Farewell and some quick APPE tips

As my final year in pharmacy school nears its end, I feel like it's time to say goodbye. This blog has seen me through a lot, from applications, to acceptance, and through many significant moments of my life. However, the timing feels right to close it now.


I'm happy, and very nervous to say I will be starting my PGY-1 residency this summer. Although it feels like something I've wanted and work so hard for these past four years, the prospect of it beginning soon terrifies me. I'm happy and sad at the same time that I'll be staying close to this place I've called home the past four years for one more.


I grew as a person and as a student these last four years. I remembered how much I love to learn and how much I enjoy being challenged. I never thought I would fall in love with acute care, but I haven't enjoyed anything as much as the insanity of an acutely change environment.


I actually didn't expect to fall in love either. Between classes, exams, leadership, and work I really had no time to devote to other aspects of my life aside from enjoying the friendships I made in school. After my ex-fiancé broke my heart my first year in school, I really didn't expect it to happen again so soon. But She changed my life at the most unexpected time.


We found each other when I needed someone the most, even though I didn't know it at the time. I was lucky to have her in my life. I regret that our relationship ended the way it did, but I can't help but feel so fortunate to have known her and loved her. I wish I told her I loved her, but it's too late for that now I suppose. I still think of her every day and I hope she's happy.


We may not be cheering for our hockey team together this year... and it's probably silly, but I'm glad every time our time wins or her baseball team wins because I know it at least made her smile. I still feel the loss and some days are harder than others. Some days I regret I let my anxiety and fear about change and uncertainty strain our relationship. I hope we win this year and I hope some day we find our way back to each other, even if it's just as friends.


I learned and grew so much through this blog and to those that rode along with me, thank you. It's been an amazing journey. Good luck to all of you on yours.


-- edit--


I figure I should at least end with some useful advice on APPEs.


To those of you who want the most out of your APPEs here is what I've learned:


1) Always ask "Why?" and dig deeper. Why did we start that medication? Is it appropriate? Is the dose, route, frequency, and/or duration correct or appropriate?


One of the biggest challenges for me was to remember to always question every thing. If I didn't catch any mistakes or improve patient care, I at the very least gained some valuable clinical experience.


2) Be as positive as possible about your rotation. Forget everything you may have heard. The mindset can very well be what holds you back the most or gives you the best experience you've ever had. Some days are hard, when you're tired, burnt out, and really just want to be done, but some days I took a step back and reminded myself that I'm here to learn and at the very least owe it to these patients to provide the best care possible.


I made some great interventions, but most of all I learned how to think more like a clinician and less like a student.


3) Do what you're comfortable doing. If you really want to do well, learn a lot, and especially gain the trust of your preceptor: know when you're not comfortable with something and let him/her know.
This is important for multiple reasons. If you don't understand or aren't comfortable doing something- research it and talk to your preceptor. They are there to guide you and help you think independently. This in turn helps your preceptor not only trust you more, but to gauge your abilities and feel more comfortable as time moves on to work more independently. Many of my preceptors hung back near the end and let me do my thing. Of course they checked every thing I did, but they were comfortable knowing I wouldn't make any decisions or talk to the team without talking to them first.


Learning to be autonomous is important and they are more willing to observe from a distance if you show them that you aren't likely to make dangerous errors, but they can count on you to not over step your boundaries. I know people that just guessed, but sounded confident. During rounds, this is especially dangerous. What if the team takes your incorrect advice? That's detrimental not only to patient care, but also with the relationship with your team.


4) Pick something new to learn, something you aren't familiar with and challenge yourself to learn it.
I always picked my areas of interest and I came up with lectures on topic discussions. This was a great way to improve my knowledge and teaching abilities.


and finally...


5) Trust yourself and know it's OK to be wrong when being pimped by preceptors, but take it in stride and say you'll look into it more and get back to them.
I can't tell you how many times I was too afraid to say an answer because I wasn't 100% sure it was correct. I hate being wrong and I hate feeling dumb, but you're there to learn. My best preceptors always asked me "why" after I answer their questions. Sure, it's annoying sometimes, but because of this they not only made sure I knew what I was talking about, but it made me challenge myself, too.  

Heartbreak and Rotations

Most of us have experienced heartbreak. That aching and sadness that lingers for so long after a break up. It effects most of us in most if not all parts of our lives. We try to separate and compartmentalize. In a profession where at times peoples lives hang in the balance, it's important to be able to focus on that and not on your own emotions.


Losing someone I fell in love with has been so tough on me. She meant more to me than anyone else really ever has. I find myself wanting to cry as my mind wanders back to her while waiting for my shift to start at the hospital. I find myself wondering how she's doing, what she's up to, and what's going on in her life. I find myself hating myself for every single thing I did wrong. I am trying so hard not to let it effect my work, but sometimes it does overwhelm me. I try not to let it effect my relationship with my friends. I am actually quite adept at hiding my feelings around others. That fake happy smile I've grown accustomed to giving the crazies at the pharmacy, I find myself giving to my friends. Which is why I find it alarming that even doing that is becoming difficult.


I know I should lean on my friends for support. I know I should talk about how I'm feeling, but I can't. The only person I want to talk about this with is the one person I can't. I'm not used to that. The only person I trusted enough to share that guarded side of me is gone. I lied and told her that I was just an open person, but the truth of it all was, it was just because it was so easy with her. It surprised me how quickly and how fully I learned to trust her.


I was in the ICU the other day... with an elderly woman and my team. They needed to check her back and the way they moved her caused her pain. I quickly stepped in to support her head and neck and I found myself trying to comfort her because I could tell she was in so much pain. As I supported her head and stroked her hair she closed her eyes and breathed a little easier. I almost cried because she reminded me of my grandmother whom I also recently lost. I was angry with myself because I am usually able to separate myself from these situations. To focus on the emergencies at hand and objectively focus on my patients... but I was unexpectedly vulnerable that day. As I tried to comfort her my thoughts went back to my grandmother. It was exactly a year ago that she passed that day. My ex got me through that loss. She kept me smiling and going through that time where I wanted to give up. I was burnt out and angry, but she helped me pick myself up and keep going.


I know these feelings will pass. It's just so hard to know that my best friend doesn't want anything to do with me anymore and its my fault. I guess it's easier to tell strangers through text than trying to talk to my friends.


I'm sorry for the Debbie downer post...


I hate to end the blog this way so I hopefully will not. Match results are one week from today... so perhaps I'll have happier news to share then.

This year

Happy new year!

This is a big year for me, my classmates, and other class of 2014 members.

When you think of graduation you think of all that comes with it. Degrees, jobs, careers, the rest of your life. You may or may not be drowning in debt, but graduation has always been a fun milestone and this is my final one that involves didactic courses! I'm excited and terrified about what the future may hold, but I want this year to be my year.

I don't know what may or may not happen in the next year, but it's exciting nonetheless. 2013 was quite a year for me and it challenged me in many ways and I'm ready for the new challenges that lie ahead in 2014.

I don't want to call these resolutions, but I suppose you could classify it as such.

I want to be happy again. With myself, with my life. I let my happiness go because I was holding onto too many things already gone. I'm proud of myself for making it this far, but I did lose my way in 2013. This year I want to be happy again, with myself, my life, and purge the toxic people out of my life. I know I'm a good person, somewhere inside. Deep down there's still that girl that believes the best in everyone, that gives everyone a chance. The girl that comes out when talking to patients. The girl that isn't jaded by others and by life.

But cutting people out of your life, toxic or not, is emotionally taxing. As I realize more and more those that need to leave from my life, the sadder I become, yet I know it's for the best. I love and care deeply about my friends, relationships, and family. Deciding to walk away from someone is not an easy task for me. I have a tendency to hold on to people I love, regardless of how  much they hurt me because I care so deeply. I also know how much lighter my life is without someone who constantly makes me feel like a horrible person, or makes me feel unloved. I don't deserve that, no one does.

So this year, I will graduate. I will find my place in the world whether it be a residency or a community pharmacist.  I will find happiness in myself once again and hopefully never lose that girl that loves the people in her life and never takes them for granted.

Bring it on 2014. I'm ready.