“I encountered the little boy …” CHRISTINE NGUYEN, 7/25/10

I encountered the little boy of 8 years old and his young father in triage.  The boy closely resembled his father: brunet, tan, large eyes, shy, anxious.  As the nurse and I took their medication history, blood pressure, blood glucose  and the like, I could see the tiredness in their eyes, the worried look in their faces.  It was all new to them, and it seemed as though the boy did not know why his father had brought him here. 

We took in medical information from the father, and he talked about his job in construction, the long hours, the physical strain.  I was immediately touched by how hard he worked, yet he had still mustered up the time and strength to bring not only money, but health care for himself and his little boy. This was true love and caring.   At the end of our meeting, I gave the boy juice and crackers in an effort to raise his spirits and gave the man crackers since his blood glucose was low.  I bid them goodbye and saw my next patient.

Hours later, as I was working at the pharmacy area at RAM, taking drug prescriptions from patients, I saw the familiar tall man and his son walking toward  us.  I smiled and waved at them.  The boy smiled back.  The man, mouth full of gauze due to his dental extractions, smiled with his eyes.  I asked them how their day went, and they answered (or nodded) enthusiastically.  After all this time, all this waiting and all this pain, they were truly happy.  This, I thought, is the reason why I am here. To see a patient from beginning to end, to know him on a personal level, to actively care about his health  and to see him off until the very end.  This is what pharmacy is all about. 

There were times when I would see a patient for the second, third  or fourth time at RAM.  We always greeted each other with a warm smile, a manifestation of mutual regard for one another, a trust and an understanding that, truly, there is no rift between him and myself, between volunteer and patient.  Immersed in this intense, compassionate environment, I was changed. 

Because when you are surrounded by thousands of enthusiastic patients despite the defeating odds they face, and hundreds of volunteers fatigued and pressed for time, you cannot help but hope.

“It almost seems surreal to watch …” AMBER LANAE SMITH, 7/25/10, 8:21 a.m.

Location: Triage

It almost seems surreal to watch as nurses, pharmacists  and volunteers begin to tear down the triage area. For the last three days, I have watched as health professionals from all backgrounds worked together for a common goal — something that to me is the epitome of what we all as humans should strive for — love and support of people. This is not my first year at RAM, but it has definitely made my list of top five favorite moments of service.

For me, this trip didn’t start on Thursday morning at 5a.m. —  instead it started the day Adam Krukas handed over his title of team leader (trust me, those were big shoes to fill)! I had visions in my head for where I wanted to expand our team roles and how I wanted to use our team to create an atmosphere that shows pharmacists are an undeniable asset to the health-care world. With a brain full of ideas and an executive board who was willing to work hard, we set out to make this year’s RAM better than any other year (a feat I believe we accomplished)!

Our emphasis as a team this year focused on two vital areas of health care: health education and smoking cessation. In each of these areas, I feel our team excelled and gave the best they could to arm the patients at RAM with tools that could improve their lives. While some efforts were received with open minds and lots of attention (the game), other efforts were harder to approach because they are never easy topics (smoking cessation). But I firmly believe that in each area, at least one patient gained some asset that will help them succeed.

One area that I feel we had the most success in was the A1c clinic. In this part of the triage, the patients had to wait for five minutes to receive their test results. It was during this time that the pharmacy students were able to devote their efforts to direct patient counseling. Several of us spent long periods of time educating patients on the importance of controlling their blood glucose, and we really got to know our patients.

There were a few patients who I talked with at length about their diabetes and their health care in general. Two patients in particular, my “mountain man” and my “veteran,” reinforced my desire to provide everyone with the best service that I can. I saw my “mountain man” all three days, and together we did everything we could to get his blood glucose to drop (a feat we never accomplished — although he still referred to me as his angel from heaven — a nickname I’m not sure I’m worthy of).

The “veteran” was a giant man (not in weight, but in stature) who had kind, old eyes and a heart of gold. I managed to get this patient a world-class treatment on his mouth and some of the best patient care possible. I followed him through the day and checked in multiple times; each time, he had a huge hug for me (and I’d be lying if I said it didn’t make my whole heart soar when he did).

There are two other aspects of RAM that I feel deserve attention, before I finish. The first being the friends you make with other health professionals, especially the nurses. It is amazing to watch as people come together and work so hard from 5 a.m. until 5 p.m. Some people spent the entire day refusing to eat so that more patients could be seen; others rotated through, caring for their teammates they had just met a few hours before starting.

There were three nurses in particular who I felt gave our pharmacy students the best education they possibly could (Vicki, Carol, and Pam). Each of the nurses was excited to impart their years of experience upon our students and made it fun in the process. (Just ask Derek — his nurse made him think she was crazy and danced for her patients)!

But even more amazing than the nurses was our team for RAM this year. Adam said it perfectly when he said that it is amazing that the VCU School of Pharmacy RAM Team is the only student-run organization (with a wonderful preceptor, of course — Dr. Sisson). And in my personal opinion, we did one heck of a job providing the best care we could this year. It has been an absolute honor and privilege to work with each of the students on my team. Every single one of them has touched my heart in a different way, and I will never be the same again.

How can you put into words the impact that service has upon your life? Each year I strive to give all that I have to people, I expect to leave giving everything I have got to improve each person’s life. And yet at the end of the trip, I find that I take more with me than I feel I could have ever given. Not only do I get the opportunity to leave with new friends, I take home stories that make me laugh or cry (or laugh so hard that I cry), things that gross me out  and, above all, I take home a heart overflowing with a desire to love people that much harder and give them that much more of myself. With gifts like that, how could anyone not want to be a part of RAM?!

Look at my life, look at my choices. I think it’s safe to say that anyone who devotes one weekend to RAM made the right choice.

“There is something completely different …” AMY DEMBOWSKI, 7/25/10, 6:53 a.m.

Location: Triage

There is something completely different about treating a population like the one we are seeing at RAM — whether there should be or not, there simply is.  Here, members of dentistry, nursing, pharmacy, patient advocacy and education work together to fight something greater than any illness or disease.  We fight the inaccessibility to health care that has led so many people to their current state. 

New this year, the pharmacy students have been running stations for point-of-care HbA1C testing, and I have had the opportunity to work here for a large part of this weekend.  These patients have been incredible. Most diagnosed diabetics, they can explain their medications, describe how they do their foot exams regularly  and actually want to understand their A1C values. Unfortunately for others, some have never been told they have diabetes. 

I met an amazing man today, a man who spent over 30 years as the chief manager in a coal mine where he had countless stories of coming to the aid and at times saving his workers following accidents.  But behind his stories and humor was a man worn with age and reliant on free medical treatment — a man who today would be diagnosed with diabetes. Following a blood glucose well into the 300s and an A1C of 9.5, he was a prime example.

As I told him what these values meant and explained to him what diabetes was, I could feel his fear and worry.  I was so thankful to have the time to walk him through the situation and go over what may take place during his trip to the physicians following our discussion. I walked him to the urgent care area, where physicians and medical students see patients with extremely high blood pressures and blood glucose levels. As I left him in their care, I was happy to hear the physician begin his conversation with empathy and patience. He emphasized that diabetes was manageable and described the details of my patient’s future care. 

With that moment, the simplest realization occurred.  At RAM, health-care providers are not just connected by knowledge and clinical skills, we are connected by compassion and a devotion to these patients. We work collectively in a way not seen in many health-care settings presently, yet it feels more comfortable than anything else would. 

When you come to RAM, it is not all about the clinical experience that you will gain, while as students you get plenty.  It is about comforting the fears of patients, hearing the stories from those who just want someone to listen  and playing tag with a 6-year-old who just waited four hours for her mother to see a doctor.  These people are unique, they are incredible, they are grateful, and overall they are in need of whatever we can offer them.  This is one of the most rewarding things I could’ve ever done, and I know I will be a better pharmacist and person for it.

“This year has been so much fun at RAM.” HOLLY MOORE, 7/25/10, 6:25 a.m.

This year has been so much fun at RAM.  I came last year for the first time, and I was given many different jobs.  I helped in the pharmacy pre-counting antibiotics and pain medications, worked in triage taking vitals and information, and talked with patients in triage about their current medications. 

This year, while many of the same jobs were offered, I was really able to do a myriad of new activities.  I volunteered as a “runner” and helped a social worker discharge patients from medical care.  I also worked with two women who were performing pulmonary function tests on patients with lung problems.  In the triage area, I was able to do A1C checks on people and counsel them on proper glucose control. 

With all that said, probably my most memorable activities were when I was distributing goodies to people.  We played a game in the grandstands as people sat and asked them questions about healthy living.  Thanks to fundraising and generous donations, we were able to offer books, shirts  and food to anxious patients.  Furthermore, thanks to the Massey Cancer Center’s donation, we were able to pass out athletic shirts to patients. 

Lastly, I spent some time in the vision tent where glasses can literally be made in less than an hour.  Here, the Lions Club had boxes and boxes of sunglasses for the patients.  People could pick any pair they wanted, completely free.  Every time I told patients that they were free, they got so excited.  It was so much fun seeing how grateful they were for anything.  It felt like a small Christmas, giving patients these items.  It’s the most refreshing thing in the world to be able to please someone with such small gifts.

The thing I’ve always said about RAM is how great it is at humbling a person.  In pharmacy school, everyone gets so caught up in what they think is important — grades, organizations, residencies.  It’s so nice to come to RAM and realize what’s really important in life.  Being out in a field working from 6 a.m. to 6 p.m. with patients and other providers really lets you get back to the basics. 

I just wish that everyone had the ability to experience this because I really feel that it would bring us all back down from our little pharmacy bubbles and make us realize what we should be focusing on.  I’m so glad I’ve had the opportunity to come for two years in a row.  It gives me stories and memories to tell everyone about, and it’s definitely an experience that you can’t find anywhere else.

“What does it mean to be a professional?” ANDREW CARMICHAEL, 7/24/10, 2:40 p.m.

Location:  Triage

What does it mean to be a professional? I found out it’s giving back to your most needy population base; learning from the patients as much as they learn from us. RAM has reaffirmed some of the most important feelings I have about pharmacy, such as the need to serve the community with not only my expertise but my time and emotions.

I’ve talked to patients about their health, diet and prescriptions. I’ve spent time relating my hardships during the long process of giving up smoking with theirs in the hopes that it can inspire them to keep trying to make themselves healthier and kick the habit themselves. The dentists spent time showing me extractions, root canals, restorative care and fillings so that I could understand their profession a little better and come to respect the work they do more intimately.

I had to break the news to patients in triage that they were not as well as they thought they were, by taking their vitals and A1C. Throughout all this, there were thank you’s that were unblemished by saturated gauze and small winces of returning pain. The patients appreciated everything we and all the other health professionals had to offer. This is keeping so many from unforeseen illness, disability and ER visits.

By educating and taking care of these patients, we give their children and children’s children the chance to improve life, health and even financial well-being. RAM is an example of the roots that embody each medical professional’s oath and what we all seek to do for our patients. RAM will be the drive for me to continue my professional career and the reminder that it’s important to dedicate our time, free of charge, to our communities. Our reward is being their gatekeepers to health and their friends as well as providers when they are in duress. I can’t express the gratitude I feel for being chosen to take part.

“After running around for most of the day …” ERIKA STIENE, 7/24/10, 2:20 p.m.

Location: Triage

After running around for most of the day yesterday, I spent most of this morning in triage working with an older nurse from U.Va. I’m not going to lie — even though I have been here before, when I first sat down with her I was slightly intimidated. You could tell she knew her stuff and had everything under control, so I definitely didn’t want to be the pharmacy student that got in her way.

Initially she ran the show, but as time went on she felt more comfortable trusting my readings for vitals and took the time to explain to me different conditions or procedures. By the end of the day, instead of me thanking her for all of her help, she was expressing with other nurses how thankful they were to have pharmacy students with them in triage. They explained how nice it was to have a student to clarify drug names, normal doses and indications.

Some of them had never even heard of certain medication these patients use. For example, they had never heard of Suboxone, a medication many of these patients unfortunately use to treat drug addictions. These few comments helped affirm another reason we are at RAM.

With all of these health-care professions in one place, pharmacy can often get lost in the mix. Many people have no idea what skills we possess or are even confused how a pharmacist can help in a setting like RAM. Although not always explicitly recognized, through our involvement in triage, the grandstands and the medical tent, pharmacy students definitely play a helpful role in RAM.

“Both days at RAM have been scorching hot …” SHREYA PATEL, 7/24/10, 1:40 p.m.

Location: Pharmacy

Both days at RAM have been scorching hot, but it doesn’t matter because the experience has just been beyond imagination. This is my first volunteer event where I have seen and helped this many people. Word on the street was a number close to 1,500 people showed up.

Yesterday was amazing for me. I started of my day with triage, where I was paired with a nurse. I did blood glucose testing while the nurse checked blood pressure on the patients. It was overwhelming at first, but once patients started pouring in, the process became natural. This was a great confidence booster in the communications field.

After triage I shifted to the grandstands where all the patients were sitting before they were registered. This was also something different for me. I helped patients fill out their personalized medication lists. It was a great feeling when I was able to help them figure out the name of their “water pill” or “stomach pill.”

While I was there, the vision center needed help making glasses and they were looking for dexterous people willing to help. I thought that would be very cool. Since the stands were taken care of by other pharmacy students, I decided why not go try something different? So there I was, in a bus spotting and aligning bifocals and single lenses before someone took them for cutting. After that I was in triage for most of the day.

Today I was in the pharmacy at the pick-up area where I counseled patients. That was the best part of this trip for me. I have learned a lot in this trip and would definitely want to be part of RAM next year. I would recommend it to everyone, if they can. I loved the group we had and the amazing experiences at RAM.

“Running around on only …” AMANDA KROLL, 7/24/10, 11:09 a.m.

Location: Pharmacy

Running around on only eight hours of sleep in the past two nights, I finally have a minute to sit down, relax and reflect on the events of the last two days.  Friday started out at 5 a.m. in the pharmacy with a moonlight inventory of medication. 

By 8 a.m., patients finally started to trickle around to the pharmacy to start picking up their prescriptions. I had a really great time and learned a lot from counseling patients on their medications since this is not something I usually have the opportunity to do while I am at work.  Adam’s cheat sheet was really helpful, and I was able to learn a lot by listening to other people counsel patients on their medications, as well.

After a FABULOUS lunch, I went to triage — which I was slightly nervous about.  I was teamed up with a couple of great nurses who were really knowledgeable and helpful in showing me how to triage patients.  The most rewarding part of this experience was talking to the patients and learning their stories.  I had numerous patients tell me how thankful they were for RAM.  One lady told me that she made too much money to qualify for Medicaid or Medicare but not enough to purchase her own insurance since her employer didn’t provide it.  If it weren’t for RAM, she and her son would not have had the opportunity to receive health and dental care this year.

I also had the opportunity to work with Mary and her smoking-cessation booth.  She is so knowledgeable about the negative effects of tobacco and empathetic to those who are addicted to it, it is truly inspiring.  After spending the afternoon with her I really started pushing tobacco cessation because I realized how much the patients really are listening and taking to heart what we have to say.  The women’s health booth right next door to the smoking-cessation booth was full of bright and positive women! They are such an inspiration, and I look forward to seeing them again next year.

The group that came along to RAM from VCU School of Pharmacy is amazing! Everyone is so much fun to be around, and I am learning something from everyone! I can’t wait to see what the rest of today and tomorrow bring!

“What an enriching experience …” ADAM KRUKAS, 7/24/10, 10:09 a.m.

Location: Pharmacy

What an enriching experience we are having here at RAM.  We started off by making the seven-hour drive out to Wise, Va., with team member Christine Nguyen.  After making several wrong turns, we finally arrived at the Wise County Fairgrounds and helped with setting up the pharmacy. 

The next day started at 5 a.m. My responsibility was to help coordinate the pharmacy operations.  I trained students on procedures such as how to process prescriptions and counsel patients on medications. 

Most of the prescriptions that we filled were for the dental clinic.  Many of the patients come to the pharmacy with bloody gauze in their mouth after their dental procedure, and many of these patients can’t speak because of the gauze.  When we ask for information that we need to fill their prescription, we have to ask them to write their information down instead of just tell us.  We made it a point to counsel patients to let them know the important facts about all of their prescriptions, since many patients may not have access to health care besides the annual RAM clinic. 

When creating the formulary for the RAM Pharmacy, we focused in on the medications that can be found on the $4 plans.  This allows increased ability for patients to afford their drugs and continue to take them to control their health conditions.

This is my third year attending RAM.  I have really enjoyed the experience of speaking with the patients, seeing their point of view and hearing their stories about how they do not seek health care because they do not have insurance.  One of my most memorable patients last year did not have insurance, but was having heart attacks and could not seek medical attention.  It is scary to think that anyone would not have access to care under those circumstances. 

Last year, the VCU School of Pharmacy RAM team created some new programming to spread the word about resources about smoking cessation.  This is a great need out in Wise, as many people smoke here.  We focused on the health benefits of quitting, as well as the cost savings.  Some patients were motivated to start quitting that day, while for some patients, we started the thought process for them to quit.  

Overall, RAM has been a great experience.  Between gaining practical skills, interacting with patients and talking about their medications and disease states, encouraging smoking cessation and hearing patients’ stories, RAM has shown me a new perspective in health care.   Having grown up in the suburbs of New York, I never saw, firsthand, people without access to care.  RAM has changed my perspective and increased my desire to continue to do medical mission trips to help those with unmet basic medical needs.  

“Drills, pulled teeth and bloody gauze …” DEREK MIRES, 7/24/10, 9:37 a.m.

Location: Pharmacy

Drills, pulled teeth and bloody gauze are pretty unfamiliar sights for a first-year pharmacy student.  But today, I spent my morning shadowing the professionals in the dental unit.  It was a pretty amazing experience, to say the least. 

Patients wait for hours to have their entire mouths cleared of teeth.  I was able to see a man, not much older than myself, have every tooth pulled from his jaws.  The dental surgeons were whispering words of encouragement, and the dental assistants lent their hands for a reassuring squeeze. 

Later, Dr. Sanjiray, an experienced endodontist, demonstrated a root canal.  He narrated every step and was quick to answer any questions. It was great to see the perspectives of other health-care practitioners.  I feel more prepared to counsel the dental patients on their prescriptions.  Overall, it is an experience that I wish more of my classmates could partake in.