High school mentorship journal entry No. 4, AILEEN BI

Today’s Date: Oct.  12, 2011

Total Mentorship Hours: 61.5 hours

Mentorship Research Journal #4

My fourth journal entry begins on Sept. 7, when I returned to shadow at the VCU School of Pharmacy.  Dr. Stevens was conducting a lab with the class, while Dr. Mawyer tested the students’ counseling skills. Dr. Mawyer was a pharmacy resident interested in clinical pharmacy, like that practiced in the Ambulatory Care Clinic, due to her desire to practice “clean medicine.” 

The second-year pharmacy students were required to be able to counsel on Warfarin, a blood thinner used to prevent the formation of blood clots in the blood vessels.  The drug works by blocking Vitamin K, which aids blood clotting.  The students must have had to memorize myriad facts about the drug in order to sufficiently answer questions the patient might have.  Their directions had to be very specific, or else they could be putting their patients at risk.  Most importantly, they must be able to communicate their directions sufficiently, in a manner that was more like a conversation than an order.  In this class activity, Dr. Mawyer played the role of the patient, while the students assumed the pharmacist role. 

In addition to Warfarin, students were also required to research the INR, or International Normalized Ratio, which determines a patient’s risk for bleeding.  The ideal ratio is between two and three; a high INR indicates risk of bleeding, while a low INR indicates the risk of painful clot formation.  If the patient’s INR was too high, then the dosage of Warfarin would be lowered.  Practicing counseling skills required that the students demonstrate their understanding of the medication while preparing them for their future careers.

I participated in another class activity on Sept. 14, which focused on genetic testing.  In this activity, students researched different kinds of genetic tests from different companies.  For example, the company Navigenics offered genetic analysis that could be conducted with a saliva sample.  DeCODE offered genetic tests that could be conducted with skin cells from the side of one’s cheek.  The students were responsible for reviewing these different means of genetic testing and determining which kinds of tests they would recommend to their hypothetical patients.  When making these recommendations, the students kept in mind patient convenience, counseling services provided, level of privacy and confidentiality, and possible test limitations, which are all very important factors for patients.  This activity served to allow students to practice their research skills, which are essential for pharmacists, who must frequently research drugs and pharmaceutical companies as more and more enter the market.

After observing several classes from the students’ perspectives, it was time that I explore pharmacy school education from the teacher’s perspective.  Over the next few Mondays, I mentored with Dr. Donohoe, an assistant professor at the School of Pharmacy.  My task was to help create PowerPoint presentations for her class, using the text “The 200 Most Common Drugs.”  During my time with her, I prepared presentations on cardiovascular agents and lipid-lowering agents.  I relied on the text as my guide– by looking up terms with which I was unfamiliar, I recognized them more easily over time. 

Dr. Donohoe gave me additional help by explaining the terms I did not understand.  Through this process, I came across a slew of new medical terms.  While working on the cardiovascular agent unit, I learned about ACE inhibitors, which treat hypertension and heart failure.  Drugs that fall under this drug group typically end with “–pril.”  ARBs also treat hypertension and heart failure and typically end with “–sartan.”  Amiadorone, which also treats the heart, is known for its many side effects. Clonidine is used to treat hypertension and has to be taken often.  Pertaining to lipid-lowering agents, cholestyramine binds with the gastrointestinal tract to block bile acid, which in turn helps lower cholesterol.  LDL and HDL are two of the main groups of lipoproteins: LDL is more commonly known as the “bad cholesterol” while HDL is the “good cholesterol.”  Myopathy is associated with intense muscle pain.  This experience gave me a small glimpse into the vast amount of vocabulary students must pick up over time in order to function as pharmacists in the work field.

I returned to the Ambulatory Care Clinic on Sept. 20. This time, I mentored with Dr. Mayer, who also works as an assistant professor at the School of Pharmacy.  While reviewing a patient’s medical history, she noticed that he had Oslo-Weber-Rendu Disease but was not familiar with that particular disorder.  I watched her put her researching skills to the task and find out that it is a genetic disorder that causes abnormal blood vessel formation.  On Sept. 28, a patient with hypothyroidism, a condition in which the thyroid gland fails to produce enough thyroid hormone, came into the clinic complaining of symptoms that she believed might have been caused by the medication she had been recently prescribed.  These symptoms included intense swelling of feet, dizziness, and headache. 

The pharmacist with whom I was shadowing at the time allowed me to check the patient’s medications, just like I had seen the residents do at my earlier visits.  I found many of the medications challenging to pronounce, but the patient was very patient and knowledgeable of her medical needs.  The resident suggested that the patient’s swelling might have been caused by amlodipine, which had been prescribed to help lower her blood pressure. 

While in the workroom, I overheard another resident discussing her latest successful motivation interview with one of the physicians.  She explained to me that sometimes motivation interviews are conducted to improve patient compliance.  The patient is asked open-ended questions about his perception of his health and other matters.  The pharmacist must give empathetic responses throughout the interview and focus on assessing the barriers preventing the patient from taking more responsibility for his health, then steer him in the right direction.  She explained that it was essential that the patient understand why he should take care of his health and the steps that will take him to that direction.  She seemed content with her recent achievement, as she expressed how much she liked “making a difference” in that patient’s life.  As someone who views pharmacy as a likely career path, I was encouraged by this reaction.

As my mentorship experience has drawn to a close, I would like to sincerely thank Dr. Ballentine for arranging the numerous shadowing opportunities I received in the Main Hospital, Ambulatory Care Clinic, and School of Pharmacy.  I had initially chosen to pursue a career in pharmacy because I felt that it fit well with my personality, according to the research I had conducted on this field. 

No amount of research, however, could have taught me as much as going directly to the professional scene, where I was able to observe many different types of careers in the pharmaceutical field, from education to ambulatory care.  The students and residents I met along the way were also extremely helpful in informing me about this career path.  Overall, this experience has painted a much clearer picture of the pharmaceutical field than the one with which I had began this mentorship experience.  Now I am much more confident in my decision to pursue a career in pharmacy, and I am very grateful to this experience for allowing me to enter college with this newfound sense of direction.

“Patient interventions when you least expect them,” CATHERINE FLOROFF, 7/29/11

DSCN0959.jpg

Catherine Floroff (center) had a rewarding patient intervention experience at RAM.

 

 

For many reasons, Remote Area Medical (RAM) is an experience I will never forget. Patients in triage, the medical tent and those receiving dental care all have significant stories that brought them to the fairgrounds to receive treatment. However, I quickly learned that patient interventions can happen where I least expected it — at the smoking cessation booth.

The first opportunity I had to sit at the smoking cessation booth was on Saturday. As soon as I walked up to the booth, I was met by a woman in her mid-40s who stopped by on her way to the pharmacy to retrieve her medications. I will call her Barbara.

Barbara’s eyes looked desperate, and her body language seemed very sluggish. From her demeanor, I could tell she needed to talk about a problem she was having. I asked her if she struggled with smoking. When Barbara replied yes, I then proceeded to put together some materials that could help provide tips on ways to quit.

Then she started to cry. I grabbed a chair and brought it to her. I asked Barbara if she had a few minutes to talk about her situation and I reassured her I was there to help. We spent the next 20 minutes or so talking about her situation. Barbara was the sole caregiver of her sister who was struggling with COPD. She smoked four packs a day and found that stressful situations made her want to smoke even more. Recently, Barbara explained that her fiancé had asked her to quit smoking. She also explained that praying helped during times of extreme cravings.

When she calmed down, we were able to go over the materials that would help her on the path to recovery. In the end, she thanked me for taking the time to listen and provide assistance because her doctor never did in the past.

Patients came and went by the booth throughout the course of the day. Moms, dads, brothers, sisters and friends spoke to me about their loved ones and how they wish they would quit smoking. A pregnant woman in her mid-20s stopped to grab some patient assistance materials and explained that she planned to quit once her baby was born. A 16-year-old boy sat down in the chair to tell me that his friend asked him to start smoking for no reason. I asked him if he planned to quit. He replied that his mom smoked and that made it OK for him to keep smoking. While his story and many others are difficult to recall, the reality is that they are true.

My experience at RAM was very humbling and one I will never forget. It reminded me of why I wanted to be a pharmacist. It also reassured me that patients will always need our help. I will never forget the raw emotion I felt during my four-day experience at RAM and how these patients helped me to better myself as a future pharmacist.

“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.

“We’re halfway through our trip.” SEEMA BANGER, 6/7/10

We’re halfway through our trip. It is unbelievable!!

Yesterday was our last day in Paraiso. The clinic ran as usual, and we were able to serve about 70 individuals. I was assigned to do the vitals yesterday, which I thoroughly enjoyed.

After the house-call team returned, we had more hands to help around so I joined the consultation room for the first time. The role of a student in the consultation room is to go over the symptoms described during the registration period and perform any other exams needed (lung sounds, heart sounds, etc). It was intriguing to be a part of consultation, being a pharmacy student, while the medical students got a perspective of the pharmacy world.

This trip is definitely a learning experience, and some things will stay with me forever. We had an interesting patient yesterday who was about 12 years old and had kidney problems and thus had high blood pressure as well. She was on four different types of blood-pressure medications, which is obviously not common for a 12-year-old.

The patient population in Paraiso is very different, and each patient presents a unique problem. We were upset that it was our last day, but we were also looking forward to having the entire day off today. So on our day off today, we went to a beach called Boca Chica. We had fun, we bonded, we relaxed. It was a vacation day for us and very well spent.

Tomorrow, we are setting up our next clinic — so keep checking back to hear some more stories!