Our pharmacy had started a new chemotherapy program at my hospital. My boss (Director of Pharmacy) and I (Assistant Director of Pharmacy) were very excited to embark on this new task. We had one four foot hood and one pharmacist preparing chemo on a daily basis.
Our pharmacy had all the necessary precautions when it came to preparing chemotherapy. We had the usual gowns, gloves, blow-back needles, filter straws, masks, chemo pads and chemo waste receptacles. Our policy stated that pregnant women (or soon to be pregnant women) would not prepare chemo. In addition, no one (male or female) would be assigned to prepare chemo more than two days in a row.
Our pharmacy did not have the manpower to devote two people to preparing chemo (even a double check was difficult). Yet even if we wanted to, our hood was especially small, so it could only accommodate one pharmacist. Thus, chemo could only be prepared by one person at a time.
It’s human nature that every doctor and nurse wants their patient to receive their chemo first. However, this was simply not possible. Therefore, we prioritized who would be first.
Our policy stated that high dose chemos (ie Methotrexate) would be prepared first. Then, clinic patients would be given priority. Next, pediatric AIDS patients followed. Finally, in-house adult patients would have their products prepared.
This was all accepted and agreed upon by all respective doctors, nurses, managers and pharmacy members.
All was going well with the new chemo program, Until the day that Dr. Howard complained.
Dr. Howard (not his real name) had an adult patient on 5 north who was getting his chemo around 2pm. However, Dr. Howard generally made rounds in the morning (9am- 10am). He wanted to be there when the patient got their chemo in case there was any problems.
In addition, he pointed out that many of the chemo nurses only worked to 3-3:30 pm. Thus a chemo preparation arriving at 2 pm created a hardship for the nurses.
Dr. Howard requested that something needed to be done. My boss agreed. He stated that Dr. Howard’s chemo preparations would be prepared first.
A few days later, Dr. Fein (not his real name) wanted to speak with my boss. Dr. Fein was in-charge of the pediatric AIDS department. It seemed that the pediatric patients were getting their chemo at about 12 noon. Their increased nausea (due to the chemo) caused many of the pediatric patients not to eat their lunch.
Dr. Fein requested that something needed to be done. My boss agreed. He stated that Dr. Fein’s pediatric aids patients’ chemo preparations would be prepared first.
Soon after, Shirley (not her real name), the nurse manager, from the clinic stated that many of their clinic patients were waiting two, three, sometimes four hours before getting their chemo preparations. This was totally uncalled for.
Shirley requested that something needed to be done. My boss agreed. He stated that Shirley’s clinic patients’ chemo preparations would be prepared first.
The next day, my chemo pharmacist approached me. She had
- A chemo preparation for one of Dr. Howard’s 5 north patients,
- A chemo preparation for one of Dr. Fein’s pediatric AIDS patients, and
- A chemo preparation for one of Shirley’s clinic patients.
“Which one do I do first?” she asked.
I smiled. I knew this was going to happen.
“I don’t know.” I replied, “But I’ll find out.” I marched into my boss’ office.
“ The chemo pharmacist approached me,” I said, “ She had
- A chemo preparation for one of Dr. Howard’s 5 north patients,
- A chemo preparation for one of Dr. Fein’s pediatric AIDS patients, and
- A chemo preparation for one of Shirley’s clinic patients.”
I paused. My boss said nothing.
“ So my question is,” I continued, “ Which chemo preparation do we do…”
“First,” he answered.
“No, that’s the easy one.” I replied.
He looked confused.
“What do you mean?” he said, “The question is which chemo preparation do we do first?”
“No it’s not,” I responded, “ if you go up to Dr. Howard, Dr. Fein, or Shirley and say ‘which chemo preparation do we do first’ they’ll all say do their patient’s chemo first. Thus, the question we should be asking is ‘tell me which chemo preparation do we do last?”
My boss thought for a minute.
“I don’t know,” he said.
“The chemo pharmacist can only make one chemo preparation at a time,” I said, “someone has to be first and someone has to be last. So tell me, which chemo preparation do we do last?”
“That’s a good question,” he stated, “I don’t have an answer for that.”
“See, that’s the problem with my question,” I said,” No one has an good answer for it. ‘Which chemo preparation do we do first is easy to answer. ‘Which chemo preparation do we do last is a lot more difficult to answer.”
I continued, “Thus, until I get a good answer from you, or a doctor, or a nurse, or even an administrator, I have a policy in place telling me what the order of chemo preparation is. Therefore, I’m going to follow the policy.”
I left my boss’ office. I told the chemo pharmacist which chemo preparation to do first and which chemo preparation to do last.
Dealing with the Daily Stress
This was just another stressful event to cap off another perfectly normal day. Imagine starting a new program and dealing with doctors and nurses who wanted to call the shots. What could be more stressful than that?!
There are many stressful occupations and Pharmacy stands with the best of them. Even though “Let Pharmacy do it” has become our stressful mantra, I enjoyed my many years working in hospital pharmacy.
In order to deal with the daily stress, I practiced two concepts:
- I did Danny stuff: I have my wonderful wife to thank for this concept. She always felt that it was essential to make time at work for something for me. I needed to do things to make me happy. In other words, do something for Danny.
- I became selfish: I worked very hard. I devoted 150% to my job. I was constantly there for my staff. I did everything to help the patient. I did everything to make the doctors, nurses, and administrators happy. I wrote reports, worked on projects, and implemented new programs. I did a lot for everyone else.
Which is why that I became very selfish. I felt that I deserved to. Since I was constantly doing things for other people, I needed to become selfish and do things for me.
As I stated, I liked my job. I enjoyed working in hospitals as a hospital pharmacist and manager. But there were days when the aggravation and stress just built up and I needed some release.
I always tried to incorporate my stress reliever activities into my work assignments. This was truly beneficial. Here are some of the things that I did.
Designing Poster Sessions
I worked for a boss who was the Director of Pharmacy. She was also the newly inducted President of our state pharmacy society.
“I’ve come up with a new idea for our annual society meeting,” she said “I want you to come up with a poster session.”
“Sure,” I replied, “what’s a poster session?”
“It’s an event where people stand in front of posters that they’ve created. They present their ideas using a standardized format. They also discuss their research using charts, diagrams, and photographs,” she said.
“So, the poster session is an event where the presenter’s peers walk amongst the posters.” I replied.
“Yes, but it’s more than that,” said my boss, “The poster session allows the presenter and the peer to interact. The presenter discusses how they implemented the project, what data they received, and what conclusions were drawn. This way, the peer can take back some of these concepts and start them in their own pharmacy.”
I enjoyed preparing the poster session. Through the years, I constantly sought new concepts and things that I did in my pharmacy in order to create other poster sessions.
My rule for designing a poster session was to keep it simple. Some presenters used outside companies to design their poster sessions. They invested big bucks to produce laminated posters in a plethora of colors. I printed my posters session on individual sheets from my desktop printer.
My phrases were short and my font was large. Just like a good resume, I was a firm believer of using sufficient “white” space in my poster.
But the two most important points were
- I needed a good (elevator) speech. My peers didn’t spend that much time as they moved from poster to poster. So a good speech that hit the key points was essential.
- I wanted a simple idea that my peers could take back to their pharmacy and implement. “The Use of High-Dose IV Labetalol in Hypertensive Crisis” was not a poster session that I would choose to present.
I was very fortunate to present sixteen of my poster sessions at the American Society of Health-System Pharmacists meetings throughout my career. Here are some of the topics;
"Matching Soft Skills Between Employers and Job Candidates- A Formula for Success”
“Pharmacy Technicians Embrace Video Learning—Helping Others by Helping Ourselves”
“Bringing the Pharmacists to the Floors: Getting Up Close and Personal”
"Creating a Hospital Pharmacy Website—Identity Crisis Solved”
“Implementation of Six Sigma Methodology to Minimize Overtime Expenditures”
“Teaching National Patient Safety Goals: A Picture Perfect Image of Our Staff”“
"Implementation of a Return Procedure to Impact Pharmacy Costs”,
"Handling a Sentinel Event A Manager's Insight”,
"Clarifying the Extent of the Pharmacist's Role”,
"How To Feel Like a Millionaire: Motivating Your Staff”,
"Evaluating Technicians Using the Peer Review Process”,
"Drug Shortages: Treating the Patient with What You Don't Have"
Collecting Pharmacy Stamp First Day Covers
In 1979, the US post office issued the 8-cent Pharmacy stamp. I remember attending a History of Pharmacy lecture in Trenton, NJ. The speaker was a gentleman named George Griffenhagen.
Mr. Griffenhagen had an extensive collection of Pharmacy Stamp First Day Covers (FDCs). An FDC is an envelope which bears a stamp that is cancelled on the first day that the stamp is issued by the postal service. In this case the Pharmacy stamp bore a “First Day of Issue” cancellation and was cancelled at Cincinnati, Ohio.
The reason that stamp had a “Cincinnati, Ohio” cancellation, was that the postal service issued the stamp at the American Pharmaceutical Association Convention in Cincinnati, Ohio. At the convention, many pharmaceutical corporations, colleges, individuals, and stamp companies designed their own special envelopes or cachets. The 8-cent stamp was affixed to their envelopes and cancelled with the “First Day of Issue” cancellation.
I am proud to own one of the largest collections of Pharmacy Stamp First Day Covers.
Throughout my pharmacy career, I have had many opportunities to display my collection. Pharmaceutical sales reps, fellow pharmacy colleagues, and many others have all marvelled at my collection.
I have presented my collection at stamp shows, a public library, two ASHP conventions, and the New Orleans Pharmacy Museum. I am currently working on displaying my collection using Apple’s iMovie Program.
Writing Light Hearted Fluff
I always enjoyed writing. I started writing articles for pharmacy journals in 1994. My articles were always written in the first person. I told the audience what I thought or what I did in my pharmacy.
My articles were what I described as “light hearted fluff.” Although there were many outstanding clinical articles, with detailed charts and extensive research, I never wrote that way. Instead, I described things that I did in my pharmacy that the reader could do in their pharmacy.
Or I would pick experiences that I encountered at work. For example, I remember that I once wrote an article entitled, “Call Me and I’ll Be Around.” I was on-call and a physician phoned me at 2am one night. He woke me out of a sound sleep and expected me to be brilliant in answering his questions. I wrote the article the very next day. It was published in a major pharmacy magazine shortly thereafter.
One of my favorite articles that I wrote was called “Protocol for Mrs. C”. Mrs. C was a cancer patient. Unfortunately, the cancer had advanced to a very serious stage. She was in a great deal of pain. What’s more, even with a walker, she had difficulty walking and getting around.
Mrs. C came into the clinic on a weekly basis to receive her chemo medication. One week she was told that she qualified for a new drug study that the physicians were conducting. The drug study was a double blind study. The parameters of the study stated that Mrs. C would receive either the study drug or a placebo in addition to her regular therapy.
None of the doctors, patients, nurses, or sales representatives knew whether Mrs. C was receiving the study drug or a placebo. Only I (as the pharmacist) had that information.
After four months of participating in the study, Mrs. C’s pain diminished dramatically. She no longer need a walker or any assistance to get around. Her outlook improved greatly. In fact, it appeared as if the disease was progressing more slowly.
The sales rep began touting the benefits of this new miracle medication. The doctors were ecstatic and couldn’t wait to try this new medication on their other patients.
I didn’t want to violate the confidentiality of the study so I didn’t say anything. But I knew. Mrs C was receiving placebo. She had not received any doses of this miracle medication.
Creating Video Productions
I like to make videos. Some people paint. Some people knit. Some people pay a musical instrument.
I like to make videos. I have my own YouTube page where I post my videos. To share them, I send out the link.
To enhance my video experience, I called my video production “Dan-Z Films.” A “Dan-Z Films” screen begins and ends each video.
I worked with Apple’s iMovie to make my videos. Using iMovie also gives me an appreciation for video making. A one-minute video takes about four hours to create. A two-minute video takes about eight hours and so forth.
Although it takes a great deal of work to create videos, iMovie makes it quite easy. Furthermore, the final product looks quite professional.
It was very easy to incorporate my video making into my daily work routine. Some of my “work” videos included:
- A video where my pharmacy staff demonstrated the unit dose process,
- A comic con open house video that my school used to attract new students, and
- A teacher appreciation video where the teachers danced to Pharrell Williams’ “Happy” song.
The Work Will Always Be There
My friend was a workaholic. She worked long hours, came in on weekends, and even took work home with her. Even when she was on vacation, she would call in to find out what was happening.
I felt differently. I knew that the work would always there. I also knew that I could find even more work to do if I wanted to.
I also made sure to complete my work. I gave it my all and made sure I did an outstanding job.
But I also took the time to do non-work related tasks. I always made sure to do stuff for “Danny”. For this was the best way to relieve the day-to-day stress.
Daniel Shifrin, R.P., M.S. is a recently retired pharmacist who enjoys sharing his insights about hospital pharmacy. He is proud to own one of the largest collections of Pharmacy Stamp First Day Covers.