Partners in D in Full Force during the Open-Enrollment Period

Every fall quarter, Partners in D, a state-wide initiative spearheaded by faculty members at UCSF School of Pharmacy and funded by the Amgen Foundation, offers an elective class to students interested helping seniors with their Medicare Part D plans. After thirteen hours of intensive training over a four-week period this fall, over thirty student pharmacists became Medicare Part D specialists, serving as patient advocates in the greater San Francisco areas.

Most of the Partners in D outreach events take place in senior housing complexes and clinics. In only one short week after the beginning of the open-enrollment period (November 15th to December 31st), Partners in D has gone to five different underserved communities, helping over one hundred seniors from various ethnic backgrounds find and enroll in the most economical Medicare Part D plans for 2009.

As one of the two student coordinators for the Partners in D outreach program, I attended four out of the five outreaches this past week. Given my busy second-year-pharmacy-school schedule, which involves not only studying the essential materials from my classes, but also leadership responsibilities from more than one organization, I have been very sleep-deprived this quarter. Nevertheless, the experiences and rewards that I have reaped from the time I have put into the Medicare Part D elective and outreach are invaluable.

For one thing, I have acquired a tremendous amount of information about Medicare Part D from two of the most enthusiastic authorities in this subject, Dr. Marilyn Stebbins and Dr. Tim Cutler. Having attended all the training sessions for the second time (I took the elective class last year), I now feel a lot more confident in being a patient advocate for Medicare Part D, something that I will be heavily involved in as a student-intern at my sister’s independently owned pharmacy. I now have winter job security because she has hired me as the “expert” to help patients with their Medicare Part D plans.

More importantly, I have rediscovered the joy of public service, a strong and intrinsically rewarding feeling that I have not experienced at this magnitude in a long while. No matter how tired I was after each event and how I wish there were more hours in a day for me to squeeze in some studying, I would be happy that I had been involved. Every single senior that I helped had showed a tremendous amount of appreciation for my knowledge and time to provide them with the information and assistance that they otherwise would not have gotten elsewhere.

With the guidance of my energetic preceptors, Marilyn and Tim, I have helped seniors saved thousands of dollars from their drug cost in 2009 by enrolling them in the most cost effective plans, based on their current medications. This week, the most money that Partners in D had saved for one person was over $19,000!

Who knows what these seniors would do if Partners in D were not acting on their behalves? They may be stuck on very expensive plans and end up resorting to skipping doses, not filling their prescriptions or buying their medicines from another country to save money. They may go broke paying for their medicines in order to stay healthy or end up critically ill in the hospital due to cost-related non-adherence.

The more outreach events that I attend, the more I value the foresights of the UCSF leaders who created Partners in D. However, a disturbing truth lingers in my mind: Although Partners in D is a state-wide project and all the pharmacy schools in California are helping seniors with their Medicare Part D plans, we are only reaching a small percentage of the elderly population in California, not to mention nationally.

Despite the availability of a website (http://www.medicare.gov/) as an unbiased source for plan comparisons, only about two percent of the senior population utilizes it. Most are not even aware of its existence. The plan finder tool within this site is so difficult that I, along with most of my Medicare Part D classmates, could not even navigate through without the proper training. I cannot imagine how the pre-Internet generation can figure out the way to use it without aid.

Throughout our interventions this week, we have come across seniors enrolled in unnecessary and expensive health plans through sales representatives who offer them free gym memberships or rides to their providers. As a result, they can no longer see their regular physicians and pay more for the health care. Unfortunately, for some of those seniors, the consequences of their “choices” are not reversible until the beginning of 2009.

As a product of the Asian culture and philosophy, where the elderly are well respected and supported, I have an extremely difficult time seeing the jewels of our wisdom and the bridges of our future extremely helpless in a matter so vital in their retirement years. Until the government finds more practical and available solutions to support seniors in their Medicare Part D decisions, healthcare providers are the best and most accessible resources during this long adjustment period.

To become a Medicare Part D patient advocate, you can enroll in Partners in D’s fall elective class offered through the School of Pharmacy. It is open to students from all schools at UCSF. In addition, the following are web resources for additional information about Medicare Part D:

http://partnersind.com/
http://www.medicare.gov/

It's Been a While

It seems forever since I last blogged. I should be studying for my physio exam, which is bright and early tomorrow morning, but I think I'm too burned out from trying to jam 200 pages of condensed materials in my head over the past few days. I have no idea what I know and what I don't know but I just don't care. I ran out of steam this time.

I still enjoy learning and have been pretty good sticking to my studying schedule this quarter. Unfortunately, there is just so much information for my slow brain to keep up with all the classes. I guess I'll go to the gym, get my frustrations out and hopefully will be able to get something in my head so I won't fail the test tomorrow. Arghhhh......

I Was Lucky...

to score above average on my pharmaceutical chemistry exam! It was mostly luck that I knew all the structures being tested, didn't make a mistake on the things that I did know, totally derived the pKa equation out of my understanding of basic chemistry and blanking out on only one question out of the whole test. I did study quite a lot before the exam and felt that I had a pretty good handle on things, but a lot of materials were covered in class prior to the midterm. The test, like most, could not truly reflect what a student really knows. Although I did pretty well on it, it does not mean that I know more than someone who has a lower grade on that exam. It just means that I had a good day and everything went my way.

Study Break

After a whole day of hiding in my room, I decided that I should reward myself with a very pleasant activity: jogging along Ocean Beach during sunset! When I got there, the huge round orange sun was sinking, from my car, I observed as it dipped below the horizon. The chill almost prevented me from getting out of the car, but I figured I needed to get some more oxygen in my muscle and brain, as well as putting some "stress" in my body so the glucagon and epinephrine can kick in for some glycolysis and lypolysis.

I really wanted to be right beside the water. Instead, I used gravity as an excuse to take the lighter workout by jogging on the sidewalk along the Great Highway. After a while, I was thinking to myself: "This sucks! I don't want to smell the smog from all these cars and hear their loud noise!" So, I bravely headed to the shore and was so glad that I did.

Since I was quite a distance south of Judah (the Muni stop), there was not anyone by the beach, and I had it all to myself. Although my leg muscles were sore from the over-production of lactic acid, the soothing sound of the waves, the pastel-colored sky and the endless ocean completely satified my soul with the fuel that I will need for another long study session.

Intellectual Development

After four weeks of trying, the pressure of exams (I have three midterms next week!) has finally molded me into a very good student. My daily routines now consist of eating, going to classes, reviewing notes, reading and reading. Of course, I take a break here and then, but most of the time, I'm glued to the study desk in my room when I'm not in class.

It sounds pretty boring, but I rather enjoy it. In a way, I feel so lucky to have the means to put education before everything else at this stage in life. I don't have to worry about money (at least not right now...I'll worry about repaying my loans later), kids, dramas, etc. Having the time to devote solely to learning about the human body and pharmaceutical products is such a previlege. Although I do not like exams, I must say that they have pushed my persistence in the pursue of knowledge to a whole different level! Without them, I don't think I can sustain reading and studying for over twenty minutes at a time. Hooray to good old exams! Hmm...maybe your won't hear me say that when I get my scores back next week!

More Butterflies

After an afternoon of frustration trying to study and not being very successful at it, I decided to take advantage of the free admission day at the Flower Conservatory and see the winged beauties at the Butterfly Zone before the exhibit ends on November 2.

I had a very relaxing hour clicking on my Canon 40D with the macro EF 100mm 1:2.8 lens. Although I was only able to use the tripod as a monopod (facility restriction), the images turned out really great. These are the three pictures that I really like.

While taking pictures, I met another amature with almost the same camera as mine. We started to talk about how the stripes of the zebra butterfly looks white instead of yellow in the picture. He told me a little bit about using RAW format instead of JPEG so I could preserve the real colors in my subjects. It all sounded good but I don't really have the time to edit the image after shooting. Besides, RAW files will take so much more memory, something that I am not really looking forward to dealing with right now. Therefore, I am sticking with JPEGs for a while.

A little bit into our conversation, he started offering his lenses so I could try using them (his backpack was full of lenses, used ones that he bought from other photography enthusiasts). I felt kind of bad holding his camera to try out the lens that he claims to be "a very good lens," but I didn't want to offend him by not taking his offer. I wonder if, someday, I will become as generous with my photo equipment as he was. As of now, no one is touching my "baby." I was even reluctant to lend it to my dad! Talking about obsession!

I was so sure...

that I got 100% on my first midterm exam in pharmacokinetics (PK)! I found out my the grades a few hours after the exam and learned that my it was at the bottom of the totem pole again. Most of my classmates got an A but I didn't. I still don't know what I did wrong (b/c I didn't care to pick up my exam). I thought I had the strategies and logic down for figuring out the half-life and concentration of a drug at anytime during an IV infusion. I guess I was wrong.

I was shocked...and then disappointed...for a while. Then I realized that I had done my best to study for the exam. I read and tried to understand the materials as much as I could. That's all I can ask for of myself right now. Something is not clicking and I see it as a confirmation that PK is really not my thing. It's so sad that this seems to be the easiest class out of the five that I have this quarter. Physiology, pharmacology and pharmaceutical chemistry exams are next week and I am barely going over the first week's lecture notes and reading materials for all of those subjects. As much as I enjoy learning about prostaglandins, hormones, and NSAIDs, I just can't keep up!

Dinner at Mary Anne Koda-Kimble’s Home

I just had the most amazing dinner with the dean of the best pharmacy school in the UNIVERSE, Mary Anne Koda-Kimble. As an effort to raise money for community outreach activities, Mary Anne has been offering 12 dinner tickets every year during the School of Pharmacy’s Spring Auction. Last spring, I was one of those lucky 12 who paid $70 for a seat at her dinner table. It was one of the best $70 that I have spent thus far in life. In fact, I would venture to say that was one of those priceless memories you can rarely buy with money, but Mary Anne's generosity had made it possible for me to do so.

Despite her extremely crazy schedule as a dean, a healthcare provider (and who knows what other leadership activities and personal projects she manages to squeeze in with her time), MARY ANNE KODA-KIMBLE made us a uniquely delicious gourmet dinner at her cozy and artistically decorated home!

The night started in the living room, an additional unit built on top of a roof, so we enjoyed a panoramic view of the city, including the famous Golden Gate Bridge, as we mesmerized at the beauty of the high rises, lit by the golden late afternoon sun. While chatting about school, we were served drinks of our choices (including red and white wines) and a few rounds of hors d'oeuvres infused with Mary Anne's originality, such as the create-your-own type of appetizer, where you can choose from the homegrown and homemade fig or quince jellies and three different cheeses to top a paper-thin wafer cracker. The textures of the different ingredients and sweetness of the fruits complimented each other perfectly. Figs also tasted surprisingly sweet when wrapped by thin pieces of smoked salmon. Another one of my favorite appetizers was the cream puff with cheese, which was baked to crunchy, creamy and buttery perfection. I could not help but reached for more of the cute tiny treats, even though I wanted to save room for dinner.

Dinner was a buffet-style meal with a selection ranging from bread, salad, chicken, prime rib, Morrazella cheese and stuffing, each uniquely and deliciously created and made by Mary Anne. I wanted to try everything so I took a little bit of each (and went back a second time for another helping). As someone who has been in the work force, I was able to pay for some expensive meals, but never had a better gourmet dinner. All of the dishes were wonderful, but my number one choice was the salad, made with a mixture of green leaves, walnuts, pears and pomegranates in a light and slightly sweet vinaigrette dressing. I have never seen, or even though of, making salad with pomegranates before! What a clever idea and great combination of antioxidants to balance out the meat dishes! We sat around the candle-lit dinner tables, listening to Mary Anne and her husband, Don Kimble, tell stories about the pharmacy school experiences and love life while savoring the mouth-watering food on our plates.

Dinner would not have been complete without Mary Anne’s special dessert using apples from her own backyard as the main ingredient. The apple cubes were baked with crispy macadamia nuts and caramel on top and served with a scoop of homemade ice cream. Although my intestinal tract had not gotten a chance to process all the hors d'oeuvres and the generous dinner portion, I managed to clean up my dessert plate.

Everything was wonderful about the night: the ambience, the food, the city view and the soft music playing on the background as we talked throughout the evening. Most of all, what I will remember are the interactions with my classmates, who are intelligent and caring individuals, and the honor to be present at Mary Anne’s house, talking to her and calling her by her first name (which she had insisted on ever since our first day at UCSF). As a first-generation immigrant and a first generation in college, I had never even dreamed of socializing with so many well-educated and genuine people. The evening was so real and unreal at the same time. It is DEFINITELY an experience that I will take with me for the rest of my life.

Balance and Adjustment

I find myself dosing off or being really distracted every time I touch the book. When I manage to stay awake during my "reading sessions," I goof around with my pictures and do other things...like writing on this blog. It's hard adjusting to school and finding the energy to sit through hours of reading. I hope I will get into the swing of things sooner rather than later, like when midterms are days, instead of weeks, away.

I know I will be able to do okay with a little cramming before the exams but that's no way to learn. I'm trying to read before attending lectures so I can actually understand and take in more information. It's hard to keep up with the crazy pace of pharmacy school, though. It's only the fifth day of school and we have already gone through about 60 condensed pages of physiology, about as many for pharm chem, one chapter of immunology and a lot of review for pharmacokinetics. I can hardly keep up with the reading.

On top of classes and studying, I'm learning how to say "no" and stay away from my computer so I don't spend too much time on emails or pictures. There are so many extra-curricular activities that interest me, but I have to constantly remind myself that I need to do well in what I have already committed myself to do. I can't have it all....It's so hard to find the "golden mean."

The Beginning of the Second Year

Today was the third day of the quarter and I already falling behind. There are so many things to read before going to class and I haven't even gotten all my books yet! It's crazy! I don't know how I'm going to keep up with the pace of school and fulfill my roles as a student leader in various organization.

I am currently a historian for two organizations: APhA-ASP (the student chapter of the American Pharmacist Association at UCSF) & Phi Delta Chi (a national pharmacy fraternity). In addition, I am also one of the two student coordinators for Partners in D, an organization involved in helping seniors with their Medicare Part D plans. As a student coordinator, my job is to recruit my classmates for the elective class that we hold in the Fall and organize volunteers for the outreach events that we have throughout the year. I am also the editor-at-large for Synapse, a student newspaper at UCSF.

That is a handfull...especially with four very intense classes this quarter: physiology, pharmacokinetics, pharmacology/pharmacological chemistry and immunology. I'm hoping I will survive without any major damage to my poor body. I'm kind of nervous about this year's commitments and academic demands.

Back to SF

I'm so excited that we're leaving for SF soon! It was good getting to be around my husband everyday and spending time with friends, family and the dog, Marley, but I'm ready to have my own space back. The crazy LA smog has worsened my allergies. I am even allergic to plants and my bed sheet! My body is itchy everywhere and the heat doesn't help. I'm not sure I'll like the SF chills much better than the LA heat, but my itchiness needs a break. I think this is also my body's way of telling me not to put all those junk (yummy Asian food with lots of MSG, oil, salt & sugar) in my stomach. Well, I'll start eating more fruits and veges once I'm in SF; can't resist all the good and cheap restaurant food here in LA.

Strange Ending

Friday, August 29, 2008 marked the end of my first summer internship as a student pharmacist. I came into the experience about ten weeks ago with a lot of vigor, curiosity and positivity. Although the latter two elements remained mostly intact, I must say I have lost steam. Towards the last two weeks, I could not wait to get back to UCSF to recharge my energy and to load myself with more knowledge so I can become more effective in empowering patients to take charge of their health care.

I can't exactly pin point one cause for my loss of energy in the job. It must have been a culmination of many things: the long chaotic days with constant change in pharmacists due to my sister's absence; the feeling of not having the time to slow down and process the mass of information around me; not being able to leave the pharmacy for a short while due to my managerial duties; etc.

Overall, I would say that I had a positive experience and learned a lot from my ten weeks of work. The best part of my job were getting free lattes everyday (I make my own most of the time using the huge latte machine that we have for the adjacent coffee shop that my mom runs) and having yummy home-cooked food when my mom was not on vacation. I also enjoyed counseling patients who were grateful that I spent the time to explain their medications in a language that they could understand. Most of my patient interactions were very positive.

Strange things happened, though, as it did in the last day. While I was occupied with a task away from the front counter, I heard an elderly Chinese patient screamming "Ms. Ung!" several times very loudly. I knew she was trying to get my sister's attention because she heard my sister's voice. I recall hearing a co-worker telling her in Mandarin that Ms. Ung was very busy and he would relay any message that she had. After a while, she walked away. A few minutes later, when I answered the phone, I heard the same voice asking: "Ms. Ung?" I told her I was "Little Ms. Ung" and she said many things that I did not understand. The only thing that I could make out was that she was outside by the door. She hung up when I handed the phone to my coworker, who was better in Mandarin. About five minutes after the mysterious phone call, I walked to the front counter and still saw her standing by the door. That's when I decided to interrupt my extremely busy sister and told her that someone must be really desperate to see her.

The patient's face lit up when she saw my sister at the front counter. She walked in briskly with a plastic grocery bag and handed it to my sister. She also said many things to my sister in Mandarin. Seeing that my sister had no clue what she was saying, I translated what I could decipher: "Ms. Ung, I brought these cucumbers for you. They are a little dry because I forgot to water them." My sister thanked her and the patient left the pharmacy. It was funny seeing the puzzled face of my sister and my coworkers. My sister thought that she had some ulterior motives for going through all the trouble just to give her the cucumbers. However, I think the patient was grateful for having such a great pharmacist that she needed to make sure her gift got to the right hand and and it was acknowledged.

Chasing Butterflies

After spending an afternoon at Huntington Library and a good hour chasing butterflies and bees with my new macro lens, here are a few good shots that I got:

Mr. Robert

I worked for almost 12 hours straight today because of the installation of a new robot in our pharmacy. When I tell people that we'll be installing a robot, they imagine a fully walkable metal figure with a head, legs and arms that can understand vocal commands. In reality, it's more like a soda machine, only three times bigger and a lot more sophisticated. It came into our pharmacy today and the place felt really crowded with the technicians and extra hands to help fill the machine with a lot of meds. We call it Mr. Robert because that's how my mom pronounce "robot" with her Chinese accent.

As of today, it has not been able to fulfill its duty since more preparations are needed for it to be totally functional. We're all excited about having it count, fill, label and close the medicine bottles for us after we type and program the prescriptions into the computer. Before all that, though, there is a lot of learning to do and adjustments to make.

Deep Breaths

I was practicing my relaxation skills by breathing deeply and thinking positive thoughts as I walked from my car to the pharmacy today. I knew it was going to be a better day because my sister was going to be there...and it WAS! Even my mom was there to take care of the attached coffee shop so we don't have to send the technician over to make drinks when there are customers. We were able to catch up with the piles of work that fell behind for the past week and I was even able to take a little time out to run some errands. It was a pretty quiet day at the pharmacy. My sister was whining about the slowness and how bad it was for her business while I was secretly glad that we were able to breath a little. Everyone seemed to be a little happier at work today. I even got to enjoy a nice lunch with my mom and sister. What a great day at work!

Basket Slamming Time

I was so frustrated at the substituting pharmacist today that I had to slam the baskets to get my point across. It was pretty unprofessional for me to do that but being put in a managing position when I'm only the intern pharmacist is pretty tough. My sister, who is normally in charge of the place, has been out pretty frequently lately, to take care of some other businesses. While away, she relays most of the decision-making to me so I have to take all the stress of managing a business. However, it's kind of hard to work with people who don't really care and are not team players.

While the rest of the team was slaving away answering phone calls, filling medications, helping customers, etc., the substitute pharmacist just stood in front of his computer, surfing the Internet! He didn't even bother to check the labels (with the words "delivery", "pickup", and "waiting" clearly printed!) and try to put the medications in the appropriate piles. After a few times of repeating to him our procedure, I just had it and decided to pick up his slacks on top of all the work that I had to do. However, I had to make sure he knew I was really pissed at him by slamming the baskets after bagging the medications and sorting them out. There was nothing else I could do. He didn't even want to be there to start with; he just did it as a favor for my sister.

Work has been backed up for the past two weeks and it doesn't help when the main pharmacist is not present most of the time. It was so busy today that I forgot to drive my car to the car wash as intended and got a parking ticket for not moving my car after two hours! There went my three hours of work! In addition, I had to gulp down my lunch in about five minutes at around 3pm! What a day! I don't know how many of these crazy days I can handle before totally breaking down and do something unimaginable. I'm so glad the summer internship is going to be over in about two weeks! There's my confirmation for not wanting to take my sister's offer of taking over one of her pharmacies after graduation!

Summer Pharmacy Internship-Week 8

I spent another crazy week at the pharmacy doing ten thousand things at the same time. The pace is too hectic and there are too many problems. Patients do not want to wait for their meds and they get really mad after waiting for five minutes. My temper is becoming a little short. Not having enough sleep (I stay up late almost every night watching the gymnastic competitions in Beijing) make me even more agitated. I couldn't wait for this week to end! I'm so glad it's the weekend and I don't have to work!

I'm going to try to take care of some school-related business and run a few errands this weekend!

Summer Pharmacy Internship-Week 7

This week zoomed by with two freezing days spent in San Francisco's Hotel Kabuki for the Partners in D training. Although I knew it was going to be cold in SF, I was not nearly prepared for being frozen by the fog. The cold weather prevented me from staying out of the hotel. Luckily, the hotel room came with a nice bath tub for me to thaw after an afternoon of running errands around town. The training was two days long, but I was only there for one day. It was a very long but productive day. I got to meet faculty members and students from all the pharmacy schools in CA involved in the project while learning more about Medicare Part D for seniors.

Work was extremely busy and has become a daily routine. I'm learning a little here and there and helping patients with the OTC meds whenever I can. I find that my days are much better and I make much less mistakes when I have enough sleep! Time for me to go to bed now. It's getting really late.

The Weekend's Gone?

It seems like weekends fly by too quickly. Every Saturday and Sunday, I seem to be occupied with things I don't really want to do. There's less than a month of summer left in LA and I haven't even opened many pages of the book that I had wanted to read. There are so many things left on my list of "things to do before going back to school." I need some time off from work but my sister really needs my help at the pharmacy since she sent one of her employees to her husband's store to help out, and she will be off for the next two weeks, entertaining her in-laws, who will be visiting from Hong Kong and Canada.

Yikes, I am working way too hard! I guess I can't really complain too much b/c all the hours that I put in, including the overtime, have funded my online spending sprees for luxurious photographic equipment. :) I can't wait to get the new external flash, diffuser, extension tube and extra battery for my Canon!

Week 5

After a week of intensive searching, we're finally going to have a new delivery employee. I've talked to numerous people on the phone and interviewed about a dozen face-to-face. Through this process, I've also learned to screen out people on the phone and gave interviews to only those who I thought will be satisfied with this low-skilled and low-paying job. It surprised me how many highly qualified people were willing to apply for this position! The economy must be really bad.

It's so hard to find the "perfect" person for the job. I'm going to make a decision on who to hire tomorrow. Hopefully, it will be a good decision so I won't have to go through the interviewing process again!

This week was a pretty bad week for me. I've made numerous mistakes that could have been prevented by simply paying more careful to details. I gave a patient the wrong bottle of antibiotic because of the similarity in medications and names. Luckily, the mistake was caught by the tech before the med left the building. I also made a mistake by giving the patient's significant other another person's medications because they have the same name. Again, I was fortunate to have the patient call to alert us of the mistake and he brought back the medications when picking up the correct ones. I wonder if my boss would have fired me if she wasn't my sister.

It's so dangerous to try doing things too fast. However, the patients give us so much pressure by being really cranky when they wait longer than 10 minutes. Making medical errors is the scariest part about being a pharmacist. Also, it seems like the more I work, the less I think I know. There are so many different medications and I wonder how I will learn them well enough to do a good job at patient counseling.

Summer Pharmacy Internship-Week 4

This week just flew right by without any time for me to learn new things, as far as medications and counseling go. Our pharmacy was short-staffed b/c one of my coworkers was sent to another pharmacy to help trouble shoot and train their employees to use our computer system. Another one was taking two days off to study for exams. Our morning deliverer also stayed home for one day, so I had to fill in for him. In the midst of all these chaos, I had to screen potential employees on the phone, interview them and hopefully be able to find a new deliverer by the end of next week. It was really stressful being pulled from different directions all at once.

Despite all these craziness, I improved on one important aspect of my communication skills: cutting off excessive talkers! One of my weaknesses have always been letting others take control of the conversation, even when I was in the position to take control and really bored by what they had to say. I was afraid that I would hurt their feelings by changing the topics. Being as busy as I was this past week at the pharmacy, I had to be efficient with my time and practiced taking control of the conversation when someone started to talk too much during the interviews.

I'm glad this week was over and I will have a chance to see the Body Worlds 3 Exhibit tomorrow at the California Science Center. I can't wait!

Mariachi Music & Mexican Dinner

On Saturday night, Thomas, his mom & I went to an upscale Mexican restaurant to watch a dinner show by a live band, Mariachi Sol de Mexico. The show started at 7pm but a long line of people was standing outside waiting to be seated by 6pm, when we arrived.

We were one of the first groups to be seated, slightly off-center from the stage and 30 feet away. Occupying the long rows in front of us were three big parties there for birthday celebrations. Looking around, I noticed that we were the only three Asians in the entire room full of about 200 people.

Our waiter, who was very fluent in English promptly took our orders for drinks and came back with them within minutes. We started with a typical but extremely tasty free appetizer of tortilla chips and fresh salsa. The menu included choices of fajitas, enchiladas, tacos, burritos, steak & seafood, all came with a sides of rice & refried pinto beans. We were also one of the first groups to get our dinners. I hungrily devoured my huge fried sea bass and was almost done with my dinner before the lights were dimmed, obscuring the paintings of Frieda Kahlo and Diego Rivera's masterpieces on the walls.

The stage, which was nicely painted with bright green vines and red flowers, were then lit up, revealing the nine uniformed men with Mexican bow ties, three guitarists and two trumpeters in the back row and four young and handsome violinists in the front row. The upbeat music immediately started with one of the young men in the front row singing in Spanish. Although I had no clue what he was singing about, the energetic beat of their Mariachi music was enough to captivate my interest. One by one, the men took turns singing, and playing their instruments when they were not singing. They went on continuously for about thirty minutes.

They took a short break from singing for one song, when they encouraged the ladies from the audience to dance on stage. After that, the main man, who was a trumpeter and singer, made birthday and other announcements in both Spanish & English. The band then went on to sing what seemed to be a traditional Spanish birthday song, followed by the English one. After that, they continued to awe the audience with their amazing voices and music for another half an hour before the show came to an end.

Our bill, which was a little over $100 for two drinks and three entrees, were a little pricey for the quality of the main courses. However, we knew going into the restaurant that we were paying for the entertainment and it was worth every penny. The band was so vibrant and captivating that they took my breath away for the whole hour that they performed. What also amazed me was the cooperation among the different band members in lighting & the switching of positions among singers in that limited stage space that hardly fit nine men and their instruments.

According to reviews that I read on Yelp!, people drive quite a distance to get here to see this band & they have performed at the Hollywood Bowl and the Academy Awards. They are practically right in our backyard (a few blocks away from where I currently live), and it took us until now to discover it!

Highlights of Year 1

1. Making amazing friends: Becky Snyder, DeAnna Sosnowchik, Michelle Tadano, Pei Yu Lee, PDC brothers, to name a few.
   
2. Placing second in the OTC/Herbal Patient Counseling Competition with Hilary Campbell.
3. Working for Synapse (UCSF's student newspaper) as a staff writer & photographer.
4. Wine-tasting during the Spring Retreat in Napa Valley with four generations of PDC brothers.
5. Collaborating with medical and nursing students to organize UCSF's 10th Annual Integrative Medicine Forum.
6. Learning to take better pictures by being the "un"official photographer for the School of Pharmacy.
7. Jogging/strolling along the Coastal/Lands End trail with the wonderful views of the Golden Gate Bridge alone and with friends: Lynn Chen, Karoline Tum & Thomas.
8. Enjoying heavenly coffee and almond croissants from La Boulange Cafe in Cole Valley, a few blocks from my apartment.
9. Getting to know faculty members through social/extracurricular functions: Conan MacDougal & Christy Robinson, Lorie Rice, Dean Mary Anne Koda-Kimble, Mike Winter, Dr. Shetlar, Dr. Shafer, Sharon Youmans, Bob Day, Robin Coreli, Marilyn Stebbins, etc.
10. Hearing Dean Mary Anne Koda-Kimble's charismatic & animated speeches at the new student orientation and the White Coat Ceremony.
11. Witnessing amazing talents from fellow students: Skit Night, Mr. Pharmacy, Cultural Mosaic Show.
12. Providing free/subsidized services to the underserved while volunteering for the Hep B Clinics and Partners in D outreach events.
13. Getting over the fear of giving injections and gaining confidence in phlebotemy.
14. Being well-trained in insulin injection & the use of asthma inhalers.
15. Shadowing a clinical pharmacist, Lenny Chen, at Ocean Park Health Clinic in the Outer Sunset.
    

Summer Pharmacy Internship-Week 3

Today was a crazy day with many insurance and other problems that I couldn't solve. The work was backed up and I kept forgetting to get the medications done for patients in a timely manner. Although working in the front was more stressful compared to filling medications behind the counter, I feel that I've learned a lot by answering patients' questions, counseling them and typing some prescriptions. I learned quite a few things about medication therapy today. The most interesting was the following:

• H. pylori Triple Therapy- A patient with bacterial infection by H. pylori came in the pharmacy with the following prescriptions: Amoxicillin 1g, lansoprazole 30mg & clarithromycin 500mg twice a day for 14 days.

Magic Mouthwash

Today, I compounded my first magic mouthwash prescription with a mixture of 40 milliliters of each solution: antacid, hydramine & viscous lidocaine. It was pretty interesting and easy. I also noticed that the sig was: swish and swallow one teaspoon...oops, forgot how many times a day...

Summer Pharmacy Internship-Week 3 & Insomnia

I took an antihistamine/decongestant combo for my allergies before going to bed and at I'm now wide awake at 4 am-thanks to the side effect of the decongestant! I figured I might as well make good use of my time instead of tossing and turning in bed.

It was crazy at the pharmacy today, after a three-day weekend. I worked about 10 hours and my feet were so painful (they still are, but I'm glad to not be standing anymore). I felt like a robot, cranking out one bottle of prescribed medicine after another. I filled hundreds of prescriptions, but didn't even know the general indications for most of them, and there was no time to learn.

One particularly interesting prescription that I came across today was the magic mouthwash. It's an easily compounded oral solution with a mixture of three different ingredients in equal portions: 40 milliliters of hydramine, antacid & lidocaine solutions to make 120 milliliters of the final product. The technician compounded the solution using the instructions written by the doctor. Lidocaine makes the solution viscous and hydramine adds a pleasant smell. The Maalox provides a minty scent to the solution and makes it milky in appearance.

From Wikipedia, I learned that the magic mouthwash is used to treat inflammation, infection, and/or pain. It is commonly prescribed for pain related to oral ulcers caused by chemotherapy or radiation therapy. Some formulations may include tetracycline (antibiotic), Nystatin (antifungal), glucocorticoids (anti-inflammatory). Maalox acts as a coating agent and sucralfate can also be used for the same purpose.

Based on my knowledge, the magic mouthwash the technician prepared today must have been used to reduce pain (lidocaine) and inflammation (hydramine). I should have looked at the sig to see the instructions for use, but I'll ask my sister about it later.

There are so many things to learn and so little time. I haven't even completed the first item on my list to do this summer yet! Hopefully, I'll get at least one day off per week in August to catch up on some things that need to be done before going back to school in September. I really miss school and seeing my friends and classmates, but don't look forward to the hectic pace of life.

My Thousand-Dollar Camera Lens

After days of reading reviews, researching and much anticipation, I went to Samy's Camera, spent twice the amount of money I made in one week, to get the ultimate multi-purpose, super fast and low-light shooting lens from canon: EF-S 17-55mm IS USM f/2.8! It's such a big purchase that my credit card company had to wait until I called to confirm the charge before removing the hold. The charge more than doubled the price of my Canon Rebel XTi and the salesman was trying to convince me to upgrade my camera, saying that the lens was too good for it. Although he was probably right, but I am quite happy with the camera right now and plan to use it for at least two more years. I would rather spend more money on a macro and a telephoto lens right now (if I could afford it!). I am seriously considering getting at least another lens before the end of summer. A good carbon-fiber tripod with a ball head (the cost is about $500) will complete the number of items to fit in my newly purchased camera backpack!

Fourth of July

It's 1 AM and I still hear fireworks going off around my neighborhood. It was so smoky earlier that I could smell them during my ride home on the new apple-red Vulcan that my husband recently bought.

Our dog, Marley, has been really anxious for the past week because of all the noise they create. We were seriously considering putting him on lorazepam but decided to keep him calm by letting him come into our room tonight. Poor thing! He was so shaking so hard when we got home.

Why do people spend so much money on fireworks? Kids are so spoiled nowadays! All these illegal air-born ones and the noise at such hour really annoy the heck out of me.

Summer Pharmacy Internship-Week 2 & Paycheck

It feels good to be on the positive side of finance again after I got my first paycheck this week. Even though it wasn't much, b/c it had only been one week since I started work, but it's better than having to pay out constantly without making any money.

Work continues to be interesting but really tiring after about eight hours of standing. I find myself falling asleep soon after dinner every night and not having the energy to review more of the OTC topics. So far, I have only managed to read a portion of the heartburn & dyspepsia chapter in the OTC Handbook. The review was much needed and the knowledge helps when I counsel patients on the OTC & prescription antacids, H2RAs, & PPIs.

Counseling continues to be a challenge but I feel fortunate to have a chance to practice. It keeps me on my toes in reading up on certain medications on a nightly basis and asking questions about them so I can do a better job.

Summer Pharmacy Internship-Day 4

Today marked the end of a looooong first week back to work. I woke up to my alarm, still drowsy from my deep sleep, and soon realized that my lower back was sore and thighs very painful with every step. "Great! That's what I get for trying to be healthy," I was thinking to myself.

I was hoping for another easy day at work while driving in the lighter-than-normal LA traffic. I wish I was one of those lucky enough to be warm and cozy in bed on this Friday morning. Unfortunately, work started right away, even though I got in about 15 minutes earlier than my scheduled time (9am), and continued on non-stopped until lunch, which was close to 2 pm. I was completely out of fuel and in exhaustion by then, but had resume work after about twenty minutes later. My work day did no end until twenty minutes after six, by which time, I could barely walk without causing pain to my body, from the waist down.

I'm so glad tomorrow is Saturday and I will get to recharge for the next two days! Phew! What a week!

Summer Pharmacy Internship-Day 3

Today was another easy day at the pharmacy with many of opportunities to counsel. I felt so inadequate during counseling, but thankfully, my sister was available to help with the things I didn't know. I also had a chance to look up some information before talking to patients because it was not very busy and we were over-staffed. I learned about another medicine the OBGYN uses to stop contraction, nifedipine. Nifedipine is normally used for chest pain but it's interesting how it can be used to help prevent premature birth. I can't wait to learn more about the different classes of prescription drugs over the next three years in pharmacy school.

My other duties at the pharmacy today included creating a promotional letter and coupon for my sister and brother-in-law's newly acquired pharmacy, typing prescriptions, helping a senior call for her ride (multiple times and over an hour before they actually came to pick her up), ringing up purchases and answering the phone. Since business was slow and there were enough staff members at the pharmacy, I decided to take off early to go for a jog. The jog through LA fog was depressing but I was glad to get some much needed exercise.

Road Trip: June 2008

Four days after finals, my husband and I finished packing up my worldly possessions from my apartment and moved them to the Phi Delta Chi house, where I will be living starting in the fall, for storage. Packing and moving was a pain but we were happy to get the moving done (thanks to the help of a day laborer we hired at the U-Haul vehicle pick-up station)!

Our 11-year-old purple convertible Toyota Celica took us more than 1000 miles in less than one week: from San Francisco to Klamath Falls, Oregon, then back to Los Angeles. Our major destinations of interest were Lava Beds National Monument and Lassen Volcanic National Park, with the former being a disappointment and the latter a pleasant surprise. It was interesting learning about the different types of lava rocks and formations and how the lava caves were formed. However, being a person with little curiosity about caves, entering one was enough for me even though there were more than ten lava caves developed for visitors to explore. The Petroglyph Point was the only highlight of Lava Beds National Monument, where we learned about the ancient size of Tule Lake and history of the rock art and the Modoc War.

Lassen Volcanic National Park was a true delight. Its lush green pine forests, snow-capped mountains, serene crystal blue frozen lakes and geothermal features filled my eyes with wonder. In a way, it is a combination of Yosemite and Yellowstone without the summer crowd. I was surprised that there were waterfalls in the park because I had imagined it to look like the planet Venus from the description written in the Lonely Planet.

We drove through most of the park and hiked through three miles of the snowy Bumpass Hell Trail to see geothermal features. The steam vents, fumeroles, mud pots and boiling pools were not as impressive as those in Yellowstone, but the trek was quite fun with lots of slipping and sliding in the hilly and snowy paths. The views of the snow-capped mountains were also breath-taking. Our hike was delayed twice for trail maintenance by the California Civilian Corps, composed of mostly young men and women, who worked hard to make our paths safer.

The road trip was such a good way to relax after one of the most stressful final examination week of my life. It was nice to just soak in the fresh air of nature during the day and come back to a clean hotel room for a refreshing shower at night before going out for dinner.

Summer Pharmacy Internship-Day 2

Another 8 hours of standing at the pharmacy and I was exhausted after work. Today was another relatively easy day at the pharmacy with no long lines or angry customers. Like yesterday, I also had a chance to do a lot of counseling, with the guidance of another pharmacist sister of mine (the boss was off to take care of other duties today). I was proud to remember most of the counseling points on the use of an asthma inhaler during one of the counseling sessions. The patient, a teenage girl, seemed to be able to understand my instructions. With more time, the session would have been better if she could show me how to use the inhaler. As usual, I did a lot of counseling on antibiotics and remembered to emphasize their proper use to prevent resistance. Using my very broken Vietnamese, I explained to a young couple that the dexamethasone injection was used to stimulate fetal lung development because the doctor thought there was a chance of premature labor. Dexamethasone is a corticosteroid normally used to treat other conditions, such as arthritis, asthma, severe allergies and cancer. It's interesting how it can also be used for fetal lung development. The doctor who prescribes this medication, an OBGYN who specializes in high-risk pregnancies, also uses many unconventional drugs to stop contractions.

Summer Pharmacy Internship-Day 1

I've been back to work for two days now, but today was my first "real" day as a pharmacy intern. I was just goofing around, soaking in the work flow and getting myself reoriented with the computer system yesterday. Today went by really quickly with no major "rushes." The pace of work was pretty steady throughout the day, which was pretty untypical for most pharmacies. I'm glad that I didn't have to work through any angry/very anxious patient of a long line.

My sister, the main pharmacist and owner, had a lot of confidence in me. She allowed me to pretty much counsel patients on most of the medications and showed me where to look for more information when I needed them. However, when the patient was standing in front of me and there were other people waiting around for me to help them, it was pretty hard to read up quickly and have enough confidence to counsel on the drug if I didn't already have prior knowledge. I did my best at what I knew how to counsel and found it easier to just ask her about the unfamiliar prescriptions and had her answer questions that I did not feel confident in addressing.

Through counseling, I was able to put my "Emergency Contraception Training" to work, pull up some basic knowledge on heartburn medicines to answer the patient's questions, explain to parents how to give antibiotic suspensions to their children with the proper storage information, learn how to communicate with patients with limited spoken language skills through writing and body language. I didn't feel totally comfortable in my consultation role but figured I had, in general, made a positive impact in projecting the image of pharmacists as friendly community resources.

Hardest Final-DONE!

I felt so light this morning after finishing the pharm chem exam. I am SO glad I was able to study for it despite having woken up feeling really spiritless and crappy yesterday morning. Stress from finals really hit me hard this time I just freaked out yesterday afternoon when I felt I didn't have the needed energy to make it through studying for pharm chem! After staring at the syllabus for about 20 minutes and a few sneezes, I decided that I really needed to take care of my body. Luckily, after a stinky bowl of Chinese herbal decoction (my apartment is still smelling like a Chinatown herbal shop today from the cooking of it) and about an hour of nap time, I was able to squeeze in about six hours of productive studying. Although I couldn't calm worries (and didn't sleep well as a result), I was able to provide answers to all question and think I did at least well enough to get a B in the class. I would be SO happy if I got an A though. I'm normally not obsessed over grades but for some reason, getting an A in pharm chem was one of my goals for this quarter. It's so lame. I know!

Nerves, Crazy Nerves!

The anatomy exam is in an hour and I'm extremely shaky! Those damn nerves! For some reason, I'm letting them take over my body again. I need to take a deep breath and know that I will be okay regardless of the exam score. After all, I only need less than 50% to pass the class! How I wish we don't have letter grades like the medical students!

Public Speaking

After three presentations in front of my classmates, I am really convinced that I need a lot more practice in public speaking. I don't mind presenting information in front of a big group but I don't know why I get so nervous at times. I wish I could control my emotions in ALL of my presentations and not let my nerves get the most out of me. Unfortunately, I sometimes tend to get really shaky and trip over my words or start babbling and make a total fool of myself.

Oh well...I just have to conquer my fears and speak up more in front of big groups. I wonder if there's a class that I can take to improve on my public speaking skills.

Results: OTC/Herbal Patient Counseling Competition

I was thrilled to find out that Hilary and I won second place for the OTC/Herbal Patient Counseling Competition. It felt really good to know that we had done well given my nervousness at the time. It's a confirmation that I have at least learned something during the crazy spring quarter of the first year in pharmacy school and actually retained it well enough to counsel a patient. I'm looking forward to this summer's internship at my sister's pharmacy, when she will let me do a lot of patient counseling. It will be a good break from studying. I'm ready to put the books aside and do some hands-on learning...while making money and spending time with my family (my mom also works there!).

BURNT OUT

My time has been occupied mostly by things other than studying these days. I don't feel the urgency to cram even though there are five finals to take next week and I haven't really touched my books since the midterms. What happened to the "eager-to-learn" me? I have no more energy and can't wait till Friday of next week! Sigh.

Integrative Medicine Forum

After months of hard work and planning, the one-day Integrative Medicine Forum was a huge success with a turnout of close to 300 participants. Attendees ranged from UCSF students to members of the different communities within San Francisco. As one of the organizers of the forum, I was very busy trying to make sure that everything was going well, especially with breakfast and lunch. By the time I took care of all the meal-related stuff, I was too tired to participate in any workshops or lecture. Therefore, I went through the whole day of the forum without learning anything from the speakers.

From the feedbacks of my classmates and the written evaluations, I found out that Dean Ornish was very inspirational and many of the workshops were interesting. Despite the limited vegetarian option and lack of choices for lunch, people who had suggestions for improvement in food expressed great satisfaction with the quality of the forum. Many commented on the great level organization and comprehensive selection of speakers.

Being part of the planning committee, which was composed mainly of first-year medical students, involved a lot of time and energy. We started to meet and plan since January, in order to get speakers and food donations. I never imagined myself to be someone who would ask businesses for donations; I took over the position unwillingly, but learned a lot from doing it. I wish I had more control of the lunch situation.

I don't know how event planners do it, but it takes so much time and organization to put a big event together. I probably will never take up event planning as my job. It's so stressful!

Cadaver Face

For our Anatomy 116 class, we've been working in lab with the cadavers all quarter long and I hadn't really had any frightening episodes like I dreaded I would have...until today. We're working on the muscles, nerves and features on the neck and face and I freaked out when I accidentally flipped over the hemi-sected face while looking at it by myself. I can still imagine the facial hair and eyes and couldn't stop thinking about it while I was talking to someone over dinner. I kept seeing the hemi-sected face superimposed on the face of the person I was talking to. It was scary even thinking about it, but I couldn't help it. I hope I won't have nightmares tonight! I am glad we didn't have to look at the face until this late into the quarter. I don't know how I would have survived this quarter living by myself if we had to do that since the beginning of the quarter.

PubChem

In the bioinformatics course (BPS114), I get to revisit the NCBI website introduced to me by my bio professor at Pasadena City College. He made us do a genetics project using BLAST, a database within the NCBI website that allows you to search for homologs using a gene sequence. At the time, I hated having to complete the project and was happy to get it over with. Little did I know that I would be doing a lot more genetic research using the same website here at UCSF. It really amazes me how many genes we have sequenced and mapped but I'm really glad that I'm not involved with those projects. They seem so tedious! We even have complete a group project that's worth 30% of our lab grade using those gene databases! I'm so not looking forward to doing it. It's a good thing that we at least got to pick our team members.

Well, I'm studying for the second midterm in this class and not much is getting into my head. I keep on wanting to practice multi-step metabolic reactions for pharmaceutical chemistry instead. However, I managed to find something interesting from studying BPS 114 today: the PubChem database from NCBI! It's really a cool website where we can type in the names of drugs and find structural, chemical and other information for them. It also has a link to PubMed articles using the MeSH tree (a controlled vocabulary to help us refine search) as a search strategy. Through PubChem, I found a link to DailyMed, an NIH website with free information on all FDA-approved drugs. I think that site will become my good friends throughout my years here at UCSF and career as a pharmacist.

OTC/Herbal Patient Counseling Competition

For the first time since I started school at UCSF, I participated in the School of Pharmacy's one of many competitions today. My main motivation for becoming part of the OTC/Herbal Patient Counseling Competition was to show support (since very few of my classmates had expressed any interest). I also wanted to get some hands-on experience in what a therapeutic oral exam would be like, in preparation for next spring quarter's toughest class.

As someone not really living for the "thrill" of competing and inexperienced in working under time constraints, I got really nervous thinking about it last night. Although I regretted signing up for the competition and thought about quitting several times throughout the course of last night and this morning, I decided to bite the bullet for thirty minutes and risked making a fool of myself in front of a panel of judges, composed of two faculty members that I highly respect for their works in herbal medicine (Dr. Cathi Dennehy & Dr. Candy Tsourounis), Dr. William Soller and Chris Nguyen (a UCSF-graduated pharmacist).

With practically no prior preparations, except for our faint OTC knowledge from this year's courses, my partner (Hilary) and I had 15 minutes to read and prepare for our presentations. We were given a case, which contained symptoms of two self-treatable disease states and the patient's information. Hilary SOAPed out the disease state for more thorough presentation while I was responsible for a quick counseling on the simpler disease state. Basically, healthcare professionals use the SOAP sheet as a standardized way to communicate with each other. It contains the patient's subjective and objective information, the pharmacist's assessments of the problem and plans to solve it.

It seemed like we just walked in the preparation room with the case when the five-minute warning was given. We barely had time to read the case and quickly jot down some essential information from memory and the few facts we could look up with the references provided. We were given ten minutes total for the presentations. While Hilary presented the case as if she was sharing the information with other healthcare professionals, I had a little time to mentally organize and strategize my speech. I thought Hilary did an excellent job and was glad that she agreed to take the more involved part.

When she was done, I talked to the judges as if they were my patient. I think I remembered to convey most of the essential information, such as the cause of the problem, the name and class of medication used to treat the condition, desired outcomes, directions for usage, possible side effects, storage information, etc. I think I spoke rather quickly because I couldn't calm my nerves.

I don't think we used up the alloted time, but feel that we did well in general. It would have been better had I not been so nervous, though. Hilary and I both felt that we made a good team. She complimented me on my empathy for the patient.

There was a total of five teams, 2 first-year teams and 3 second-year teams and the top 3 will be rewarded with gift cards (courtesy of The Center for Consumer Healthcare, I think). I have no clue whether we will win since we didn't get to listen to the other teams' presentations. Regardless of the results, I'm glad I stuck to what I had set out to do despite my anxieties about competitions and my presentation skills.

It Takes Only a Few Drops of Black Ink

to stain a beautiful white outfit! I was very sad to hear a medical student say: "What's up with you pharmacy students? I was at a domestic violence conference and some pharmacy students were studying with their flash cards while a panel of speakers were talking about their traumatic experiences!" I was more than mortified to hear that about my fellow student pharmacist and apologized profusely about this inappropriate behavior. I wished I had enough sense then to tell her then that it's the exception and not the rule. Most of my classmates are intelligent, conscientious, warm-hearted individuals who put more than 100% in helping the underserved communities on top of studying. We try so hard to establish ourselves worthy of being included in the decision-making process in the interprofessional healthcare team. Unfortunately, we still have long ways to go..

It's a Spring Thing!

I just finished the 3-week midterm exam marathon, with 2 exams each week! The grades that I have gotten back so far were okay...within the A and B range. There were classes that I wished I had studied more for despite the decent scores. The grades didn't really reflect what I truly did not understand. I have resorted to procrastination and studying "to the test" and not to learn for at least two of them.

I've been having such a hard time focusing these days! There always seem to be better things to do: like running along the coastal trail near Ocean Beach and around Stow Lake in Golden Gate Park; taking, editing & uploading pictures onto Picasa Web Albums ; reading "Eat, Pray, Love" while enjoying a hot bath; watching "Dancing with the Stars;" volunteering for Hep B clinics; etc, etc. Anything but studying. I think I am having too much fun and not doing enough studying!

The funny thing is: I am not the only one slacking off. Many of my classmates are just like me-they can't stay focused on studying. I thought students were the only ones going through this phase, but a professor told me during our conversation yesterday: "I am having a hard time staying indoors these days. It's a spring thing; I just want to get out of my office and be outside. Are you experiencing the 'summer-idus' just like me?"

Well, that says it all. Students are not the only ones anxiously waiting for the arrival of summer!

The Final Quarter of the First Year

Things seem so much easier after the winter quarter packed with difficult classes, shadowing, pledging for a fraternity, etc. There is at least some room to breath with no afternoon classes on most days this quarter. There are challenges this quarter, like anatomy labs with its unbearable formaldehyde fumes, the re-surfacing of kinetics in pharmaceutical chemistry and boring lectures about compounding and infusion devices. However, they are nothing compared to last quarter. I'm glad I survived winter quarter with grades comparable to the first quarter, and without an incomplete mark.

Highlights in CP112

In the first year of pharmacy school at UCSF, we take classes in clinical pharmacy that cover a gamut of general pharmacy-related topics: cultural/diversity sensitivity in patient counseling, over-the-counter drugs, hands-on training on medical devices for common diseases, etc. I would say that the highlights for this quarter's CP112 class were the pulmonary skills lab and the diabetes training workshop.

In the pulmonary skills lab, Dr. Lisa Kroon and Robin Corelli gave us information inhalers commonly used to control asthma and COPD. Coincidently, I was, at the time, suffering from allergy-induced asthma and benefited tremendously from the workshop. After the lecture & demonstrations, I found out that I was using the pirbuterol inhaler incorrectly by not inhaling and holding my breath long enough for the mist to be absorbed in my lungs. I'm so glad we had that workshop, because it not only helped me obtain more benefit from my asthma medication, but I am now better trained to teach my future patients. Using those inhalers correctly can be a great challenge, as I have learned from my experience.

Another good thing that came out of that workshop and the reading on asthma was my medication adherence. I became more compliant in using the corticosteroid nasal spray after reading about the potential pulmonary damage from untreated asthma and the amount of time required for corticosteroids to take effects in the body. Knowing that my Nasonex doesn't start working until after 2 weeks of daily administration, I stuck to the regimen without expecting immediate relief, and finally got my allergies under control. Thankfully, I now do not have to rely on the pirbuterol inhaler for chest tightness because there's no more post-nasal drips to fill my lungs with fluids and cause vasoconstrictions.

Another really cool workshop that I just had last week was the diabetes training, where I tested my blood glucose level and injected myself subcutaneously with saline solution using an insulin needle. The blood test, I have done before, so it was less exciting than the self-injection. It was fun to actually not feel the needle going in at all when I placed the needle on my pinched-up abdominal area at a 90 degree angle. I can now tell my patients that it doesn't feel as bad as it looks when I counsel them on self-injections.

The first final is in two days and I feel so unprepared!

Job Interviews

The recruiters came to UCSF to interview for summer internships and I signed up for four interviews: Walgreens, CVS, Rite Aid, & Longs Drugs. I felt pretty good after each interview, but I am wondering whether I will be picked for any of the structured programs, which sounded pretty competitive.

My classmates were all dressed in dark-colored suits and I was the only one with a white skirt and pink and white top. There was a lot of waiting in between, but most of it was nice because I actually had time to chat with my classmates. By the end of the day, I was really exhausted and couldn't wait to go home so I could jump into the shower to take off my professional clothes, make-up, and the wax on my hair. Looking pretty isn't easy and I'm glad I'm not a movie star. I would feel horrible having to look pretty in make-up, wax, and uncomfortable clothes all the time.

I Did Okay on the P-Chem Final.

We finally got our p-chem final exam back today and I found out that I got a C on the final exam but a B overall for the class. I was really happy because I was expecting a C. Things worked out okay after all!

I can't believe finals start next week! I haven't studied for any subject yet and we have five more final exams to go! It's kind of scary when I think about it. I'll try not to freak out because I know everything will be alright in the end.

I'm looking forward to camping during the 10-day spring break!

Can't Let Go

This quarter has gone by so quickly that I feel like I have not learned anything even though I am always busy. Aside from attending lectures, I hardly have any time to study the dense materials for the five remaining classes that we have. Thank goodness p-chem is over...I still don't know the final grade though. Hopefully, I've scored enough to get a "C" in the class overall. I was actually hoping to pass the course with a "D" before going into the final. I had such a hard time focusing when I looked over the materials the weekend before the exam. Luckily, due to errors in the printing of the test, we were given 40 free points (20% of the test), and I only needed a 22.7% to pass the class with a "D". I hope I did enough to get the 40% I needed for the "C".

For the past few weeks, I've been spending most of my time with Phi Delta Chi's (PDC is a professional pharmacy fraternity) pledge class, completing events required for the induction to the family. During the process, I have experienced first-hand how frustrating leadership can be, especially when you are forced to step up because no one else has bothered to do so. I felt that I was doing all the organization by myself even though I was supposed to work with my fundraising team.

Stress from school and an unpleasant phone call from the collections agency about a huge debt that wasn't even mine (but I had to take care of anyway) escalated my negative feelings and I just blew up. I said things that I shouldn't have said, and words spread like wild fire. As a result, my teammates seem to be really angry with me and I am suffering the consequences of awkward silence around them. Although I have sent out an unofficial and generic apology, I doubt that it has helped the situation. I've once heard that words can stab like knives and once the damage is done; scars remain even after the wound has healed.

Lessons learned:

1. I need to let go when others do not meet my expectations for what their responsibilities should be. I can be harsh on myself but not on others because I need to respect their standards on how they should live their lives and be more understanding of their situations. Drowning my head with negative thoughts when others don't fit my definition of "doing one's job" would only hurt myself and result in negative interpersonal interactions.
   
2. Be careful of what I say. Once words are out of the mouth, they can't be taken back and some relationships are forever damaged as a result.
   

Elections, AKA Popularity Contests

Today was the first day of elections for leadership positions in various organizations on campus. These are the trends that I have observed observed so far:

1. The VP positions seem to be more popular than the president-elect position, which in both of the elections that I have attended today, have been run, unopposed.
   
2. Many other positions also have single candidates so no voting was necessary for those seats. There are WAY TOO MANY organizations in this school and not enough people willing to sacrifice the time for leadership positions, which is understandable because of the additional IPPE requirements this year.
3. Voting is supposed to be a democratic process where the most qualified candidates are chosen for each leadership position. However, the most popular individuals among the people present for the elections usually win. Decisions are usually not based on how qualified the candidates are but on emotions and personal affiliations; sad but true.
   

Sleep

After weeks of exhaustion, I was finally able to sleep for 10 hours straight through the night for the first time! It felt sooooo GOOD! There always seems to be so many things to do and so little time. I never expected the pharmacy program to be so demanding on my time. This is one of those times when I wish that there were more than 24 hours in a day.

I can't really write now because I have a kinetics final next week, a pharmacy calculations quiz the week after that, and a presentation plus other fraternity pledging events to prepare for. Last Friday was our last p-chem lecture and I will never have to think about it again after next Thursday. Studying for it is going to be a real torture though. I don't think I will spend more than 8 hours on it, even though I have not done anything for that class aside from attending lectures and taking notes. I was going to burn the book, which has been untouched since last quarter, during the bond fire next week, but our pledge class has decided to attend the Chinese New Year parade instead of a bond fire. Oh well, I can always burn it in March when I go camping with my classmate, Becky. We will both get a kick out of it. Oh, that reminds me I have to book a camp site now.

Persistence & Cole Hall Emotions

It's only my second quarter at UCSF, and I have already developed a love-hate relationship with Cole Hall, the place associated with extremely fun times (like Skit Night and Mr. Pharmacy) as well as two pretty excruciating experiences so far with the fire alarm. When the fire alarm blasted off this morning during the middle of our CP112 midterm exam, I immediately remembered how the same thing happened during our White Coat Ceremony, when I was already grouchy for some reason.

My first reaction was of course to cover my ears in order to remove the source of annoyance. However, I had an exam to finish, and seeing that no one else had moved out of their seats, except for those who had already finished the test, I decided to free my hands so I could finish the rest of the test. By that time, the professor in charge had already said: "There is no danger in this building. Someone at Long/Moffitt Hospital (right next door to us), must have pulled the alarm. Obviously, I can't stop the exam right now, but I will give you extra time to finish." I was wondering if it was a patient who had done it, but was too annoyed by the forceful and constant vibrations in my ears as well as being too occupied with trying to finish the test to pursue the thought any further.

After about five minutes of trying to desensitize my ears to the vibrations, I finally found a solution to my distress: covering my head with the long coat I had beside me. That did the trick and the alarm stopped just as I was finishing up with the rechecking of my answers.

Ten years from now, I will probably look back and remember how annoyed I was in having to endure about 15 minutes of the eardrum-blasting beeps during a midterm that I was not totally prepared for due to the long two-week of midterm marathon. However, what I will remember most is the power of perseverance my classmates have shown over and over again. They have amazing ability to not only withstand adverse situations, but to do well on exams despite adversities. We had a code blue team in the classroom during our biostatistic exam last quarter when a classmate passed out. Nonetheless, most of my classmates were able to focus and did well; the mean was a high B. My classmates' intelligence, hard work, persistence, and qualifications continue to amaze me.

Access Denied!

I have been running into many embarrassing moments lately with my communication: stuttering while making an announcement in class, not being able to pronounce words while presenting my chapter summary to the group discussion, blanking out when I am expected to speak in a group discussion, etc. I never realized that my communication skills were so poor! My brain is not allowing access to words when I need them most and I am left utterly and horrifically speechless!

A Lot of Chemistry

It seems like most of what we learn this quarter is mostly chemistry. We are finishing up physical chemistry (thank goodness!), studying advanced organic chemistry (which isn't that ADVANCED if you have a good basis in undergraduate ochem) and biochemistry (I love that class!).

I can't wait till Feb 21, when I finish my pchem final exam! For six weeks this quarter, we are focusing on kinetics, rather than thermodynamics (last quarter). I see SOME relevance of kinetics to the pharmacy program, but it's probably not going to help me in my future career as a pharmacist. I think I will take one of my classmate's suggestion and burn my torn pchem book during the bonfire with my fraternity pledge class the weekend after the exam! I know I can save it for my mentee next year, but I think it will be really satisfying to see it go up in flames....I don't know...I'll keep that thought in mind for now and decide later. I still have plenty of time. Oh, I just realized that I have not opened that book even ONCE this quarter, and probably won't do so in the next three weeks. Therefore, I won't be surprised if I didn't get a reasonable grade for the test I just took this Monday and the final I will take in about four weeks . I think I will pass the class though. And that's good enough for me!

We just had a 2-hour ochem test today and it was 15 pages long! Even though I didn't really start studying for it until two days ago, I think I passed it with at least a C. Aiming low can alleviate so much stress and add to the quality of life as a student (that is, if we still have a life outside of school!). In general, the ochem class is mostly review with a little bit of new info and some applications to drugs. I am so glad I just took ochem last year and read the chapter about acid/base chemistry in Klein's "Organic Chemistry As a Second Language" over the winter break. I don't know how I would have survived without that book in the undergraduate ochem class.

Biochemistry is my favorite class this quarter! Our instructor is a fairly young and well-dressed professor who is really organized, thorough, and clear in her lectures. We are focusing on human metabolism and it's really interesting to learn how the body uses food sources as energy and store them for future use. There are many details to remember, such as the names of regulatory enzymes and intermediates in different pathways (glycolysis, beta oxidation, citric acid cycle, etc), but I don't really mind them. I know I will forget them in the future but it's cool to learn about all those details anyway. Hopefully, by the end of this class, I will have a solid foundation to help me understand the pathophysiology of different metabolic diseases. It seems like studying for biochem is all I want to do nowadays! I know I should put it off for now and focus on anatomy, though. The midterm is a few days away and I haven't even studied for the class!

I did it!

After studying super hard for the pharmaceutical calculations quiz over the break and the weekend before the quiz, I aced it with a perfect score! First of all, I am proud to know that I still have those mathematical skills...after A LOT of practice...but I still have them! Second of all, I am so thankful to pass it after the first try because I don't have to study for it again, until a week later (for the midterm). I wrote my introductory chemistry teacher and thanked her for being such a great instructor. The quiz was easier to complete with the dimensional analysis skills she had taught me about 21/2 years ago!

Medication Compliance

I've been sick most of the time since the beginning of the quarter: sneezes, headaches, body aches, post-nasal drips, and coughs. As a result, I haven't been able to study much and spent most of the time in bed. I've been to the student health services twice to get help from the doctor and to get prescription drugs for my illnesses. After a lengthy discussion with the nurse practitioner, I realized that the persistent symptoms of nasal allergies result partly from my noncomplianced to medical regimens.

In order to become a pharmacist who promotes medication compliance, I think I have to convince myself to do that first. I was told by previous doctors and my pharmacist-sisters to be consistent with the use of Nasonex and antihistamines so I wouldn't get major allergic attacks and persistent coughs. However, thinking that I didn't have to rely on medicines to do the job, I used alternative means to strengthen my body: Chinese tonic soups, herbs, and cupping. In short, I don't like taking western medicines.

So far, I have failed to "strengthen" my body enough to get rid of allergies, leading to painful coughs and chest tightness. My stubbornness has resulted in the reliance on the use of another medicine, an inhaler for asthma, Maxair Autoinhaler (bronchodilator). The NP said that allergies have triggered a mild asthmatic reaction and that using this drug will also help my cough. My resolution: continuing to take Zyrtec (antihistamine) for as long as I need it, take cough syrup QHS PRN, and use the inhaler when I feel tightness in my chest. I hope these drugs will do the trick. Otherwise, I will not only miss out on learning in classes, but also shadowing a heart/lung transplant pharmacist and participating in other professional activities.

Pictures of Mr. Pharmacy

Winner of Mr. Pharmacy 2008
Runner-Up of Mr. Pharmacy 2008

Judges and audience getting a good laugh.

Mr. Pharmacy

I am so behind with work right now but I found myself wanting to write...and who can turn down the urge to write?

I just attended the most amazing "pageant" in the history of pharmacy school: UCSF's Mr. Pharmacy 2008! So much talent and fun were present that it inspired me to take over 500 pictures of the contestants and audience during the event. Prior to the show, I did not have much expectation and went primarily to support our class's fund-raiser for graduation. However, although I was preoccupied by picture-taking, I enjoyed seeing the amazing talents exhibited by all these men and people involved who made the show such a success. Despite the hectic schedules, they made an effort to to organize the event and prepare for the acts. Student pharmacists at UCSF are truly phenomenal! I really mean it. What an honor to be learning among these people.

Walter Valdez, the runner-up, sent the crowd on a wild roar when he related his favorite childhood story, in which he peed on his pants in class and was eventually saved by his best friend from embarrassment with the throwing of a wet paper towel accompanying with the words: "We were fighting with wet paper towel." I never knew he was such a great story-teller. That was one of my favorite acts of the show.

Of course another popular performance, which also had the crowd rolling with thunderous laughter, was the song "P-Chem Blues," by the winner, Trevor Oelrich. He was not only a great singer and writer, but could also accompany his singing by playing two musical instruments: the harmonica and guitar. The best part was that student pharmacists in the crowd could relate to his lyrics about the first-year course, which was the cause of many nightmares of delta G and partial derivatives.

The turnout was awesome and the crowd extremely enthusiastic. I think the event raised a tremendous amount of money for our class, thanks to Krystal Pong's initiation and the help from many of our classmates. Some people were lucky enough to win prizes donated by several local businesses. However, the biggest sponsor of the night was Wal-mart Pharmacy, who's representative was also a judge for the competion, donated money for the winners' classes and Marnee Thai's dinner for all attendees, as well as giving away 3 ipod shuffles.

It was a night filled with laughter...and now...back to reality: trying to catch up with piles of school work and reading! sigh.

Spontaneity

I had the nicest lunch hour today in the student lounge with a group of classmates. As usual, I went up there to heat up the noodles that I had made for lunch, for two days in a row, not really expecting to enjoy the food nor to find any company there. To the contrary, I was pleasantly surprised and greeted by a diverse group of classmates that I am extremely fond of for their down-to-earth attitude and genuine personalities.

We made small talks about various topics which included food from different cultures, the weather, among other things. However, my favorite part of our conversations was hearing the stories two classmates shared about disciplining and the comments about what damage females can cause with their fighting strategies (hair-pulling, scratching with their long finger nails, cracking skulls with their pointy high heels, and intimidating with their postures and facial expressions).

I had the most unexpected fun in a long while in that one hour shared with my classmates at the cost of not writing up the shadowing reflection for my IPPE experience. I figured that in the end, the one hour spent with them will be more pleasantly imprinted in my memory than most experiences in pharmacy school, which is composed of sitting in classes, studying endlessly in order to catch up with lectures and exams, trying to squeeze more activities into the limited "available" schedule, reading junk emails, and responding to numerous deadlines.

An added bonus to experience was the mixture of the crowd. I have been bothered by the fact that most of my classmates, myself included (sadly), form small groups of the same ethnic make-up to hang for lunch and other events. Since this group was composed of almost every ethnicities represented by the class, I was enlightened by stories from various cultures and different perspectives from the group members.

Although having a hectic pace is an inevitable part of pharmacy school, I believe there is nothing more important in life than a little spontaneity. It adds a little twist to my mundane existence and richness to my experience as a student pharmacist. It's important to achieve goals, however, it is also important to enjoy life at the same time. Who knows when I'm going to take my last breath? Therefore, I need to soak in life and enjoy my existence while l am still able.