Beejal
at
Tuesday, September 04, 2012
Hi everyone,
I’ll begin by noting that words just don’t give justice to
how great this rotation is! There is so much that I’d like to say about it, so
of course this means that this is another extremely long post! O:-)
I wish that more people knew about PHO! Dr. Howle is an exceptional preceptor, and
you get to interact with Dr. Frame and Dr. Christen a fair amount as well! You are surrounded by experts in cancer, and
while it can be overwhelming, about half way through the light bulb goes off in
your head and you say “I get it!” Dr.
Howle describes it well: We have never
been taught anything about PHO in school so our 5 weeks consist of building
from the ground-up. Also, this experience would be very different
if I didn’t have the support of my classmates.
I had the rotation with Meenakshi and Tony, and we really worked well
together. We studied together, we
motivated each other, and we helped each other with advice about our
patients.
A typical day
We round with the team every morning and attend meetings
with them (Tumor Board and Presentations).
For a majority of the day, we
work up patients and look up what we don’t know about their medications. Almost every afternoon, we spend a couple of
hours on topic discussions (sometimes with the BMT and Peds Surgery students)
and patient presentations. We discuss
chemotherapy agents, children’s cancers, and supportive care. Below are a list of the topics that we got
through (it looks overwhelming… and it was indeed). In the evenings, we usually check on patient
notes and prepare for the next day’s topic discussions.
·
Acute Lymphoblastic Leukemia
·
Acute Myeloid Leukemia
·
Osteosarcoma/ Ewings Sarcoma/ Rhabdomyosarcoma
·
Neuroblastoma
·
PTLD/Burkitt/Hodgkin/Lymphoblastic Lymphomas
·
Brain Tumors
·
Sickle Cell Disease
·
Radiation
·
XLP1/XLP2
·
How cancer arises
·
Neutropenic Fever
·
Chemotherapy-induced Nausea/Vomiting Pain
·
Colony Stimulating Factors
·
Oncological Emergencies
· Anemia
There are many things great about Dr. Howle. She does weekly evaluations and is very
receptive to our feedback. We get the
opportunity to let her know if we’re overwhelmed, what might help us more, what
we don’t feel comfortable with, what works really well, what should and should
not change for her future students, and what
more we would like to see or do. A
couple of weeks after starting, I asked to see a bone marrow biopsy, a lumbar
puncture, and a patient education on chemotherapy. Dr. Howle made it happen for all three of us within
the next two days. Furthermore, Dr.
Howle’s teaching style worked very well for me.
She would quiz us every day about our patients, their chemotherapy,
their disease state, and their labs. Repetition
is my friend! She really made sure we
were comfortable and ready to be independent.
She gave us constant feedback and made sure we knew what was expected of
us. Pharmacy aside, Dr. Howle is also such
a fun person to be around! She is
dynamic, has much sought-after work-life balance, and really cares about us
beyond our abilities to be pharmacy students.
Her main concern was to get enough sleep, and I’ll be the first to admit
that sleep was ENTIRELY necessary to stay focused during this rotation.
The Attending Physicians are excellent teachers, experts in
their fields, and very open to pharmacy input.
The team consists of one senior resident, two interns, and two-to-three
medical students. This is a “Sub-Intern”
rotation, so not every medical student will circulate through our service; it
is selected by only those 4th year students who want to specialize
in it.
Reflections
Until now, I always said I liked working with geriatrics. I never thought that I would enjoy kids, but
they are all SO cute! The little ones are
so playful! The older ones have had a
tough course so far, but you have respect and admiration for how much they’ve
been through. I have always wanted to have
a relationship with my patients, and I really like what I found in PHO. I ask myself if pediatrics in a different
specialty would be as fulfilling, and I don’t think it would be. I also ask if I’d like Hem/Onc on the adults
side, and I am planning on learning that by shadowing.
Before this rotation, I really loved the patient and
inter-professional interactions in the Generalist rotation (Block 1, blogs 1
and 2), but PHO took inpatient pharmacy to another level. Similar to the Generalist, PHO had patient
interactions; however, these patients and their families are fighting chronic
disease and you are helping them through their acute problems. You have a relationship with the patient and
their family, you are in a more critical environment, and you are monitoring
very sensitive drugs. I liked the
intensity of this unit, and I think I would be great for this type of
pharmacist position.
I walked into this rotation having a slight interest in
hematology as it relates to anticoagulation.
During my Generalist rotation, I had a very interesting Sickle Cell
Disease patient which prompted me to ask, Why
not hematology as a career specialty?
I always enjoyed learning about cancer, and even worked in a basic
science cancer lab, but I never really considered pursuing pharmacy in the
cancer field.
My advice for anyone thinking
about taking this rotation
I really
didn’t have a good reason for ranking a rotation like this except that an
upperclassman gave it exceptional reviews. I think
I’ve found my niche here, but it is a very specific field and it could be a difficult 5 weeks if you had no interest in cancer. I worked day and night learning about the
cancers and my patients. Know that it will be your life 18 hours a day (with built in 6 hours of sleep!), 6 days a week (you can have 1 day off!), over 5 weeks. You also should be mentally prepared both to see the cutest kids ever and the sickest kids ever.
Looking to the future
The other field that I’ve considered is Cardiology. The Experiential Training gods were looking
out for me when formulating my rotation schedule because my next site is
Cardiology at the VA hospital in Ann Arbor.
I’ll be able to directly compare my two interests and decide what I’ll
be looking for in a career.
Tune in next
time! If you’ve been keeping up, it
seems like every rotation I get a little bit closer to what I want to be when I
grow up!
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