Maply sweetness

Nana's little maple nugget.

Some reasons I'm glad to be a hospital pharmacist

Early in my pharmacy career, before I graduated and sat for my boards, I decided I would follow the hospital practice track. I had worked in a very successful independent pharmacy while a student, but institutional practice beckoned to me. Now, just about twenty-five years after getting my degree and license, I am contemplating why I feel I made the right choice.


1) I don't have to worry about getting robbed at gunpoint.
2) No one asks me where the motor oil, sunglasses, Christmas cards or Sham-Wows are.
3) I'm not asked to fix electric razors or sell lottery tickets.
4) My workplace doesn't sell tobacco products or liquor. No conflict of interest.
5) I get to sit down.
6) My lunches are covered, and I can take timely bathroom breaks.
7) I have many knowledgeable pharmacist colleagues on site and at my disposal if I need to kick something around.
8) I am generally viewed as a learned member of a team of health professionals, not a speed bump in someone's discount palace pilgrimage or an unappreciated arbiter of prescription benefits.
9) I won't be inundated by waves of middle-aged, unemployed men armed with coupons for free Viagra.
10) I don't have to find a relief pharmacist so I can take a day off or a *gasp* vacation.
11) No smarmy drug reps dropping in. Well, they still drop in, they just can't get to me without going through our front office people. Good luck with that, Buffy.
12) No aisles full of sketchy herbal remedies and weight loss products.
13) No Muzak.
14) No Muzak.
15) Still no Muzak.
16) That was snarky. I'll try to be better. OK, I enjoy the kind of dialogue you can have with a physician after years of working side by side and carefully building a professional relationship based on mutual respect and deference. I imagine some of my retail comrades experience this if their store is inside a clinic or in a medical building. I hope so.
17) No cash registers.
18) No contact with damp/dirty/blood-stained/altered/forged prescriptions.
19) Daily opportunities to directly improve patient outcome by making major clinical interventions.
20) And last but probably the best: No screaming, snot-nosed children.

The downside? The fact there is a third shift and I am required to cover it once in a while. And there are the times the pneumatic tube system delivers blood, urine or stool samples to the pharmacy instead of the lab. I sure do dislike those steamers.

Pandemic, schmandemic

Thank you, major media outlets. No, really, thank you.

Hospital emergency departments were already overtaxed and bulging at the seams with patients, now we're dealing with what CNN has referred to as "the worried well." Who the hell got them so damned worried, huh? Who has them convinced that a little sniffle and a slightly funny scratchy feeling in their throat means they have the piggy plague? Who oversold this panic-demic?

It would be laughable except these anxious souls are truly frightened. Worse, they are filling up beds in the ER, thereby potentially delaying treatment for more seriously ill people. Ambulances get diverted down the road to the next available facility, and maybe further if that ER is backed up.

I give it two weeks before the panic peddlers pick up on this and start inundating us with touching stories about the patients that couldn't be seen in a timely fashion and are forever diminished, or dead, because of it. Forget the Tamiflu, I want a supply of Zofran so I don't turn myself inside out puking in disgust once the sob sisters get revved up.

It's just possible the real danger has yet to present itself. As it seems the H1N1 novel virus of 2009 is so far turning out to be a pig in a poke, the masses who have been taken in by the unrelenting media hype will become skeptical. That skepticism may indeed cost them their health, if not their lives, if this new virus follows the pattern of its pandemic predecessors that emerged as mild bumps in an epidemiological curve and returned months later as merciless and efficient killers.

As it stands now, I'm not sick. No one I know is sick. And statistics say you're probably not sick, either. Now wash your hands, stay well and stop the madness.

"We all gon' die!"

So much to do, but where do we start?

I've already let you in on our plans for a new flower garden in the back yard. I got most of the outline dug out yesterday, and though the actual digging was easier than I imagined it would be, the bed itself has taken on a much larger footprint than I originally planned on paper. We are going to have to hire someone to do the heavy work, or it will be years before we get this done. I'm not kidding. At least two years. Any of our neighbors can back me up on this. Once I get the outline completed, we'll call in our landscaping guy. It's nice to have a landscaping guy. He'll probably want his trailer back, though, so there's another chore to finish. Half a trailer load of topsoil has to be relocated, and soon.

Our raised bed kits absolutely must be in place by May 7 so we can get the tomato plants purchased and planted before all the good ones are gone. I probably shouldn't have picked this week to work night shift. It's going to rain all week, though, so nothing would get done outside anyway.

We also have to finalize our plans for an extension of our existing deck across the back of the garage. We know what we want to do, but there's an awkwardly placed retaining wall that has to be worked into the design. At least we have a reputable contractor, so that's one less worry. Oh, and we need to replace our garage door as well.

So. Raised beds need to take priority. Then the new flower bed. Then the deck. Well, the flower bed and the deck can be done simultaneously, since we'll use different contractors. But before the deck goes on, we may need to address the new rain garden location, so we can bury the drain pipe from the garage downspout first. Geez, it shouldn't be this hard. But it's going to be great when it's all finished. And whatever we decide, it's not going to be a catastrophe if we're wrong. I have enough of that kind of pressure at work, thank you very much.

Hurry, Friday

I need to garden.
I desperately need to get outside amidst the maple helicopters and grass clippings and get busy cleaning up winter's detritus. I have yet to clear the dried skeletons of last year's perennials to make way for the season's new growth. Old leaves are still blanketing the rain gardens and native plant borders, though they are no longer needed to protect tender shoots from cold winds and serve only to deaden the subtle colors of the newly bloomed columbines and native iris. The birdbaths and feeders need to be scrubbed and filled again. The new beds I so blithely drew on grid paper last week have to be dug, turned and amended with compost before I can even think about buying the new peonies, lavender, coneflowers, salvia and sedum that will provide summer blooms against the backdrop of the existing drifts of blue iris.
But, I dread the digging. The ground here is insanely rocky. There is no simple way to turn the earth; a shovel is a poor weapon against such stubborn, stony land. This job will require pry bars, pickaxes, rakes and maybe a backhoe to finish. Oh, and I forgot the hatchet and bow saw to cut the tree roots.
Maybe I'll just sleep on Saturday.

Ruby-crowned Kinglet

Any other avian action shots snapped in the garden this week would be pornographic. The birdies are very, very randy right now.

The changing of the guard

Last week, we lost a good neighbor. He was a retired Lutheran minister, a ham radio operator, a former Air Force Reserve chaplain, a french horn player, a radio operator on a B-26 Marauder. He flew 40 missions over France and Germany as a young man in the Army Air Corps. He was 60 years old when we moved in next door nearly 25 years ago, and became a good, although not close friend. I grew to love him like an uncle, and I am sad that he has passed.

Now, my husband is almost 60 and I am not far behind. It seems to have fallen to us to assume the questionable privilege of being the oldest couple on the block. I'm not absolutely certain of it, because I have never seen the people that live in the house on the farthest southwest corner, but I think it's a safe bet. This is indeed uncharted territory for me. I really wish my wise old neighbor were here to give me guidance. I wish I could have had one more chat with him about nothing in particular, and everything in the world. I wish I could have said, "Goodbye."

Another update on Oscar and other things

Relations have improved immensely among the feline residents here at Casa Nana. Oscar no longer hangs in the library, but has become an integral part of the pride, although somewhat low in the pecking order. Willow and Lily still have no use for him, but then Lily really doesn't care much for any of the other cats, sometimes even her own offspring. Longshanks and Oscar are pretty tight, and are often found sleeping in close proximity on couches, chairs and beds. Those two share a common history of living rough, so really not surprising that they bonded after all. Group grooming sessions are not rare. Peace reigns at feeding time, litter box visits are respected as the private moments they are, and toys are (for the most part) shared. All the cats have a bad case of Spring Fever, though, and the sound of a window opening brings most of them galloping faster than you can say, "SQUIRREL!" Soon it will be too hot for them to do much more than lie around like half-baked rolls of cookie dough, so we'll enjoy their antics while we can. Good kitties.

We're off in a couple days to sunny San Antonio to make the acquaintance of our little grandson. We met him over the Holidays, but he was pretty fresh off the showroom floor, so to speak, and not much of a person yet. He's got an actual personality now, so much fun will be had.

Looks like we picked a good week to get out of the Ozarks. Chilly nights and gloomy days predicted until next weekend. I really must get the gardens dressed and the raised vegetable beds started very soon, or I'll miss the boat. The growing season is long here, but I'd like to get the kitchen garden established before the heat of late Spring comes on. So far I'm planning tomatoes, cilantro, salad greens, bell peppers both green and red, jalapenos, poblanos, marigolds for insect control, and basil. I can't wait!

Just two days away......

From this


...and this


Merry Christmas to Nana!

Update on Oscar the Yardcat

Since his surgery a couple of weeks ago, Oscar the Yardcat has become Oscar the Library Closetcat. We started keeping him in the library because it was warm and secure, we could keep him away from the stairs in his immediate postop period, and the other cats could be prevented from picking on him. Once he got stronger, we allowed some feline interaction, but it has not gone well. Oscar is all of 10 pounds, despite having been an unaltered tom, and our big bruiser Longshanks is at least 15 pounds. And he's pissed off, so Oscar has been keeping to himself, holed up in the back of the library closet behind a heavy-duty camera case my husband keeps in there. Every once in a while, Longshanks gets a whisker bent and goes in there to pick a fight. I'm not sure this is ever going to get better.

NKA

NKA
...Healthcare shorthand for No Known Allergies.

I propose another acronym: NFWA, for No F***ing Way Allergies.

Case in point: Tonight I processed an order set for a new admit which included a list of her preadmission medications, height, weight, and allergies. This apparently tender person listed an allergy to taco seasoning. Taco. Seasoning. Not chili powder, not MSG, not enchilada sauce, just taco seasoning. I had to share this gem with my colleagues, who were suddenly all smitten with the notion of ordering in Qdoba for dinner, so it worked out well. We consumed "taco seasoning" to protect the tender one. I cheerfully fell on that grenade.

Some other NFWA I've documented include oxygen (must be from a clan of ammonia breathers out there in the hollers) and dog milk. I don't want to know. I don't want to know.

Life goes on

Today I planted bulbs. Grape hyacinths and giant globe alliums.



Yesterday I planted my feet and stared hatred in the eye.

I worked all day as the polling place captain for the Obama campaign at one of the reddest precincts in the reddest region of the red state of Missouri. I was told I should be ashamed of myself. I was rebuffed when I offered a simple "Good morning!" or "Thanks for coming out!" I was ignored, reviled, bumped, falsely accused of profane language, blamed for the injury of an idiot who wasn't watching where she was going (although I was nowhere in her vicinity), shouted at from the street, flipped off, called a communist, intimidated, harassed and stalked. Absolutely stellar "Christian" behavior from allegedly God-fearing Republican voters.

And, yet, I can't stop smiling.

As we stand on the verge.....

Chris Matthews said tonight, "I'm getting that Christmas Eve feeling." I am getting that night before the BIG exam feeling, that night before surgery feeling, the anticipation of a good outcome if I can only make it through a difficult challenge, the promise of the reward that will make me forget the trials endured to achieve it. Anxiety washes over me when I remember how elections have been stolen in the past, and the dread of the consequences if the polls prove wrong. My nebulous angst about the election in general is translating into doubts about my ability to manage the task at hand tomorrow. It will fall to me to keep the voters lined up in such a way that the sight of them waiting will not discourage other voters from joining the line. I will have to be the resource person for people who can't find a place to park, or don't think they can stand in line that long. My job is to keep them happy; my job is to keep them there. It's going to be a long, long day.

I don't believe I have ever cared so much about the outcome of a presidential election. I started this journey last autumn when I began to read The Audacity of Hope. Now, nearly a year later, I have experienced the overwhelming presence of the man himself. The sheer energy, determination, intellect and yes, love that emanates from him is indescribable. I would not have believed that I would ever stand in a line that was more than a mile long to hear anyone speak, but I did and I would do it again. "With a righteous wind at our backs," we can change course. There is absolution, after all. I must remember that tomorrow night, no matter the outcome. The hope is real. The possibility for redemption is real. The time is now.

Happy Hallowe'en!

Meow, y'all!

Abby and the Yard Cat

We recently were delighted to host our daughter and grandaughter for a two week "plus change" visit while our son-in-law was touring Korea and China with the Vancouver Symphony. Abby was enthralled by our half-dozen strong pride of housecats, but they would have nothing to do with her. Oscar, the cat who has chosen to live in our yard, was more than happy to entertain her from the safety of the far side of the door glass. That reminds me, I have to clean those windows, as well as the glass doors on the media cabinet.

Fingerprints and noseprints notwithstanding, we miss them terribly since they returned to Canada a few days ago. I really miss Abby's little toothless smile that greeted me when I came home from work in the late afternoons. It never failed to make the day just fall away. See you at Christmas, my darlings.

Just in time for Hallowe'en, Joe McCarthy rises from the dead

"I wish the American media would take a great look at the views of the people in Congress and find out, are they pro-America or anti-America? I think people would love to see an expose like that."

-- U.S. Congresswoman Michele Bachmann of Minnesota.

Modern-day McCarthyism is rearing its ugly head, ladies and gentlemen. Sarah Palin speaks of the real America, the pro-America parts of this country. As opposed to bogus America, anti-America parts? Where, exactly, would those be? I'm guessing inner city neighborhoods, college campuses, the ravaged, hurricane-scoured Ninth Ward of New Orleans, the entire state of California maybe, just for starters. What about the parts of Alaska that harbor secessionists? Sounds pretty anti-America to me. But Palin's husband "palled around" with the founder of the Alaskan Independence Party, and was himself a member. There's a word for that, let me see if I can remember.... I think it's TREASON.
Look, I'm old enough to remember the height of the Cold War, the paranoia and suspicion that pervaded my childhood, the threat of Soviet ICBMs coming over the Arctic to vaporize our cities, the mushroom cloud that hung over daily life in the Fifties and Sixties. I also remember the lies that got us deeper and deeper into Vietnam, the invocation of "law and order" that Nixon used to divide the country and garner more power for himself. If you do not learn from history, you are doomed to repeat it. Here we go again.
Apparently Ms. Bachmann has attempted to back-pedal, denying she ever called for an investigation of anti-American Congressmen and Senators. I refer you to the opening quote. Yet, in the very same statement she continues to say that Barack Obama is "not for America." I think I'll send her opponent some money. His name is Elwyn Tinklenberg, and he's received 1.3 million dollars in new contributions since Ms. Bachmann tried to play hardball with Chris Matthews last Friday.
Wake up, voters. This country is being overtaken by false patriots who do not understand the Constitution they claim to defend.

It's happening, sooner than I thought it would

I'm losing my focus, or my grip, whatever you may call it.
Work got the best of me over the last two to three weeks. Just back from a vacation, and I was frazzled on Day 1. Things did not improve as I struggled through split shifts and on to the following week, when I was tasked with training a young pharmacist who had spent his first year out of school languishing in the retail side of the profession. He is bright, but he doesn't retain processes well. He damn near broke me. I ended the week in my boss' office, actually crying. I never cry in front of people at work anymore. Last week was not much better, as new procedures for handling outpatient infusion admixtures were implemented in the IV Room without anyone actually 1) telling the staff or 2) writing out a policy and procedure. No one knew who among us was responsible for prioritizing the orders. One of the more ambitious techs took the initiative but didn't understand enough about staging chemo infusions to be able to cut her way through the Gordian knot that met us that morning. I had literally piles of new IVs to check and get out the pass-through window to go to inpatients. Lots of bicarb IVs for renal protection, first dose of the day Protonix IVs, epidurals that were let run out over third shift, and there was the TPN compounder setup to check from stem to stern before we could start mixing neonatal IVs for the day.
I've had a three-day weekend, and been able to spend some real time during the day with my grandbaby before she returns to Canada this week, but my free days were tinged with the dread of returning to work on Monday morning. It colors my every thought; I can't even bring myself to venture outside to plant a few bulbs for fear those dark haunts will intrude and spoil what is one of my few remaining pleasurable activities.
So I stay inside and tackle the mess that is my actual desktop and mail file, only to find I have inadvertently allowed my driver's license to expire. So am I senile, or depressed, or just overwhelmed?

An open letter to Barack Obama

Barack Obama, you have created a monster. You have awoken me. You have galvanized me. You have politicized me.
In the last two months, I have emailed my Congressman twice, signed petitions and volunteered for your campaign, put a yard sign out in your support, and now I've written my Senator about energy policy and the oil lobby.
I'd like to share that letter with you:

Dear Senator McCaskill,
We've all heard the chanting from the Republican National Convention echoing in our memories: "Drill, baby, drill!" It's a short-sighted, and one-sided, solution. In fact, it's no solution at all. Drilling in the Arctic Refuge will not impact our current energy situation, and will eventually do little to reduce the price of heating oil and gasoline in the next several decades. We won't even begin to see peak production the ANWR until well into the late 2020's or early 2030's. Additional off-shore drilling will similarly not have a significant effect in the near future. The answer is not to just reduce dependence on foreign petroleum, it is to maximally reduce dependence on petroleum from any source, period. I'm tired of subsidizing the oil companies' profits, and I'm tired of subsidizing petty and dangerous oil rich dictators like Chavez. We need to stimulate research and development of alternative energy sources, provide incentives for conservation and strive to protect and cherish the wilderness areas that survive, rather than sacrificing them on the altar of political expediency. Thank You for your kind attention.
Sincerely,
Jacqueline B. Watkins, RPh
Springfield, MO

Look what you've done.

Time to pay up or hang up the pestle

It's pharmacist license renewal time again. I've already renewed my "license by exam," a.k.a. my original pharmacist license earlier this year, and now it's time to pay The Man in the state where I actually practice. It's a rite I repeat every two years to assure my continued ability to make a very decent living in a profession that shows little sign of slowing down with the economy. As long as my generation keeps on keeping on, there will be work for me and my colleagues aplenty. I really shouldn't complain about forking over 375 clams every two years, but it does make me whimper a bit. I'm secure in the knowledge that should my Board ever decide I've been a bad pharmacist, they will most assuredly be able to afford lots and lots of rope with which to hang me.
Cheers!