Rotation 2 – Solid Organ Transplant: A New Lease on Life

Posted by Emily VanWieren at Sunday, September 18, 2016

Rotation 2 – Solid Organ Transplant

A New Lease on Life

First Impressions

I was super excited to start my first day with the surgical transplant team. There are a multitude of complex medications used in transplant recipients, and I knew there would be a great role for a pharmacist on the team. I wasn’t super excited that rounds start at 6 AM. The first day I set my alarm at 4:15 was painful - I am not a morning person!

There were over twenty people on the surgical transplant team, which turned into a super intimidating herd of white coats blocking the hallways on rounds. The team was inter-disciplinary and consisted of physicians in all ranges of training from attendings on down to fellows, residents, interns, and medical students. There were Physician Assistants, Nurse Practitioners, and also the pharmacist. You could tell the team respected my preceptor because they straightened up when they heard her walking down the hall. She had recommendations on dosing, stopping this drug, starting that one, ordering new labs, and the team accepted the changes she suggested. I was so impressed by all her knowledge of the patients and their medications!

A Day in the Life

The team I was with transplanted livers, kidneys, and pancreases. My typical day consisted of early morning rounds with the surgical transplant team followed by rounds with the nephrologists in the morning and the gastroenterologists in the afternoon. In between rounds, I would look up questions from the medical team and talk to the patients. I interacted with even more interdisciplinary members of the team and I got a full appreciation of all the care that goes into each transplant recipient. There were social workers, nurses, discharge planners, dieticians, and even interpreters for a deaf patient.

My favorite part of this rotation was educating patients on their new medications. There are a lot of new medications transplant patients have to take to suppress their immune system and prevent infections and they have to take them on a very specific schedule. I taught them the names of their medications, why each one is important, when to take them, and when they need to get their blood levels checked. I got to establish relationships with the patients and it was cool to see their new lease on life and how serious they were about taking their medications to keep their new organ.

Megan and I were able to watch a kidney transplant from a living donor to a recipient. We weren't sure how our stomachs would handle it, but we were both so fascinated and didn't feel squeamish at all. The surgeons talked us through the procedures and we were able to see inside a living human's body! It was also cool to see the anesthesiologists in action since they choose, prepare, and administer all of the medications on the spot. It was humbling to see the whole process from donor to recipient and then educating the recipient on their new medications.

Reflections

On this rotation, I learned a lot about transplant medications and many other therapeutic areas such as diabetes, hypertension, and kidney and liver disease. It was very rewarding to be able to make an impact on patients’ lives by teaching them about their medications and how to support their new organ. On my next rotation, one of my patients recognized me and waved me down. She wanted to thank me again and tell me how well she was doing and that she hasn’t missed a dose. I spent many long days at the hospital and sacrificed sleep on this rotation, but it was well worth it to see the full impact of a pharmacist’s role on the medical team.

A Bit Much

Posted by Matthew Lewis at Friday, November 11, 2011

As you well know, things are progressing on rotation, but outside of rotation, things are crazy. I am trying to get an abstract presentation for the International Society of Heart and Lung Transplant (ISHLT). My preceptor wants a draft by Tuesday, and the final submission is due Friday. The stats meetings are quite long, but every meeting is another factor put into the big picture. My project has generated at least 30,000 cells in Excel worth of data entry (yes, I'm counting blank cells because I did have to determine if they were supposed to be empty). I have a volunteering session at Hope Clinic on Wednesday night. Our dinner with donors to the College of Pharmacy is Friday night. I have a paper, a monograph, and an in-service all due and presenting on Friday, and I should have drafts of my monograph and in-service in by Tuesday, Wednesday at the latest. I'm not complaining mind you, I'm just telling you that sometimes it gets busy and storms of deadlines batter the USS P4.

Oh yeah, stack on Midyear planning. I have a great idea of where I want to go for residencies in and out of state, but I have to figure out who I'll be talking to and what questions to ask. I also have to prep my CV and get that squared away. I very recently came to the realization that not only do I want to do residency so I can be a clinical pharmacist, but I also would like to serve the US somehow in the US uniformed services. I say uniformed service because there is the army, navy, and air force under the department of defense, but there is also the public health service, which has a uniform, ranked members, and can be deployed to disaster areas (and overseas I think). The public health service, for those of you who don't know, are responsible for the FDA, Indian Health Service, CDER, and the CDC to name a few. So, on top of all the deadlines, I've got to figure out what the next five years of my life are going to look like. They all offer great opportunity and require, at the very least, immediate sacrifices in different areas.

On the matter of residencies, I was told that I should think of stories concerning patient care that will be important on interviews. This brought up my lung transplant patients, so I asked about two gentlemen in particular when I saw my preceptor for that rotation. They are both doing well, but each had a bout in the hospital, which was quickly resolved. I then asked about another patient, Mrs. B. She was waiting for new lungs and was deteriorating. Her problem was that she was a small patient and a more rare blood type. Nothing came up. She passed away. I had talked to her a few times just one on one during rotation and got to know her a little bit. When I showed her my laptop and that you could write on it. She wrote "Please get me new lungs." half in good spirits, half pleading at that time, knowing there was nothing we could do to speed the process. It hit me hard to learn she passed. That's the risk you run when you get to know people and they want desperately to stay alive with a poor prognosis. Our system and modern medicine can't help everybody yet. I just wish that I see cases like Mrs. B as few and far between as fate, God, and human effort will allow.

What day is it?

Posted by Matthew Lewis at Wednesday, August 31, 2011

It is hard to believe it's Wednesday already and the first half of the first week of the second rotation is done. As I suspected, I am very familiar with lung transplant issues due to my PharmD project, which is finding out if an anti T-cell drug (antithymoglobulin) has a good risk vs. benefit ratio. I am loving this rotation! It feels great to actually know something about the medications and the patient population, instead of neonatal patients and issues.

However, this rotation started off with lots of work and patients. The expected learning curve is shorter, since we are now all rotation pros, having been on the scene for the lengthy time of four weeks at a previous site. I have already gotten assigned an in-service presentation, did a medication class overview, with another one on the way, got assigned a larger topic on infection protocols, and had four patients. Okay, you might not think four is a lot, but when you consider most of these patients are going home on 20+ medications,multilayered comorbidities, and need extreme education, it becomes a lot. In fact, transplant pharmacists educate everybody because anti-rejection medications like Prograf and Cellcept have severe side effects like nephrotoxicity and debilitating diarrhea which must be managed with appropriate dosing and therapeutic choices. I'm happy here though despite the work load. This is going to be great, but it's going to fly by.

Well, that was fun.

Posted by Matthew Lewis at Wednesday, August 24, 2011

My NICU rotation is all but wrapped up, and I learned a great deal about being a clinical pharmacist. Yes, there was drug information learned like pharmacokinetics of caffeine or proper medication selection with neonatal abstinence syndrome (that's when mothers have to go through methadone withdrawal or a child was exposed to illicit drugs). More so on this rotation, I learned process. How to go about researching, writing, and organizing a topic presentation. How to figure out what to expect when you initiate drug therapy and which of those results have a clinically significant meaning. My preceptor is incredibly knowledgeable about her specialty, especially since she has been with neonatal medicine close to when it really became its own branch of medicine. To fully appreciate that fact, consider that now we just give a baby caffeine to help it remember to breathe. My preceptor started her career shortly after they abandoned mechanical bed shakers.

However, this is all drawing to a close. By Friday night, the first rotation will be done and gone. Due to my desired career path, it will be a very long time before I need to drudge up the medication lessons I learned here. The process lessons I learned, like how to investigate and build the patient's story, I will take with me to my next rotation, which is transplant pharmacy.

Transplant pharmacy rotation is one of fields of pharmacy I am highly interested in going into,and I ranked this rotation very highly. Where I knew next to nothing about neonatal intensive care medications, I come into this rotation with a decent background. Although we were hardly taught about transplant medications in class, my pharmD research project is in this area and my summer workplace supplies transplant meds to patients, so I have a better knowledge on these than my average classmate. I am also glad to be back into working with adults, since I can talk to them and my classwork applies to this population more.

In other news around pharmacy school, we had our first seminar session where we learned a little bit about the P1-P4 mentoring program and then had an info session on the APhA pharmacy convention, commonly called Midyear. I can't wait for both of these things to start. The mentoring will allow me to help somebody have an easier time in pharmacy and really get their new career going. Midyear will help me get my own career going. It's scary and exciting at the same time.

P.S. Sorry about the lack of pictures. It turned out to not be an option after all. Have to respect patient and family privacy!