one of peds rotation and its after 10 at night and I’m crying already. The patients I have today are sick, really sick. I was assured earlier that most of our patients aren’t like these because these are in a special ward. But these are still these. I’ve never known DiGeorge syndrome and I’m grateful that I haven’t. Three of the 8 kids on my list are DNAR and they’re just babies. DNAR means “do not attempt resuscitation”. How do people do this day in and day out? How can I? So many medicines! Such little bodies! The slightest error on a med could cause serious damage, permanent damage or even cause them to die. And yet, many of these will die early anyway. I don’t question God, not tonight, but I feel for the parents and the kids who have never known not getting poked or prodded. Who’ve never had a chance to fly. But I am not one to know that they don’t fly somehow. Each person has their place, even these. Life is short but for them? So much shorter and yet it feels so long when they suffer.

I’m going to get my boat tomorrow night. I’ll drive up there and spend the night and then we will set sail on Friday morning, early. I’m excited, scared, and wanting to wait but I NEED this now. I NEED to get out there and recharge for next week. I’ve gotta take care of me or I’m not going to make this. Time for bed.”

I did go and get my boat. I love it. I stayed on it for three nights and three days as I learned from the previous owner how to sail. We sailed it down a little closer than it was, yet it’s not yet to its home… I have to take care of myself when life gets hard and I’m glad to have the boat to do that. I’ll be writing more about her later.

Today, though, was another hard day on rotation. Today we learned that one of the babies, really she’s two, will be removed from her life supporting ventilator in the near future. She has no hope for recovery and her parents have been holding on for a glimpse, a sign, anything they can. They’ve decided it’s time and despite what you think, they may be right. It’s not my place to judge them. I have not lived in their shoes and God am I grateful! I nearly cried when I heard the news but I held it in. Then when it was time to go home the tears began to flow on my drive. Even now they threaten to fall.

All of these children! It’s different when you get to grow old and die after having lived a long and fruitful life. That’s different, that’s the way it’s supposed to be. But when you’ve just barely had a chance and that chance was never one out of the hospital? What is life for? What is their purpose for being here? What can we learn? What can they show us?

There’s really a lot we can learn. We can be reminded that life is indeed short, whether you die at two or at 102. Life races by. We can learn to live our lives to the best of our abilities. We can learn to be grateful for our own problems. I’ve heard that if we were given a chance to trade problems with another we’d beg to have our old ones back.

We can also learn that when we have a chance to make a decision that many of our decisions don’t affect only ourselves. We might, and often are, affecting others. Some of these children wouldn’t be in the hospital if their parents had taken charge of their health. Some of the children are recovering from addictions that their parents have. Some of them are suffering from malnutrition and abuse. Some of them are there because of a genetic malfunction. There are so many things to learn!

Even our genetics are things we have some control over. Have you heard of epigenetics? What you do, whether you exercise or not, what you eat, what your mother ate, whether your father smoked? These all change how OUR genes are expressed. So even some of these can be better controlled and prevented. We are barely learning the tip of the iceberg.

Do me a favor. Go love on your babies, your mothers and fathers. Go hug your friends and kiss your spouses. Life is what we make of it. I vote we make it good!

thanks for reading,

me

Ambulatory Rotation

Another month of pharmacy school has gone by, this one at a doctor’s office where I was able to work with an amazing team. Each day we had new people come in to ask questions about the meds, to find out how to get healthy again, to find out how to stay healthy… these people, patients, needed time to digest what their doctors have told them. They needed time spent face to face to go over their conditions and to know that someone was listening to them. We would often spend an hour or more talking with them, getting to know them, finding out their likes and their dislikes, finding out how we can help them take charge of their health. It was humbling.

They would look to us because we understood their conditions and because we understood their medicines. They would trust us when we told them they needed to change something because their kidneys were bad, or because if they stayed on it they’d mess up their hearts. We would help them understand how to take their blood thinners and how to measure their sugars. We did all of this and so much more.

One man came in with blood pressure to the roof and we put him directly with a doctor and recommended what would help right away. An hour later his blood pressure was back down and he understood a little better how dangerous that could be.

One lady came in and just happened to mention she felt like an elephant was sitting on her chest a few nights before, she was there to check her blood thinner. We sent her back for an ECG to make certain she would be OK to go home.

Another couple came in because his blood work didn’t look good, they were scared, they thought this must mean the end is coming quicker than they thought. We were able to give them comfort and reassurance that all he needed to do was change his diet some, drink more water, and have an evening walk every night. Simple things that every one can do to prevent the fears they had that day. His wife began to cry she was so relieved that this was something they could handle.

Another man came in to make certain he wasn’t bleeding internally because of his blood thinner. He had started it because of a blood clot of unknown origin. I see him sitting there and I wonder quietly like the rest why it happened and pray to myself it’s not an early sign of cancer.

Real people, real blood, real dreams, real lives. Dozens of them over the last month. And to think a pharmacist does nothing but count pills? Nonsense.

thank you for reading,

me

Rotations continue

I have one more week and then this rotation will be in the books. As these past several weeks have gone by I’ve found myself discouraged. I know that hospitals are necessary, I know that many medicines are necessary as well. I know people get sick and people die. But. But how can I help? What difference can I make? Any at all?? I wonder how these became so sick? What happened? Some of them seem like they just don’t care anymore. When did they give up? When did they lose hope?

And then… am I being overly critical? Am I really any better? Sure, I’m healthy, for now. Sure, I think I have my act together. But really? Three years ago? Four or Five? Did I have my act together then? Not really. I had some who would ask me why I put up with so much? Why did I stay for so long? Why didn’t I leave when things went bad? I’ve been asked why didn’t I change things back then? Why?? Why did I stay 25 years with a man who couldn’t love me?… these questions are kind of like asking someone why do you bother breathing? Why do you bother eating? There’s no real answer except it seemed the right thing to do at the time… (Please don’t stop breathing or eating, by the way.)

So, an outsider, someone who hadn’t lived in my shoes, who hadn’t any way to compare her life to mine, would probably wonder why I didn’t change for so long. I wish I had an answer. I wish I did. If I did then maybe I could help another lady find the answer too. I know, in part, some of the reasons. For one, I loved him despite everything. For two, I had hope for things to get better. (It wasn’t until I gave up hope that things started to change.) Three, I felt like it was wrong to leave… no… matter… what. The church is very vocal about leaving a marriage. (And because of that, many, many women are still in abusive marriages, with no hope for a way out, thinking that somehow they can pray their husbands to treat them well… But that’s another post.)

And so I think of the patients I have met these past two months… Did they decide to quit? Or give up? Is it too hard to dream of better things again? Does it hurt too much and they just want it all to end? I see the man or woman who is my own age and at the same time I see them as they may have been as a healthy child… or if not a healthy child, as a child with hopes and dreams, none the less.  I guess, the hardest thing, is seeing each individual as a person, a creation of God, who, for some reason or another finds himself or herself in a lonely hospital bed staring at the ceiling with wires and tubes attached everywhere wondering what on earth to do next. I wish I could show them a picture of themselves when life was good and full of possibilities and dreams, so that I could remind them that they don’t have to give up. I want to remind them that they are worth the effort of getting well. I want to be able to sit with them and listen to them and to give them hope again.

How? As a student I have no power, and I have no permission to just talk to them. So, with determination, I move on, and I continue to dream. Partly to dream of the day when I am no longer the pee-on that I am and am able to do exactly that. Until then, I offer them a smile, a soft touch, or a gentle ear when I can.

thank you for reading,

me

 

Sunshine and Rotations

I’ve been busy these past couple of weeks. It’s like I barely have time to breathe. As a Student Pharmacist I am required to do rotations, and the last year of school is all rotations. I’m not complaining. I love it! I love actually having a chance to use all of the things I’ve learned. I love being able to work with real patients, real people, real lives. It’s hard work. This rotation is in the hospital environment and so my patients are sick, really sick. If I can do something that helps them to get better or to feel better so that they can go home then I have done well.

Each person, each patient, is so very individual. There is no one who is treated exactly the same because no one is exactly the same. Pharmacy is intricate. I love it. This week I’ve already been touched by the lives of dozens of people. Elderly mothers, grandmothers, great grandmothers… in their 80s and 90s. Men who are forced to the hospital by their wives. People who suffer chronically from pain. And people who have lived such lives that it’s not a surprise they show up in the emergency room.

I look on and I wonder how they got there. I wonder what went wrong, what could make them better. It’s not all about the medicine. There’s a man who is an alcoholic and now has nowhere to go, another who is recovering from cancer, a lady who doesn’t qualify for a transplant. There are many who go home well, and there are others. These others who now have to face the end of their time here. Who now have to face the reality of death. Life is 100% fatal and there’s no way around it.

I’m reminded to be grateful for my health and yet I am also reminded that my health is not a mistake. I work hard for it. I eat healthy food, lots of fresh fruits and vegetables. I drink a lot of water. I take the stairs frequently. I exercise. I sleep… I try to balance my life in a way that keeps me healthy. It’s not an accident. Health is only maintained on purpose. Sure, there are things we cannot control, but those in the hospital? Most of them had more control than they knew. Most of them could have prevented themselves from needing to be there. The smoker could have quit, the obese woman could have gotten help sooner, the alcoholic as well.

So, I wonder, as I go there each day, how did things go wrong? What happened? Why did these people quit taking care of themselves? Or why did no one ever tell them they had a choice? Please don’t bash me. It’s true. Absolutely true, there are things that can not be avoided. But, trust me here, you (and I) have a lot more control of how we end up than we believe. Even the smallest of positive changes can be celebrated for every little change can be built upon and then, then, our lives can be full and healthy.

thank you for reading,

me