By “Ami”
Over the next year, I will share my unique experiences while on rotation. To speak honestly and openly with you, I will write this column anonymously under the name “Ami.” It is my hope to provide you with insights about rotations and the many pharmacy opportunities I encounter.
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“Who’s next? Please line up.” I watched as the medical technician tugged the gown over his arms and wrapped his face with the shielded mask. He walked over to the front of the bed and braced himself to climb onto the CPR step stool as the nurse stepped away from the patient’s chest.
I wish I could tell you what was happening with the patient, even the slightest history of the medical condition or cardiovascular procedure that brought him to the surgical ICU with an open chest, delayed sternal closure, and Steri drape plastic film. Truth is, it was only day 5 of my first APPE rotation and I had only just met the pharmacist who pulled me and the crash cart along with her about 15 minutes prior to the code.
My first code.
Not like on TV
It was not like what you see in the movies and television shows. There was no rapid sprinting down the hallways, no bellowing of orders across the patient’s unconscious figure, and definitely no rapid drawing and piercing of needles into the patient. It was calm. The team of 10 was ready.
I just had some questions: “Where do I stand? Anyone? Am I in the way?”
No, literally. With the essential members of the code team, I tucked myself between the crash cart, pharmacist, and newly inducted ICU nurse, crouching forward to shrink myself as if I was invisible. The 57 minutes of crouching and shifting felt like a game of pinball where I was the silver flipper at the bottom, moving forward and back and forward and back as I swerved the arms that reached around me to grab saline pushes or gloves and masks. At some point, the pharmacist silently demonstrated the assembling of an epinephrine push and sodium bicarb syringe. After the first two, demand began to increase and she began tossing boxes of epi in my direction.
My fingers trembled and fumbled.
Then an eerie silence fell into the atmosphere. Why did they turn the monitor off? Why is the surgeon just hovering there? Should I move? The pharmacist is not moving. Wait, where did she go?
“Thank you for your help,” the Surgical ICU Chief stated. He looked directly at me. My forehead furrowed, “Who, me?” I was just standing here. Nodding his head, the chief sauntered off to the nurses, making his way down the procession line thanking each and every nurse and technician and staff member.
I felt a shuffle next to me. “What happened?” I looked at the faces around me. Mostly everyone had scattered and somehow due to the shuffle, I found myself standing by the bed. Chest open, eyes shut, monitor off. “He’s gone,” I whispered to the pharmacist. That was when I turned to look at the sobbing widow behind the glass doors.
Where do I stand?
My day 5 was the first of numerous occasions where I encountered the one constant domain of a health care profession, that of life and mortality. From day 5 to now, I (along with many student pharmacists) find myself facing the quandary of “where do we stand” with our patients and their families—the ones we have saved, the ones we have lost.
From day 1 of a new rotation block, we hit the ground running with journal clubs, new drug presentations, etc. When we see the patient, we quickly transition from the pleasantries to questions about medication habits, multiple pharmacy locations, and counseling points on the new prescriptions. But what about the most human encounters? Why do we shy away into a corner as the other health providers rush to the bedside? When do we really get to interact with patients when they have just lost a loved one?
So often, I want to say something. I want to be able to look someone who has just lost a loved one in the eye and share my compassion and empathize with them. So often, I find myself holding back because if my preceptor or if the pharmacist I am shadowing that day does not do such a thing, I should not. Right?
That is what I want to ask our Preceptor Feedback author: How do I, the student pharmacist, stand tall and forward for my patients while maintaining the respect for other providers? And what other advice can you provide for students just starting out on rotations?