At the age of 26, I was almost two years into my career as a pharmacist, and I should have been able to enjoy the fruits of my labor. Unfortunately, the previous day at work left me feeling burned out, and this had been occurring with increasing frequency.
My 2:30-11:00 PM shift started with a 3:00 PM clinical meeting that allowed both the day shift and second shift pharmacists to attend. Apparently the meeting was about updating the pharmacokinetic dosing protocols, which was my area of expertise. As I entered the meeting room, our new pharmacy director told me that my presence was not needed even though the current dosing protocols came from my project as a pharmacy student. “We don’t need input from people who aren’t going to be here when the updated protocols go live,” he said. This was in reference to the fact that my wife had matched into a pharmacy residency program out of town and I was going with her.
Soon after the non-meeting I received a paper order [this was the mid-2000s before EMR was required] for a patient that was being treated for hyponatremia. The neurologist ordered hypertonic saline at a specific infusion rate. For safety purposes I always double check the calculated rate, and it appeared to be slightly too high as ordered. When the neurologist returned my page, I suggested a lower rate and he said, “So you think I don’t know how to manage hyponatremia?” I said no and explained that I was concerned about central pontine myelinolysis. “Oh, so now you think I’m an idiot.” I continually emphasized the patient safety aspect and he eventually acquiesced, but not without reaffirming: “Look, I’m the doctor, you’re the pharmacist.” I thought he was kidding, but the next day he complained about me to our clinical coordinator.
Later that evening I was reviewing culture results for all the patients on my floor that were on antibiotics. I noticed one patient was on ciprofloxacin for a urinary tract infection and the urine culture came back showing resistance to it. “Why are you interrupting me during dinner?” said the internist when he returned my page; I could hear his wife and kids in the background talking to the waiter. I told him about the situation and he said, “You paged me for that? Just pick anything that the organism is sensitive to.” I told him that I had to speak to him first because I couldn’t change the antibiotic without a physician order, to which he replied, “At least it would’ve saved both of us from a page.”
This was the perfect storm of events. I had already been thinking about applying to medical school since early in my fourth year of pharmacy school. That day made me realize that I wanted to captain the healthcare team, to be more involved in a patient’s care, to be able to make my own decisions. I had all this advanced medication training and I felt like my job (at its core) was literally to be a gatekeeper to medications. I had the ability and knowledge to contribute more to a patient’s care, but I didn’t have the license that would allow me to do so back then. Today I do, and I am much happier for it.
Next post: When did medicine even become a serious consideration? Why didn’t I just quit pharmacy school and start medical school right away?
Have you had a day (or days) that made you want to quit your job and/or change careers? Comment below so we can discuss.