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The Odyssey, Part 2 – All’s Well That Ends (in) Well(s)

Wells, Maine.

An interesting choice of townships to be sure. A resort town of just over 11,000 people, Wikipedia reports that is is the 3rd oldest town in Maine. Travel southward just a short 21 mile jaunt (sorry…34 km) on the I-95 and you arrive at the popular shopping mecca of Kittery / Portsmouth on the Maine-New Hampshire border. Follow the coast to the north for about 10 km and you land in Kennebunkport. If that sounds familiar, it might be because the Bush family has a retreat there. Their compound has hosted a number of world leaders though the years, including Margaret Thatcher, Mikhail Gorbachev, Vladimir Putin and Nicolas Sarkozy during the presidencies of H.W and W. respectively.

Wells Beach is a popular destination spot, so here it is in all it’s splendor:

On the left, our position on the beach looking southward towards Ogunquit*. Bald Head is the point waaaay off in the distance. This area is lined with vistas, with proper two and three-story chalets overlooking the water, not any hardscrabble, clapboard cottages or nondescript bunkhouses to be found. A large number of the beachgoers spoke French, as evidenced by the succession of Quebec license-plates we passed as we walked along the strip.

*The purple blob pictured above is not to scale

So why Wells, you ask? This first leg was one of the easiest to identify as my father has an aunt and cousins in the area. I recall being here twice before: once when I was barely school age and again in my mid-twenties when we visited Loudon, New Hamphire to see a Nascar race. On the first trip, I have still images in my mind of a car museum (no longer in operation) and mini-golf (we saw a course, but not sure if it was the same one). The second trip stands out for two things:

  • 1) Mom wanted to hit every antique store along the old highway. Usually we had already passed them, so a-backtracking we would go! I’m exaggerating of course, but it seemed like more than a few. I think I may have even bought a diecast model at one, so we were all complicit to a degree.
  • 2) Locks! They lived in a different house back then, but when we had visited Dad’s aunt, her husband had a collection of locks. Old, new, large, tiny, combination, keyed, you name it. This was both eccentric and fascinating, with each show-and-tell explaining the craftmanship, location and practical purpose of various locking mechanisms.

Our visit this time was a short one. We arrived Sunday evening, had dinner at Batson River, conveniently located on Mile Rd leading to the beach. It was a very busy spot with a bit of a wait, but the pizza was quite tasty. On Monday, we spent the majority catching up with family at their home on the outskirts of town. It is a beautiful spot with ample privacy, mature trees and a pool. I also got to visit my first Hannaford’s supermarket for food and libations. They had a pharmacy, so like a moth to a flame, I flew too close and therefore had to inspect their fascia and fixtures, check for product ‘holes’ in the displays and look at foreign packaging of familiar cough and cold products. It was in the front left corner of the store and appeared closed off, with a drop off at one end and pick up at the other. We grabbed some Neosporin off the top shelf directly in front of the dispensary, but didn’t catch anyone within view behind the glass. After cruising the aisles to accidentally find an amazing red blend from California, we headed back for a evening BBQ featuring cheesesteaks and salads.

As a sidenote, watching one of these monsters in action is a treat:

Apparently you can cook anything on a Blackstone. If you have a hankering for omelets or just want to show off your Teppanyaki skills, this is the griddle for you!

One more TripAdvisor review if you’re interested: should you visit Wells, check out the Bitter End restaurant. I can let the website pictures speak for themselves, but if you are looking for an atmosphere that includes dory boats mounted in the yard, a bathroom covered wall-to-wall with pop-culture icons, and a fun cocktail list, you will not be disappointed.

Tuesday, Aug 13 arrived. We had bought breakfast supplies and enjoyed some toasted ham and egg sandwiches to start the morning. We checked out of the AirBnB shortly before 10am and began our next segment of the tour.

Wells (ME) –> Windham (NY)

For those who enjoy following along on real paper maps, like 5-year-old me for instance, I’ll give a quick synopsis of the route.

  • This journey took us further down the I-95, spending about 15 minutes crossing the corner of New Hampshire before entering Massachusetts.
  • Jumped on the 495 at Amesbury to venture southwest across the state. Thankfully, the main highways were mostly free of construction and road rage incidents. I learned fairly quickly that with any decent volume of traffic on the road, adaptive cruise control was not my friend. If we were stuck in the middle of three or four lanes, it was a constant speed up/slow down as cars and SUVs flew by on either side.
  • Next onto the 290 at Marlborough. We passed through Worcester and once we hit Auburn, merged back to a highway with an ‘I’ in front.
  • Other than driving through Springfield, a city of over 150,000 people, the I-90 wasn’t too interesting to drive. It was hilly and forested but the US does do a great job at rest stops; they are never too far apart and provided all the conveniences of gas, snacks, coffee and restroom facilities.
  • We crossed the NY border at Stockbridge and across the Hudson River to begin heading south on the I-87 until we reached Climax, NY (no really 🙂
  • Another 40 minutes west into the mountains and we arrived in Windham, the ‘Gem of the Catskills.’

It was now mid-afternoon and we were ready for a bit of reprieve from the car. It’s also a good time to pause the narrative and invite you back for part 3, where our story takes us to visit family friends, eat some amazing Italian takeout, white-knuckle through New Jersey, and watch tourists scream on the Talon: Grip of Fear!

Stay tuned…

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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The Odyssey, Part 1 – The Intro

Having some extra time this summer to ponder next steps in my career has come with a helping of spontaneity as a welcome side effect. One of those moments led to another, that became one of the most enjoyable road-trip adventures I’ve ever experienced. As a pharmacist on hiatus, much of the trip was divorced from my professional side, although it crept through here and there. If you would indulge me, the desire to recount this story has stoked a small fire within me to begin writing again. I will do my best to refrain from wandering off on too many tangents, jumping down rabbit holes, or hopping off tangent holes.

It began back in the spring when I was finding my way back to old hobbies and discovering new ones. It was a commitment to learning a new routine and involved connecting with friends on a whole new level. I help mom and dad out in the yard, or grab coffee with a friend in a neighbouring town. Running errands during non-peak retail hours is an added bonus! On a random Thursday, I asked Dad if he had any plans and we took a drive to Lunenburg for lunch. In the course of sampling some craft beers and deep-dish donair pizza, the topic changed to planning summer trips. Last summer we had flown to Toronto to do some sight-seeing and take in a weekend of Blue Jays games at the newly renovated Rogers Centre. It was a great time as we were in an AirBnB across the street from the stadium.

Suggesting we could do another weekend of baseball, it was met with an underwhelming response, mostly due to the air travel and the congestion in the city. Quickly, the discussion pivoted to bucket lists. I wondered if he had one. To be honest, I wasn’t expecting a firm answer; through the years, I couldn’t identify any single place or attraction that would elicit excitement. His answer rather surprised me: “I had always wanted to see the Fallingwater house”.

I will pause for a moment in case some of you are deciding whether or not you should know what that may be. My bet is that the vast majority will not. I certainly couldn’t recall anything by that name coming up in previous conversation. As an aside (one tangent isn’t too many…), Dad had taken architecture in university and had therefore studied some of the greats, including the esteemed Frank Lloyd Wright (1867-1959). Known for pioneering architectural moments in the early twentieth century, he influenced countless architects and apprentices over a 70-year career. One of his philosophies was to let the environment dictate the design of a structure. If it was pastural, forested, hillside, or urban, the look and feel of the structure would complement the surroundings. His crown jewel was Fallingwater, a ‘summer house’ built from 1935-1937 in a small locale called Mill Run in southwestern Pennsylvania.

Now that we had a destination, we began plotting our route with a few guidelines:

  • Keep the bulk of travel to main highways and interstates.
  • Whenever possible, avoid more than five hours of driving on any given day.
  • Stay in towns outside of large downtown cores. We wanted to avoid excess traffic and keep lodging costs down.
  • All four occupants in the car, mom, dad, myself and my fiancee, each needed to suggest destinations or attractions for us to map out along the way. Although we had an endpoint, this was a trip with experiences we all would share.
  • All food, accommodations, gas, consumables (ahem…wine with dinner?), etc. would all be split 50/50.

So on August 11, to celebrate my parents 51st wedding anniversary, we emptied the car of any contraband (joke 🙂 and set off to enjoy half the fun of getting there!

Tantallon, NS (Canada) –> Wells, ME (US of A)

The drive wasn’t notable, with a handful of stops for gas and bio breaks. The border was weird, as it always seems to be. Trying to remember the last time I had set foot in the US was harder than it should have been. With the pandemic in the rearview, I usually just add three years to whatever time period I ‘think’ makes sense. Thankfully it was wasn’t more than ten; in that case, border agents start asking more pointed questions about past convictions and reasons why you haven’t visited such a fabulous country in such a long time.

By Sunday night, after my calculations, we already had experienced 1/6th of the fun! We had an unflashy new currency, a brand, spanking new time zone, and shrinking distances to drive (silly metric conversion)! We settled into our AirBnB off the main drag and fought with the smart TV until bedtime.

Stay tuned for Part 2, where the adventure really begins!

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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Letter To Me

Dear Devin,

The year is 1998. It’s December, and we have just learned that we failed the physiology final midway through second year. We are despondent and openly wonder if pharmacy is the right fit as a career.

Mom and Dad tried to guide us in high school; there was no plan for university other than wanting to stay in a science-related field. Mom’s background is child-development, so she always seemed to know what her kids would do or experience before we did. Dad’s training was in the fields of architecture and environmental design, requiring spatial orientation and extreme precision. Neither knew much about pharmacy other than they had a pleasant family pharmacist and were impressed by his combination of social skills and pharmacology knowledge. Sounded like it could be a viable option.

After 2 years of a chemistry degree, acceptance into the pharmacy program was an enormous source of pride. Eager to learn about a different kind of chemistry, there was another wrinkle to consider: the advent of problem-based learning (PBL). This style of learning is quite self-directed with minimal didactic lectures. Relying on peers to help educate and problem-solve was a dramatic departure from previous university experience. Accreditation for this new program was conditional, so that added to the nerves. As an aural/visual learner, frustrations began to mount with the lack of direction. Building a house without a foundation and having to craft all the pieces from scratch was proving to be a tall order.

Rest assured, we ARE on the right track. Waiting to re-write the exam at the end of the academic year was a struggle, but you’ll earn your pass and shall soon forget how close you came to moving in a different direction.

Pharmacy has been THE perfect fit for you and your personality. The highlights are numerous, but I shall attempt to preview a few of them:

  1. Benefits of Problem-Based Learning – Stay with me here. The method that almost broke our spirit ended up providing valuable tools for your journey. We will earn the ability to work collaboratively as a clinician, vetting good evidence from the poor, and learning how to own therapeutic decisions.
  2. The pharmacy community – From our time in class or tutorial, to our clinical rotations, to our first solo shift behind the counter, to our first medication error, there will be a sense of belonging from countless professors, preceptors, mentors and confidants along the way. As an older and wiser you, I am excited to say that many of your classmates still hold special places in your life 25 years later.
  3. A wealth of opportunity – This doesn’t just refer to roles of employment with escalating responsibility. It also includes contributions to continuing education, advisory/steering committees, regulatory projects, advocacy events with government representatives, and the chance to specialize in special populations or disease states.
  4. Continuing Care – This segment of pharmacy will prove to be one of the most rewarding in our career, both as a facility consultant and later as an operations manager. Working with the frail elderly will provide a rich appreciation of the delicate balance between therapeutic outcomes and quality of life.
  5. Coaching – Watching people grow their skills and thrive along their chosen paths will become our main fount of purpose, streaming with pride. You never know when someone you introduce to the profession of pharmacy will choose it as their own career path.

In addition, there will be a few items that with the benefit of hindsight, are now a source of amusement:

  1. Carbon Paper – It shouldn’t come as any surprise that dot matrix printer ribbons were past their prime from the time we accepted that first pharmacy job. Filling out manual claims on carbon copies and mailing them to insurance plans will seem ridiculous almost immediately. Enjoy the ‘zip-zip’ sounds and the tearing of those perforated strips while you can.
  2. Sleuthing – On occasion we might feel like a big deal when reading a prescription with terrible handwriting for a drug name that hasn’t existed in two decades from an out-of-town doctor who graduated med school in the sixties. It may impress the new interns, but we have to acknowledge just how terribly unsafe many of those orders will be.
  3. Compounding – Taking out the hotplate and magnetic stirrer to melt some soft paraffin is surprisingly satisfying, that is until the the cap is removed from the bottle of LCD that remains to be added. That dark brown liquid with an unmistakable scent lingered like no other. It managed to stain everything and seemed to splash by itself no matter how careful we tried to be. Take home point: always take advantage of our yearly quota of lab-coat purchases!
  4. Errors happen – The goal of perfection is noble, but impossible. Enter each day with the mindset to help as many people as you can safely and conscientiously. We will own our mistakes and do our best to learn from them. Do not allow a singular negative patient experience to detract from hundreds and thousands of positive interactions. Our intention is to help people, and we certainly will.

To sum up, please stick with this gift of a career and keep an open mind about what kind of pharmacist…check that…person you want to be. Be thankful for the journey and the people that make it meaningful. Use your lessons to inspire others to grow within the profession. Stay curious. Stay grounded. We may never fully appreciate the impact we will have but down the road a little ways, those fingerprints will be recognizable.

Can’t wait for you to venture out into young adulthood and make some marks! Best of luck on our chosen path.

Sincerely,

You/Me #stillaworkinprogress

PS – Hashtags (#) will make more sense in about 10-15 years 😉

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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Changes and Choices

Change. It is both inevitable and unstoppable, inspirational and heartbreaking. It is both emotive and stoic, superficial and intensely personal.

This past 6 weeks have no doubt reminded me of the power of change as my place in the pharmacy world has been upended. After 25 years in the profession, a restructuring has suddenly left me on the outside looking in.

Initially, this came as a surprise; every role comes with ups and downs but usually even out over the long term. The idea of letting go of a work routine and the network of people that go along with it was always a possibility, but not something I had strongly considered. I am proud of what my teams have accomplished over the years and did my best to prepare them for their next chapters. I just know that they will continue to thrive, though I shall dearly miss being along for the journey.

Although disconcerting, the weeks that followed were full of well-wishers offering support and guidance. What could have been a much darker experience was helped immensely by a stable home life and a passion for the arts; after performing with an amazing cast in Jesus Christ Superstar last June, I am equally chuffed to be back onstage with http://stageprophets.ca for a 2-weekend run of Music Man that takes place in mid-May. It’s a grueling process, but storytelling at it’s finest!

What I have recently found embedded in this cacophony of change is a tiny, exuberant voice that grows louder with each passing day. The message is simple: be thankful for new choices and new opportunities.

“The secret of change is to focus all of your energy not on fighting the old, but on building the new” -Socrates

Leave it to a 2,500-year-old Greek philosopher to challenge the status quo by being curious and asking the experts questions on topic definitions that he did not fully understand: https://en.wikipedia.org/wiki/Socratic_method. My first choice is to adopt the above strategy and be open-minded to the growth opportunities I have today and to those that present in the future. I have looked at some graduate courses, but also have interest in other segments of the pharmacy profession outside of retail, including industry and government. There are so many directions to explore and learn, many of which I am assuredly unaware as of this writing.

“Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.” -Barack Obama

This quote from Barack resonates deeply. We all strive to make our marks wherever we dabble. I feel there are so many more contributions I can make to a profession that has given me a rewarding career to date. The thought of once again being that catalyst for change certainly excites me. I want to immerse myself into the next work environment with a renewed fervor, pushing my own creative limits and trying to make better those around me.

“Every day the clock resets. Your wins don’t matter. Your failures don’t matter. Don’t stress on what was, fight for what could be. “ -Sean Higgins

A quick web search on ‘Sean Higgins’ directs to a Wikipedia page for a former NBA basketball player turned Chairman/CEO of an investment company. Admittedly, I did not research this to any extent, but I keep picturing a resetting 24-second shot clock that is used on the court. It seems to fit.

I actually wanted to end on this one because frankly, I don’t agree with the second or third sentences. My wins did matter. My failures did matter. At least they mattered to me. They all helped to mold and create the person I am today. Those experiences will allow me to make the best choices when embracing the inevitable, unstoppable change. The latter part of the quote makes sense. Although I value the past, it will not define me. The time has come to move forward with wide-eyed exhilaration.

“Choices are the hinges of destiny.” – Edwin Markham

Quotes courtesy of https://blog.hubspot.com/sales/quotes-about-change

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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Hanging Up the White Sport Coat

Perhaps the title may be a bit confusing for some; reading a pharmacy-centric blog, surely I must have meant a white lab coat. Maybe someone is retiring or taking on a new role within the profession that doesn’t require the customary uniform?

Alas, my reason for writing today is one of personal loss. The only real pharmacy connection I can find relates to my career in continuing care and servicing the needs of the frail elderly. Quality of life is paramount in this population, but being objective with decision making requires a certain degree of disconnection, and none of it truly prepared me for this day.

My maternal grandfather passed peacefully on Jan 23, 2024 at the age of 102. It was a life well-lived and loved. He, like my grandmere (also 102) was of sound mind and independently living in the same house where my mother and her 7 siblings all grew up. It’s not often that someone in middle-age gets to boast that they still look forward to visiting the homestead for a serving of rappie pie from the oven, or fresh biscuits and beans. My teenage daughters also cherish their relationship with one of the longest married couples in all of Canada, spanning 9 decades and lasting approximately 81 years, 190 days.

He was a proud WW2 veteran and member of the Wedgeport Legion Branch 155. Stories of the war were plentiful, especially in his later years. During my pharmacy degree, I performed a 2-week hospital rotation in Yarmouth and lived with them about 10-15 minutes outside of town. They were in their late seventies at the time and were absolutely thriving. It was always amazing to me how well they both moved around the house without a hint of a limp or other injury. My grandmere would knit on the couch (still does today), while grandpere would fuss with his garden in a plot across the road. Visitors were always constant and everyone welcomed.

War stories aside, Charlie was a man of music. He was always humming and playing the harmonica. Most of the tunes I didn’t recognize save for the chosen few he would perform during fundraising variety shows at the Legion. Many of my family members participated in those shows; they never failed to be crowd-pleasers.

I was asked the day before the funeral if I would sing in the choir. It was bound to be an emotional ride for my aunts on the pulpit and we wanted to all be up there for support. Of course there was no hesitation even though I hadn’t heard the songs since the time I had been an altar server in junior high. Before we started, I made a point to say, ‘He gave us all these voices, now it’s time to use them.’ We managed to hold it together for most of the mass. The acoustics in this 200 year old church were warm and full. My mother stepped up to deliver the eulogy, and promptly read a poem she had written for her father’s 90th birthday. It contained anecdotes about returning home after being away for three full years overseas, raising eight children with his bride, his fondness for the good times, and his generous and gentle nature. There was not a dry eye in the house. Everyone did an amazing job that was fitting for an amazing life.

Rest in peace our beloved Grandpere Charlie…you’re up there serenading the angels in your white sport coat and pink carnation.

https://www.huskilson.net/obituary/charles-charlie-muise

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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100 Words

One hundred words. It all starts here.

The yellowed, rabbit-eared pages of 2023 have finally turned and we find ourselves staring at a crisp, blank sheet that is begging for the first entry of 2024.

As the 36 drafts in my dashboard can attest, there have been multiple stops and starts in getting myself back to a writing mode. I am thankful for many of you that checked in periodically to see how things are going.

I am happy to report that the passion is indeed still here. It’s time to once again choose a path of aspiration and inspiration!

#CountThem

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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Missed a Deadline

It seems that I may have moved a few things down the priority list over the past year. Unfortunately, writing has been one of them that languished near the bottom. Every so often, a spark would fire in my brain; an amusing comment about the recent demands on the profession, or an observation related to the breakneck pace of market changes, would flicker and dissipate before I had the chance to commit those thoughts on paper.

It might be a form of burnout, but with every month that passed without a completed article, the mental pressure began to rise. This was a strange phenomenon, as writing had always been my solace; a safe place to reflect and find silver linings amongst the shadows.

One night in early April, I had checked in early to a Sydney hotel room. Catching up on some messages, it dawned on me is that we were quickly approaching a huge milestone: the 10-year anniversary of this blog! In my fervor to finally chase an inspiration, I clicked on my PharmAspire bookmark, typed in my username and password, and lo-and-behold, was met with the following message:

‘For security reasons, your account has been locked. Please click the following link to reset your password’.

With the recent uptick in cyberattacks across the globe, it has been prudent for many services to impose a form of 2-factor authentication. As I hadn’t logged in for way too long, these changes occurred in the background at some point. No problem, I tell myself, I’ll just follow the link and reset.

Big problem.

The rescue email I had originally used to set up the site was on a friend’s server that was now defunct. Another method I could have used to identify myself as the user of the blog would be to provide my initial welcome email confirmation when setting up the site. Did I mention that the email account was no longer available, and that it was 10 years ago? The third way was to provide a transaction code for a paid subscription to the website. That didn’t work either as the site was free when I joined.

Thankfully, through a contact I have with the parent company for WordPress, I was steered in the right direction and was able to prove this collection of content, many of which contain fanciful metaphors and questionable sentence construction, has been created by yours truly. To be honest, I haven’t felt that sense of relief in awhile.

This is a short post. I haven’t spent the proper time to edit so forgive me for the rough nature of the prose. As I ease back into things, I’ll quickly sum up:

  • I had lost access for a short while to the site, but am now back up and running
  • Thank you to those who have pushed me in the past year to get back to writing; the pharmacy profession has been facing its share of challenges, but we’ll continue to find and talk about all the amazing things being done to improve patient care.
  • It has been WAAAY too long since I’ve written anything for myself. The break was necessary, but I’m ready to rediscover my passions.

For those who have followed me for some time, you may be aware that I have been dabbling in musical theatre over the past 5 years. The pandemic interrupted many productions, and this current project is 3 years in the making, with multiple stops and starts due to gathering limits. I have been cast in Jesus Christ Superstar, with a run this coming weekend from Jun 2-4 in Wolfville, NS.

If anything could inspire a few future posts, it’s the magic of storytelling on a grand scale!

Stay tuned…

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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Chased By The Dinosaur – Part 2

Back in Part 1, we took a brief look at the pandemic’s impact on pharmacy and the substantial wave of change we face from primary dispensers to primary clinicians.

This evolution has been occurring over the past decade since medication reviews and minor ailment prescribing were first offered in a number of provinces. With post-pandemic reopening, the difference now is that pharmacists are no longer carrying all of the burden to promote and create public awareness of accessible, pharmacy-driven clinical services. You could easily argue the opposite; members of the public are coming to expect and demand that pharmacy fill gaps in the healthcare system, particularly with assessments and disease-state management. This demand is driving innovation and challenging the very image of a standard dispensary that has existed for as far back as most can remember: a pharmacist in a white coat standing in the middle, surrounded by support staff who are greeting customers and filling orders.

To wit, I am very proud of my company’s latest partnership here on the east coast! It’s a pharmacy model that eschews the reliance of imagery that uses counting trays, pills in bottles or ointment jars to promote pharmacy. Instead the focus is on allowing pharmacy to be available for orphan patients, and better triage healthcare needs. This should help reduce the glut in emergency rooms, decrease wait times for services, and aid in the management of various disease-states.

So with all of this pushing forward, is there any hesitation? Perhaps, so let’s dive in.

First off, I have never spoken to anyone in the profession, from students, to recent retirees in all pharmacy environments, that hasn’t endorsed giving pharmacists increased latitude with respect to clinical decision-making. I have heard plenty of stories where pharmacists did indeed have a better understanding of a patient’s needs but recommendations to a prescriber were either ignored or rejected. When they first appeared in the standards, some held trepidation that they could perform injections or diagnose minor ailments. When the title of pharmacy technician became regulated around 2010, it took awhile for the profession to integrate the role.

Counting my university degree, this marks my 25th year as part of the profession. Relating my introduction into pharmacy practice with PharmD graduates of today is quite the discussion. I do tend to forget how much has come and gone until someone reminds me of something notable. For example, I recall when statins were being hyped in the late 90’s as a game-changer in lowering cholesterol and reducing cardiovascular risk. We learned the mechanism of action of these HMG-CoA reductase inhibitors in lecture. When Zocor (simvastatin) was approved in Canada during 1999, Merck shipped sleek boxes containing foil packs of shield-shaped tablets that served as a conversation pieces in the dispensary. There were a bunch of similar drugs introduced in the coming years and most are still available in generic form today. One notable molecule lost in the annals of time was Bayer’s Baycol (cerivastatin), that was pulled from the market in 2001 due to alarming reports of rhabdomyolysis, a condition caused my damaged muscle tissue releasing proteins and electrolytes into the blood. Another emerging drug class in the early 2000’s were the COX-2 Inhibitors for arthritic conditions. Effective for inflammation but less corrosive to the stomach lining than previous therapies, physicians were handing out samples for Celebrex (celecoxib) and Vioxx (rofecoxib) to patients eager to find relief. Unfortunately, the sheen came off of this therapy class due to evidence of increased heart-related events, and subsequent removal of rofecoxib from the market in 2004. It’s worth noting that these variants were pulled voluntarily. Both classes are still widely used and provide significant benefit to scores of patients worldwide. The takeaway from me was recalling the countless conversations with our scared and/or upset patients that needed to look for alternatives.

Further skipping down memory lane, we reminisce of the days of writing third party credit claims on carbon copy forms and counting pill bottles to manually create drug orders. There was no internet, no email, or laser printers. Every store had an outdated Remington’s reference and CPS versions dating back to the 70’s. Smoking was still permitted in workplaces until the mid-2000s. Older physicians wrote for arcane drug names like Ilosone, Ledercillin, and Doral. We wished that all pills were shaped like Premarin because of how they spread out on the counting tray just right.

The good news is that some things haven’t changed too much:

  1. Patients still need us to guide them through the healthcare system and trust us to be their advocate.
  2. An appropriate drug regimen can manage disease and significantly increase quality of life.
  3. Relationships made within the pharmacy community last for careers and beyond.
  4. We still feel rewarded when patients bring their baking at Christmas as a show of their thanks.
  5. Mentors are valuable no matter when or where you are on a career path.

The last point is resonant on a few different levels. When I graduated, the world was an oyster. I had a brain chock full of the latest guidelines, all the me-too drug names (brand AND generic) and 15 minute counseling monologues to deliver on each. My preceptors valued my ability to find the best answers to clinical questions, and my eagerness to create algorithms for the staff. They would admit to feeling like dinosaurs; their knowledge was a bit dated, and that we forced them to step up their games. On the other hand, I would marvel at how they would be so relaxed with a cancer patient, or be able to pick out the three most important items on a counseling document. It amazed me at the ease of which interaction risks were contextualized with the history and desires of the patient. Finally, I appreciated when they had the perfect piece of friendly advice for every situation I would encounter.

So now that I am a full generation away from that first shift, I could acknowledge that I’m too far behind, start coasting and risk being eaten whole, but I refuse to throw my hands up in the face of massive change. The work experience gained and relationships forged over the years will serve me better now than ever before. I may offer perspective and guidance to ensure new clinical tools are properly integrated into a struggling healthcare system. The advice that I still receive from my mentors may now be dispensed to the next wave of practitioners. We will complement and support each other on our respective journeys.

For those of us beyond the first leg of our careers, the dinosaur running behind us is fading further behind. The only thing at risk of extinction is the notion that our value to the profession is somehow diminished. Whether you have 5 years, 15 or 50, the quality of patient care you deliver every day will never get old.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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Chased By The Dinosaur – Part 1

It’s been over 8 months.

8 months of vaccination clinics. 8 months of feeling so close to reopening. 8 months of waiting for the miserable pandemic to end. 8 months of writing attempts that never saw the ‘publish’ button. I have therefore resorted to Jurassic Park-esque imagery to help maintain my focus for another 700 words.

During these 8 months, I’ve paused on quite a few things in my life in an effort to really seek out what is important. Like you, my friends and family have handled this crisis and coped with their fear in markedly different ways. There is a spectrum of behaviours, from outright flaunting the rules, to occasionally bending them for mental health reasons, all the way to isolating from everyone regardless of public health advice. There are members of the public in staunch opposition to government mandates and to the vaccination itself. There are others who feel government hasn’t been aggressive or decisive enough with restrictions. As a healthcare provider, I do trust public health officials. Just as I have devoted my career and livelihood as a pharmacist to seek the best outcomes for the populace, I expect the same of them. Even if we may not always agree with how to get there, we are unified in the why: we need to keep people as safe and healthy as possible.

I wrote in a previous post that time seems to simultaneously drag and disappear. While the outside world continued to be consumed by coronavirus variants, personal routines with work and school have not been the same at all. If you line up all of those long, drawn-out hours spent at home where nothing happened, they somehow condense into large blocks of time where nothing happened. In fact, I was out earlier helping an elderly neighbour shovel her driveway and asked about her husband, who hadn’t been well for some time. She informed me that he had passed before the pandemic started, which was 3 YEARS ago. Between masking, bubbles, and distancing, I’ve lost touch with so many people, but that one had me swallowing a little harder.

As we re-emerge, one thing is certain: another wave of change. Change has been foist upon us at many stages in the past 2 years, most of it has been rather uncomfortable. In pharmacy, most of the changes had to do with educating the public on everything from which prescribing services were available in the absence of primary care and walk-in services, to everything vaccine: availability, eligibility, booking, cancelling appointments, testing types, public health isolation recommendations, and more were funneled though frontline teams. We’ve contributed to getting vaccines into arms and doing our best to support a fragile healthcare system. Pharmacy initiatives that have been in the works for years have been fast-tracked, and due to a worsening physician shortage, many pharmacists are finding themselves as the main point of contact for many patients and their families. These changes are extremely stressful but they a quickly becoming public expectations. Those of us who have been practicing for awhile are attempting to meet these new prescribing expectations head on. This leads me to my next point….

This dinosaur to which I have referred isn’t coronavirus, or public health, or the confusion sown by the rapidly changing evidence. I’m actually running from the thought of being labelled a dinosaur.

(to be continued)

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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Looking Through the Hourglass

It felt like May was particularly rainy and glum this year. Maybe that’s because mowing season has started and I find myself needing to schedule 30-min blocks in between the sprinkles and showers so I don’t end up with a mire in the back yard.

Also…it’s early-JULY.

We were so happy to mark the end of 2020, and already 2021 is half over. A close friend lamented this morning that in the moment, individual days seem to be long and torturous, yet strings of them grouped together seem to disappear in a flash. It has been hopeful to see provincial governments put plans into place for reopening society given the aggressive vaccination plans leading into the summer.

My thoughts today aren’t even pandemic-related per se; in fact, my last post was about visualizing that finish line and trusting the public health officials who have access to the best evidence in the world. Instead, I’m really marveling at the amount of time spent and time lost since first receiving word in December 2019 that an emerging virus could potentially amount to a global threat. That was a full 18 months ago.

As I settle comfortably into my middle-age with a pharmacy career that spanned two decades in June, 18 months represents the halfway point to a mortgage renewal, or a quarter of the way to paying off the car. Thankfully, my job hasn’t been reduced or cut, and I have had all the means to hunker down and isolate for prolonged periods. The same can’t be said for so many who are struggling, so I am thankful my family has been healthy and safe. For perspective, that time period represents about a 1/30 of my life experience. I immediately think of my kids in junior high and high school. At a time when they should be out and about, networking, learning lessons on independence and consequence, those 18 months have meant that approximately 10% of their lives have been dominated by public health messaging and restrictions.

Sometimes I take for granted what it felt like to be a teenager. Professionally, counseling them on acne creams and birth control is part of the daily routine for me, but extremely important to them. Keeping focus in the classroom on a sunny day in May or June used to be challenging enough, but taking classes from home on Zoom calls ratchets up the difficulty. With after-school club activities all but eliminated for the entire year, there has been minimal talk of band practice, theatre rehearsals and volleyball drills. I hesitate to say the year was lost because we learned so much that will help us as a society in the future, but many opportunities for personal development were certainly missed.

We are now poised to enter phase 3 of reopening here in NS. There will be larger gathering limits, indoor dining, and tourist attractions are polishing up in hopes of a busy summer of travel. It really can’t come soon enough; looking through that hourglass, we’ve watched a lot of sand fall to the bottom. The only sand I hope to see this summer will be under a beach towel, as friends and family gather to smell some BBQ and watch the sun go down.

Time is a precious gift. Cherish those moments when you can, as time has a way of marching on whether we notice or not.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.