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.

Conflicted

As the year winds down and everything is getting more complicated for me. Do I do a residency? Do I stay in this relationship I've found myself in? Do I take that job?

I'm torn and at crossroads in both my personal and professional life.

I don't think I'll be happy taking that job, but conversely I don't know if I'll be happy doing a residency. I feel lost. I worked so hard these past three years to make myself a competitive candidate and now I'm not even sure that's what I want anymore. Is it fear of failure? As much as being challenged appeals to me, I don't know if I am cut out for it. I don't want to burn out, but I don't want to settle.

It doesn't help that I'm so conflicted about my relationship. She makes me happier, but at the same time she hurts me. A part of me feels like I'm just afraid to let go because saying goodbye to her breaks my heart. She puts a smile on my face whenever we get to talk. But... at the same time, when she pulls away from me it hurts. I know she's scared. I know this is just as hard for her as it is for me, but it's hard not to hurt when it happens. It's hard not to want to pull away, too so I can protect my own heart.

A part of me feels like she's ashamed of me. I feel like a secret she doesn't want anyone to know about. Maybe it's true and maybe it's not.

I deserve someone who will love me for who I am. I deserve someone that will let herself fall, even if it's terrifying.

But I want her.

APPE Tips

I'm going to preface this with: these are only my opinions based on my own experience and what my friends and I discuss. This is more a comical recollection of "don't let this happen to you..."

So... APPEs (Advanced pharmacy practice experience) is the year where we pay the school money to work for free. Depending on your school and your experiences, it feels like slave labor (aka doing things you do as an intern in the community for pay) OR it can be an amazing learning experience.

I've only had a few rotations so far and I've experienced both ends of the spectrum. I've been bored to death at a community pharmacy because they ran out of things to show me and I've been driven into the ground with work in an overwhelming, yet amazing learning experience.

Tips for surviving your APPE...

1) DON'T be an asshole. Seriously, even if you think you know everything, you probably don't. You're here to learn, they're here to teach you. Pharmacy is a small, small world. Don't burn your bridges.
1b) Don't talk back to your preceptor. If s/he says, "look something up", just go do it. If you have to look up a lot of stuff, chances are you need to brush up on your stuff. Don't throw back attitude and say "why don't YOU look it up?

I know those two seem like common sense... but from collective experiences... common sense is severely lacking for some.

2) If you're going to do a journal club or case presentation... be prepared to know it inside and out. Especially if you have a challenging preceptor. Be thorough and concise. No one wants to sit through a 2 hour case presentation full of arbitrary information.

3) SPELL CHECK. For the love of god. Spell check everything.

4) Be personable. Ask questions when you don't know about something. Like didactics, this experience is partly what YOU make of it. If you're going to sulk in a corner, it's going to be a long shitty block. Try and interact with everyone there. Chances are you're bound to at least connect with someone in the pharmacy.

5) DO NOT ask for extensions (unless an unforeseen emergency like a family illness or the like occurs). Deadlines are given in advance for a reason... learn to manage your time. It makes you look really unreliable and irresponsible if you're constantly asking for extensions. I'd probably pull an all nighter (difficult at my old age) before requesting an extension.

6) If you have a special interest, try and see if you can pursue that, but do not act like a 5 year old on a temper tantrum if the preceptor would prefer another project. You're going to need to be well rounded for boards anyways and you never know what you could fall in love with.

And now I'm sleepy... (APPE narcolepsy) perhaps there'll be a part II some day.

Done!

And just like that, the didactic portion of my pharmacy career is over. The only thing that stands between myself and my pharmD are my advanced rotations!

It's so surreal. The past three years have seemingly disappeared in the blink of an eye. A very long, painful, stressful, exhausting blink. It's bittersweet really, saying goodbye to the people that have become my family over the past 3 years. I've grown so much as a person over the past few years. I had my setbacks just like everyone else, but I'm at such a wonderful place in my life right now. I'm hangin' up the #2 pencil reserved for exams and kinetics problems and replacing it with my favorite pen.

In the words of Barney Stinson, it's time to suit up! I'm terrified really. I'll be asked opinions on real living, breathing patients. There will be many trials and tribulations I'm sure, but I'm almost mentally prepared for it all.

As for the special lady I mentioned in my last post... things are going well. She makes me smile every day and helped pull me through those last few weeks of hell. She fits into my life so seamlessly sometimes I wonder how I ever did without her. I can see myself falling for her and the thought scares me a little, but when she flashes me that smile of hers, I know I'm a goner. We've had our rough patches and I'm sure there will be more, but she's been such a positive addition to my life.

Whoops

So it looks like I gave you an update very early in the fall and suddenly it's a month away from the end of my didactic career! My apologies to anyone who has been waiting for an update.

Third year has been an intense whirlwind. I feel like I catch up only to fall quickly behind again. A lot of people tell me second year is the hardest year, but at my school third year definitely takes the cake on difficulty. I've been challenged again and again to balance my studies with my organizations and with my jobs.  I've learned a lot about myself and other this year and I wish I had the time to share all the tiny little moments that changed my views on life this year.

I'm battling a hard case of senioritis right now and struggling to catch up. It's been a difficult home stretch for me personally. I've had to struggle with a lot of personal events that turned my life upside down while struggling to stay afloat in school. But I won't bore you with the negativity.

I wanted to share my excitement (and fear, lots and lots of fear) about finally going on rotations. I've got some amazing blocks at some great hospitals and I'm excited for my final year and all that I will hopefully be able to learn from it. Even with all the negativity that I've felt hold me down thus far I still have to realize all the good that has come of it.

I also met a girl. It's really too soon to say how it may go or way things are headed, but she makes me smile and really brightens up my day. I think she's the best part of this dreary home stretch I've been on. When I get a text from her I start smiling like a fool and I feel like in that moment my mood instantly improves.The only downside is that she is very distracting. I really adore that she kind of helps keep me on track and actually cancels plans we have so I can study so that I don't have to. My friends have also begun to hide my cell phone to keep the texting to a minimum during our study sessions.  I'm excited and (terrified) of how things may or may not progress... but as always I have to keep my chin up and take things as they go.

I guess all in all I'm still happy. I have my bad days like everyone else, but I am keeping my head above water and taking things one day at a time.