Sarah Wheeler, on rotation. (Photo by Dan Smith, NCH)

I was both thrilled and daunted to discover my first APPE rotation would be in the emergency department (ED) at Nationwide Children’s Hospital. Emergency medicine pharmacy was my number one specialty of interest entering my final year of school, but with a lack of prior hospital experience, and years since my last significant interaction with children, I knew I was facing a huge learning curve.

One of the first lessons I learned on my rotation was that pediatric pharmacy is unique because the patients aren’t simply smaller versions of adult patients. On one of my first days, I was alarmed by the heart rate of an infant in the mid-100s, thinking she must be distressed. However, I quickly learned that many vital signs have different norms in pediatric patients that fluctuate as they develop. 

Likewise, the way pediatric patients process medications is vastly different than adults. Human growth is non-linear; therefore, distribution, metabolism, and elimination of drugs for pediatric patients are unique, making it important to use age-specific dosing or specialized pediatric formulas for calculating pharmacokinetics. Finally, dosage form is an important consideration for pediatric patients. Most young children are unable to swallow tablets, so taste must be accounted for with any liquids they are prescribed. Occasionally, patients need medications that do not come in kid-friendly dosage forms, which requires compounded medications to meet their needs.

Alison, I strongly admire your willingness to take on such a concentrated APPE rotation in a neonatal intensive care unit. I personally do not have any experience with pediatrics, however, I have had some rotational experiences in adult intensive care unit settings, which I am sure are both very similar and vastly different patient care settings. This off-label use of adult medications in children is unique knowledge to learn and an experience that will inevitably come in handy during your career. 

Way to go with following your dreams and challenging yourself! 

In order to speak honestly and openly with you, I write this column anonymously under the name “Alison.” It is my hope to provide you with insights about rotations and the many pharmacy opportunities I encounter.

Hello student pharmacists, and welcome back as I navigate along this APPE rotation journey with many of you. Last issue, I had just finished up a rotation at a renal transplant center. Now I am on to rotations three and four. 

I feel as if I had been holding my breath ever since rotations started in May, and it wasn’t until rotation four when I finally started breathing again. To go from being in a school setting for so many years, to working more than 40 hours a week, was an uphill battle. However, I strongly believe that around your third or fourth rotation, things begin to normalize and plateau. You can finally catch your breath. 

UT–Austin APhA–ASP Chapter members Helen Zhou (left) and Michelle Tran provided students with handmade anti-stress bubble wrap packages during finals week last fall.

Public perception of mental health has undergone great changes over the past several decades. Topics such as depression, bipolar disorder, anxiety disorder, attention-deficit/hyperactivity disorder, and posttraumatic stress disorder (PTSD) were often disregarded and only rarely viewed as diseases. Even now, mental illnesses are still associated with a large stigma and many people view the issues as something to “get over” rather than to treat. Although there is a more public understanding that has increasingly developed on the subject, the outdated concept of ignoring mental illnesses is still extremely harmful to afflicted patients. 

With this in mind, The University of Texas (UT) at Austin College of Pharmacy APhA–ASP Chapter started a new operation last year called Operation Brain. The initiative emphasizes enhancing the mental health awareness and education for both student pharmacists and patients. 

Operation Brain has two main objectives: to facilitate conversation around mental health and to concurrently help health professionals in need.

The first thing that went out the window was personal hygiene. When I stayed up the night before an exam, my body reflected all the usual battle scars: sleep deprived eyes, coffee breath, and 3-day-old hair. The weeks leading up to finals, my apartment became a national park with mountains of laundry and take-out tray canyons. It was completely normal for my flashcard count to exceed my steps for the day. “This is fine,” I told myself.

Just like on the graphs I had to study, my stress grew exponentially during my first year of pharmacy school. Doctorate programs demand academic rigor of their students, and reasonably so. To become a PharmD, students must receive a thorough training. However, the training you receive can also be applied to yourself. While caring for the outside community is a noble and necessary pursuit, health professionals should do the same for their own community. How can you begin to heal others if you have not healed yourself? 

In collaboration with the Howard University Chapter of the American Society of Consultant Pharmacists, I developed an initiative called “Healing Healers.” The purpose of Healing Healers is to promote healthy aging and stress relief among health professionals.