Take It To the Limit One More Time
It was weird to think that this was going to be the last time doing this. That particularly struck home during the final two weeks because it occurred to me that there would be no contacting the next preceptor. This was it, one final push to take me to graduation more or less. That alone energized me for the closing chapter of my pharmacy apprenticeship.
My final task was the last of the core requirements, my hospital rotation. This one was at Mercy Hospital over in Council Bluffs. Thankfully I was familiar with the route to get there from the time spent in Council Bluffs just a few weeks prior. Like most hospital pharmacies it was buried within the bowels of hospital. Thankfully the instructions as far as getting there were excellent so there were no problems. Also we did not have the issue initially that would arise later.
My initial week was spent in an IV making boot camp. Its a necessary skill set to have, just in case the technician is delivering something to the floor, you might be called on to make an IV. And an important difference in policy existed there: if you are female you're assumed pregnant until proven otherwise and making chemotherapy drugs is forbidden. At the VA of course you made it if you were assigned. Given the fact that pharmacy technicians are overwhelmingly female for the most part, being one of the segment of the population with a Y chromosome means I'd be going in the hood regardless of tech availability. I had gotten a massive amount of real life IV making experience courtesy of the VA. Hence why my period there was somewhat truncated. I'd go in and make a few that needed to be done when I got there early in subsequent weeks, but I quickly moved on to other areas since that set of skills was pretty well established.
One point of distinction was that they had the glove box instead of the clean room as the USP 797 solution (for the benefit of those who do not have experience in the business, that is the list of rules and regulations that govern making sterile products like IV bags, they limit the number and size of particles the air is allowed to have, thus, in theory, reducing the risk of contamination). It wasn't quite as uncomfortable to move around in as I had thought, but it did get pretty hot pretty fast. I pity the folks that had to come after me. I tend to sweat a lot so I was probably leaving the inside of those things a little more moist than most people wanted them. It took a little time to retool my technique to match it, but it wasn't quite as bad as I had originally thought it would be. The only problem is getting the gloves on initially, that requires a little bit of pulling and stretching. Also it took some getting used to having a massive blind spot to the immediate right and left because of where the gloves where attached to the box itself. If I had to make the decision, I think I would be more inclined to go with the glove box as opposed to a clean room, depending on the circumstances. Another factor is the cost is on the order of tens of thousands vs hundreds of thousands to build a clean room. Definitely a better choice there.
Most of my mornings were spent going over the patients in the hospital. This was where the rotation really got awesome. For the most part antibiotics are handed over to pharmacy to dose and more specifically Mark. The would write for an initial dose of the med, say 1 gram of vancomycin and then add pharmacy to dose. At that point, we were given carte blanche to do whatever we wanted other than discontinuing the medication. We could order dose changes, switch IVs to orals, and order labs. Everything got put in handwritten notes. It was a bit of a struggle for me. The legibility of my handwriting decreases precipitously with speed. If I take the time I can make my writing more legible, and to be fair, even when I'm going fast its generally better than worst of what I've seen. After we had gone through all the patients and wrote the notes for them, it was time to take them up to the patient's charts. If we were just saying that the situation was stable, it just got a sticker and went right in. Anything where we were writing an order was scanned in first so the order could be put in.
After we got back, there was usually a short lag time and then we went to the ICU for rounds. For the most part, our presence was purely ornamental, particularly when the tablet we used to access patient records wasn't working well (which was fairly frequently). Tuesdays and Thursdays I got to relive the tour of the hospital I got the very first day only in the company of the P1s and P2s. It was nice to see some familiar faces.
It was very surreal when the last week rolled around. Like I said, I had gotten into the comfy routine of contacting my next preceptor to get things rolling with the next rotation only no next rotation. I had the usual laundry list of projects, nothing that was too heavy on research. One was why we don't tube insulin, another was a dosing chart for TPA dosing. The big one was a presentation on ceftaroline, a new antibiotic, that was delivered to the nursing staff. And on the final Wednesday, I got to go and watch a surgery. It was nothing too complicated, just a gall bladder removal. It was quite interesting though, if I wasn't so deathly afraid of sharp objects, I might have considered it a career option. There are actually a lot of tools that go into you, they use cameras that are inserted inside you, the idea being the less deep they have to cut into you, the better. And then I actually got to hold the gall bladder they removed (naturally I was wearing gloves). Sure enough there were some gallstones, I remember feeling this hard mass about the size of a marble, smooth and round.
And then Friday rolled around and just like that, my duties and obligations as a pharmacy student were over and done with. It was quite the amazing experience and journey. Of course, at the time, it didn't seem like as much of an overwhelming accomplishment. I was well aware of the fact that a fancy degree doesn't mean anything unless you get a job with it. At the time I hadn't gotten the good word from Walmart that would lead to the single biggest move of my life. But there was still a sense of great achievement in that I had finally ended the days of formal education. Next stop, graduation.