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! Welcome back and thank you for following along on my journey through APPE rotations. Things have changed drastically since I last checked in with you. I have since finished my rotation in the NICU and Labor & Delivery (L&D) floor, and moved on to rotation number five, the most nerve-wracking rotation of them all. However, I will get to that in a bit.
Working in the NICU challenged me in a way that I wasn’t prepared for, in a way that caused not only growth as a pharmacist, but growth emotionally. I have already spoken to the nature of working in the NICU and the babies that I had the opportunity to interact with on a daily basis. However, at that point in my rotation, I hadn’t encountered much loss.
Coping with death
My last day of rotation was a blur. I had just finished rounding on my patients with my preceptor and the other health providers on our team when we received a hurried phone call from L&D stating there would be an emergency delivery in the next 10 minutes. This emergency delivery was for a 23-week-old baby. I remember quickly grabbing the code box, knowing that we would likely have to use it, and running as fast as I could to the operating room. As I entered the anteroom to the OR, all you heard was screaming from a mother in physical and emotional pain, while nurses and physicians ran around in a confident, but frantic, manner trying to prepare. My preceptor and I immediately began calculating the doses of epinephrine and surfactant that would be needed. Within minutes our newest patient, a patient just slightly larger than my hand, was born.
Intubation, chest compressions, and three doses of epinephrine later, the neonatologist called the time of death. My heart felt a pain that was completely new to me. The tears immediately started forming in my eyes. Tears of sadness, but also of frustration. I wanted there to be more that we could have done. I learned more than I could have ever imagined on my NICU and L&D rotation, but I also learned things that cannot be taught in school. I was given the opportunity to see a life come into the world and also see it leave. I was given the opportunity to learn how to cope with death. I have been to many adult codes that ended in sadness, but to watch a child go through that process is entirely different.
Undue anxiety
At this point, I was ready to move on to my next rotation; however, I was also absolutely terrified. Leading up to rotation number five, it had easily been the most anxiety-inducing of them all. It was my community pharmacy rotation. Go ahead, it’s okay to laugh a little.
I had plenty of experience in community pharmacy, but it wasn’t where I ultimately wanted to be after graduation. My community pharmacy experience was pretty limited to where I work—which is for an HMO—meaning that I had no clue about the basic ins and outs of different insurance companies. My mind was blown by how many new medications I didn’t know everything about that were on the shelf, because they weren’t on the formulary for the company where I work. And what do you mean I have to call prescribers because of prescription errors, prior authorizations, or insurance problems? All of this was absolutely foreign to me. I was terrified.
Fast forward to the last week of this rotation and I quickly realized my fears were premature. Am I the only one who makes assumptions on how things will play out, causing myself so much anxiety, and in the end everything works out well? You would think I would have learned by now.
On different pages
The only difficult thing that I encountered during my community rotation was with my primary preceptor. We never seemed to communicate effectively. We were always on different pages. I love being efficient, effective, and knowing my expectations. I didn’t always have that on this rotation. I am usually a person who has no issues confronting a problem, but I felt uncomfortable approaching my preceptor. So instead of addressing the miscommunication head on, I felt unsure of what my role and expectations were the whole time.
So, for our Preceptor Feedback| author:
- How do you go about addressing effective communication, or lack thereof, with your preceptor?
- Is there a way to approach the topic with confidence and without offending your preceptor?
Until next time, y’all!