Thursday, October 31, 2013

3 Day weekend miracle

I got a phone call from my friend yesterday that made me feel both nerdy and awesome.  He is a chemist in Hawaii that works on radio-labeling packaging and pharmaceuticals and I'm sure a bunch of stuff that he isn't allowed to tell me about.  It had been a while since we had spoke over the phone so it was nice to catch up but eventually he said: "I wish I could say I was calling to catch up but we need to talk science." The fact that an old friend called me out of the blue to resolve a pressing science issue was cool... even though the actual issue was not that science related.

At any rate, enough about my friends exciting life as a chemist in Hawaii and back to New England Pharmacy... last weekend I was surprised to find that another intern signed up to take this weekend.  I was thrilled to get a 2 day weekend out of nowhere but then today my preceptor (at the school/unpaid internship) told me that I didn't need to come in tomorrow (it would be my last day) so now I have a 3 day weekend.  I made a list of things that I plan to do; it's starts with nothing and ends with a little less than that.  Actually, I may try to do some of fun things that Melissa has suggested like "socialize with other people" and "leave the house." Sadly, Melissa picked up a second job a couple weeks ago so she will be working Friday and Saturday this week and only getting Sunday off.

 

Thursday, October 24, 2013

Time, money, love, marriage

All work and no play makes Jack a dull boy.  All work and no play... I'm just kidding, I'm not going crazy so don't worry, but I'll be damned if working every single day at 7 AM doesn't suck big time.  Because of the constant state of  going to and coming from work I haven't really got to do much exciting over the past couple weeks, but now that my audience has tripled (hey Mom and Aunt Heather) I feel that I owe it to the reader to produce a blog entry every few weeks.

So I guess I was kind of lying when I said "nothing" exciting has happened over the past few weeks. I did go to Oregon for the weekend to attend a friends wedding. I also scoped out a few locations for Melissa and I's wedding as well. We came up with a place, the Grand Lodge out in Forest Grove.  We wanted some place that had a hotel for the out of town people as well as an outdoor area for the wedding.  I also like the idea of a venue that produces its own beer and wine.

I was thinking the other day that I should probably recount the proposal just to have it on record (Melissa and I have a weird tendency to remember the exact same event happening two different ways, but it has already been a month so we probably remember it differently right now anyway).  So it was a Friday night. I had driven back from Springfield, MA where I was doing my rotation to Worcester where I picked Melissa up from the train station (she had the day off and took the train out from Framingham).  I had suggested a date night that involved walking through the Worcester Art in the Park project and then having dinner at a tapas place that I was told was good (and it was).  I figured that a proposal could happen on the walk in the park but the art ended up being a little strange and the park was way smaller than I thought it would be so we ended up walking around to Newton hill on one of the trails there. The Newton hill park had been turned into a frisbee golf course and I figured that would not be a good place for a proposal either.  We walked around for about an hour and took some pictures of the art. There was one piece of art that was a tea cup that you could sit in, I had my camera and took a picture of Melissa in the tea cup and a little girl came up and said "hey, that's my house!" and Melissa asked her if she should get out. The girl said no and that she just wanted to be in the house too and to have her picture taken with Melissa, there were a few pictures taken. Here is one of them.

After that we went to the Tapas place, there was a sangria and some pretty random foods: shrimp burgers, lamb lolipops, maple goat cheese (or something like that).  We had a good time, which was great because we were in Worcester and I don't think that the two of us had ever had a good time in Worcester together (she always wants to go towards Boston, which is fair).  Even though the tapas place was great, a restaurant didn't seem like the right place either. We headed home in my 4runner.  On the way home we listened to a song she said that she and her friends liked from back in the day, it was about the Mass Pike and we were driving on the Mass Pike... so that made the song sound just a little better I think.  Once we got home I decided that I had prolonged the proposal process long enough, after all, it had been on my mind for a few months now.  I had thought of trying to do it in Iceland but it didn't work out, then I thought about doing it Oregon but I thought that might be to Portland centered and finally decided that I should probably do it around where we live. So asked her in the living room at the house with a family ring that my mom gave me to use.  It didn't fit her finger at all but at least I had something for the gesture.  She sounded surprised, so that was good.

Wednesday, October 2, 2013

Finally got heckled/The 7 day work week/H1N1

I was finally heckled by a Bostonian (well technically just someone from New England) today. I was walking home from my rotation and a guy yelled out his truck window "Hot day for a suit buddy!" His statement was true, but I wasn't wearing a suit (although I did have on a tie so that is pretty close).  Because he was at a stop light I had time to respond "yeah, tell it to my boss." I was proud to receive a heckle and to also be able to respond with a moderately witty come back. The guy looked at me like I had a good point. I don't really control what I wear to work and we both knew it.

I guess technically it is not "work" in that sense because I do not get paid. I am learning by doing the work that I will some day get paid to do... and because I am learning I pay to do the work.  I wonder sometimes if I have fallen for some kind of educational pyramid scheme. At least I get paid for 20 hours of the 60 hours that I spend in the pharmacy each week.

Melissa and I have had colds for a couple weeks now and I have been reading a book about the Spanish flu, the outbreak started in 1918. It was actually a variant of the influenza H1N1 virus but it had 24 million casualties (versus 14,200 casualties in 2009). I guess a century can make a world of difference, really only 91 years.  The 1918 outbreak was when doctors discovered that keeping sick people in separate rooms would help slow the transmission of disease (among other things), it would have been nice to be a doctor back then... I totally would have thought of that one. Up until that point (and actually still during the outbreak and throughout WWI, with so many people they didn't have a choice) they just kept people in big open spaces. I can't help coming back to the point that some things in history seem so obvious now, and I am eager to see what will be obvious to us in the future. Anyway, I guess their attempt at flu, measles, and pneumococcal vaccinations/treatments involved 500 mg IV infusions, of a serum isolated from horse blood, twice over a two week period (and I was complaining about the pinch I felt when Melissa gave me a trivalent influenza vaccination that was a total of 0.5 mL)... what a difference a century makes.

Tuesday, September 24, 2013

Rotation 1: Complete

Time flies when you are having fun, it also flies when you are busting your ass and driving for 2.5 hours each day across the state (but don't worry, I was also enjoying myself).  6 weeks seemed like it would be a long time (then it flew by), I later realized that at one point in my life I thought the two years I would spend in the Peace Corps was a long time (and then it flew by), same for college and the first two years of pharmacy school.  Where does all this time keep going?  I guess my new theory is that as I get older and my metabolism slows, my time speeds up... it's science I swear: http://www.theguardian.com/science/2013/sep/16/time-passes-slowly-flies-study .

Anyway, notable features of the past two weeks:

1st, there is a thing called "The Big E." I went there with Melissa. It was essentially the Massachusetts state fair but because all the states are small out here (and technically MA is a commonwealth), they instead have a Big East Exposition that features farm animals and rides and everything that I came to expect from Salem, Oregon around mid August but instead of just one state it has the five states of New England. With a name like "The Big E" I was surprised to find it was actually smaller than Oregon's state fair, but it sort of made sense as Oregon is larger than MA, NH, CT, ME, and VT combined (I'm guessing, someday I will look at a map to verify this but not today).  We ate a lot of crazy fried things: cheese curds, oreos, some corn meat ball thing, and even potatoes (they called them french fries).  The rides looked like they were the same rides as when I was a kid, literally, so that kind of made them scary to ride all over again (that and the risk of vomiting on a ride increases substantially when you eat fried food and drink beer for a couple hours before hand). 

2nd, I did a lot of counseling patients at the clinics in Spanish.  Most people didn't really care about where I learned to speak it but I did notice that if they were Puerto Rican that I shouldn't say that I learned it in the Dominican Republic (and if they were Dominican that I should emphasize that I have never been to Puerto Rico).  It is funny to me how people with very similar customs and history can have such a disdain for one another, it reminded me of a guy that I used to work with in Oregon that hated people from Washington (or people in NH that hate Massachusetts for that matter, one professor once referred to MA as the "people's republic of New England"... or something like that, probably less clever).

3rd, took a second trip to Vermont.  There is a pretty big organic/local movement going on there, very Portland, Oregon.  There seemed to be a lot of hippies there but I am not sure if my perspective is just skewed from being in places that don't have hippies.  The town we visited was Burlington, it is the home of UVT and so many of the people around us were college students. I felt old. Melissa said that that is how she feels every day at work (working at a university health center).  I ate sheep cheese, it was ok. Cow cheese is better, but the bleu goat cheese was best.    

4th, I went to the basketball hall of fame. I established that I have a 20 in verticle leap (in dress shoes, I could probably have dunked if I was in my Nike's... just saying).  I learned that the Oregon Ducks won the first NCAA championship in 1936 but it was 4 years before the invention of the jump shot [Thank you to my uncle for catching this: the Ducks won in 1939, and the jump shot was likely invented in 1934. The man who invented it (Ken Sailors) was on a team that won the NCAA championship 4 years later... so my basketball facts were all screwed up]. Also, the Harlem Globetrotters were actually from Chicago and they beat the professional championship team in 1940... so they were kind of a big deal.  They started out as a "barnstormer" team that would travel through rural america and play local teams throughout the country.

5th, just started a rotation at a hospital that is a 10 minute walk from my house. Walking to the rotation is unquestionably awesome. 

Monday, September 9, 2013

Evidence

We have been reading a lot of POEMs in school... don't get excited, I haven't been getting in touch with my feeling or learning to express myself in rhyme.  It turns out that POEMs means Patient Oriented Evidence that Matters... which means mostly reading about clinical trials (and they almost never rhyme).  

Back in my chemist days, I never really put much thought into the fact that all the chemistry knowledge that I tried so hard to obtain over 5 years of undergraduate and graduate education had nothing to with the work that I actually ended up doing as a chemist... I mean, other than thinking "this sucks, this job has nothing to do with what I learned in school."  

Now that I am seeing how pharmacists practice in the "real world" with "people that could die" I am seeing that a lot of the theories and pharmacology that I loved learning about actually breaks down or are completely irrelevant.  Over the first few weeks a question like "why do they treat a person with systolic heart failure with metoprolol?" would prompt a response "it decreases the workload on the heart by slowing it down as well as increases their left ventricular ejection fraction by blocking the remodeling,  both are mediated by the adrenergic system as the body responds to the heart's increasing inability to move blood throughout the body" but now I know that the real answer is "because there's evidence that less people die when they have heart failure and take it." 

Ok, I get it... hospitals aren't built for science projects. Someone informed me recently that they are built to keep people alive, which is probably more important.  Similarly, someone once told me that ink factories aren't built for science, they are built for making ink (well, actually the ink factory that I worked at was built to be a warehouse for plumbing company but it eventually turned into a building that makes ink). I remember at the old job, the Plant Manager adopted a thing called "lean manufacturing." It involved making smaller quantities more often instead of big quantities all at once.  He said dozens of times: "It don't sound like it should work better, but it does, so we do it (and then he would throw up his hands and roll his eyes)." So I guess that it is a universally applied rule whether it be with medicine or making ink that goes on cardboard. You go with what works.

Unrelated, on radiolab they talked about how the color blue never came up in any of Homer's works or in the bible or anything really from the B.C.E.  There is no question that the Greeks were able to see the color blue (we have been able to see colors since before humans evolved from apes) but their explanation was that they hadn't "discovered" the color blue yet.  Looking back through history they found that most cultures first acknowledged the color red, followed by green and then yellow.  The color blue is the most difficult to create with dyes (I can vouch for that) and red forms naturally as iron oxidizes (usually forming rust) so they thought maybe that was why the same civilization that built the Parthenon hadn't bothered to acknowledge one of the primary colors. If something as fundamental as the color blue was not acknowledged by the Greeks, I am left to wonder what we are not seeing today that will be flagrantly obvious in 2000 years.    


Tuesday, September 3, 2013

Weekends/Floods



So there has been a lot of flash flooding over the past few days.  I am not sure if this is something that has always happened or if it's a new piece in the New England crappy weather repertoire. Apparently cell phones make the same emergency broadcast sound that televisions used to make, and I guess that radios made even before televisions (We were walking around the house Sunday morning trying to figure out where the emergency sound was actually coming from because the TV was turned off). 

Someone told me that we are seeing flash floods more often because somehow* more moisture is being trapped in the warm air (making it even more disgustingly muggy, when I first moved to New England I thought that I had developed some kind of new problematic sweating disorder but as it turns out; everyone else lives their lives as if they have been wrapped in several wet towels between the months of April and September).  Just like before, when the air finally cools off, the capacity of the atmosphere to hold water is lost and we get rain... but because of the super mugginess, we are left with a downpour of rain of biblical proportions.  I can't remember where I heard this, so maybe it's not true (I feel like I have to use that disclaimer a lot these days, I blame google.)

Regardless of how it happened, the rain left us with a couple feet of standing water in some locations and as I drove into work on Sunday morning from Framingham through Wellesley to Needham (In reagards to Springfield and last weeks mention of richest to poorest cities in MA, Wellesley=6 and Needham=16, Framingham only 175 (but we have better water in Framingham than they do, don't tell Needham)).  Anyway, the point is, between Wellesley and Needham I saw a couple Mercedes try to drive through a puddle so deep that I had turned the 4Runner around (there was also an old Corolla sitting precariously in the deepest part of the puddle, I was left to wonder if it was abandoned once the battery/alternator/etc. got its first contact with the water).  I couldn't help but wonder how two people driving such nice cars that have an ungodly amount of electronic equipment, could rationalize attempting to push through 2 feet of water... unless of course they rationalized it by thinking "well, the guy on the other side of the puddle is doing it in his Mercedes, why can't I?" 

So once I got to work in the 16th richest town in MA, I started thinking about the dynamic and general stress level I see with the staff. The ones that worked in Springfield (347/350) and Needham (16/350). It seems like in Needham things are a little more stressful, as if there is constantly a fire that needs to be put out. In Springfield, it seems more relaxed some how, as if the fire has already been burning for a few years and it is probably not going to be put out at this moment either.  Springfield is also a tertiary/teaching (highest level) hospital that has specialists in everything versus Needham which is a tiny hospital that ships most of its serious patients off to a bigger hospital when things get really bad.

But yeah, I am finding that the weekends are actually leaving me more tired than the week because the weekend is when everyone wants to hang out and also when my work wants me to hang out as well. This is fine with me but because of my work schedule I am getting stuck wearing Khakis in social circumstances such as bars/restaurants and end up being "that guy."  I have started taking new measures to bring down my khaki to jean ratio, such as bringing a change of social clothing along with me to work so that I can change from the work clothes.  There is a sad irony in putting so much effort into looking casual but I feel that it must be done.

*I think it's climate change related 

Thursday, August 29, 2013

The beginning of the end (of Pharmacy School)!

I have an uncle that was on Jeopardy once. He told me recently that I should continue blogging. After thinking about it for a couple weeks, I think I agree with him that I should continue writing about general life events. Maybe something important will happen and it will need to be documented.

 Lately I have been reading a book on the Byzantine empire and its troublesome years in the middle of the 6th century, and it wouldn't be possible to read about today if a guy named Procopius didn't write down everything that happened (I guess technically someone else, probably guys named Agathias or John Malalas, would have wrote some stuff down, but it wouldn't have been the same because their writing is lame and half made up... according to historians). I also just finished the first book in Stephen Kings The Dark Tower series, which also taught me a valuable lesson: that Stephen King is a weird dude and I don't think that his writing is for me.

Anyway, I also hear that creative writing and expression is good for your IQ... or maybe I am making that up. If Agathias can make stuff up, why can't I?

 So classes are over for me, I officially know what I need to know to successfully go into a professional environment and walk around like I don't know anything. They say that you do most of your learning in the 3rd year, which kind of makes the last two years of studying and agony even more crappy.

Luckily the last year of school is also significantly more interesting. Every 6 weeks we get a new gig, in a new city at a new institution. For me the current gig is ambulatory care(which means outpatient clinics and not emergency medicine, assuming that ambulatory care involves an ambulance is a rookie mistake... at least that is what I was told when I made that mistake a couple years ago; ambulate means to walk or move about) The city is Springfield, Massachusetts. The current institution is Baystate medical center.

Let's start with the city:

Springfield, MA answers the age old question of: what do you get when you cross the 3rd poorest city in Massachusetts with the corporate headquarters of the largest hand gun manufacturer in the United States? The answer of course is a historically and culturally rich city... and also, by pure coincidence, the home to the second largest trauma center in New England.

When I showed up to my rotation at the hospital and was standing outside the "Wesson" building I didn't realize it was THAT Wesson (After a few days of seeing Smith and Wesson advertisements throughout the city I had a moment of clarity). I also was left to wonder if showing up to the trauma center with a gunshot wound would be awkward. You probably have to sign some kind of waver. Anyway, enough about guns. Actually one more thing, the Springfield rifles from WWI and WWII, definitely named after and built in Springfield, MA.

Unrelated, Springfield is definitely not the location of the Simpsons (despite the vote that took place in 2006 or whenever that said it was), Matt Groening said it was Oregon a year or two ago, but it was obvious before due to the general lack of gun violence in the cartoon. Regardless, Springfield is a very pretty, although rundown, city with lots of large old, unique, and very elaborate houses and churches that leave you wondering what the city must have been like when they were built. Also, basketball was invented in Springfield so it is the home of the basketball hall of fame (also not in the Simpsons)!

Now, about the rotation (the gig): It involves counseling patients about their medications. The first two weeks involved counseling heart failure patients as they were discharged from the cardiac unit... which translated into telling a lot of people that Metoprolol, furosemide, and lisinopril can make you dizzy if you stand up too fast.

This week has been a general pharmacotherapy clinic where we are talking to patients who have more than five medications and/or multiple disease states and also a clinic dedicated to helping people manage their diabetes. It has been a good opportunity to polish up the Spanish as many of the patients are Puerto Rican and speak a similar Caribbean Spanish to the DR. So far it has been a pleasant experience despite the 2.5 hours of commuting each day from Framingham.