Day 6: Round with a Resident

Today was another great day! I got to round with the PGY2 hematology/oncology pharmacy resident. We spoke to patients who were in the hospital post-bone marrow transplant and/or for complications regarding the transplant.

The medical team consisted of the attending, resident, 2 interns, a 4th year medical student, and the pharmacy resident. Each of the doctors had a few cases each to present to the team. The reason the patient was in the hospital, any issues/complications over the past 24 hours, remarkable lab values, etc. were amongst the topics presented and discussed outside of the patient's room. After the presentation, the team went inside to speak with the patient. The attending was mainly who spoke to the patients.

This was my first experience seeing communication amongst medical professionals, and communication to patients. One of the required readings before the start of pharmacy school was The Anatomy of Hope, which was written by an M.D. to describe the very delicate process of delivery good/bad news to patients. and his experiences with trying to give false hope, being overly optimistic, or even to negative. The different scenarios even had different results in terms of patient outcome. I highly recommend reading it.

But I digress...

There was a large variety of patients that we saw, from ones who could be discharged the next day, to ones where we couldn't give any good or bad news (unchanged progress), and even ones who needed to go to Hospice. The dialogue used by the physicians were very deliberate.

The pharmacy resident provided input when necessary regarding a patient's medication regimen. A lot of things were recommendations in antibiotic regimens (especially vancomycin). Some of the other roles the pharmacy clinical specialist are to answer questions about adverse reactions, recommendations about drug substitutions or dosing, etc. According to the pharmacy resident, one of the things he learned is that sometimes a question can't be answered right away, and that's okay. Most questions asked are about very rare reactions (<10% of cases), but one of the skills we learn in school is how to look up drug information and support decisions based on primary literature (i.e., clinical trials).

Learned so much today! Starting to think maybe I want to do a residency...

On deck for tomorrow: Emergency Department

Day 3: Oncology Pharmacy

I was all gowned up today in the clean room for my 8AM-4PM shift. Most clean rooms and IV rooms are in the basement of a hospital, with zero windows. In the Cancer Hospital, however, the whole back wall is open to the vast North Carolina landscape. It's a wonderful atmosphere!

Before lunch, I shadowed the technician and watched him mix bag after bag of chemo- and non-chemotherapy medications. The clean room of the Cancer Hospital takes orders from the oncology inpatient, infusion outpatient clinic, rheumatology, IDS, pediatric floors, solid organ transplant, rheumatology clinic, etc. It was exciting to see all the antineoplastic medications we learned in pharmaceutics and biochemistry. It's so refreshing to see all of the things we learned in just one year being applied in all aspects of the hospital.

After lunch, I shadowed the pharmacist, who happened to be a resident today. A graduate of UNC, he told me all about his path to residency which was good perspective. I learned how to verify IV's, and it is much different from verifying medicines in the community. The only way to check if an IV bag has been made properly is to verify the vial, concentration, correct volume(s) injected into the bags. The volume injected is determined by providing the syringes used marked or pulled out to the point that was drawn up. We also had to verify Body Surface Area (BSA) for each patient, which is used a lot for chemotherapy drugs.

Today was the first opportunity I got to see drugs I learned in class used as therapy. So exciting!!!

On Monday: Pediatric Pharmacy