R & R... sorta

My vacation block could not have come at a better time. Don't get me wrong, I LOVED my first two rotations, but I needed some sleep. After moving back home from Chicago, my parents can attest to the fact that I probably slept for a week straight. When I was not sleeping, I was reading (since I was the only person who hadn't read Hunger Games).

The first Saturday I was home, I went to my friend's bachelorette party. My first close friend to get married, so OF COURSE I had to go.  First up was the Bridal Shower which was at the country club. After the bridal shower, we drove to Sweet Minihaha Campground. As soon as we arrived we changed into our swimsuits and mixed up some adult beverages. Around the campground you can go tubing down the river so we went to one of the sand banks and squirted people with water guns (why, you ask? Because we could). After that we started a fire and began marking s'mores. Following the tasty treats, we headed to the main building at the campgrounds because they were doing karaoke. We busted out many tunes and had a blast. I left early the next morning because it started to rain on me since the cover to the tent I was staying in was not up...

After that glorious week, I went out to NYC. So, I made the mistake of purchasing a flight that left at 5 AM from Chicago. What I didn't realize was that the Greyhound does not run all night long. So, I had to leave Wisconsin around 1 AM and drive to O'Hare, oops. I was ready to pass out once I got there, so I had a rather pleasant nap on the flight to New York. Since I have done most of the tourist stuff in NYC, I mostly stayed in Queens and hung out. I only went into Manhattan about 3 times, meeting Charlie for lunch, meeting Charlie after he was done working, and to eat lunch. I am pretty sure I chose to go there during the hottest days of the summer. Seriously. Painfully hot. On the one day that it rained (crazy humid though) I decided to head down to Chinatown because I had been asked to purchase some purses and jewelry. While walking down Canal Street, I was asked if I was looking for purses by a random man on the street. Of course I probably should have kept walking, but instead I responded, "yeah." So he led me to some people a few blocks away that were selling Louis Vuitton handbags. Based on what they were telling me, it sounded like they had "fallen off a truck." Personally, I do not think they are that cute so I walked away. The same guy came back and told me of another place... once again, I probably should have just walked away-but I didn't. This time I was led to a massage parlor. I glanced at my phone, naturally it was dying, and sent a quick text message to Maggie telling her of my predicament. Her response, "Isn't it fun!?! Like a scavenger hunt." Um, no, more like a death wish. Needless to say, I was led into a back room that was locked. After saying a quick prayer, I followed the lady into the room, which was filled with purses! I made it out of the massage parlor in Chinatown alive... and with pretty purses (You are welcome family). New York was a blast and I didn't want to leave, but unfortunately I had to get back to WI.

Nicole's wedding was beautiful. It rained so the ceremony had to be under the pavilion, but it was beautiful. The food was great and I was able to catch up with so many people I had not seen in a while. I would have stayed longer, but I was exhausted.

I spent more time home with my family which was lovely. I ate more food than humanly possible... and slept A LOT.

Following that time, I headed back to Des Moines for a week to pick up some shifts at the pharmacy to make some money. This girl is broke. I worked in Des Moines for a week, then drove to Minneapolis to see my sisters and mom. We had a family weekend at Alisha's. It was fun, we did a little shopping at Ikea and went to a piano bar.

A few days afterwards, I drove to Omaha with Mollie to fly to Texas to see our friend, Cortney. Let's just say that the three of us probably embarrassed ourselves in public a few times... and ate a lot of food. It turned out to be an EPIC weekend. With a little bit of shopping, a lot of partying, some sun, and a lot of inside jokes- it is a weekend, I'll never forget (or my liver).

Now back to the pharmacy world....
xoxo


Caitlin

A Perspective on Death and Dying

Five weeks ago I completed my first pharmacy rotation at a cancer center and today I completed my second rotation in critical care. Prior to pharmacy rotations I categorized myself as someone who did not deal with death well. For example, my eyes could start tearing up just thinking about my grandmas that have past away. I avoided all talk about death and what I would want if I were in a poor medical scenario. I never spoke about what I wanted, and I never asked friends or family what they would do. In oncology it seemed like the family members were the ones scared of death more commonly than the patient. At what point is enough, enough? I watched patients that were in pretty bad shape get very toxic chemotherapy because their family members were not ready to let go. If the patient would have skipped the last round of chemo and done home Hospice (go home and a service comes to the house to help keep the patient comfortable), maybe the patient would have had more time to spend with family rather than stay in a hospital bed. It is horribly sad to watch patients and their families cope with situations but it has helped me realize a lot about myself.

Oncology taught me that modern medicine can do some AMAZING things, but also many horrible things. Seeing patients experience horrible side effects made me second guess chemo, but the miraculous outcomes I saw, made me a believer again, just not for all patients.

I am torn over some of the heroic actions that health care professionals take in the ICU to keep patients alive. All the actions are done to the extent of the will of the power of attorney (person assigned to make medical decisions) if a patient is unable to make their own decisions. Prior to this experience I was selfish in the sense that I would want heroic measures taken on every person I know. But, that is not what everyone wants, it has even made me question what I would want. I watched a patient's wife of many years make the tough decision to let her beloved husband go so he would no longer suffer. He had lived a fantastic, fulfilling life and she thought he would not want to be kept alive if his mind and body were not functioning without medical interventions and support. Even though she did not want to let him go, she made the tough decision based on what he would want. Many families do not have these talks. I had never asked my parents what they would want, until tonight. As morbid as it seems to talk about it now, it is better than guessing what your loved one would want.

If I were to fall over today, hell yeah I want CPR done on me. Fifty years from now, that may be a different story. I have not lived yet to my full potential so I would want to fight if there is a chance that I would have a recovery. Although I would not want to be kept alive on a ventilator without any mental function.

I hope this inspires you to evaluate your thoughts and beliefs on life and death. Talk to your friend and family about it.

Murphy's Law

For those who do not know, Murphy's Law basically means that "anything that can go wrong, will go wrong." Welp, the past 2 weeks have been abiding by Murphy's Law.

Last Monday I received a phone call from the people I was supposed to stay with in Chicago for my Northwestern rotation telling me that I could no longer stay with them. Um, EXCUSE ME!??! It was 2 weeks away from me being in Chicago! So at that point I took to Facebook asking my friends to help me find somewhere to live... other than under a bridge in a cardboard box. Luckily on of my sister's has a friend living there who is going to let me stay in Wrigleyville for 2 weeks. Which by the way leaves me still homeless for the other 3 weeks but I'll deal with that when I'm in Chicago.

I spent the weekend in Gulfport with some fantastic Drake Alums. After enjoying a wonderful day at the beach and going out, I spent the night on their couch. Which I was awoken in the morning by their roommate's pitbull jumping on me. Sunday we got brunch at Stella's which is AMAZING. The day was even better after drinking my mimosa and getting a little bit of the "hair of the dog that bit me" ;). All day long Rachel and I lounged around their house and ate a ton of food. In the evening we decided to go see the Snow White movie. I decided to drive so that my car would be in St. Petersburg which is closer to Tampa than Gulfport. When Rachel and I got to the parking garage I put it in park and tried to turn my key. Oh well, JK because my key WOULD NOT TURN. My car was stuck in the on position. Fantastic. The rest of our group came over to my car and tried to help find a way to turn off my car. We tried jiggling the wires and the steering wheel. We had about 3 people searching on their phones to see if there was something on the internet to help us. Finally someone figured out that we could pull a fuse out of the fuse box under the hood to turn off my car. The problem was that in order to unplug my battery, we needed a special tool. Unfortunately we were messing with my car for 40 minutes so we missed Snow White. I was scared that if I left my car with the battery still hooked up that it would be dead by the time a movie was over. So I left and drove back to Tampa while the group went to Prometheus. Back in Tampa I pulled out the fuse to turn off my engine. A USF security officer came over and tried to help me unplug my battery but once again we did not have the correct tool to unplug it. So I said, "Whatever, I just hope that my car starts in the morning." Annnnndddd I went into my apartment and drank a large class of wine.

Monday Morning I woke up and showered. I got to my car and tried to press the clicker to unlock my car, but it wouldn't. So I walked back to my apartment and started searching for my spare keys. Of course I couldn't find it for about 15 minutes. FINALLY I found my spare key and went back to my car. At my car I manually unlocked my door, popped the hood, and put the fuse back. Once the fuse was back in, I sat down and tried to start it. SURPRISE, it wouldn't start. So Sunday it wouldn't turn off, and Monday it wouldn't turn ON. At this point, I called American Family and asked them for a preferred tow service. Luckily, we added towing on my car two weeks ago because I thought it was acting funny. I sat down inside the lobby of my building to wait for the tow truck. 45 minutes later, the tow truck showed up. At first I was planning on going to Sears because I do not know Tampa that well, but the truck driver suggested we look for a Saturn dealer. Luckily, there was a Cadillac dealer that is certified to service Saturns. $88 later, I dropped my car off there and they drove me to the hospital.  After work the dealership picked me up and took me to the dealership. They were STILL not done working on my car. So I sat at a computer reading about treating sepsis. Yup, I'm that nerdy. One of the staff came up to me and said my car was almost done, so I should pay... $450. They had to replace my "cylindar and house." Basically the part you put your key had to be replaced and the part that it goes into. After paying I went and sat outside to wait for my car. Thirty minutes later I went inside and drank some water. Fifteen minutes later my car was FINALLY ready. When the guy got out of my car, I asked him if there was anything I needed to do or if I could leave. He gave me a wide eyed look and said "I'll be right back" and ran inside. After a couple minutes I walked inside and asked one of the staff if I could go... which I could.

Tuesday morning I got to the hospital and went to my seat... only to find my computer gone. The computer which my final presentation was on... AHHHH. I asked the secretary if she knew where my computer was because my presentation, which I had been working on for about three weeks was on. She had no idea, but asked the IT guy to find out if he could find my presentation. Around noon he finally was able to find my documents. So at least I now have my presentation, which I have on a flash drive and I emailed to myself.
 
I gave money to a homeless man last week, shouldn't I have good Karma!??! Hopefully my luck turns around! Hopefully you all found my misfortunes amusing.

xoxo

Caitlin

Alphabet Soup

I'm in the start of week three of rotations. Time has FLOWN by. As you probably realized, I titled this post "alphabet soup" because oncology abbreviates everything. Most chemo regimens have little names for them, IE, FOLFOX, FOLFIRINOX, CarboTaxol, ABVD, VIP, etc.

I do a lot of topic discussions with pharmacists and go to presentations so last week I learned about melanoma, pancreatic, and breast cancer.

Melanoma can cause some pretty nasty skin break down. I had no idea that it could look so disgusting.

Pancreatic cancer has usually metastasized by the time it is diagnosed. This means that the cancer has spread to different parts of the body. This is why pancreatic cancer often has a poor prognosis. The treatment for pancreatic cancer is usually either Gemcitabine or FOLFIRNOX (5-FU, leucovorin, oxaliplatin, irinotecan). The major issue with the FOLFIRINOX regimen is the toxicities that occur. Irinotecan is also known as "I ran to the can"... it causes excessive diarrhea. 5-FU can cause mucositis, which are mouth sores. Oxaliplatin also has side effects.

Breast Cancer has different markers that can lead to the use of different drugs. If not treated, it very commonly metastasizes to the lungs.

... I won't bore you all with more details on different cancers.

I really enjoy the pharmacists that I am working with. One of the pharmacists is trying to get the cafeteria and patient food to be improved. She is hilarious, she took a plate of eggs to some of the "head honchos" to make them smell them. When you take the lid off, they smell like sulfur (so I've heard). Which, if you have people who are already nauseous and then you give them horribly smelling food, they will probablyyyy vom.

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For Memorial Day weekend I met up with a few people from Drake in Clearwater. Traffic sucks going there! But, the beaches were beautiful. AND, since I work at a cancer center, I made sure to wear sunscreen and reapply. ((I couldn't show up sunburnt!)) We all drank lots of beer and just hung out on the beach all day. I am convinced that people from the Midwest know how to party more than other parts of the country. Most the people in the group were from the Midwest and it was a blast.

I managed to go to the beach twice and a baseball game (Rays v White Sox) during the weekend! Solid week followed by a solid weekend.

xoxo

Poop Police

I finished my first week of rotations. Crazy. It has been a LONG week. I feel like every patient we get has metastatic cancer. This means that their primary cancer has spread to other parts of the body- which is not good. These patients sometimes get chemo or experimental drugs to see if something helps or to just make them not feel so "crummy."

I wake up around 6 am if I am feeling up to running. Running around the campus has been the best way for me to get the "lay of the land." After getting ready and packing my lunch, I walk about 15 minutes to my rotation site. Depending on the day, I try to get there anywhere before 7:30-8:15 AM. First thing I do is work up patients. Working up patients means that I go through patient profiles and look at their vitals and medications. One of the preceptors refers to us as the "poop police." Most of patients with cancer are on narcotic pain medications such as oxycodone which can leave patients very constipated. Actually I had a recommendation this week to add Senna S (stimulant laxative) to a patients profile. I'm pretty sure we spend most of our day talking about bowel movements. We ask every patient, everyday.

At 8:30 AM I meet up with the physician, physician's assistant, nurse practitioner, and my pharmacist preceptor for rounds. We fill the physician in on the patients and what has been going on with them and any recommendations we have. After talking about all the patients on a floor that are ours, we go into their rooms and talk to them. We usually finish this around 11:30 AM.

At noon, I usually go attend the noon conferences. Noon conferences are presentations that are given to the medical residents. I go because I am still trying to learn about different types of cancer. This week I have learned about breast cancer, non melanoma skin cancer, and lymphomas.

The afternoon is usually spent making sure everything that was discussed in the morning rounds was done. If there is not much to do on that, I work on my activity logs and write my interventions. Everyday I have to write what I did during that day and grade myself. Additionally, I have to write two interventions. So, when I recommended that Senna S be added to that patient's profile, it counted as an intervention and I had to write about it. I also have topic discussions with pharmacists. Earlier this week I learned about Melanoma and today I talked about Anthracyclines, ifosfamide, and cituximab/rituximab/Hertuxin (all different drugs used for cancer).

Basically by the end of the day, I just cook dinner and lay around my apartment doing nothing. It is nice to not have tests and exams- nice, but weird.

Welp, hopefully the weather holds up so I can be a beach bum tomorrow :) (probably bad timing since I just learned about melanoma and non melanoma skin cancer, but oh well.)

xoxo

A long journey...

After five years at Drake University, I have finally made it to Rotations!!! Immediately following my last final, I met my parents at Gazallis (if you have never been there- GO!). After eating my last yummy spicy chicken pita for a while, I moved all my stuff out of my apartment. Luckily, I am the youngest of 3 so my parents are crazy fast at moving. Within a few hours, all my stuff was loaded up in my Dad's truck and my car. After a 5 hour drive, we unloaded all my stuff in the kitchen. THAT was overwhelming. Sitting in the middle of a sea of my stuff, I almost had a meltdown! Then, my dad did what any caring parent would do-  handed me a beer. After consuming that, I gave up and went to bed. Sadly since I went home immediately following my final, I missed out on what was apparently was a crazy, celebratory P3 (I guess it would be P4?) Booze Cruise. But, I spent ALL Thursday unpacking, repacking, organizing, and of course the most important thing... got my hair dyed.

Friday, May 11, 2012, I left Janesville, WI with my mom to head to Tampa. I hate driving, so I convinced her to come with me. I learned along the way that Illinois may be the worst and longest state to drive through... EVER. I believe it took over 8 hours to make it through the state. Somewhere in Illinois or Kentucky, we saw a sign for a winery and decided to stop to take a break from driving. As we pulled up to the winery, we both said out loud that we had been there before. Turns out, four years prior we had stopped there on our way to the Florida Keys. Apparently my family enjoys wine!

My mom and I switched driving every few hours. After driving through the mountains, she needed to rest her "balls"... eye balls that is. I had a very long laugh over that statement- partially because it was probably midnight and because it was hilarious to hear my mom say balls. I had the lovely job of driving through Atlanta. The Lucacris song- "Goin' hundred on the highwayyy, if you do the speed limit get the **** out of my way!"... is an accurate statement to how people drive in Atlanta. Only, I was not doing hundred on the highway, so people wanted ME out of their way. Needless to say, I'm glad it was somewhere around 1 am that I drove through there, rush hour has to be TERRIFYING.

After switching drivers again, we were both really tired somewhere around 4 am, so we stopped and slept at a rest stop for a few hours. Once we got to Tampa, we then had the joy of attempting to locate the building that I had to check in at. Only, my phone died literally 10 minutes before getting to the University of South Florida campus so I was unable to bring up the address to type in the GPS. After locating it, I was given directions to the apartment that I will be living in for the next 5 weeks. I expected it to be just like West Village, which it is similar... only with ants (thanks humid, Florida weather). After unpacking, we decided to try to find a beach to try to sleep on. SURPRISE, just because I'm in Florida doesn't mean I am close to a beach, sadly. So, I googled beaches trying to find the closest one. I entered the name of the beach in my phone on the GPS and we started driving. As we got off the highway, my phone died, AGAIN. My charger in my car apparently does NOT work anymore. So, we were in the middle of Tampa with no directions to the beach. Of course, I could not remember the name or address of the beach. I brought up the GPS and tried to give directions based on what I could see on the map. We stumbled upon a random little beach, not the one we intended, but whatever, there was sand, sun, and water.

After leaving the beach and cleaning up, we decided that we should eat seafood. After utilizing handy google.com, I located a restaurant called Captain Just Crab Shack that had 4.5 stars. We went there for dinner. YUMMMMMMMM. It was AMAZING. We did not do too much the rest of the evening.

Today, Sunday, May 13, 2012, I drove my mom to the airport. I need to figure out how long it will take me to walk to my rotation and what is around USF.

xoxo

Reality Sinking in...

EEEEEKKKKK! I passed my practical. I am one step closer to rotations. It has finally started sinking in that I will be in Florida in 16 days on my first rotation. With Drake Relays this weekend, I find it rather difficult to study for my Oncology exam and Diabetes Final. *Breathe* I love my rotations schedule. LOVE.

The Next Step

It is April 8, 2012. I am 36 days away from going on rotations. I find this exciting, and terrifying. Am I ready? Will my housing situation for my rotations fall through? I decided to keep this blog to chronicle my experiences on rotations during the next year. I will be unable to provide a lot of detail because I need to abide by HIPAA rules. But, I plan on sharing what I learn and how those experiences affect me.

My first rotation is an Oncology rotation in Florida. This should be an interesting experience because I am currently doing my study guides for my oncology section of Therapeutics and because I am horrible at dealing with death. Hopefully I will be able to see some miraculous cancer remissions to offset the patients we lose while I am there. I guess I'll find out in 36 days....


Caitlin