List of things that make hospital pharmacists irate (formerly The Apathetic Pharmacist)

2) Medication Reconciliation Sheets.

2009-08-09T04:43:00.004-04:00

#2. The Med Rec Sheet.

Medication reconciliation is another one of the many things that make pharmacists irate. Perhaps a bit of background is required.

Sometime back a long time ago (I'm not really sure when...before my time, anyway) someone in academia and Joint Commission decided it would be a great idea to have a prepared document that was able to be generated listing a patient's medications they take at home and the list of medications they are taking while in the hospital. With this list, practitioners would then decide whether or not each med would be ordered, continued, discontinued, whatever. And if a patient is on, say, two statins, the physician can note this and tell them they only have to take one of them. A sheet is thus filled out upon admission, transfer, discharge, etc.

Now while I admit that this all sounds rosy...and it's probably needed... it unfortunately gets executed in a way that causes the average hospital pharmacist to want to just end it all and jump into the nearest volcano.

In fact, personally, if I were given the choice between dealing with a med rec sheet and stabbing myself in the eye with 25 years worth of Rossanne Barr's blood red tampon drippings frozen into the shape of a giant 25 foot tall, razor-sharp icicle...I'd make sure my vision insurance is up to date and stab away.

So where do I start.

Well, it should be understood that every initiative that is started and, later, required in hospital pharmacy practice is started by people in academic teaching hospitals. As such, all initiatives are designed and created with these types of facilities in mind. So, in these humongous hospitals, they employ 50 bazillion pharmacists. And, as such, one or two of them are freed up to go around and compile medications to be placed on med rec sheets, analyze them, and THEN give them to a physician for review. I'm sure the whole thing works dandy in this setting. Keep that all in mind.

Now that I think about it...this is a pointless tangent, children...whenever I was on rotation at the hospital that was attached to the school I graduated from...I'd see dozens and dozens of pharmacists every day...but I swear to God, I never saw any of them doing any actual....work. The IV pharmacist is the only exception I can think of. In fact, the ED pharmacist I hung out with just stood around the ED all day doing nothing, then went up to the surgery satelite he was also responsible for and played on the internet for a few hours.

Yeah...

Anyway...in the real world, there aren't that many damned pharmacists laying around.

Let's take my institution for example.

I typically work afternoon shifts from 1-11 (mostly because I still sleep until 11:30 most days...) As such, and being that I work in a locale where something like 80% of the people are on Medicaid, there are only 7 full time day/afternoon pharmacists for a hospital with a census of 150-200. That's all we can afford.

That means that I am there, alone, between the hours of 5:30-9PM. Not to mention that our hospital can't afford to give their employees a typical prescription insurance card that can be used at an actual retail pharmacy...so we actually have to dispense prescriptions for every hospital employee, too...which is total balls.

So, yeah, one dude, alone, with 150 patients and a mini-CVS on the side. So that one pharmacist is dealing with the mountains of post-op admission orders (which, yes, have med recs of their own) and regular admissions that the first shift nurses were too damn lazy to send down during their shift, so they punted it to second shift...which starts at about 4:30.

All of this together means that there is no way in hell I'm going to be able to go down, interview a patient, and compile an accurate med rec sheet.

So, in these non-utopian hospitals...who does the compiling of info for med rec sheets? And it's the damnedest thing...I actually had no clue. In fact, none of the pharmacists did. So I looked into it one day when it was slow. Turns out that it's rather random based upon which floor it is. But USUALLY, it's a nursing aide. And that should frighten you.

Personally, this doesn't surprise me at all. It explains why I get orders for drugs such as "Zopenex 0.31mg" and "hydracompatyazime 25mg". And they'll write down any stupid ass thing the patient tells them, too.

I swear to God this is true...one time we got a med rec sheet that had "Cannabis" listed as a home med. (the physician ordered it because he was a "liner"...I'll get to "liners" here in a bit...) The pharmacist on duty called the physician to "clarify"...of course putting the phone on speaker so we could all hear the mass hilarity...our buyer offered to drive up to Homewood (Pittsburgh ghetto) to try to get some if Cardinal was out of stock.

I few weeks ago I had one that listed "whiskey" as a home med.

I swear to God this is real.

Now one might think...well...that's no big deal...right? I mean the physician checks them and knows what's wrong....right? ....uh...right...?

Ha. Haha...hahahahaha. No.

As I've discovered, either way too many physicians know jack about drugs or way too many are too lazy to actually read the things. So what happens is that they will order drugs that are jotted down wrong. Then we get it. We notice that it's wrong...however...yippee...we don't have prescriptive authority...so that means we get to CLARIFY all of this shit.

Say some crazy patient tells the clerk that they take "Phoslo 125mg one cap TIDAC" (this happened yesterday). The physician orders it. Well, sumbitch, it only comes in one strength, 667mg. So that means we have to clarify it. If we just put it in for 667mg TIDAC, an idiot nurse that thinks they are more of a drug expert than a pharmacist will call you and threaten to write you up because you are trying to overdose a patient with 5 times the ordered dose. Not to mention the patient's calcium is like 13 and they suffer from renal failure, so they shouldn't be taking it, anyway.

So to avoid this, we call the ordering physician and do the song and dance of "clarifying" the med rec sheet. Usually this means we tell them what it should be and they agree with us.

Sometimes we get physicians that are privy to the whole stupid ass system and humor us to the "importance" of our phone call. We know it's stupid, they know it's stupid, but we just get it over with and that's that. I can deal with those people.

But there are "those."

The ones that actually know what Phoslo is will scold you for wasting their time as Phoslo only comes in one strength. No, they don't care about JCAHO regs. They care that their golf game was interrupted. They will call you an idiot, tell you "Yes, MORON, make it 667mg"...and then you hear the words "stupid f'ing pharmacists" faintly in the distance...right before you hear the click of them hanging up on you.

Then you have the ones that have no idea what the hell Phoslo does, they just ordered it because it was one of the options on the home med list. You'll tell them "Well, not only is the dose wrong, but the Ca/Phos product is above 55...which has been shown to increase risk of mortality in these patients. After about a 5 second pause, they'll just say.."Uh...yeah...let's cut that one and I'll consult Renal about that." Of course, I could tell them that Renagel is a great alternative, but being given advice from a pharmacist is like a 15 year old kid getting scored on by a 3rd grader in a game of neighboorhood pickup ball to these people. So they kinda avoid it at all costs. Plus, they play golf with the nephrologists, so consulting them gives their friends a reason to bill the insurance companies.

Then we have my most hated brand of med rec sheets. The ones filled out by the "liners".

So what, pretail, is a "liner?"

A liner is when a physician is too damned lazy to actually read their med rec sheets and they just draw a giant ass line down the "Order" column of the sheet. They get away with this because they know that the pharmacist will have to make sure everything is kosher...plus the nurses wait until 4:30 to fax down new admits as they don't want to deal with them on their shift...and by then, they are already long gone and some random hospitalist has already taken over call for that patient.

"Of course I read it. Honest." A classic example of a "Liner." Due to the lack of a defined insulin sliding scale for the above patient, we had to call the physician on call to get it corrected. Not to mention the fact that Vicodin doesn't come in 7/750 (that's 7.5/750). The dude that wrote the order slipped out right after signing off on the order. It probably wasn't a coincidence.

So anyway....to put this into perspective. About 10-70% of med rec sheets have issues that need to be corrected depending on what day it is and who's in the ED/OR/whatever.

At 5PM when the nurses from first shift fax all of the new admissions they've gotten since 1PM, then run out of there as fast as they can upon hitting the "send" button...and like 30 of them do that at the same time...which means I get a stack of like 20 admissions and med rec sheets. And they start coming over and collecting at about the same time the army of first shift pharmacists start to leave...

...and of these, like 5 are wrong.

2 are so f'd up that I have to call the pharmacy to figure out what the hell that patient takes.

Meanwhile, there is a nurse that's addicted to Vicodin at the door demanding her bi-weekly candy.

I have three nurses on hold demanding meds that found their way to the mysterious black hole...

Then I find out that the patient's pharmacy is Caremark mail order (God help me)...next thing I know, I'm sitting on hold with Caremark on speaker phone, talking to a nurse about why her Phoslo 125mg hasn't been sent up to the floor yet on another phone, checking a script for Vicodin my tech so kindly typed in and filled for me...then another nurse shows up at the window wanting to know why she can't get through to the pharmacist because both lines are tied up and she needs her now dose of Maalox...

...all at the same time...

...and it all piles up there because the entire implementation and existence of med rec sheets in the typical community hospital is so poorly executed...and so relentlessly dumped onto the the laps of helpless pharmacist...that it makes all of us so damned irate. And there is no way to make it any better because, again, in the real world...there are restrictions on manpower...

And I'm not even going to go into the situations where a physician discontinues a medication on the "current medications" sheet (which is one section of the med rec sheet), then reorders the same damned drug with the same damned direction on the home med list (the other part of the med rec sheet). Does he want it...is he just testing us to see what we'd do? How the hell should we know.

But when I get in a med rec-caused situation that stymies me from accomplishing anything...yeah...sometimes I curse...sometimes I throw things...sometimes I bang my head against the wall...and sometimes I just cry.

But at the same time, at least it shows me how needed we apparently are. Because if we weren't there, I'm pretty sure that an only moderately-opiate tolerant patient would die from taking 300mg of OxyIR (like I had one med rec say...those pesky extra digits...) And saying that we legitimately save patients from harm can seriously be drawn just off of the strength of the organizational abortions that are med recs alone. Job security...right? At least that's what we tell ourselves.

And that's why med rec sheets are one of the things that make hospital pharmacists irate.

1) The Mysterious Black Hole

2009-07-24T22:19:00.007-04:00

1) The mysterious black hole.
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Yes. The mysterious black hole.

Ask any hospital staff pharmacist and he/she will know what you are talking about.

By my estimation, there is a realm of existence somewhere in the unknown universe where millions, possibly billions, of unit dose medications are floating around in the vacuum of space - lost in time from all of humanity for the rest of eternity. Perhaps we have allowed Marvin the Martian to come to discover Viagra.

Marvin after visiting the mysterious black hole.

So what the hell am I talking about?

There is this bizarre phenomenon that is observable at every hospital I've ever been to...and it seems to be an issue everywhere.

Pharmaceutical products, while in the institutional setting, have the physical chemical property of vanishing from the face of Earth. And not just the pharmaceutical itself, but the packaging, labeling, and every physical record of its existence.

Case in point, every day pharmacies compound IVs. Say a physician wants to be a dick and order a bag of IV fluids that aren't commercially available as a precompounded bag. Say, D5 1/3 NSS w/ 30 of KCL. Then say it's 8PM. You are the only pharmacist around and you're one technician is about to go on a round. You have the tech make it and it goes with her on the round. Now the ODDS of that bag of fluid finding its way to the mysterious, evil black hole are roughly 40%. You will sign off on the bag. The tech will put the bag on her cart. The cart will leave. 15 minutes later, a nurse will call you. They will claim your tech has been by and the IV isn't there. So what happened to it? The mysterious evil black hole got it. It happens that fast. So you have to personally go back and make another one while the tech is gone because you don't want the patient with a K+ of 2.8 to suffer. Of course when the tech comes back, she SWEARS she put it in the med drop-off box. You have no reason to doubt her. Just in case, you send her up to investigate the med room. Sure enough, it's not there. And that solves it. The black hole strikes again

Artist's rendering of The Mysterious Black Hole. circa 2009. Note the high percentage of items that are expensive or take some time to compound. According to Mike's First Postulate, 1 minus the product of 100 divided by the cost of a product in dollars times the number of minutes it took to make said product is the probability of that product disappering into the mysterious black hole. Take the TPN for example. 1-(100/[$99 + 35 minutes]) ~ to a 25% it will go missing. Any drug with a probability of less than 0 can be assumed to not have this property. Mostly because nobody cares enough about them to become irate if they go missing.

However, the most...well...mysterious property of the mysterious black hole is that the status of each item appears to be transient in nature. They have the tendency to magically reappear the next morning when the techs go around to round up the unused meds from the night before. Where did it go, how did it get there, why did it go there...nobody knows...but there it is. Back from it's mystical and wonderful journey to the center of somewhere...back to the exact same spot it was put 14 hours ago.

Some may say, "But Mike, perhaps they were just misplaced." Bullshit. There is no way in hell a person can misplace a gigantic-ass TPN the size of a small table. It's an unfathomable thing to happen. And we all know that nurses are bright people that never make errors and have IQs well above 140.

Another interesting phenomenon are the types of drugs that never seem to magically reappear from the mysterious black hole. These usually include drugs that are remedies for common ailments. For instance, I usually observe a 5-count sleve of azithromycin missing from the Pyxis. Or perhaps a patient's Advair discus went missing before it ever got used once. Or perhaps a Lantus pen went missing.

Some may say, "But Mike, those items were probably just embezzled by nurses that are too cheap to get a script for a Zpak or are too cheap to actually be expected to buy their own maintenance medications." Ha, fools. Clearly the martians that live near the mysterious black hole are using them. It is perfectly reasonable that they have bacterial infections or suffer from asthma. We all know that nurses are the most trusted profession on Earth. The Gallup Poll says so. They would never, ever lie about where the meds went or, *gasp* steal them. Sure, nobody would ever find out, the pharmacy never keeps track of which meds go missing, and the temptation to take them is gigantic...but they are NURSES. They would never, ever do anything wrong. Ever.

The mysterious black hole. One of the things that make hospital pharmacists irate.

My Car Exploded. No....seriously. Boom

2008-06-03T12:56:00.002-04:00

So I haven't posted in months. I suppose one or more "clever" person(s) has noticed how fitting that is to my blog name.

Anyway....MY FREAKIN CAR EXPLODED!

So I'm at Sam's buying bulk Mike-sustaining supplies. This includes bulk chimichanga packages, bulk pot sticker packages, 30-packs of bottled water, bulk packages of Kashi Go-Bars, and #90 Adderall 20mg....which is kind of like a bulk purchase.

So anyway, I'm checking out and a few dozen employees start running in and out of the store in a panic. Over the intercom they announce, "if you are parked in the side parking lot, you need to move your vehicle....NOW!"

Being that I was parked in said lot, I kinda put a little bounce in my step and "rode" the back of the cart to the door where the old receipt checking guy was doing his incredibly easy and pointless job.

As he's magic markering my receipt he says to some other employee, "Hey, Bob, will you tell the owner of a Red Buick in the side lot to come to the parking lot IMMEDIATELY."

Odd, I thought....I was driving a red Buick.
So I continue using the shopping buggy as a scooter and scoot myself to the parking lot where....you guessed it...my worthless deathtrap of a Buick was engulfed in flames and a dozen or so Sam's monkeys were dancing around my car with fire extinguishers. It was like trying to extinguish Dante's Inferno with a squirt gun.
And not a cool super soaker

....oh no. One of those dinky plastic jobs you buy at Kroger for 85 cents in the checkout isle.....
.

In time they realized that their futile attempts at making my car less on fire were...well...futile. Eventually the fire department shows up. For some reason they decided the best course of action was to beat my car with a giant ice pick looking thing (no, seriously). After realizing that you can't beat a fire to death, they whipped out the water hoses and finally took the fire out. By this point, I swear to God, no less than 400 people were standing in a circle around the car. I almost expected a guy with a hotdog on a stick to show up in a few seconds all pissed off that they extinguished his barbecue. You'd be amazed at the amount of smoke a 1998 Buick Regal LS can produce.

Then this idiot old guy notices all of the parking spaces available and actually parked his car three spaces away from my charred hunk of metal with a dozen firemen running around it, blasting it with water. He gets out all proud of his space, then while walking to the enterance, glances right and *realizes* in a sort of shock the commotion that has magically appeared in front of him. He then gets in his car and moves it away. It was damn hilarious.

So afterwards, when it's out, I approach the car. A firemen goes, "I'd hate to be the poor son of a bitch that owns this piece of ****!" as I'm standing two inches behind him. I pat him on the back and say, " 'at's me, buddy." The look on his face was priceless. I think he may have actually thought I was mad at him.

I tried to talk to them about the entire process of why a car decides to spontaneously explode. Their best answer was, "It's been happening a lot around here lately. This is the fourth one in two weeks. It just seems to happen." I asked to see the security tape, but for some reason the Walton's only pay for "lookin'" cameras, not "recordin" cameras as a Sam's employee so eloquently pointed out. Being as though I only had liability on that piece of crap, I'm up ****'s creek without a mechanism for fighting it's current. I'm personally hoping more cars explode and some ******* arsonist is lighting them up. Then I might get some cash from someone.

That won't happen though. I'm sure my car randomly exploded. It's so absurd and ridiculous that it is just one of those things that *would* happen to me.

Here are some cell phone pictures I took:

I guess I have to get a job now. My evil plan of waiting as long as humanly possible thanks to diligent budgeting has been royally f'd over. Oh well. Maybe it's the universe's way of telling me to stop doing nothing with my life. A nice exploding car....that's one hell of a way to get a point across....

Oh, yeah, the last few months of my life....uh...I graduated finally...I should probably take the Naplex eventually...

Rotation X: Acute Care II.....the post that goes nowhere....

2007-10-12T15:35:00.001-04:00

So rotation number ten was in Uniontown, PA....a medium sized town roughly 40 minutes from Pittsburgh....and 40 minutes from Mo'town. It was much more like Pittsburgh than WV culturally. The first day I'm there this pharmacist walks by us around lunch and goes, "Jeet jet? Some good pizza dahn'n the cafeteria, n'at." Haha. They speak Yinzer. The Pittsburgh accent is absolutely confounding to outsiders. It's barely English. I was with two other students and the one from around Beckley (Southern West Virginia) asked me what the hell that person just said. I told her he just wanted to tell us they make good pizza down in the cafeteria....she says back to me, "Nah, he said something about an airplane....I think." Good times.

The rotation was made easy because I was with a person whose love for clinical pharmacy matched my love for pharmacology/medicinal chemistry. Between the two of us, there literally was about 3 things all month the preceptor asked we couldn't come up with the answer to off the top of our heads. I'm pretty sure we left her with an incredible impression of WVU students. The words, "Wow, most students don't know that" came out of her many times during the month. I suppose that should be expected......she tells me she usually gets mostly Pitt students .

I also missed an entire week of the rotation because my lungs hate me. I feel bad for the poor dermatology (I think resident) guy that saw me in student health when I came in. He was so lost. I presented with a history of asthma , afebrile lung infection x 3 days, and marked SOB. His first idea was to give me Biaxin and send me off. Uh, no. The correct answer is give me a nebulizer treatment and some damned steroids. I spoke up and asked for steroids...he went and got the attending family medicine doc...she agreed with me. 20 minutes later I'm breathing a-ok and I got a script for sweet, sweet prednisone.

I don't know what it is, but the vapor from nebulizer treatments tastes really good. I know I'm probably crazy on that one. Actually, I think it's a remnant from my childhood. Remember when the fire department would come around to your elementary school and stick your class in that playhouse thing and pump in that fake smoke....then you had to get on your hands and knees and crawl out. The nebulizer tasted like that shit. Mmmmm.

Due to said steroids, I opted to get some greasy-ass food to defray potential "stomach ouchies". Yes, that's the technical term. I figured I'd get some fast food for the first time in ages. Like as in high school. I was disappointed in my $3 worth of food prepared in 35 seconds by a guy making $5.15/hour. WTF has happened to Wendy's? Their shit used to be delicious. Now the fries taste like cardboard and the best part of their hamburgers are the buns. Jesus. My phlegm was saltier and less soggy than their fries. I think that when Dave died, his company died with him. I miss that son of a bitch. His warm, portley smile on those damned commercials made me feel happy. Just like the guy that pimps those delivery diabetes testing supplies who used to be on the Quaker Oats commercials. I swear to God, every time he's on one of those diabetes commercials, I get this urge for some damned oatmeal. God damn Quakers and their subliminal mind games.

What the hell else do I miss?

Hmm......that Supermarket Sweep gameshow. Shit was hilarious.....and robot dancing. That shit needs to make a comeback. When was the last time WVU has a good mass riot/couch fire? 2005 after the Elite 8 in basketball? That's bullshit. That's the one thing I miss I can actually change. Fuck it, I'm going to go light something on fire right now.

Rotation IX: Acute Care with Omniscience Personified.

2007-09-14T16:36:00.000-04:00

So I really didn't know too much about this specific professor, Dr. P. The only thing I know about him is that he is very adamant his students know that when you have a cold, you burn roughly 7 calories per sneeze.

It turns out that he knows everything.

No, seriously, like, everything. It's creepy. Other faculty members I've been around, I really don't sense anything remotely close to omniscient....this guy, no, he actually may have memorized the entire contents of PubMed.

I was at first clued in on his stature as a clinical pharmacist when he was nominated to sit on the Pharmacy academy on the National Academies of Practice during the first week of my rotation. If you don't know what that is, it's kind of a big deal. Any time you are going to be added to a list of 28 or so elite people and the name Koda-Kimble is on the list, well, in pharmacy, you are hot shit.

So anyway, I got to work with this dude for a month. Suffice it to say, I am and remain blown away with the sheer amount of crap that he knows. He raises the bar too damn high. I can't ever even theoretically strive to one day become as good of a clinical pharmacist as this dude. It's not a good idea to put people who have only done this stuff for a few years with this dude. It's like me trying to learn basketball from Michael Jordan. Sure, watching him dunk is cool, but it won't help my slow, white ass...it just makes me feel useless.

Anyway, the rotation went well. I got to see first hand how little medical students know about drugs...again. I asked them about it. Turns out they only get 6 weeks of the stuff total in school. Yikes. From what I've seen, medical training seems to be more like a series of apprenticeships rather than actual school. They just learn about the drugs on rotations as they need to. Whereas pharmacy school is just a series of useless classes that involve things like memorizing telephone numbers of the local poison control centers and knowing what the transtheoretical theory of change is (My WVU peeps know what I'm talking about...)

Back on track...

Patient care is an interesting thing with me. Personally, I hate following patients and using guidelines to solve problems. It's just boring. Really boring. I guess I did a good enough of a job, they never threw back one of my recommendations as incredibly stupid or not the best course of action. If you use chemical classifications to describe drugs, it will confuse the common med rotatee like you wouldn't believe. Calling an ED drug a phosphodiesterase-5 inhibitor will make them step back, pull out a PDA, look it up, then come back pretending like they knew what you were talking about the entire time. It actually quite humorous to watch.

My evaluation took the a slight deviation from normal. I was mildly chastised for not working hard enough and not caring...but with this guy, he realized I belong in Industry or in a lab somewhere and didn't hold it against me. He actually took over an hour to completely evaluate me...20 minutes of which was to try to convince me to go to graduate school and "use my talents." Eh...that's another 6 years. I'm thinking no. Especially because they hire PharmDs in industry, anyway. Why get another degree if my current degree should get me where I need to go?

Oh....and he also said I talk too fast and look like I'm about to fall asleep far too much. Par for the course.

According to the Princeton Review - It's official - West Virginia U is, again, the #1 party school in the nation.

2007-08-20T17:08:00.000-04:00

I'm like a damn prophet.

Last year WVU was underrated at #3 behind U Texas at Austin and Penn State at College Park. They clearly did not research that properly at all. I mean, C'mon, we set damned couches on fire after sporting events and Morgantown accounts for roughly 1% of all alcohol sales in the US (at least that's the rumor...) UT and PSU can't carry our beer bongs, let alone challenge us for the throne. I've been in both. They are both weak. Well, relatively weak, anyway.

To the press write up:
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MORGANTOWN, W.Va. (AP) — For the first time in 10 years, West Virginia University is back where students say it belongs, ranking as the nation's No. 1 party school in the annual survey by The Princeton Review.

To the historic disappointment of school administrators who have worked hard to curb underage drinking and other rowdy behavior, WVU has been among the top 20 party schools seven times in the 15 years students across the nation have been surveyed.

Not since 1997, however, have the Mountaineers taken the top spot. Last year, WVU was No. 3, bested by the University of Texas at Austin and Penn State — both of which remain in the top 10 this year.

WVU also ranks No. 1 in the category of Their Students (Almost) Never Study.

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To everybody that contributed, good job!

Holy crap...E.S. Posthumus is releasing another album!

2007-08-16T01:28:00.001-04:00

For the longest time I thought that the Brothers Vonlichten of ES Posthumus wouldn't make another album because their unbelievably brilliant music (like, the best shit put out by anybody in the entire US right now brilliant) didn't seem to catch on with the mainstream (not that it surprised me or anything...music without English lyrics backed by movements and intricate instrumentation is usually...well...a death sentence...)

....and paying all of the people to play cello, violin, and the rest of the ungodly huge assortment of instruments they use probably wouldn't be worth whoever pays for production of their album to make another one.

But, alas, it appears that they have been going hog wild in the background making more music. This appeared on their website:

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According to ancient legend, the tiny island of Numa was completely destroyed by natural disaster in the Southern Indian Ocean. Its inhabitants had been highly civilized and advanced seafarers. They traded with peoples from every corner of the Earth and developed a language that incorporated all known tongues from that era.

On our next release, "Cartographer", we imagine what this language sounded like and combine it with compositions that are uniquely those of ES Posthumus.

"Cartographer"
ES Posthumus
featuring Luna Sans
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Fuckin' eh! The little music sample they gave on the site sounded like an evolved version of an earlier song they did named "Nara" (known to the casual person as "The Theme Song to CBS' Cold Case) That shit makes my damn month. I have no idea when it's coming out, but apparently the gears are a' turning.

I'm pumped. I thought that I'd never hear this type of music ever again. Thank Jebus!

Rotation VIII: Multiples of Five.

2007-08-09T18:39:00.000-04:00

I. Rotation VIII.
II. Guide to getting narcotics.

-------------------------------------

I. Rotation VIII: Community Pharmacy

So my 8th rotation was labeled as "Advanced Practice Community." This is essentially a euphemism for "spend 4 weeks counting by 5s". It wasn't really all that bad. It was a little independent chain. The dude owns five stores in the North Central WV region. The store I was at was doing 300 scripts a day - absolute insanity for an independent. From my old Kroger days, I really envy the guy, too. He has the power to hang up, tell off, or ignore anybody he wants to without the possibility of some retard district manager coming along later and giving the offender a gift card for being an asshole.

The joint was also a professional compounding center. Interestingly, his best sellers were this methimazole topical cream for cats with hyperthyroidism and a nifedipine/hydrocortisone/lidocaine suppository for hemorrhoids.

Whenever I wanted, they let me hide in the back and work on the retarded assignments the school of pharmacy forces them to make us complete. They also didn't mind that I took hour long lunches. I probably only ACTUALLY spend 2 hours a day counting and 6 hours doing busy work or just kinda spacing out. It was quite nice, actually.

But, man, it all makes me remember why I hated retail. All you are anymore is an insurance billing technician and narcotics diversion officer without any actual power. I'm being 100% serious - I think pharmacists should have the right and authority to arrest anybody on the spot who is forging a script. In fact, give us all guns, too. Then nobody sure as hell would rob us anymore. I want to be sitting there, counting pills, with one of those over-the-clothes gun strap things over my labcoat.

I want a .50 caliber Desert Eagle, too. Check out what this thing does to a watermelon (about halfway through video):

Hell yeah. I want THAT on my side when Mr. Oxyhead comes in to rob me.

So back to the point, the druggies were running strong in the particular area I was in. The second week I was there somebody called us up and asked for brand Oxycontin 80s. And what makes it worse is that you know the type as soon as you pick up the phone, too. Every other word is sir this, sir that, please this, thank you that. They are the only nice patients you have. Hell, I wish only druggies came in...at least my day would be pleasant. On the other hand, it pisses you off that they think you are being fooled by their facade.

Anyway, after I said "no," she asked if I had any of the "blue round ones with the W in the middle of a box on one side and 03 then 52 on the other side...I think it's Watson brand" (Note: it's actually an "M" and Mallinckrodt brand...but I give her points for effort) Impressed by her opiod-addiction-fueled knowledge, I actually went to see if we had them for shits and giggles. I go look at the ones we have..and they weren't the Mallinckrodt brand. So I get back on the phone and I say "All we have are green ones with 33 on one side and 93 on the other."

And what does the woman say?

"Oh, no, the Teva ones really don't do me that much good, thanks, I'll call elsewhere!"

I mean, c'mon, she can tell me what freakin' brand it is by the imprint. WTF?

All in all it was a good rotation for what it was. The folks there were friendly as hell and made me feel at home. They even bought me a going-away cake when I left. Awww...how sweet.

My preceptor didn't really like the ratings thing on the evaluation form, so just gave me 4.5/5 on everything. So...yeah.....no comments page this time around. He told me I should get a PhD in pharmacology.....which is honestly the best idea, based upon my talents, I've heard so far.

...and this bring me to another thing that bugs me....

...why the hell do people think that the "next step" for pharmacy graduates is a residency? I swear to God, the next person who looks at me and asks if I want to do a residency I will douse in gasoline and set on fire. (Note to FBI: Not really.)

Ok, ok. I understand that if you want to pursue some sort of specialized clinical pharmacotherapy career path, it's definitely what you want to do. However, what this fails to realize is that clinical pharmacy is the most boring thing on the damned planet.

There is a reason why I got straight Cs in therapeutics in the actual school part of pharmacy school....it is basically the equivalent of memorizing an encyclopedia. The only real interesting part of pharmacy school is pharmacology and biochemistry. It's cool shit. You know how shit works and you can brainstorm how doing shit to said shit will make other shit happen. It's pretty sweet.

But anyway, I just don't understand why "residency" is considered the "next step". If I had to sit in a hospital and deal with applying guidelines to patients, I'd probably kill myself.

The next step is PhD in pharmacology or medicial chemistry for me. That's the real science right there. If I had the personal motivation, didn't care about money, had a desire to actually help humanity, etc, etc, I'd probably do it.

Ah, oh well.

------------

II. The Pharmacists' Guide to Scoring Narcotics

I feel as though this should be available to the public. I figure the more druggies know, the less I have to deal with actually noticing their obvious BS and, thus, annoying me by making me do something about it.

1) Do not address a pharmacist as sir/ma'am.
Why? Because retail pharmacists don't get praise or a general happy/nice attitude from ANYBODY before we actually bend over and let you ram us in our collective asses via making us do your bitch work (call the Dr, call the insurance, diagnose your allergic rhinitis, etc).

We are like your spouse/friends/family. We KNOW that whenever you are nice to us, you just want something. I swear to God, whenever I answer the phone and the first thing that comes out of your mouth is "Hello, good sir, how are you this morning!" I know you are one of two things. A guy trying to sell me something or a drug addict looking for Xodol 10/300.

This is what you do. After I give you the stock phone intro, just say, "Hey, you guys got any Xodol in stock?"

Simple.

2) Do not wear anything that says the words thug, g-unit, sean jean, or is the logo of some hippy band from the 1960s. A tshirt from an 80s hair band is questionable. Also, be sure to shower.

Why? Personally, I don't discriminate, but from my limited experience, your average retail pharmacist is one prejudiced ass motherfucker. Usually with reason. If you look like a shady character, you'll be put under a microscope.

This is what you do. Go to Target and buy one of those decent looking suits they have that costs like $70. Wear it to pick up your Vicodin. In fact, treat PICKING up you drugs like a kid on his first job interview. Uncharacteristically wear a suit, show up a few minutes late, only answer when spoken to, and act like you've never done it before.

3) I know it's hard....but don't call your narcs in early.

Why? It makes you a marked man. If you call a script for a narc in any more than 1 day early, we make a note of it and we NEVER EVER FORGET.

This is what you do. Suck it up. Call the day it's due. Triple bonus points if you actually wait an extra day or two.

4) Don't tell me you dropped your pills down the sink.

Why? Because this is easily the most commonly used bullshit excuse in the history of opiate addiction. By my count, around 25% of all hydrocodone preparations produced wind up in the sewer system of every town in the US. In fact, it wouldn't surprise me to find out that hydrocodone has some sort of static-electrical attraction to running water or something.

This is what you do. DON'T LIE TO US. Every excuse you come up with sounds absolutely retarded. No matter how brilliant you think your excuse is, we've heard it before. Do you honestly think we believe that you are going to allow the drug you've been trying to get filled early every day for the last 3 weeks to "accidentally" be consumed by your Poodle? Please. We all know you have that shit locked up in a damned fire-proof safe in your bedroom. I'm sure your birth certificates and social security cards are probably on an idle table next to a fireplace, too.

5) When getting your script for a narc filled, do not stare at me like I'm Natalie fucking Portman walking around topless.

Why? Because you are making it bloody obvious you are doing something shady. Sometimes I like looking right at them for a few seconds, then go over and pick up the phone. Their eyes get as big as a damned basketball. I did that once and the dude got up and ran out of the store.

This is what you do. DON'T STARE AT ME. For one thing, this isn't Subway. You don't have permission to watch me, anyway. And secondly, again, you are just creeping me out. LEarn to use your ears or something. Christ...seriously, anything, just don't stare at me intently for 5 minutes straight.

6) If you have a prescription for an antibiotic and a painkiller, for the love of God, don't tell me you "only need the painkiller."

Why? Because we aren't a bunch of fucking morons. If anybody is given a script for an antibiotic + pain med, it is 100% of the time more important that you get the antibiotic before you get the pain med. And, again, WE JUST KNOW YOU ARE TRYING TO PULL ONE OVER ON US. It's like a freaking innate instinct. We are the most omnipotent, omniscient, omnimalevolent sons of bitches you will ever know.

So what do you do? Jesus, just pay for the damned amoxicillin.

7) Don't tell me to not bill a narc to your insurance because it's too early to go through.

Why? Because, again, we aren't fucking stupid. Why in God's holy name would anybody waive the chance for an insurance company to pay a large portion of the medication cost? We're gonna run it through your insurance anyway just to see what happens.

This is what you do. Go somewhere else. Duh.

8) Don't ask for brand name anything.

Why? Because, once again, we aren't fucking stupid. We know you are going to sell whatever goes out of our store with a brand name on it. We also know that there is about a 0.00001% chance that there is a legitimate medical problem that prohibits you from just taking the generic product. It's called an AB rating.

This is what you do. DON'T ASK FOR BRAND. Instead, educate your customer about the wonders of bioequivalancy and FDA Orange Book ratings. Tell them they can get equally as high at a fraction of the cost. If they still think they feel a difference, educate them on the potential of placebo effect.

That's all I got for now. Till next time.

Why WVU is the greatest party school EVER.

2007-07-23T20:55:00.001-04:00

Ah, sweet memories. I was down the street when this went down. You could hear the riots from a few miles away, I'm told.

Rotation VII: Mmmm...corporation smell....

2007-07-20T00:07:00.000-04:00

Part I - Rotation (boring)
Part II - Viva Pinata
--------------------
Rotation number 7 was an elective rotation. "Elective" at WVU means something not involving actual drug therapy. I was excited.

I worked at UnitedBioSource. They do a motley assortment of things. The Morgantown branch focused on 3 things primarily.

First, they handled the Mylan clozapine prescription monitoring program. For those of you that have to call that mysterious number on the back of the brochure to report patient WBC and neutrophil counts before you can dispense the drug....that's who you called.

They also act as monitors for clinical trials. This means that they deal with all of the paperwork that goes into getting clinical trials off of the ground. 90% of the physicians who fill out paperwork do it wrong. UBC frequently has to proofread and mail things back to them even though the directions are clear as day. If a form says to fill out page 3...you should probably not leave it blank. This would not surprise any pharmacist reading this blog. What, you mean a physician is too lazy to actually follow the rules? Surely, you jest....

The odd thing is that 90% of the workers only make about $10/hour. I was the second most highly educated person in the building after the PharmD who was the main executive of the enitre branch. This made it an interesting rotation because I was bombarded with drug questions all day long. Everything to what would happen if you take drug X with clozapine to why is Grandma Tess constipated.

They are also coordinating the Tysabri pregnancy registry, too.

Like the Mylan rotation I got my own cubicle, phone, and PC with internet. When I had no specific task to accomplish, it was internet play time. This time there was no proxy blocking my internet abuse.

It's raining outside right now and I'm too lazy to go get my evaluation, but I got insanely high marks. This presentation I gave on Tysabri and MS apparently was mindblowing. I guess I was able to teach the folks there about things they've been confused about for months. That made me feel rather useful.

--------------------------------
Part II

Viva Pinata is this game for Xbox that I've been getting into recently. It's rated "E" meaning that it is appropriate for all ages. Heck, it's even got it's own Saturday morning TV show to scare children with. So I figure it's a good wholesome game. The reviews I've read indicate that it's a really immersive game where you basically play god. That sounds cool... so I picked it up.

So I start building my "garden"; a plot, roughly 100 ft by 100 ft, that I can grow plants on and raise animals. So I spend a good 30 minutes getting my plot nice and grassy...the next thing I know a worm shows up and wants to live in my garden. I'm thrilled. Then, via a combination of mashing buttons (who reads the instructions...) I learn that I can make the worm mate with another worm to form new, little baby worms. Awww, how cute.

So it has a list of shit I need to do before they have a kid. I need to grow more grass and build them a damned house. This takes me a good half hour. Then I spend another half hour trying to figure out how to get them to hump...I eventually figure it out. By this time, I now have snakes, butterflies, toads, and other animals visiting my garden. They decide to get it on....which apparently involves solving a maze (literally). So 1.5 hours later..I have a worm!

Being a new, happy parent, I decided to give him a name...I named my first worm child "Wiggly". I was proud of my accomplishment. *I* made a worm. I loved the little guy. Then the next thing I know...one of the fucking toads comes around and EATS MY FUCKING WIGGLY. I was pissed! I let out this little yelp of anger, "FUCK YOU!!!" My wife comes running in.."babe, you ok?!?!" I look up at her, "That god damn toad ate my Wiggly!!!"

So what do I do? I take out my shovel and I wack that damned toad 6 times until it died. Michael Vick would have been pleased. Oh yes...it felt good. Yet...I felt remorse. It was just a part of nature...it sucks...but its a necessity. In fact, in order for the TOADS to reproduce, they are required to eat a worm.

Then it hit me...WHY THE HELL IS THIS GAME RATED "E"?!?!

I don't want MY theoretical 5 year old playing this game. You have money grubbing hos that won't sleep with you until you buy them a house...heck the idea of animal sex in general...then you have murder being performed when one animal comes along and eats another animal you have spent hours trying to make...then the game allows you to perform acts of animal cruelty on the offending animal by allowing you to beat it until it dies from internal hemorrhaging. Hell, as you play the game you eventually get a sharp metal shovel you use to beat to death this native islander warrior looking dude that comes along to screw with your garden. This game needs to be rated "T" for teen AT LEAST.

The shit is hardcore....I mean...damn....I almost cried when that toad ate my sweet, innocent, defenseless Wiggly...

Mike Moore is the liberal Thomas Paine. A masterful propagandist. And I mean that in the best way possible.

2007-06-21T22:14:00.000-04:00

So I got to see this documentary early because I'm awesome like that. I was very pleasantly surprised. Fahrenheit 9/11 was about the most retarded thing I have ever seen...and I can't fathom how this came from the same human being. There is no confrontation, no divisive BS...just the stories of those that have been screwed by the US health system with little editorializing from Moore until the end. As a pharmacist, one specific scene inside of a British pharmacy was particularly satisfying:
------------------------------------------------

(Paraphrased from memory)
Scene - Moore walks into pharmacy. Interviews the pharmacist about copays...everyone pays 6.65 pounds copay for everything..no matter what. Then Moore starts to look around to find the differences between the British and US pharmacy.

Moore: Where is the detergent and bread..and stuff..?
Pharmacist: What...?
Moore: Well, back home we can get those things in pharmacies.
Pharmacist: Uh.....no, I have studied far too in school long to worry about your laundry, sorry.
-----------------------------------------------

I about fell out of my chair on that one. Classic.

If we can get that shit in the US, call me fuckin' Karl Marx. I'll take it. Actually, the British family medicine physician still pulled in $200,000/year..cruisin' around in an Audi and living in a sweet $1 million loft in London. I was expecting them to be paid shit....honest. Moore is known to skew..stuff...so maybe it isn't the norm...but if it is...I might just move to England. I know Canadian pharmacist still get paid upper 5s, lower 6s like in the states and they operate in a socialist system.

I was expecting the movie to focus on the uninsured, but Moore rather focused on the insured who were fucked over by the insurance giants. Interesting - and brilliant - move. That alone will allow his critics no use of the "if they weren't lazy, unemployed people, they'd be fine" defense that conservatives like. Like Thomas fuckin' Paine.

The story of a fella who needed a bone marrow transplant but was rejected by his insurers is absolutely gut wrenching.

Moore's directing is really good too. From the aesthetic sense, anyway. His selection of music was effective. Lots of string classics like Pachelbel's Canon and Barber's Adagio.

Liberals will love it because they are programmed to.....conservatives will hate it because they are programmed to....moderates will likely be very intrigued.

~Apathetic.

Rotation VI: The Faculty Don't Take Yo Shit, Young Man!!!

2007-06-19T23:24:00.000-04:00

Rotation six was my first rotation with an actual pharmacy faculty member. It's like a completely different universe. While they actually pay attention to what you are doing and don't lock you in a room for hours at a time...on the other hand, you are given a huge-uh-ma-gantic amount of work to do. I was only there for 20 hours a week and it seemed like I never stopped working. I'm glad to be done with it. I need a break.

The actual rotation wasn't too bad. I was at Health Right, a free clinic, and at the WVU Hospital pulmonary clinic. The rotation didn't really have a theme, per say. I just kind of followed the professor around wherever she happened to go.

Apparently I suck at writing. Every single thing I turned in, I had to rewrite. It was usually stupid tickytacky stuff like forgetting to write in complete sentences and rambling on in tangential rants too much. I never do that. Oddly, my previous preceptor told me I did the best written work he had ever read. Eh. Whatever. I blame Pope Pius IX and Steve Buscemi. It's their fault. The bastards....

Moving on, I've noticed that people seem to like me. I can tell them anything and they just smile at me. It's probably because I'm 24 and I look like I'm about 18. (See below) I get carded every time I go to Dave & Busters. The last time I went the cashier told me I'd be hot when I'm 30. WTF does that mean? Anyway, a cute little kid telling you that you suck at glycemic control seems to go over better than a regular white-coated Joe trying it out. Who knew.

"Hi. I swear to God, I can get into R rated movies..."

I feel like posting some random pictures from the repository. Enjoy.

Right now I'm at a place where I do something involving clinical studies. Honestly, I've only been there one day and I'm not really sure what they actually do there.

Comments Page!!!

Positive:
Michael's pharmacy knowledge is good. (That's it.)

Negative (Paraphrased for your sake):
Michael:
Doesn't appear to care.
Sucks at writing.
Mumbles too much.
Is inattentive.
Probably kills puppies. (not really...)

Yeah, I really sucked at this rotation. Oh well. I passed and I did well on the others. Batting 5 for 6 ain't too bad.

'Till next time.

~~~Apathetic.

God bless those Yinzers. They are apparently not smarter than a 5th grader.

2007-05-25T12:59:00.000-04:00

That idiotic show "Are You Smarter Than a 5th Grader" is holding auditions in the Pittsburgh area. Big whoop, right? Yeah, that's what I would normally think. But leave it to Pittsburgh to embarrass themselves in a sufficiently ironic way. This ad appeared on Fox 53 out of Pittsburgh during the news and it kinda cracked me up. Being that I love making fun of the University of Pitt as they are our main rivals in the universe, I had to get this on the internet so the entire world can point and laugh at the Yinzers. So I rewound the DVR and took a picture.

I'll make this a game. How many spelling errors can you find in the image below? Note: Multisyllabic words can have one error per syllable.

At least they have the Primanti Brothers.

I'll never be prepared for 40 hours a week...

2007-05-21T16:32:00.001-04:00

So I get to my new rotation. I have to pay $4/day for parking. I know that's nothing to you city living assholes. I remember when this parking woman charged me $25 to park for the day in Philadelphia. I asked her if it came with a happy ending. It damn well should have for that price. Anyway, that's unheard of in my little state. $4. Damn. I could get a prime rib sub at Quiznos....or a schmokehouse steak sub at Sheetz....or 2 power charges at Dave & Busters for that price.

I walk in, it's 9AM. She hands me my schedule. EVERY day is either 8:30-1:00 or 1-5:30. I am working 20 hours a week, plus I get Memorial Day off. This means I officially am in my 6th rotation and I'm yet to actually work more than 30 hours a week. There were only 2 patients today, I was out the door by 11AM. How the hell do I fall ass backwards into the most beautiful rotation blacks imaginable? Lucky scheduling? Karma for doing something awesome earlier in life? Me being a conniving little bastard? I'm sure all of that influenced it. But that little annoying feeling where you feel like you aren't being properly prepared is starting to creep in.

Am I going to be able to handle 40 hrs/week when I get out of prison...er school?

Actually, yeah, probably...

Rotation V: Trifecta

2007-05-04T19:12:00.000-04:00

I. Lazy Theory
II. Rotation V
III. People look up to R Kelly?
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I.

There should be a branch of philosophy designated to meet the needs of those that actually scheme and devise ways to be lazy. Many of our greatest inventions came from the desire to be lazy. Like the prostitute. But for some reason, working smarter, not harder is looked down upon in this society.

Once when I was in high school, my dad, who was a the time a grocery clerk at the Kroger in Belpre, OH, got me a job in the Kroger gas station. He said it was right up my alley - I sat in the air conditioning, turned on the gas pumps, and rang people out. Only an idiot could mess the job up.

Well...yeah...I messed the job up. I got fired because I chose to sit down in a stool while working rather than standing. Apparently I'm not supposed to try to do anything unless it is the hard way. Of course that's not the only reason he gave for firing me. Part of it was insisting on speaking in an Irish accent to customers. "Ay, that'll be $5 on pump #4, Laddy!" Apparently a manager of another store got pissed off. Fuck you, I need to entertain myself somehow.

Of course he "fired" me for a completely different reason than the real reason he wanted me gone because the real reason is that the guy was a shit-for-brains manager. He didn't like me because I tried to get the guy to make improvements in my work area. I remember the computer touch screen was messed up and never worked right, I needed a new broom to clean with because the current one was a metal band with 5 pieces of hay sticking out of it, the microphone made loud, screeching noises that temporarily made me deaf....and so on. I also came up with suggestions for improvements in the workflow and operations. I made a list of crap that was wrong and showed a senior coworker. He told me he'd show the guy. Now I assumed that most managers would actually like an employee that tries to think about shit and come up with improvements, but the guy didn't take it too well so he fired me. How dare I tell him how to do his job.

Yeah, that's a hell of a tangent. The hell was I talking about? Oh, right, lazy theory.

Now, I'm not talking about not doing my job, per se, but coming up with shortcuts that make my job easier or eliminate the pointless, idiotic parts of my job. For instance, when I worked a hospital, I got tired of mixing vancomycin piggybacks. I had to mix, measure, inject, swab, and on and on. Each one took me a while to make. So, with laziness being my incentive, I researched and found that they made these cool twist on 1 g vials. Without asking, I ordered them. We got them in, we started using them, and nobody ever asked how they got there. And the result, I have to do less work.

So what are the idiotic, pointless parts of rotations? Sadly, most of it. Unless you are at a major hospital or with a pharmacy school faculty mamber. Those are usually worthwhile.

So how do you incorporate this into rotations? I shall share an example - how to not actually be at rotations without doing so against the rules.

Ok - getting out of rotations early, sans lying or general nefarious doings. It sounds hard, but this is actually a snap. Here are a few tips.

I know this sounds counter-lazy-intuitive, but get all of your required work for the school done as fast as humanly possible. DO NOT PROCRASTINATE. Hell, get it all done before you walk in for the first day.

Why? Because most preceptors have you there specifically for the purpose of slave labor. When there is no more work for them to get you to do, they just tell you to "work on your project" and stick you in a small room for the rest of the day so they don't have to look at you. Now - if you have already done everything, you can reply back, "I'm done with it all." And what do they do? Send you home.

Another good strategy - work as few days with longer hours as possible. During this last rotation, I had the option of working 5-8s or 4-10s. Always chose the 4-10s. Why? Because, assuming you took the advise above, they will let you leave at the same time every day no matter the time you have remaining. Also, if you take a sick day, you get to stay home for more hours. If you have a school excused absence - same deal.

I would wager that I got off about 2 hours early every day. That adds up. I was there 16 days, so that's 32 hours - or three full 10 hour days, four full 8 hour days.

If you do research for a presentation or journal club, be sure to include studies you can't get via Pubmed or other electronic reference. This means you need release time to go to the university library and make copies.

That's just a sampling. The good ones are going to be held close to the vest.
------------------------------------------------------------------------------
II.

So I just passed rotation V. It could best be described as "wham, bam, thank you ma'am." I went in, I did technician bitch work, I did the occasional dosing, I went home. Nothing too exciting. They made me do an inservice on USP 797. I'm amazed that the gov't is making us do all of this shit without any sort of actual evidence or studies in existence to back up the new regulations. The rules are all so very arbitrary. But because it's the most boring subject on the planet, I'll spare you the details. Who gives a shit about Iso Class 5 environments?

I'd give you the comments page, but the guy didn't write any. Probably because he didn't really take the time to get to know me. Not that I blame him, it's stupid to make an emotional investment in a kid that'll be around for one month.

So...uh...verbally...(this fucks up my series continuity...)

Positive:
My written work was the best he's ever seen.
I'm one of the better students he's ever had knowledge wise.

Negative:
I click my pen too much. It drives him nuts.
I laugh too much, especially at random times. It confuses him and he has no idea what the hell is going on.....or if I'm just crazy.
I seem to drift off mentally a lot. (The now ubiquitous "get tested for ADD" comment)
-----------------------------------------------------------
III.

Who the fuck is this Akon guy? At first I thought it was "Akorn." But anyway, he came out of nowhere and he all of a sudden gets to do songs with these humongous acts. Snoop Dogg, Gwen Stefani, Bone Thugs. WTF? Who the hell is this guy? Then to cap it off - and I honestly think I'm the only person who has noticed this - the only song he's ever done himself is the EXACT same song as R Kelly's "Ignition." His song is called "Don't Matter." It's the same damn thing, different words. I'm sitting there listening to the song on the local top 40 station, WVAQ, and I'm singing the R Kelly lyrics, "Hot and fresh out the kitchen, Mama rollin that body got every man in here wishin, Sippin on coke and rum, I'm like so what I'm drunk.."- and they fit PERFECTLY. It's weird as hell. I thought maybe, hey, R Kelly is successful, the guy just wants to do what is successful.

However, the similarities do not end there. Remember when R Kelly had sex with and eventually micturated upon a 14-year old girl? Well, this Akon dude apparently plucked a girl out of a crowd and performed a "simulated sex act" on her. And how old was she....that's right 14 years old! That shit is hilarious. Find a better person to emulate Akorn. Hahahaha.

---------------------

Till next time, y'all's,
~~Apathetic~~

Morality is stupid - a long, rambling nonsensical diddy on Plan B.

2007-04-14T20:48:00.000-04:00

I hate politics.

I need to get that out of the way first so that nobody thinks I have an agenda of some sort. If I'm asked if I'm a Democrat or a Republican, I typically respond by saying, "No. Hell, no."

I hate politics because it winds up being a contest of double-speak between two large groups of people whom believe their arbitrary beliefs are intrinsically ethically and morally superior and that the other "side" is basically the ultimate manifestation of evil. And what do I mean by this? Take the Republicans. Why the hell is their basic belief one of Christianity, domestic "free-market" economics, states' rights, and the use of military hegemony to help perpetuate an international economy that borders feudalism towards third world labor? What the hell do they all have in common? Jesus was a freakin' Marxist that wouldn't have said one bad word to Iraq, let alone blown the whole country to hell.

Anyway, so what am I getting at?

Well, there has been this struggle for some time between the leftists and the rightists in the US over pharmacists' right to refuse doling out certain prescriptions, namely Plan B. Recently in Washington, something has come up the pike about this very issue. Here is an excerpt from a news article:
-------------------------------------------------------------------------------------

Board requires pharmacies to fill all orders

Objections by druggists centered on Plan B drug

TUMWATER -- After years of debate, the state has made it official: Patients must get prescriptions filled even if pharmacists are opposed to the drugs for religious or moral reasons.

The Washington State Board of Pharmacy voted unanimously Thursday to adopt a policy that applies to all kinds of medications, although it clearly was aimed at Plan B, a birth control measure that critics say is tantamount to abortion. Most health experts refute that claim.

Druggists with personal objections to a drug still could have a limited escape by getting a co-worker to fill an order. But that would apply only if the patient is able to get the prescription in the same pharmacy visit.

--------------------------------------------------------------------------------------

So, yeah, I want to tell the world my unique spin on the issue. And kinda like those journals you read in pharmacy school, I'm just revealing all of my affiliations....k?

Ok, so. Affiliations. I have no political party because, as illustrated above, I think they are counterintuitive towards independent and critical thought. Sometimes religion is talked about. So, yeah, I have no religion. I don't really care about it. I'm gonna be a pharmacist here pretty soon, so I guess that might affect my opinion. So no political party, no religion, profession in question. That's only a little tad bit of bias.

That's a lot of rambling up there. To my point, I hate that there are people in the country that try to legislate morality. Morality is an interesting subject because it is one of those abstract ideals that can't be quantified. Is an abortion wrong? Is gay marriage wrong? Is Marijuana use wrong? Is polygamy wrong? Is operating a sweat shop wrong? Some would say they are all wrong, some would say they are all ok, some would have mixed feelings. And guess what - that's ok - it all depends on your own personal morals. My problem with the system is that people are getting pissed off over the morality of other people. So what if Don and John down the streen get married? So what if Harry down the street has 43 wives? So what if Timmy down the street lights up a doobie at while resting alone at home? How the hell does any of that affect you? Yet we have laws against polygamy and gays getting married and using marijuana - even though these acts have zero negative effect on others in society. My personal opinion is that it is absolutely retarded to legislate morality. It destroys the freedom of one person and does nothing to the collective freedom of society.

Ah, but the question of dispensing Plan B is more complex than that. It is a unique problem that has no solution that doesn't royally fuck over the autonomy of one person or the other. It's quite simple actually. You have a girl that had unprotected sex. Was she irresponsible? Was she raped? Who knows. You are a pharmacist. She comes to you with a script for Plan B - a drug that inhibits the progression of the result of a fun night in the back of a Buick into a full-on pregnancy. You are a Buddhist pharmacist and you believe in killing no living thing, nor in participating in anything linked to the act. Ever see Kill Bill? You know the guy that refused to sell his world-class swords because they are used to kill? Same concept.

But - what do you do? Do you violate your internal beliefs and concepts or do you just go ahead and do it because it's your job?

I'm actually one empathetic mofo. I can really see how the religious would get in a hizzy when confronted with the possibility of violating their religion.

On the flip side. Say you are a girl. You just got raped. Not pleasant. You slowly drag yourself to the ER. You feel like crap. You feel used, embarrassed, and weak. They examine you and give you a script for emergency contraception. You walk down to CVS and the guy behind the counter tells you he can't fill it because he thinks it's unethical. Talk about being kicked while you are down. You are angry, maybe sad.

So whose ethical cuisine reigns supreme? No matter the solution, it's wrong. Force the pharmacist to dispense? Wrong. Block a patient from receiving urgent meds? Wrong. So what do you do? Well, you try to figure out who is the least wrong. So what's the least wrong? If you are in a large city, going to a different pharmacy isn't that big of a deal, so the pharmacist would be more wronged if he/she was forced to dispense when a solution suiting both parties is available. However, if you are in Wyoming and the pharmacist mans the only pharmacy in a 200 mile radius and the patient is 15 with no transportation, it is the patient who would be more wronged if the pharmacist refused to dispense.

So what's the answer? Fuck if I know, that's what. And any logical human being would come to the same conclusion. Yet we have leftists claiming the other side is completely idiotic and unethical, and the rightists vice-versa. Guess what douchebags, you're both being idiotic and unethical. As usual. But it clearly shows my biggest beef with politics - the insistence that every damn issue be taken with such a black vs. white tilt. That's how it always is - us vs. them, good vs. evil. Guess what. There is no us or them. There is no such thing as good or evil. They are just societal constructs that fuck with objectivity.

God I hate politics.....I need a drink....fuck it, I'm gonna go draw some more stick figure cartoons. I'll let some other poor putz figure it out.

RIP, buddy.

2007-04-08T18:33:00.000-04:00

Sad news for all of my WVU readers. The guy in the '07 class known around school as "the crazy, loud old guy" died Friday. About one month before he graduated pharmacy school to boot. I'll let the news article speak for itself.

Big Al. I'll miss ya, buddy.

Crash in Braxton County leaves Keyser man dead

BURNSVILLE, W.Va. - A head-on collision on W.Va. 5 in Braxton County has left a Mineral County man dead.

Alan Dressler, 43, of Keyser, was heading east around 4:30 p.m. Thursday when he hit a vehicle driven by Debra Bush, 42, of Sand Fork, said Deputy Bryce Scarbro of the Braxton County Sheriff's Department. Dressler was pronounced dead at the scene of the accident, which happened near the Gilmer County line. Dressler was not wearing a seat belt.

Bush was transported to Stonewall Jackson Memorial Hospital, Scarbro said.

Rotation IV, Emergency Medicine: I didn't puke!

2007-04-06T22:52:00.000-04:00

I walk into the 2W pharmacy satellite. It's 9AM. I sit down and meet my preceptor, John. He tells me he's going to give me a quick overview of the rotation. He says, "Mike, what we do he-" His pager goes off. "P1, pt unresponsive, SAH - ok, let's go."

Confused, I follow him to the ER, up a floor - jogging the whole time. I get up there and there is this lifeless woman laying in an ER bed, residents, nurses, physicians, respiratory therapists, anyway, an assorted crew. My preceptor looks in and goes, need some manitol, nimodipine?

We run back up two flight of stairs to the main pharmacy, gab some vials of manitol, 60mg of Nimotop, and we are on our way back down a flight of stairs. On the jog back down, he looks back and asks me what manitol and Nimotop do. I actually knew the answer.

So back down two flight of stairs. We get down there, they are moving her around, doing all sorts of physical examinations. My preceptor tosses me a vial without even looking at me, "Draw this up, now!" It's like the manitol seemingly instantly gave her a bit of life. I though it was cool. They take her to the CT room.

About 1/2 a second later another page comes over, "Ok, Mike, DKA, P2, ETA 5min." He calls the pharmacy and instructs them to make a standard DKA insulin recovery drip. "Mike, remember where the main pharmacy was? Go, now, and grab that bag they are making." Up two flights, grab bag, down two flights.

As they take the insulin from me, my preceptor takes me to the CT room to show me the scans. A subarachnoid hemorrhage is one of the worst things that can happen to you. "See all that white stuff covering about 1/4 of the right side of the brain? Yeah, that's bad." The neurologist did a "voodoo math trick" of his to figure her odds of mortality was roughy 1. She was deemed clinically brain dead by the next morning.

So THEN another page comes in as the CT wraps up. "Ok, Mike, P1, Car vs. Tree/ MI, 35m, vsu, ETA 15min. We gotta grab the crash cart, buddy.""

My preceptor runs back over to the ER and starts preparing epi, atropine, NaBicarb, and calcium syringes. The attending physician is there, about 20 students and residents, surgery, radiology, I think a bartender for some reason. It was a packed house. About 12 minutes until the fella got there. Then the senior surgery resident comes up to my preceptor, "John..I feel like a complete ass asking this...but can I borrow your student?"

Long story short, she was wearing heels and needed her tennis shoes she had up in her on call holding cell. As the most useless person there, it was my job to grab her shoes. Said on call holding cell with shoes was on the 9th floor on the complete opposite ass side of the hospital. So...up 6 flights of stairs, run across hospital....grab shoes...run back across hospital...go down 6 flight of stairs. I got there before the trauma. Good for me. I guess.

The guy comes in..I guess he had a nasty MI, then crashed his truck on the interstate. He died on the ER bed. They still haven't officially figured out which was the actual cause of death.

So my first hour in this place, I've ran up more steps than I can count, witnessed two people die, and become the bitch of a surgery resident. Productive day.

The first day was nutso. The others were slower, so we got chances to go over whatever diseases or treatments I wanted to go over. The previous bitching about the US education system was uprooted with this rotation. During down time, we just shot the breeze. We talked about everything from WVU football to the new Crohn's drugs.

Honestly, this was one hell of a worthwhile rotation. Every day I learned something new. Anybody who goes to WVU - I HIGHLY recommend it. It's not for the squeamish though. When I saw an open wound on a girl above the elbow about the size of a football with the bone exposed and broken in half, I about hurled. If you drive down the interstate at 75MPH, don't stick your arm out the window.

Next rotation is at Preston Memorial Hospital in Kingwood, WV.

THE COMMENTS PAGE!!!®
Positive comments:
Mike is a very intelligent individual. He possesses great knowledge in the field of pharmacy AND utilizes various references effectively to determine appropriate care/dosages of medications in the acute care setting.

Critical comments:
None

Misc verbal comments (I'm not making this up): Mike, you need to get tested for ADHD, I can tell you have racing thoughts. You need to get that squared away before you take those faculty rotations you have coming up. Get checked out.

Rotation III: PEIA Face-to-Face. Living the dream - stabbing thousands of government employees and ex-high school teachers with needles

2007-03-07T11:38:00.000-05:00

I started rotation #3 on the first week of February. It was entitled: "Ambulatory Care - Diabetes: PEIA Face-to-Face."

It was in my home town of Parkersburg, WV. It's odd going back and living with the parents. They can't tell you what to do anymore, yet you still mooch off of them. It seems like everyone I knew in high school that didn't go the military route is in jail. There is this one case I feel bad about.

There was this little Asian kid, his big brother, Zac Thomas, used to live down the street from me. Me, Zac, and the kids from the block would always play sandlot baseball, hoops at the church down the street..you know, just hanging out as kids. Anyway, we never let his little brother play because we all thought he was this nerdy little awkward guy we didn't want around.

Flash to today, he was arrested last month with an entire double stall garage full of marijuana, fully automatic assault riffles, handguns, grenades, all sorts of shit. This kid turned into a badass, hardened drug dealer. (Just like me, actually...) I guess it turns out he became the local marijuana drug lord. And just think, if I would let him play baseball with us, maybe he'd be at MIT right now.

As for my actual rotation, I have no idea how good it was. I was only there 10/20 days. My preceptor actually took a week long vacation halfway through it. I only did diabetes counseling for 6 days. So 30% of my rotation involved doing what was advertised. The other days, she was either off or I had to drive up to Weirton, WV (about 1.5 hours from Mo'town both ways) every morning to do clinical workshops for a new Rite Aid they were building up there.

I'm not complaining though. I got lots of time off and I learned volumes more in the few days I was actually there than any my previous two rotations. I feel very, very good about diabetes management right now. This was the first rotation I've done where I feel it was worthwhile. It saddens me that I only got to do it for 6 days.

The great thing is that the program focused on PEIA patients (state employees). This means I got to stab all sorts of people I've wanted to stab my entire life with needles and lancets. DMV workers, ex-teachers (none of which remembered me..because I never went...), state cops, park rangers, you name it.

Compliance with the average Joe is depressing. I'm surprised many of these people remember to breath, let alone take their metformin.

I'm glad as hell I'm back in Mo'Town though. Parkersburg is boring as it gets. Especially in the winter. At least in the Summer I can get some pickup basketball games going at City Park.

Right now I'm doing a rotation in the ER at Ruby. It's been exciting and exhausting so far. We'll see where it takes me

And a new feature, I figure folks out in the academic world would like to see exactly what the preceptors look for when grading students. I'm going to post the comments they make about me every month, good and bad.

Rotation Comments Page, Rotation III:

Critical Comments:
Student would have more effective patient communication by slowing rate of speech both in formal presentations and on a one-on-one basis.

Positive Comments:
Student's knowledge of pathophysiology, pharmacology, and metabolic pathways is impressive - uses this knowledge to deduce possible physiological causes of patient complaints.

Are You Smarter Than a 5th Grader: Vacuous Primetime TV Proves My Point.

2007-02-28T00:43:00.000-05:00

For a few years now I've become rather adamant about how useless the entire education system in the US is. Rather than teaching how to use and formulate critical thought, it seems to me that public schools have always seemed to be obsessed with teaching random arbitrary fact memorization. This will lead to a wasted education that will be forgotten months after school has ceased. It's applicable to many facets of education in this country from elementary school to college. I recall once in a public health class for pharmacy school, one of the learning objectives was to memorize the phone number of the WV poison control center. WHY!?!?!? Just think about that. I'm wasting my time memorizing a bloody telephone number I could f'n google.

To make matters worse, and this is just tangential rambling about how much pharmacy school sucks, the woman made the exam make the question unnecessarily tough. As I recall the number was something like 800-323-3322. The exam question was, roughly:

What is the telephone number of the WV poison control center?
a) 800-323-3223
b) 800-232-2332
c) 800-233-2223
d) 800-332-3332
e) none of the above

And I'm getting a doctorate degree for this shit.

So anyway, back to my point. Education in this country leaves me dumbfounded. Usually I get assholes that tell me I'm wrong, memorizing crap is good, blah, blah, blah.

Well FINALLY pop culture has come to my rescue. Fox has produced this show entitled "Are You Smarter than a 5th Grader?" The show has so many instances of irony, it's beautiful. First, it's quiz show that is ironically hosted by international idiot Jeff Foxworthy. And second, it's a show that is made to ironically make intelligent adults look stupid because they are smart enough to not memorize useless facts.

I want to get on this show some day. "So, Mike, do you know what the capital of Alaska is?"
And I'd say, "Hell no, redneck boy. I don't care if 11 year old Jessica knows the answer. I'm a successful grown ass man that doesn't need to know that. It's either know the capital of Alaska or know what drugs interact with that St. John's Wort the cooky naturalist lady down the street takes. Lucky for her, I don't give a rat's ass about the capital of Alaska. Knowing state capitals pays jack, being a 5th grader pays jack...but being a PharmD gets me bank, baby! So fuck you and fuck the city of Juneau! I'm going to go diversify my stock portfolio, bitch."

Anyway, it's proof that elementary school, at the very least, is pointless. They had a successful lawyer that graduated from UCLA on there today. He didn't know a single damned question thrown his way. And why the hell should he? It's all useless trivia to him. He forgot all of that useless crap years ago because he doesn't need to know it, hence, his elementary school education was worthless to him in many aspects. Rather than memorizing the list of impeached presidents, he could have been hanging out at Dave & Busters or...gasp...learning about something that genuinely interests him. It reminds me of a quote my favorite movie director once gave about how he hated having the main motivation driving his education being fear of getting bad grades and, thus, punished at home:
---------------------------------------------------------------------
Interest can produce learning on a scale compared to fear as a nuclear explosion to a firecracker. - Stanley Kubrick
---------------------------------------------------------------------

Damn straight.

Another annoying thing is that they obviously got ringers for the show. These kids were definitely taken from the gifted program of the state they live in. You could tell because they were cocky and thought they knew everything. I'm specifically pissed about one thing though. Some dumbassed 5th grader wrote down that "REM" stood for "Rapid Eye Movment" and they gave him credit for it. To hell with that, "Movment" isn't a word, there, genius boy.

I'm done.

~~Apathetic~~

Rotation II, Mylan: Thank God for Wikipedia.

2007-02-16T21:12:00.000-05:00

My January rotation was at Mylan Pharmaceuticals. Good for me because it's right down the street from my ghetto trailer park. Nothing like waking up at 7:55AM and being on time at 8:00AM. You learn to shower the night before.

The rotation itself involved little to no work. The first two days they made me do actual work. The other 18 days involved them dumping me off in a room and not talking to me for days at a time. I had a "project". Two of them. One was a presentation on BPH, the second a new drug primer for Januvia. Januvia kinds of creeps me out. The enzyme it inhibits, DDP-4, isn't just a metabolizer of incretins, it also activates T-Cells, inactivates polypeptide Y...among other things. Anyway, back on track, I had the BPH one done in about 2 days, the other I procrastinated on and didn't get started on until my next-to-next-to last day. So I had about 13 days where I did literally nothing, they had no work for me, I already did everything they and the school wanted me to do.

The cool thing was that I got my own cubicle complete with phone (ext. # 6339) and PC with internet access. The bitch of it is that they had this proxy blocker called "Websense" that blocked every remotely amusing site on the internet. There was a single bastion of hope; Wikipedia. Now I've never used it as a tool to combat boredom prior to this rotation, but Wikipedia is a potential source of months upon months of wasted time. Hell, I brushed up on diabetes stuff prior to my February rotation. I also learned about 15 magic tricks and how soda is made, among other things.

I once went about 3 days without anyone there actually talking to me. I came in on Monday and someone came in to make sure I was still alive about Wednesday at 3:30PM. That pretty much describes the rotation in a nutshell. A plus was that they let me take occasional field trips over to the R&D department to play with crap and over to the Marketing/Sales dept. to learn how to be a conniving bastard. It was fun and potentially useful, respectively.

Another source of fun was the fentanyl patch complaint line. You can't even imagine the stupidity of some people. One guy's druggie brother stole his fentanyl patch and used it as a coffee filter. Mmmmm, Duragesic-caramel latte. The guy calls and says, "My brother brewed some coffee with my patch, he's barely breathing, and he's foaming of the mouth....should I be concerned?" Lots of people claiming that the box only had 4 patches instead of 5. People thinking it's the Pepsi challenge and demanding a new brand Duragesic patch for the Mylan patch they "didn't like as much." A lot of people think putting it in a blender with mudslide mix is a good idea, too. But, yeah, that sort of stuff. Good fun for all.

Now I'm doing this diabetes drug management thing in Parkersburg. I'll muse about it next month.

The Rural Hospital: Whip Crackin' Polka Songs.

2006-12-24T00:06:00.000-05:00

So now that my first rotation is over and my evaluation turned in, I can blather on about it without any possible retribution. Take THAT, "system".

I've said it before and I'll say it again. Rotations are analogous to slavery. In fact, it's worse than slavery. You have to PAY to do peoples' bitch work. Ok, true, true, I'm not beaten, nor studded out to some other slave to form new, little slaves, but it's still a heaping pile of BS. They fooled me the first day. As soon as I walked in, I was given a gent dose to do by some physician. Now, I know I praised the place on the first day, but it was an elaborate ant trap. Sure, they wooed me at first with their tasty nectar of doing dosing and having an actual physician interaction the first day, but after that, the poison of checking outdates every 5 minutes for a hospital with 12 patients in it got monotonous and stab-self-in-eyes-with-spoon-18,000-times-in-a-row painful. The following is a summary of my "work week"

Get up at 7:45 AM, leave at 8:15AM, arrive at hospital at 9:00PM.
9:00AM. Do technicians' typical work. Restock ER, restock night pharmacy.
9:15AM. Do nothing for 105 minutes. Work on projects you are supposed to do at home.
11:00AM. Do cart fill.
11:15AM. Eat lunch (Free to students. The hot dogs are good. Everything else is questionable.)
11:45AM. Do nothing for an hour.
12:45PM. Go out to floor, write down info from patient chart.
1:00PM. Regurgitate what you wrote down to preceptor. Make on-the-fly interpretation of said chart.
1:15PM. Go home. At 85 miles an hour. Down a 2 lane country road.
1:40PM. Arrive at home. Play Gears of War on Xbox Live until 3AM.
3:00AM. Go to Sleep.
7:45AM. Repeat 4 more times. Tuesday and Thursday there is no cart fill. Thus I do nothing for 2 hours prior to lunch
Addendum - Friday
12:00PM - Go to IDS (Inter Disciplinary Sessions). Talk with medical students/nurses/dental students about various cases. Be frightened that medical students don't grasp the idea that a long time undiagnosed diabetic presenting with greatly elevated BUN and SCr probably has decreased renal function. (In fact, they needed my fellow pharmacy student to explain the whole pathophysiological/etiological pathway. Yikes.)
2:00PM. Go home, get Sarah, go to Dave & Buster's up in Pittsburgh for weekend.
Repeat week X 4.

Now occasionally, there were excursions from the normal flow of mental beating, but typically the excursions were worse than pickin' their proverbial cotton. Like the time they had me spend 2 hours checking the whole hospital for expired drugs for the month of November on November 29th, then made me check the whole hospital for expired drugs for the month of December two days later on December 1st. They didn't seem to care that this idea defeated the purpose of doing something on a monthly basis, but, hey, not my hospital. But that's how it seemed to work all month. You know...just making me do bitchwork for the sake of making me do bitchwork. As much bitchwork as can be squeezed in. Not that I blame them or anything. They need to keep their techs relatively happy. They have slaves in the form of rotatees that need to tapdance to their whip crackin' polka song to do the morale-killing work.

Then she got on my case for wearing my nice black wool pea coat around the pharmacy over my shirt/tie. I did this because it was 55 degrees in the Rph holding cell and I was about as comfortable as a guy being given a colonoscopy without some sweet, sweet Valium. Anyway, she gave me a 3/9 on my midterm evaluation on professionalism citing I wasn't "professionally dressed." Yeah. This from a woman walking around in Winnie-the-Pooh scrubs.

Oh well. I passed. I probably shouldn't complain, I was given very little work to do, got great hours, and got tons of free food all month long. I'll roll with it and move on to Mylan Pharmaceuticals. Home of generic Prozac caps, Buspar tabs, Imitrex tabs, and Duragesic patches. I'll have serotonin syndrome, but be too high on opiates to realize what's going on. I have no damn idea what I'll be doing there, but it should be great. No patients. Just me and the drugs. That's how I like it.

As another side note about the above, if you have an Xbox360, DO NOT buy Gears of War. I warn you. You will no longer have a personal life. I swear to God, I'm addicted to that shit. It's like video game heroin. In fact, they used to give heroin addicts copies of Gear of War at addiction clinics, but stopped after they realized the addicts were less productive in their lives on Gear of War than heroin. Hell, I'm gonna go play it online right now. WVURx is my gamer tag if anybody who actually reads this damned thing wants to shoot and kill a digital representation of me.

Till then ~~~
Apathetic.

Rotations. 1 day down. 229 to go.

2006-11-13T18:20:00.000-05:00

So I started a new chapter in my pharmacy life. Rotations. Not only that, but I get to start them with students that have been out learning thing for 6 months and while I have been sitting on my ass for 6 months. I'm a little behind and befudled compared to my peers...but that's ok, when they graduate, I'll make the people from 2008 look dumb. Haha.

The place I go is about as quaint a little town as you can get. I passed "Backwoods Taxidermy" before I pass "Dairy Queen"... a few properties down from "Dairy King".

The hospital is as small as small gets. I get there and they tell me that me and the other Rx student will split the hospital in half and monitor the whole hospital. While about 2 seconds away from having an anxiety attack, she tells us there are only 11 patients in the hospital. Yeah. 11. Wow.

So we fiddle around and become oriented to the joint before going out and taking a med hx for some random patient. That takes up 45 minutes and it's off to lunch. For some reason, they give us lunch for free. So I'm sitting there, eating my ribs, ham, potatoes, apple pie, pumpkin pie, rice, corn, and roll (hey, it's free) and this guy with a stethoscope goes, "Hey, you the new pharmacy students?" "Can you guys go review my Gent dose on Jane Doe upstairs? I started at 60mg q12 overnight, I'll let you guys do what's best."

This was a big WTF moment for me. Not only was a physician not breathing down my neck insinuating that I'm an imbecile, but he asked me to do something because he thought a pharmacist could handle it. So, I did it. With the patient's advanced age and decreased GFR, blah, blah, we decided to go with 80mg q 24 as a maintenence dose. Peak should be 4.5ish, trough, less than 0.5, but who cares, it's a UTI. I gave it to the physician, and then he thanked me. WOAH. It's the opposite of retail.

F' retail. Never again. Mark my words......unless they can buy me with lots of moolah. And Dave & Busters tokens.

Kentucky - hick, redefined.

2006-11-06T09:42:00.000-05:00

I went to a football game this past weekend in Louisville. Yeah, my team lost, boohoo. But that's not the point of this post.

This weekend has redefied my understanding of the universe. Kentucky is the most redneck, hick-ass place on the planet, bar none. I used to think West Virginia was...oh no. I was wrong. Kentucky has given me an education.

I used to think I had an accent, but it turns out my "accent" is actually 70% Pittsburgh, 20% Midwestern, 10% Southern. In Kentucky, they speak 10% Southern, 90% Swahili.

I asked a guy which way to get to the stadium, I tell you no lie, he replies, over the course of about 1.5 seconds, "I tale, yeh, baback downheeyaw street, ride'n light, down'n Arby's, lef'n, there stad'm."

After literally about 45 seconds of explaination, I realized he said "Go down the street, right at the light, take a left at Arby's, and the stadium is right there."

I was amazed at Louisville the town. Hundreds of thousands of people, and nothing to do after 10PM. Not even a Dave & Buster's. At least they had these little road signs on the way out of the state that kept a real-time scorecard of the motor vehicle fatalities in 2006.

Got past the 'ol test....got the professor "resigned"...things about my left testicle you don't want to know...

2006-11-01T13:56:00.000-05:00

I took the lame ass remediation test. Passed it with relative ease. The thing that kills me is that it was the EXACT same test as last year. The crazy woman who made me wait 6 months to retake the test because she didn't want to be bothered to write a new test for me to take gave me the same test she gave me last year. She made such a big deal out of not letting me take the same remediation test a dozen other people took when they didn't pass the test first time around due to "security" issues, yet gives me the same test as last year. I remembered some of the answers from last year. It further proves that this entire process was done under the facade of academia. Between this, the shit talking the woman was doing about me behind my back to another student, and the long list of crap excuses she gave me for not allowing me to remediate the test before October, it's pretty much a lock that she did this just in spite.

But there is a silver lining. As mentioned above and in a previous post, the woman talked shit about me to another student while that student was on a rotation with another teacher. I casually mentioned this to the dean of student services when I went in for my monthly bitch fest about how ridiculous the entire situation was. Now get this. After I mentioned it, and this MAY ne coincidence, I don't know, but she had all of her rotations canceled due to "complaints from students." Because of this, and her firmly established superiority complex, she decided to quit. Yes, quit. The crazy woman isn't at the school anymore. Did I get rid of her? Did I contribute? Either would tickle me pink. On the other hand, it pisses me off that the woman put me through that power trip of hers just to quit 2 days after I take her damned remediation test. WTF?

Another odd thing happened to me yesterday. I'm not sure if you want to know this, in fact, I'm sure you don't, so I suggest you stop reading right now. Anyway, I went to work at 4PM and everything was going well. Then out of nowhere, my left testicle hurt like a bitch. It was nuts. (No pun intended.) I had to waddle everywhere because it hurt when my testicle rubbed against my legs. I have a little bit of a cough and whenever I coughed it felt like Jackie Chan just did a roundhouse to my left nut. My coworkers thought I was dying. They sent me home. Every pothole felt like a swift kick to the nuts. It was bizarre. Then I got home and it went away after about 30 minutes. I better not have testicular cancer or anything. That would probably piss me off. I'm not down with the cisplatin.

I'll probably start updating more often. I've been in an antipharmacy funk for some time now. Starting rotations should give me a whole new list of things to whine about and poke fun at.

I Heard it Through the Grapevine.

2006-08-16T10:46:00.000-04:00

So what should I do when you find out the professor who made the decision for me to wait months to remediate is talking shit behind my back?

I'm at work, volunteering interestingly, doing a HTN workshop for the public. The girl I'm doing it with says, "Oh, I was talking to [name deleted to protect my fellow classmates], just so you know, Dr Dunsworth is mad at you because you haven't contacted her about remediation."

WTF? How the hell does another person know she is mad at me for not doing something?

I suppose it turns out that Dunsworth has been blabbing my business to Dr Abate, who, in turn, has been blabbing my business to said mystery student above, who, thankfully, thinks I'm an ok guy, so she, in turn, blabbed said business to of my coworkers in an effort to get the message to me. Which I am thankful for.

Is this like some old lady gossip circle? It's pretty bad if *I* think someone is exercising unprofessional conduct. It's not the fact that people know I'm an idiot who is unorganized when it comes to school and can't do something as simple as remediate a test. I'm a stoic individual, I am what I am, I let people see through me like a window. I don't care if the story of the last 6 months of my academic history are broadcast over NBC primetime. What upsets me is the *Principle* of the whole thing. What gives these people the right to blab my personal business all over town? It's ridiculous.

I don't even know why the woman was mad at me, anyway. The little letter I got from the chair of academic standards said, rather clearly, that I was to attend class for women's health, do assignments that were assigned for the section, and get over a 70% for the course. How more clear than can it be? Not to mention the fact that I'm not going to be in her class until midway through September. I'm not so sure why she's getting all mad.

I can't wait until I graduate. I need to get away from academia as fast as I can. It and myself aren't compatable. It's just....bizarre.

'Toons

2006-07-26T22:35:00.000-04:00

Due to popular demand....

Canada : Topless lesbians and Asians without rythym

2006-06-26T20:36:00.000-04:00

I'm not exactly what one would call a "well-traveled" individual. When people my age come into the pharmacy looking for a vacation supply of their OrthoCyclen and brag about going off to Italy for two weeks, I generally give them my stock rebuttal, "I went to Ohio once!"

It serves many purposes. One, it allows me to subtly show them that I hate them because I'm probably 50-60X better than them, yet THEY get to go somewhere cool because of mommy and daddy. Two, it allows me to malliciously use them to fuel my dry sense of humor. And, three, it makes them shut up in a haze of confusion and general discomfort.

The sad thing is that I REALLY HAVEN'T been anywhere, ever. I went to Austin, TX and Columbus, OH to visit real family. I've been to Philadelphia to visit fake family (in-laws.) And I went to Atlanta to see WVU kick the crap out of Georgia in the Sugar Bowl back in January. So to recap, I've been to a quasi Mexican city with a giant Golden Buddha, a town with....crime, a town with good cheesesteaks, and a hub for Delta Airlines. Woohoo.

Recently, I have been blessed by the Gods. As a result of my own stupidity and the natural manifestation of a couple of anal-retentive professors with nothing better to do than stir up trouble, I don't have to go to school and I don't get too many hours at work due to the hiring of people to replace me. As a result, I have free time. For the first month of said free time, I just kinda did nothing. It was beautiful. Like going back to Junior High. No job, no school, just TV and and playing outside. I love it. And then I think to myself...instead of living at home..I'm in a podunt trailer park...so..I'm not accountable to anything...so...what the hell I'm I doing here? F' it, I'm leaving the country. My anniversary ( 1 year without divorce!!!) was also the 24th, so the trip was easy to sell to the old lady.

So I did.

Apparently in order to take a spur of the moment trip to another country, you need a "passport." Damned gov't assholes. Long story short, I did some anger-fueled reading and I realized that Canada, our frozen neighbors to the North, let you in to their country with a birth certificate and a photo ID. Woohoo.

So right after hearing about the travel situation as regulated by the asshat bureaucrats, I pricelined a hotel in downtown Toronto for $70/night and I left.

The trip up was filled with intrigue. We stopped at the Grove City, PA outlet malls so the old woman could buy some MAC cosmetics. Of course I tried to convince her to NOT stop, but 5 hours of nagging ain't worth the $150 out of my wallet. About 10 miles down the interstate after the outlet exit, we noticed about 3 cars on the side of the road and a guy waving traffic toward the left lane. There was a girl laying on the ground with blood GUSHING all around her and a bunch of confused-looking people surrounding her. So I go into quasi-health professional mode.

I park and jog with the wife over to the victim. The image is seriously burned into my memory like it just happened. She's lying there, face covered in blood, a chunk of skin removed from her forehead exposing skull about 1.5" in diameter. Her eye had already swollen and was quite puffy. She was wearing men's boxers and a Hanes wifebeater that was white at some point. Blood over everything. We ID'd ourselves as a pharmacy students, first aid certified, blah, blah. Then the most frightening thing EVER happened. I found out I was the most formally trained person there. Three people were first aid trained and that's it. Zero health professionals. AHHHH! Thankfully, I didn't actually have to do much. They had her held down, they called 911, and they were following the standard Heart Association procedure. The bleeding had stopped. She was somehow conscious..well, kinda, she was disoriented. She knew her name, Amy, how old she was, but she had no idea what day it was or where she was. Thankfully about 2 minutes later an off duty EMT showed up and about 10 minutes later the ambulance showed up....and took the rear view mirror of the off duty EMT. After they showed up, I took off. I guess she "jumped out of a car." Don't know the story beyond that.

Great way to start vacation, eh?

Upstate Pennsylvania is boring. It's like driving through a cardboard box. And what the reward? You end up in Buffalo, NY. I'm pretty sure Buffalo is the dirtiest town in existence outside of New Jersey and Wheeling, WV. It made me want to stare at the dust on my dashboard for amusement. So after ignoring my environment, we arrived at whatever Great Lake it was that I had to cross to get into Canada. The customs/border security dude was easy to get by. I drive up, he asks me my nationality, my reason for coming to Canada, and how long I'm going to be there. That's it. He didn't even ask for ID. Canada rocks. The way back in the US homeland security people were way more strict. People in front of me were getting searched, annoyed, etc.

Toronto itself was awesome. By chance I happened to come on gay pride week. Coolest thing EVER. Why? In Toronto it is legal for women to go topless. For some damned reason lesbians think walking around without a bra is some sort of meditative act. The result? Hot, topless lesbians making out in the street all over town. Viva, Canada.

What really surprised me about Toronto was how racially diverse it was. There were more Asians and Indians (dots, not feathers) than this redneck white boy has ever seen before. I was also amazed with how in shape Torontonians were. There were no fat people. ANYWHERE. In WV, I'm scrawny, in Toronto I'm "thick." All of the women from age 15 all wear little black dresses EVERYWHERE, too. Few jeans wearers.

As tradition dictates, entering a town that has a Dave & Busters means I must go. The Toronto D&B was nice. Better than the ones in Pittsburgh and Austin. It was like frickin' Tokyo. 500 Asians and me. What amazed me is that these Asians could dominate the dancing game Dance Dance Revolution, yet have absolutely no rhythm at all. They have these stupid games that require timing to win and none of them won all night. then I would try the game and win within 5 tries. An an example, there is a game that involves a clock that counts upwards and you have to press a button and stop the clock at 1000. I did it on my 3rd try or so. All of these Asians surrounded me in awe wondering HOW I did it. It was odd.

I'm tired of typing.

Victoria's Secret: Semi-annual United Mens' Conference

2006-06-20T20:24:00.000-04:00

I used to have this theory.

There's this thing called the "Victoria's Secret Semi-Annual Sale" where women rush to various malls under the facade of clearence shopping in an effort to stymie the morale of men in committed relationships. I've been known to call it the "Semi-annual man torturing event" Why do I say this? Because for the third time now with the one I'm with now, and for the fourth time ever, I've been dragged to the mall to sit outside the Victoria's Secret, playing Tetris on my Kyocera cell phone in complete bordom for about an hour. Myself nor any other male on the planet can quite fathom what the hell is going on in there. Maybe they have a magician or a free bar, who knows, all I know is that something keeps them in there forever. Personally, it takes me all of 5 minutes to walk into KMART and pick a pack of size medium boxers. Boom, done. Inside of that red-tinted store must be an entire congess that votes and debates over which pair of discount bras a woman should get. Or maybe they have to solve some sort of hard brain-twister before they get the discount. Or maybe the area outside of the store is some sort of bizzare space-time-continuum interfering wormhole. God himself is confused and baffled.

So I'm sitting outside of the store, with about 10 other guys. The mall people astutely decided to put about 8 benches outside of the store. The manager of the joint must have a wife. We look like holocaust victims. Sad, desperate, no zest for life. Then the most amazing thing ever happened. Me and this black guy lock eyes. He goes, "Man, this is bullshit! How the hell long does it take to pick out some damned underwear." Long story short, we, as men, went on a 20 minute bitchfest about how annoying this sale is. The beautiful thing is that represented were all walkes of life. A fat black guy, an Asian dude, a guy from the Czech Republic, a guy in flannel and a "Chevy Trucks" cap, a guy that looked like a CEO in an Armani suit, and a pathetic wiseass (me). Yet through our differences we came together against a common foe. The stupid ass semi annual sale. "Vhat deed I do to deserf these?" says the Czech phonetically. We all knew what he felt. Sorrow. Then the black guy's wife came out, he stands up, and says "Free at last, free at last, thank God ALMIGHTY! Free at last!" And together, as men, we cheered (kinda, we were actually jealous of the guy.) One by one, they were set free until I'm the last one standing. Then she comes. I tasted freedom. It's kinda like a creme brulee.

I'm not sure if we are sexist or not, but it was hilarious. So try all you want women, you have only made us stronger.

What's wrong with the entire universe? I know.

2006-06-10T22:45:00.000-04:00

1) Insurance companies.

So you have the Medicare D fiasco making people all over the independent pharmacy world get pissed the hell off. What's really fun to watch is how pissed off independents got after Walgreen's, the company in charge of the AARP card, screwed the lot of them over in claim payments, then had the gull to ask to buy their pharmacies after months of non payment. That's one thing.

Then you have the whole fact that there is no reason why private plan D providers should exist. It's one thing to be a little socialist. Every strong economy is a mixed economy. Yeehaw. What's f'd up is when you are going to be half-assed socialist and decide to farm out the civil services you are going to provide to private companies. Either read Marx or read Mussolini, folks, not both. How much of my tax money could be saved if the retards running the country just set up the same infrastructure that processes the part B claims for tests strips and expanded it to Rx drugs. Then these worthless asshats like Humana and AARP who are doing a shitty job as a third party won't be a parasite on my tax money by making profits.

Then there is the thing that pisses me off more than anything about insurance companies, and it isn't exclusive to medicare D. And anyone with a pharmacy background knows what I'm going to say. NONE OF THE PHARMACY CARDS EVER MAKE ANY SENSE. EVER. It becomes ridiculous. Here's an example of a card you might see. And, actually, this is a GOOD example because it tells you what rediculous things you have to do to get the information needed to submit a claim in the end. A lot of the time the card is just crap with no useful info at all.

How hard can it really be to put a bin#, the ID needed to submit, and the proper group number on an insurance card? I have a retarded redneck friend that goes around making designs in corn crops that look like aliens in a UFO making some sort of postmodern minimalist art piece, yet you bastards can't unambiguously put the 3 things on an insurance card whose only purpose in the universe is to give me the 3 pieces of information I need to submit a claim? Did the insurance card's parents drink vodka during all nine month's of it's pregnancy?

Why are there so many mentally challenged insurance cards? To hell with you, insurance companies, to hell with you.

2) People

Why the hell do people think I am a fast food worker. The thing that irritates me the most is when people just say the words, "How long?" Not "How much time do you think processing that will take", or "My mom is in pain, how long will it be until I can get some Lortab in her so she will shut up?", but, just "How long?" I'm not even worth a complete sentence? I usually just tell them something ridiculous like "5-30 minutes, give or take 10 minutes." Then I hate it when they bitch about how long it takes me to fill something. I've noticed, and this usually works, if you say "Because I'm trying to not kill you." as a response to "why is this taking so long?" it works 99.9% of the time. The 0.01% is that asshole physician that thinks he knows everything, yet writes for Xopenex after finding out a patient is allergic to albuterol. (Really happened.) This is a good segway to my next hate:

3) House, MD

Ok, I'll admit it, I love this show. It's hilarious. But ever since it went on air, it seems like every physician on Earth has started to believe that it's ok to act like an asshole in an effort to pad their internal cult of personality. Remember when the kids back in the 90s started wearing their pants backwards because of those two rapping-kids-band-thing Kris-Kros? It's the same deal.

Ok, I'm done.

Random musings.

2006-06-07T12:20:00.000-04:00

I feel like making a non-pharmacy post. You know. I'm just gonna start babbling and see where it takes me.

First and foremost, I'd like to give what I believe the kids call a "shout-out" to my new favorite composers Helmut and Franz Vonlichten of ES Posthumus. They put their entire album online for free listening. Everyone likes free stuff. If you like neo-classical music, I highly recommend it. Each song is an homage to an ancient city, and it holds true rather well. Estremoz is strong with Spanish guitar, Harappa is filled with Middle Eastern strings, and Pompeii is filled with faced paced action from electric guitar and a crazy-fast string section, you know, kinda like a city being destroyed by a volcano. Beautiful stuff.

Second, I'd like to announce that I am making a catchphrase for myself. Why? Everyone that's ever been anything has had some sort of catchy phrase that people remember them by, ergo, a catchphrase. (Duh.) Bogart had "here's lookin' at you, kid", Bush I had "Read my lips...", the crazy Scientologist that knocked up Katie Holmes wanted us to "Show ME the money!!" So in the tradition of random people being catagorized via single sentences, I announce that my official catchphrase is "I am the most humble man ALIVE!" It's just dripping with self-serving irony. I am so enamoured with how little I think of my greatness that I must proclaim that I am the greatest on Earth at not proclaiming how great I truely am. My clothing line is soon to follow. Just think of how well others could have used the catchphrase:

Lastly, I have a the one year memorial to my status as a bachelor coming up 24 June. Where should I take the wife? I have 4 days off in a row and a 4 days, 3 night getaway would be great. Anyone have suggestions?

The Facade of Academia: How to piss your professors off to the point where they want to punish you in a moderately serious manner.

2006-05-25T16:19:00.000-04:00

So I bet many of you have been wondering where I've been. In an encapsulated shell trying to avoid all things pharmacy, that's where. I am so annoyed right now I literally want to chuck the TV remote through my car's windshield so it would hurt as much as me. We will start during Thursday of finals week.

***tv picture goes fuzzy signifying flashback sequence* **

So I'm sitting there about to check my email. It's finals week, and I'm about
dead, running on "E". I got a 65 on my nephrology patho test. Yippee. That means I have to remediate it. They don't do this in any other semester of patho except the last. I have no idea why. Double yippee. I wasn't expecting greatness, I studied all of about 1 hour for it on 7 hours of sleep in 72 hours. Then it hit me. Oops. I got under a 70 on my women's health section, too. Crap, I completely forgot to remediate it. The funny part is that the P-2s took that section in the fall (they rearranged the order the teach stuff) and didn't have to remediate a test if the flunked it. Interesting, no? Anyway, I was moving to a new place that week and I didn't have time for school at all, so it doesn't surprise me I did bad on the test or missed the email. Life happens. I screwed up and I accept it. I assume they forgot about it because they never tried to contact me about. (Turns out it was in a mass email I found later announcing the test was posted....hidden at the end of a paragraph...)

Anyway, I go talk to the nephrology professor, set up a test retake and she goes, "Oh, and Dr. Makela needs to see you." This is the guy that oversees patho. I knew what it was for. So I go in to talk to him. He made me wait 45 minutes while he talked on his cell phone to some....guy. Then he comes out and leads me into the conference room. Inside are two other professors, one who I think wants me dead, and the other I don't know so much. They proceed to interrogate me intervention style. I actually am dead honest the entire time. I tell them it slipped my mind and I forgot to do it and asked why didn't they email me about it? (They did as above. But they never gave me a "hey you still haven't remediated yet, you might wanna get on that...") Then he gets all POd looking and beats around the bush to insist that I didn't do it maliciously and am trying to undermine him. (I wasn't) I'm sitting there freely admitting that it's my fault, I made a mistake, and that I truely apologize. He seemed hellbent on making the little meeting an issue of how much of an usurper I was. To make matters worse, he's a psych pharmacist, so I'm sure he was examining my eyes, or movements, or breathing, or something and is convinced I was lying about something, somewhere. He drops the bomb - he's gonna fail me for the semester. Now, I got a 70%+ overall for the course, which would normally be a "C". But because I failed to remediate, I get an "F". Most normal situations would have this call for an incomplete, but I'm pretty sure this guy wants me to be induced into an academic coma. There really is no reason why I can't just retake the test the week before rotations start. They tried to tell me that it would be unfair to the womens' health instructor to have to make a new test. She would have had to have anyway, so I'm not sure why that's relevent, but, uh, hey, yeah. Heck, if that's a problem, give me an oral exam, I'll take it no problem. So I'm told that they would discuss it and get back to me.

So I go to Philadelphia to visit my wife's papa for a week. He has colon cancer so we should probably visit him, right? (The angel on the left in white says "Yes!" The one in red on the right says, "NO!") A week of calls/emails and nothing happens. I just get an "F" on my report card and that's that. I call, they beat around the bush more, refusing to tell me what's going on. I come back, ace my nephro retake (95%, w00t!), and go to the dean. He tells me the decision is that I have to come back in October, retake that section of patho, and get a 70 on it. No rotations until then. My preceptors have been notified I'm not coming. Keep in mind that the people Iwill be taking it with in October won't have to get a 70%, just me. What a crock. So basically, I'm looking at starting rotations in November, graduating December '07. I still haven't received a legit reason as to why I can't take the test, like, next week. I still have the notes. I can memorize them. My IQ is 150, I don't need a woman to read power points to me in order to understand something. I'm too ADD to pay attention, anyway. I'l be sitting there for a minute, then the next thing I know I'll be daydreaming about what it would be like to be a Pirate or something. My classroom experience has been pretty much like that since the 8th grade. It's quite a racket they have going on. The only way to be a pharmacist is to jump through their hoops. Like taking Physics to get into pharmacy school. You know. A hoop. Even if there is no purpose to them at all, jump, jump, jump away. I guess this is just another hoop I need to jump though. I'm used to it. It's like taking Physics to get into pharmacy school. You know. A hoop.

**Return to today**

So I'm sitting here. Bored. My job hired new interns to replace me. I just kinda do nothing. I've lost 7 pounds in 11 days. All I do is play basketball in real life and play NCAA '06 on playstation while walking on the treadmill (good workout, you don't even notice you are exercising...) I really have a hard time grasping why they think it is best for me to sit around for 6 months doing nothing while I could be adding to my breadth of knowledge while it is at it's peak; right after didactic training. Do they honestly think that the 3 random things about womens' health I didn't know on the exam that would have given me a 70% trumps the knowledge that will widdle away from my brain over 6 months of inactivity? I'm sure they didn't even consider it. That would require some form of compassion. I think back to when they all assaulted me in that conference room. I asked the psych guy for advice. If he was in my situation, what would he do. Rather than being compassionate, he just goes, "I'm not the person of the type of character that would get into the situation you are in." Really. Is that necessary? They are just punishing me for perceived insubordinence using the facade of academia. This has to be it. I remember my pharmacoenomics teacher mentioning in the last week of class that he KNEW some people were cheating on their end-of-semester papers by helping each other write them. He knew because he heard people talking in the halls. Why aren't these people reprimanded? That's academic dishonesty, grounds for removal from the program, period. Yet those folks are going onto rotations. I just am an idiot that forgot to do something. I did nothing malicious (I think they think I did..that's a mouthful.) yet those who did go off scot-free? Oh well, I dug my grave and I will lay in it. It really is quite a racket they have going on. I mean, who can I complain to? You, that's who. And, sadly, you probably can't help me out. Gotta love academia. You pay people to torture you.

Finals. Ick.

2006-05-03T12:16:00.000-04:00

Finals. The thorn that gets stuck in your ass and doesn't come out for a week. Moreso this semester than ever. I question why the hell the administrators think it's such a brilliant idea to have 6 major tests in one week. 4 of which are in a 48 hour period. What the hell do they expect from me? I'm not a machine, I'm a lazy ass.

So I need to get notes. You know, me and class are barely acquaintances. We see each other on holidays. You know, tests. I never take them 'cause I'm never there. I actually tried to finagle powerpoints off of a professor a few days ago and he laughed at me. I should get a cardboard cutout of myself and put it in the back of the room for all of my classes. Then maybe the professors won't hate me and would give me notes 14 hours before an exam.

On Monday I ordered Chinese food (General Tso's w/ white rice & an egg roll for those keeping track.) I swear I'm not lying - the fortune said "You are a perfectionist - don't spoil it." I had a good laugh, as did my fellow slackers.

I took the fortune with me to my first final, kinetics, with my patented C=PharmD hoodie on. I announced in front of the teacher that I needed a 6% on the final to get my "C". I then showed him my fortune. I thought he would appreciate the irony, but he just said, "Yeah, this really describes you." and sneered at me. Ok, so I don't come to your class. At least laugh at my pathetic attempt at humor... *sniff*. Oh well. For the coup d'grace, I got the final back yesterday and I somehow managed to get an 88% on it. I don't really know how. I accidently got a B for the class. Oh well. Then came the coup d'tat. I found out I have this professor on rotations. As Scooby of Doo would say, "Rut ro, Raggy!" At least it will be entertaining.

After the kinetics final, I get home at 6PM to study for the state/federal law exam with ethics at 3PM the next day. Translation: 700 pages of crap. I'm up until 4AM. I may be apathetic, but I don't need to fail. There is a line. A thin line. I sleep 3 hours, get up at 7, read more. Take law test. I need a 61% to get a C. The bastard made the last test cumulative AND worth 50% of the grade. Grrr.

After la'ethics I get home and dive right into Pathophys/therapeutcs. Alzheimers and renal diseases. They go together so well. Mmmhmm. I learned what PhosLo is for. The name makes sense. I had 14 hours to study for it after getting home from law. I waited until after dinner. And American Idol. And House. So, uh 10 hours to study. I used 6 to study. Got about 2 hours of sleep.

I get up at 7AM, stumble around, forget to shower, and I'm out the door by 7:30. I pick up a Vendi Caramel Light Frappachino from Starbucks. I didn't think that one through too well. By the time it kicked in, the test was over and I wanted to go home and nap but was too wired to lay down. Piss. The test itself sucked ass. She's one of those professors that bases the test off of lecture rather than notes. I need a 70% for a C. If I don't get it, I'm going to kill someone.

So that leads up to now. I'm chowing down on yet more General Tso's. I'm going to gain 5 pounds this week. Oh well. It's summer, I'll burn it off. I have a test tomorrow morning at 8AM, then another at 3PM, then another 11AM Friday. Jesus Christ on a pogo stick.

One of my classmates had a good thought.

"This week is academic bulemia. You consume it, spew it back out, move one. Eat something else, spew it back out, move on. Eat something else, and so on. It's bullshit, man. There is no way any human alive can actually learn this shit. Sure, I can memorize it for the next day, but I won't remember it in a week."

True.

My fortune cookie reads "We grow great by dreams. All big men are dreamers." I think that means it's time for a nap. I reread this post and I see nothing but short little sentences. I'm sentence grunting. I'm mentally drained. Sleepytime...

Don't expect much from me any time soon.

2006-04-26T08:35:00.000-04:00

I have three papers due this week and six finals next week, so don't expect me to post anything of substance any time soon.

I'm officially a clinican...I guess.

2006-04-21T21:59:00.000-04:00

Tonight was the Bowl of Hygeia. I had to eat a dinner (got some damn good chicken...) and was then forced to sit through numerous speaches just to walk across a stage to get a lapel pin. I remember a poem in there that was tangential to Dr. Suess, but the rest of the speech time was spent daydreaming about how cool it would be to be the guy AAA pays to go around the country rating hotels and restaurants. Free food, free shelter, get to visit EVERYWHERE, AND they give you extra special attention. That would be the sweetest job ever outside of porn star.

Anyway, I wasn't allowed to do anything clinically before I got this pin, but now that I do have said pin, I apparently magically transformed into a person that has permission to treat people in the time it took me to walk across the stage. I thought I felt something funny. From what I've gathered, the pin is like the rings the kids had in Captain Planet. I think I got the pharmacy equivalent of the Earth ring because I keep pointing it at crap and nothing cool happens. Why can't I be the guy that gets the pharmacy equivalent of the fire ring? That would be so useful in the real world. I can see it now.......

Oh well. I think I'm allowed to officially call myself "PharmD Candidate" now. Woohoo.

What's in a name?

2006-04-17T12:03:00.000-04:00

I am apathetic because I don't care about school. The prefix a- means against, not, or without. Thus, as a person that doesn't care about school anymore, I am, ergo, not pathetic. Does that mean that people who care about school are then pathetic by definition?

Journal Club.

2006-04-17T09:57:00.000-04:00

So I had to get up at 7AM to go do a journal club doohicky at school. We knocked it out of the park. Others...not so much. I was talking to a guy in another room with another professor doing the grilling and I guess they started whipping out questions about intent-to-treat, 5 bazillion different tests statistical test, and other worthless things only a person specializing in drug information would know. It was so bad that my fellow apathetic student actually said, and I am not making this up, "Why are you asking us questions from a class we took two years ago? None of it is in the study! I don't remember any of that crap!" I would have died laughing. That's even more brazen than me. There is no purpose at all to a journal club. It's just to torture us. Just let me get my info from the pharmacists' letter or clinical pharmacology online. They think for me.

You know what pisses me off? Those damned shirts they sell. You know, the ones designed to be worn with a tie? First, they are packaged into a fold that is secured by about 2 dozen straight pins. I swear to God, the next time I buy a shirt, I'm covering my entire body in lidocaine. I felt like a test dummy for a 17 guage 1970's lancet device. Then you have the shirt. Uncomfortable as hell. The tie is what gets me. I guess the knot looks cool, but has anyone ever actually analyzed how retarded a tie looks? Look at me, I have a giant piece of cloth dangling from my neck. What the hell purpose does it serve? Further, aren't we supposed to try to be intellectuals using our brains? Why would I want to tie a device around my neck that would constrict blood flow to my brain?

2006-04-16T18:06:00.000-04:00

I hereby proclaim that the poster UTCPharm on SDN forums be issued the following certificate:

Why school is retarded.

2006-04-16T10:45:00.000-04:00

At some point every school of pharmacy needs to insert about 8 arbitrary classes into it's cirriculum to surround patho/med chem/pharmacology classes in order to give the illusion that pharmacy school is an intensive 4 year doctorate program. It's really, really sad. It's so sad that it has sucked all of the life out of my soul. It started as I was sitting in this retarded public health class they are moving from the 3rd year to 1st year begining this year. That means we take it with the 1st years, which means everything is dumbed down AND 2/3 of the lecture is describing things we have gone over many times in the "triumvant of hard" (is triumvant a word? EDIT: No.) med chem, pharmacol, and patho/therapeutics.

So I'm sitting there in a diabetes lecture, about to stab my eyes out, and I decide I am going to protest by leaving. So in the middle of lecture, I grabbed my crap and I left. A month later, I take the test, without any real notes to speak of, and I get an "A". So I begin to wonder, "you know, in kinetics, he really doesn't teach, he just kinda goes over powerpoints." A couple months of never going to class later and I still have a very solid B in the course (something like an 88%). Same with patho/therapeutics. I don't go to lecture and my grade is comparable to any other patho class where I have wasted my time to have powerpoints read to me. The only classes I go to are that public health class (the damned woman started taking attendence) and some class about reading pharmacoeconomic literature where the guy also takes attendence.

So I am in class 4 hours a week, plus a 3 hour lab and I STILL have a 3.0 GPA. Now it's not as good as in the past when I worshiped my notes for hours at a time, but the improved quality of life is worth it. Here's a diagram:

See, I am clearly more happy. So to hell with class. Stay home, be a slacker, get the notes off someone else, and be apathetic. It's the key to happiness.

Ahoy-hoy

2006-04-15T23:43:00.000-04:00

Good day. I'm a guy from the wonderfully podunt state of West Virginia caught up in the ridiculously pretentious world of healthcare. A pair of opposing forces that set a stage for numerous bizzare and perplexing events. What do you do if a man presents to your pharmacy with a wound from a shotgun shell grazing his chest falls in his outhouse and 14 month old feces gets into his blood stream? Only West "by god" Virginny.

Some more random things about me: I hate people from New Jersey, I have no soul, and I hate drug companies with a passion. I am also the founder of ASSPhART, the Apathetic Society of Student Pharmacists Avoiding Rigorous Tasks. The club is dedicated to doing nothing and avoiding work. So far I am the only member and the only chapter is at my school, WVU (not officially recognized). If you want to join, leave a comment or something. You can send me a check for the $20 registration fee by emailing me for my address.

Stay tuned, I may or may not amuse you to some degree.