I was discouraged. I was frustrated. I found myself at the end of another shift at the hospital where I all I could think about were all of the ways the healthcare system is broken. For those of you that may not know, the healthcare system IS broken and has been for a long time. I wanted to jump on my soapbox and complain to the world about all of the injustices and frustrations that I felt. I started to review my career path and point out bad decisions that led me to this overregulated, underappreciated source of overtaxed income that required dedicated years of my life in study and mountains of loan debt to achieve.
I opened the web browser to navigate to my blog page and what did I see when the home page loaded? Negativity, hostility, fear and complaints. Did I want my small contribution to the world to be shrouded with all of these same feelings? What are all of these headlines accomplishing? Will it make anything better to list all of the many problems that I have identified with the current healthcare system? The answer to those questions, for me, was “no”.
I almost closed it up and found another activity to occupy my time when I began thinking about some of the good things that has resulted from my path. I remembered my time at a small, rural hospital and some of the lessons that I learned there that have shaped me into who I have become today. I looked at the calendar and despite suggestions from politicians to ignore Thanksgiving, I needed to take time to be thankful for a few things that I have overlooked. So, here goes.
I once worked in a small rural hospital. Some may think that to be a quaint place to work. Snuggled down in the valley between some mountains and an hour away from the next “big” city with larger, more “sophisticated” hospitals. It could be described as quaint if your definition includes the picturesque view, the patients that were almost always related to one of your coworkers and the fact that you could walk/run to the other side of the hospital in minutes rather than waiting for the elevator to take you up 15 floors. Some incorrectly assume that because a hospital is located in a rural area without the luxury of fancy robotic surgical machines and the budget for a large inventory of drugs that what they do is simple. They are mistaken.
- Do you have a two-year-old having seizures? You can’t send them a mile down the road to the hospital specialized in treating children. You are responsible for that patient.
- Did a home birth go wrong? You don’t have the luxury to divert the ambulance to the hospital with the fancy NICU. You have to do what you can to stabilize the patients and organize their care.
- A gentleman is experiencing a heart attack but lives 45 minutes from the nearest hospital….. YOUR hospital. You can’t direct the EMT’s to a closer facility as one doesn’t exist. You simply make your preparations and pray for the patient and emergency crew that they are able to deliver a patient to you with enough heart muscle left to actually save.
- Did a local farmer experience a traumatic accident with large machinery? The closest designated trauma center is miles and miles away. You do the best that you can to stabilize the patient and pray that the sky is clear so that he may be airlifted instead of transported by ambulance.
- Did someone experience a fluoride burn at the local factory? You better be ready to dust off that old binder with the recipe for calcium gluconate gel and prepare it ASAP. He doesn’t have the time for you to be indecisive or incompetent.
- Did you run out of a medication? You CAN borrow it from a neighboring hospital but the closest one is at least an hour drive and that is IF they have the drug available to lend to you.
- Did you just hear reports of a tornado touching down in a neighboring town? You comfort the coworkers who have family members there the best that you can as you prepare for the onslaught of patients that you are sure to receive. All hands are on deck for this one!
- Strokes, psychiatric patients, broken bones and many other things can be dropped at your doorstep at any moment and you are expected to know exactly what to do and how to do it with limited resources. Transportation to another facility is possible but they are far away and the patient must be stabilized to endure the trip.
But it wasn’t the experiences by themselves that taught me the most. It was the people. In situations like these, you cannot depend on extensive IF/THEN types of protocols with detailed steps for each situation like some larger facilities. The larger facilities are considered experts in their area because they see a larger number of patients with similar ailments. They have the opportunity, equipment and larger staff to prepare and require strict protocols for their most common encounters. While I recognize some benefits to these protocols, I have a deep hatred for them in general. I have found that while they are intended to decrease med errors and improve safety, they lump everyone with a particular condition into one box and treat them the same. They are so simplistic in some cases that a monkey could follow the pathway of treatment. Each patient is different and, in my opinion, needs to be treated as such. What may work for one patient can be harmful to another if critical thinking and individualistic approaches are not utilized. I promised that I wasn’t going to spend this article complaining so I will stop right there. The point of this side-tracked topic was to point out that while the hospital had multiple protocols in place, most were intentionally left vague in order to allow the caregivers at the bedside to use their judgement as to what was best for each patient. This is why the people at this hospital were so very important. Here are just a few of the lessons that I learned from them:
CS
CS was my director. I didn’t always agree with her decisions and there were times that they really irritated me. Over time, I realized that the decisions that I hated were actually the best compromise that she could make from her multiple meetings with upper management of the hospital. She was the buffer from their attempts to cut costs and our desire to do everything that we could for our patients. It took me a while to understand, but once I did, I really appreciated her way of standing up for us.
Although she worked hard for the hospital, she knew the importance of children. She cut her hours to part-time when her children were young and knew first-hand the struggle of raising a family and balancing a career that you worked so hard to achieve. She was the first to let me know that it was ok to put my children first even when that made her job more difficult. I am forever grateful to her for lifting that unrecognized burden from my shoulders.
The main lesson that I learned from her was really a reiteration of a lesson that I learned in childhood. “Don’t complain unless you have a solution”. Her door was open to discuss of any problem but if you had a complaint, you better be ready to offer a solution. If not, you would find yourself in charge of a research project, committee or a significant workload increase as you searched for an answer.
Thank you, CS, for reminding me to look for solutions and not for problems!
MS
MS worked on the IT side of the pharmacy. He was of the Muslim faith. Growing up in a small Kentucky town, I had never had the opportunity (and to be honest, the desire) to learn about this faith practiced by so many in the world. When I first met him, we worked in a tight office space. He would always step back to make room for me to pass and never shook my hand. I just assumed that he was a germaphobe. It turns out that his religion prohibited him from touching a woman that wasn’t his wife. He graciously explained this to me and to many others in future meetings that we attended together. It was a first-hand lesson in differences in culture. While it was easy to criticize the fact that his wife walked behind him (not beside him) down a hallway as an assumption of his male chauvinist side. He didn’t hesitate to take time off of work to care for his children and wife when she was ill from the flu. He respected her and simply showed it in a different way than I understood.
Thank you, MS, for teaching me not to assume the reasoning behind someone else’s actions!
DS
DS would only work evening and night shifts. At the time, I didn’t understand the desire to be left alone and not have backup when you needed it. He explained it as a way to come to work and do his job without interference from anyone. He rarely had to attend a meeting but gained all of the relevant info in a short email. This was another lesson that I learned to appreciate when I changed hospitals. I have purposefully arranged my schedule to avoid all meetings and requirements of daytime hours. This allows me to take care of my patients without being interrupted by the minutiae of daytime “required” meetings, inspections by outside organizations and interruptions by people that really have no idea what or how I do my job. It changes the focus to the patient and away from the business of a hospital.
Thank you, DS, for teaching me all of the benefits of being a night-shifter!
DB
DB is one of the smartest pharmacists that I have ever met. He never stopped trying to learn. This gentleman would work a full day at the hospital and then go home and read medical journals. If I expressed an interest in a topic, he would find a relevant article (or three) and would have copies on my desk within a few days. He would then wait for me to read them so that we could discuss their merits and application to the question that we discussed. He really pushed me to up my game. He did this in a very humble manner. He just enjoyed discussing hard topics and learning. He discovered an interest in the kidney. He would discuss this with every visiting nephrologist, shadowed clinics and read everything he could find. I would put his knowledge of the kidney against any nephrologist and feel confident that he could easily surpass them (although he would never admit it).
Thank you, DB, for teaching me to never stop learning!
SV
SV is a mom, wife and pharmacist. She knew the importance of scheduling a hair appointment or a family dinner. In my early years of my career, I would put the job above so many other things. SV knew that it was important to work hard but that our family and friends are the ones that love us and deserve as much, if not more, of our attention.
Thank you, SV, for teaching me that putting family and friends before the job can actually make you a better pharmacist!
The two DC’s
There were two pharmacy techs with the same initials, DC. They are your typical eastern Kentucky men. They have the broad shouldered, brusque appearance that reminds you of their roots but they also were the kindest to me during my pregnancies and would go out of their way to help me take care of a patient. They were man-enough to put aside the stereotype of the pharmacy tech world being predominantly female in order to take care of their families. Not only did they enter a different world from what they knew but they were able to change it. They pushed the boundaries of the tech world by volunteering for more responsibilities and performing them well. They supervised others, managed inventory, managed quality control, spoke at conferences and took vital roles in the changing IT component of the department. They set the bar so high as to what a tech can do, that I have not been able to find it again. I was spoiled. Due to their abilities, I was able to focus on the clinical aspect of patient care. I was able to do so much for my patients because I knew that other tasks were being done in a superb manner.
Thank you, the two DC’s, for showing me what REAL teamwork can accomplish!
JW
JW was our receptionist but this did not describe all that she did for us. She reminded me of a circus director. During a day, the pharmacy received multiple calls and requests for information. I don’t know how she did what she did because it appeared effortless. It was when she took a rare day off that we really understood her worth. I remember complaining on multiple occasions that I wish she worked the day AND night shift.
Thank you, JW, for showing me that good work isn’t always flashy but nonetheless VERY important!
JW
JW is a pharmacist with a very different personality from my own. She loved details and didn’t care for the codes or other things that I found exciting. She put together a newsletter for the hospital to educate the masses. She worked hard to ensure that the details of every article were perfect. I still reference one of her articles many years later.
Thank you, JW, for reminding me that it is important to surround yourself with people that have different skill sets so that we can both benefit from the association!
DR
DR was a new grad that took a very difficult position. He took the overnight position in the hospital. For this hospital, it meant that he was the ONLY pharmacist working during that time. He had no backup, no one to turn to with questions and had to deal with the many quirky things that only happen during night shift. He managed to do this with an ease, courage, proficiency and amazing energy.
Thank you, DR for reminding me not to overlook the contributions of a new grad!
SW
SW never took “no” for an answer. When the hospital did not offer the type of position that he wanted to do, he created it. He had a love for infectious disease and fought to add the responsibility of culture review to our already busy workload. After a bit of cussing for the added work, I soon realized the great service that we were able to provide to the patients and other hospital staff. He convinced others to allow him to complete a second-year residency over an extended time so that he could also financially support himself by continuing to work his regular shifts. He had goals and wasn’t afraid to convince others to bend or change the rules to fit these goals.
Thank you, SW, for teaching me to work around problems if you cannot work through them!
AH
AH is an intelligent and well-rounded lady. She is a great pharmacist but I have to thank her most for helping me decide to homeschool my children. AH was homeschooled. She not only had a great science background and knowledge in pharmacy, but she was very well-rounded in her education. Her knowledge of great writers, composers and history far surpassed my government-based education focused on STEM. Not only is she smart, but she could carry on conversations with “normal” people. It proved to me that I could homeschool my children and that they could turn out as well-adjusted adults.
Thank you, AH, for showing me that a person can be knowledgeable in many different areas and encouraging me to pursue that for my children!
FR
FR is an interesting character. He had worked at a poison-control center and museum prior to his time in our small town. He appreciated educational resources and detested the idea of just “googling it”. He worked hard to ensure that our department had all of the electronic AND print versions of the latest reference materials. He wanted us to have the confidence to find the answers that we needed in order to best care for our patients.
Thank you, FR, for refusing to settle for the first google search result and teaching us to do the same!
EW
EW is very smart but never knew it. She had the skills and knowledge to accomplish great things but she lacked the confidence and bravado needed to express them to others. During the time that I worked with her, she gained confidence. She started taking on new projects and putting her own voice and spin on them. She moved away but it appears that she is really coming into her own as a mother and pharmacist.
Thank you, EW, for teaching me to be brave and overcome my inner fears!
CW
CW was a physician that I only worked with for a brief time. He had the reputation of a tornado as he passed through the floors, wrecking the peace along the way. He made some enemies. It took a bit of time, but I realized that he wasn’t berating or yelling without reason. He took the care of his patients VERY seriously. He wanted perfection in EVERYTHING that was done for them and by anyone that was involved in their care. He was hard on everyone, including himself. The stress was hard on him. He refused to accept that the insurance should even have an opinion as to the care a patient should receive, he wanted every i dotted and every t crossed and he went to the mat fighting for his patients.
Thank you, CW, for teaching me that it is ok to disagree with others if your goal is to do the best for your patients!
JV
JV was a hospitalist. In complete opposition of CW, he had a very calm manner as he walked the halls on rounds. He made it appear as if he wasn’t working hard but still managed to take great care of his patients. He could walk into a stressful situation and provide an aura of peace as he directed the patient care.
Thank you, JV, for teaching me the importance of remaining calm in stressful situations, for myself and those around me!
CM
CM is a great primary care physician. She knew her strengths and her weaknesses. This was a rural area and every physician had to spend a small percentage of time in the ICU. She hated it. She would request my assistance on every patient in that area to ensure that she didn’t miss anything. She was not afraid to admit her weakness in this area and enlisted help to care for her patients.
Thank you, CM, for teaching me to be comfortable with my weaknesses and to ask for the help of others when I’m forced in situations that do not match my strengths!
TA
TA is beautiful, blonde and soft-spoken. That may be the reason why some may overlook her incredible intelligence but that is definitely a mistake. TA is so smart and yet humble. She was my go-to resource for questions during shifts as she almost always had the answer or an amazing viewpoint. She made me think of alternative answers and encouraged me in her soft, calm way. I don’t think she ever realized how much I missed her companionship and intelligent conversations when I left. She is still one of my favorite pharmacists.
Thank you, TA, for reminding me that the loudest voice doesn’t always have the best answers!
SR
SR is a physician that encouraged me to follow up on my recommendations. Before computer charts (I know, I’m that old!), we had paper charts housed at the nursing station. When I found small things that I wanted to do or change for a patient, but it didn’t require immediate attention, I would leave a note on the chart for the physician to review. SR nicknamed them my “love notes” and told me that she was sick of them. We worked out an agreement that I could order labs or make small changes and she would sign off on it. This forced me to follow-up on the results of my suggestions and I learned a lot by this process. She wouldn’t have made this arrangement with me if she didn’t trust me. I worked hard to maintain that trust with every order placed under her name.
Thank you, SR, for teaching me the importance of developing good physician-pharmacist relationships!
TH
TH is a physician that cares for her patients with a passion and works hard for them. One time, she bent the rules of the ICU to help alleviate the fears of an elderly lady. This lady threatened to leave AMA (against medical advice) in order to go home and care for her cat. In order to convince the lady to stay and receive medical treatment, TH found a way to obtain this cat and smuggled the feline into the patient’s room. The patient was comforted and remained in the hospital until she was healthy enough to go home.
Thank you, TH, for teaching me that breaking the rules is sometimes necessary!
I know that I have overlooked some people in this article but if I continue, it will soon be a novel. I have to stop at some point, so this is it.
Thank you, reader, for letting me take a few moments to express my gratitude for some amazing healthcare workers!