Live! From VCU School of Pharmacy

During spring break, I have journeyed to El Salvador as part of a medical mission team each of the last three years. Words cannot adequately describe how much of a blessing these experiences have been in my life, but I will try to give a glimpse of some aspects of the mission journey that are very special to me. I will provide details of my experiences by responding to a series of questions.

·         How did you have the opportunity to go?

I was granted the opportunity to be a part of a mission team to El Salvador through my involvement with the Richmond area Christian Medical & Dental Associations. They offer a Bible study/discussion session and dinner each week. One of the leaders of this group who is a doctor in the area, in partnership with My Father's House International, has been taking students to El Salvador for a number of years to participate in medical missions. My Father's House International is a Roanoke, Va.- based nonprofit organization that serves as the financial backbone for a children's home in El Salvador called La Casa de Mi Padre.

·         What did you do while you were there?

Over the course of our time there this year, we spent four days providing medical care to Salvadorians in rural settings that lack adequate access to health care. We even partner with Salvadorian doctors and dentists who join us in our efforts to help the medically underserved in their country. Every patient at least receives multi-vitamins, and some patients receive upward of five or six different medications. More importantly, each patient is prayed for, if they so desire, and we together acknowledge that God is in control of their health and is truly the Great Physician. We also spend time with the children of La Casa de Mi Padre each year, which is truly a blessing. In addition, on nonclinic days, we have gotten to travel to various places over the course of my three trips, including Suchitoto, which is home to a beautiful church built in 1853; the Pacific Ocean; an artisans market where you can barter for local trinkets; and a phenomenal dormant volcano.

·         What did you learn?

Once again, words cannot describe what all I have learned during my experiences in El Salvador, but I will share some things that stand out the most to me. From my experiences in the makeshift pharmacy setting, I was able to strengthen my medication therapy knowledge while also learning valuable life lessons. During our clinic days, I was provided the opportunity to spend time with individuals who are truly impoverished according to American standards. However, these individuals seem to be far more satisfied than most of us. They are actually content with life and take life as it comes, in comparison to many of us, who are on the go all the time, striving to obtain more worldly possessions and financial gains. It is quite evident that such material possessions cannot provide true happiness. Accordingly, while they may be poor in a material sense, they are rich in the sense of community and relationships, which are eternal in nature.

In addition, I witnessed firsthand a vast amount of broken relationships during my experiences in El Salvador. I learned about how many of the children of La Casa de Mi Padre were removed from their natural home environments by the government because of abuse, mainly sexual abuse. In addition, there is an extensive amount of gang activity in El Salvador. Last year alone, two fathers of children at La Casa lost their lives due to gang-related incidences. While these are obvious incidences of broken relationships, there are others that are not so evident and warrant careful consideration on behalf of everyone.

According to the book "When Helping Hurts," we all suffer from broken relationships in four fundamental areas, whether it be with God, self, others or the rest of creation. The importance of this brokenness has really become evident in my life as a result of my experiences in El Salvador. While the examples described above are obvious cases of broken relationships between the individuals themselves and others, I have challenged myself, and would like to challenge all readers, to consider all the relationships in our lives. When relationships go haywire in one area, it will negatively impact other areas of our life as well. I hope that we can help each other to make right the relationships in all four fundamental areas of our lives.

I also learned about the significance of looking outward instead of inward. What does this mean? Well, society teaches us to look out for number one, ourselves, as we strive for worldly success. However, no matter what material things we gain here on earth, we cannot take them with us when we leave. However, the relationships we build through helping others are potentially everlasting and far outweigh any material gain.    

Finally, life is a journey, just as I would like to describe my trip to El Salvador as instead a journey. I have learned valuable lessons during my experiences in El Salvador, and these lessons are part of an evolving process of me becoming a better human being. The lessons I learned come up daily as I walk along the journey of life. I hope that I will embrace these experiences as opportunities to mold me into the person God would have me to be instead of viewing each day as a discombobulated trip without connections to previous or future days.

·         What is the most special moment you can remember?

During the third clinic day, our first patient in line was a 17-year-old boy who came for a dental visit, a simple tooth extraction, to be exact. As the triage nurses began obtaining a medication history on this boy, it became evident that he had some serious health conditions. He had suffered from a heart defect from birth that made him unable to run or play as normal kids do. In fact, he actually looked to be more like 12 or 13 instead of 17 years old. Upon much physical exertion, his lips would turn blue from lack of adequate oxygenation. He had been told by Salvadorian physicians that there was nothing they could do for him; his life was destined to be cut short. Yet, I believe that God sent him to us that day to get him access to the necessary treatments for his condition.

The medical doctor he saw had previously worked with an international organization called Samaritan's Purse that helps to coordinate visas and other requirements to get individuals to the United States for medical procedures. In addition, Samaritan's Purse actually has an ongoing relationship with La Casa de Mi Padre because it constructed a chapel on the land that is the future home site of La Casa. Once these existing relationships were realized, the coordination efforts commenced to get the young man the help he needs. As of right now, contact has been made between the organization and the boy's family, and he is scheduled to undergo testing that would qualify him to come to the States for surgery. Please pray for Juan and the outcomes of this ongoing process.

In addition to third-year School of Pharmacy student Will Coleman, Kristin Bell (P2), Jessica Libuit (P2), Mi Jung Lim (P1) and Rebecca Saunders (P1) participated in the 2012 medical mission to El Salvador.

Today's Date: Oct.  12, 2011

Total Mentorship Hours: 61.5 hours

Mentorship Research Journal #4

My fourth journal entry begins on Sept. 7, when I returned to shadow at the VCU School of Pharmacy.  Dr. Stevens was conducting a lab with the class, while Dr. Mawyer tested the students' counseling skills. Dr. Mawyer was a pharmacy resident interested in clinical pharmacy, like that practiced in the Ambulatory Care Clinic, due to her desire to practice "clean medicine." 

The second-year pharmacy students were required to be able to counsel on Warfarin, a blood thinner used to prevent the formation of blood clots in the blood vessels.  The drug works by blocking Vitamin K, which aids blood clotting.  The students must have had to memorize myriad facts about the drug in order to sufficiently answer questions the patient might have.  Their directions had to be very specific, or else they could be putting their patients at risk.  Most importantly, they must be able to communicate their directions sufficiently, in a manner that was more like a conversation than an order.  In this class activity, Dr. Mawyer played the role of the patient, while the students assumed the pharmacist role. 

In addition to Warfarin, students were also required to research the INR, or International Normalized Ratio, which determines a patient's risk for bleeding.  The ideal ratio is between two and three; a high INR indicates risk of bleeding, while a low INR indicates the risk of painful clot formation.  If the patient's INR was too high, then the dosage of Warfarin would be lowered.  Practicing counseling skills required that the students demonstrate their understanding of the medication while preparing them for their future careers.

I participated in another class activity on Sept. 14, which focused on genetic testing.  In this activity, students researched different kinds of genetic tests from different companies.  For example, the company Navigenics offered genetic analysis that could be conducted with a saliva sample.  DeCODE offered genetic tests that could be conducted with skin cells from the side of one's cheek.  The students were responsible for reviewing these different means of genetic testing and determining which kinds of tests they would recommend to their hypothetical patients.  When making these recommendations, the students kept in mind patient convenience, counseling services provided, level of privacy and confidentiality, and possible test limitations, which are all very important factors for patients.  This activity served to allow students to practice their research skills, which are essential for pharmacists, who must frequently research drugs and pharmaceutical companies as more and more enter the market.

After observing several classes from the students' perspectives, it was time that I explore pharmacy school education from the teacher's perspective.  Over the next few Mondays, I mentored with Dr. Donohoe, an assistant professor at the School of Pharmacy.  My task was to help create PowerPoint presentations for her class, using the text "The 200 Most Common Drugs."  During my time with her, I prepared presentations on cardiovascular agents and lipid-lowering agents.  I relied on the text as my guide-- by looking up terms with which I was unfamiliar, I recognized them more easily over time. 

Dr. Donohoe gave me additional help by explaining the terms I did not understand.  Through this process, I came across a slew of new medical terms.  While working on the cardiovascular agent unit, I learned about ACE inhibitors, which treat hypertension and heart failure.  Drugs that fall under this drug group typically end with "--pril."  ARBs also treat hypertension and heart failure and typically end with "--sartan."  Amiadorone, which also treats the heart, is known for its many side effects. Clonidine is used to treat hypertension and has to be taken often.  Pertaining to lipid-lowering agents, cholestyramine binds with the gastrointestinal tract to block bile acid, which in turn helps lower cholesterol.  LDL and HDL are two of the main groups of lipoproteins: LDL is more commonly known as the "bad cholesterol" while HDL is the "good cholesterol."  Myopathy is associated with intense muscle pain.  This experience gave me a small glimpse into the vast amount of vocabulary students must pick up over time in order to function as pharmacists in the work field.

I returned to the Ambulatory Care Clinic on Sept. 20. This time, I mentored with Dr. Mayer, who also works as an assistant professor at the School of Pharmacy.  While reviewing a patient's medical history, she noticed that he had Oslo-Weber-Rendu Disease but was not familiar with that particular disorder.  I watched her put her researching skills to the task and find out that it is a genetic disorder that causes abnormal blood vessel formation.  On Sept. 28, a patient with hypothyroidism, a condition in which the thyroid gland fails to produce enough thyroid hormone, came into the clinic complaining of symptoms that she believed might have been caused by the medication she had been recently prescribed.  These symptoms included intense swelling of feet, dizziness, and headache. 

The pharmacist with whom I was shadowing at the time allowed me to check the patient's medications, just like I had seen the residents do at my earlier visits.  I found many of the medications challenging to pronounce, but the patient was very patient and knowledgeable of her medical needs.  The resident suggested that the patient's swelling might have been caused by amlodipine, which had been prescribed to help lower her blood pressure. 

While in the workroom, I overheard another resident discussing her latest successful motivation interview with one of the physicians.  She explained to me that sometimes motivation interviews are conducted to improve patient compliance.  The patient is asked open-ended questions about his perception of his health and other matters.  The pharmacist must give empathetic responses throughout the interview and focus on assessing the barriers preventing the patient from taking more responsibility for his health, then steer him in the right direction.  She explained that it was essential that the patient understand why he should take care of his health and the steps that will take him to that direction.  She seemed content with her recent achievement, as she expressed how much she liked "making a difference" in that patient's life.  As someone who views pharmacy as a likely career path, I was encouraged by this reaction.

As my mentorship experience has drawn to a close, I would like to sincerely thank Dr. Ballentine for arranging the numerous shadowing opportunities I received in the Main Hospital, Ambulatory Care Clinic, and School of Pharmacy.  I had initially chosen to pursue a career in pharmacy because I felt that it fit well with my personality, according to the research I had conducted on this field. 

No amount of research, however, could have taught me as much as going directly to the professional scene, where I was able to observe many different types of careers in the pharmaceutical field, from education to ambulatory care.  The students and residents I met along the way were also extremely helpful in informing me about this career path.  Overall, this experience has painted a much clearer picture of the pharmaceutical field than the one with which I had began this mentorship experience.  Now I am much more confident in my decision to pursue a career in pharmacy, and I am very grateful to this experience for allowing me to enter college with this newfound sense of direction.

Today's Date: Sept. 3, 2011

Total Hours to Date:  45 hours

Mentorship Research Journal #3

On Aug. 25, patient rounds with Dr. Gravatt began in the Main Hospital's prison area, located beneath the main floor.  The inmates housed here had been moved from the local jail in order to receive the kind of medical treatment given to the other patients in the hospital.  Although I did not have the chance to pass the main gate and go on rounds with the rest of the team, it was interesting to watch the team conduct business as usual from behind the gates.  With added distance between me and the team, I could see just how this large group of 10 would appear to the patients and visitors.  Afterward, we moved above ground to the emergency room and checked up on a man who suffered from shortness of breath and had initially been thought to have pneumonia.  The results of a CT scan on his chest had recently arrived, though, confirming that he did not have pneumonia.  The team then ordered a nebulizer for the patient's asthma, hoping to prevent possible airway inflammation.  When used, the nebulizer would release a mist comprising a mixture of oxygen and other compressed gasses, which would be inhaled by the patient and travel into the lungs. 

Another patient had come out of a surgery for her heart failure, in which a small metal rod had been inserted into her heart to compensate for her useless right atrium.  Dr. Gravatt had to order anticoagulant medication for her.  The medication would serve as a blood thinner, decreasing the probability of blood clotting.  During our lunch break in the workroom, Dr. Gravatt conducted a short lesson with her two accompanying pharmacy students, discussing the differences between PPN and TPN, two types of nutrition that can be given to a patient with an IV.  PPN stands for Peripheral Parenteral Nutrition and is administered in a peripheral IV site in the patient's arm.  TPN stands for Total Parenteral Nutrition and is administered through a central line, which goes through the patient's chest.  This difference in IV placement is due to the fact that PPN, compared to TPN, has a lower osmolarity, or concentration of particles.    

On Aug. 26, I was able to observe a dialysis treatment for the first time.  This procedure was administered on a patient whose kidneys could not properly filter out the toxins in his body. Dialysis serves as an artificial kidney for the patient, taking out waste and fluid from the bloodstream and replacing them with dialysis fluid, which consists of potassium, sodium, and calcium in concentrations similar to levels that would be found in healthy blood.  Dialysis is based on the principles of diffusion -- because solutes tend to move from high to low concentrations, dialysis fluid can move across a semi-permeable membrane into the patient's bloodstream, while blood diffuses into a machine. 

The patient's wife had come to the hospital that day with complaints about the care her husband had been receiving.  The atmosphere became quite tense and awkward at this point because of the manner in which she expressed her complaints, coupled with the fact that she directed all of her complaints toward one specific member of the team, insisting that she failed to treat the patient "as a patient" and ultimately disagreeing with all of the treatments given to her husband.  She was adamant about moving him to a different hospital.  I imagine that these kinds of complaints arise in the hospital from time to time.  Furthermore, I was not surprised that these complaints were delivered in such an antagonistic manner, as patients and their families have to deal with a lot of stress while in the hospital. 

However, my shadowing with the team allowed me to look at this situation from the physician's viewpoint rather than the patient's.  I was aware of the amount of time and energy that particular physician had given to the patient, as well as all of the other patients under her care.  After getting to know her personality, I truly believed that the physician had a genuine intention to help the patient get better, despite his wife's opinion.  Thus, it was disappointing to watch her work get criticized in this manner.  The head physician in the team, however, took responsibility and responded to the woman's claims with a calm tone as she explained that she would be more than willing to discuss these matters with her, one-on-one, after patient rounds were completed. 

When dealing with patients and their families, medical professionals will come across many different kinds of attitudes and personalities, and it is their job to accommodate those differences and stay calm and professional in order to reach an agreement.

I left the hospital and spent the afternoon in VCU's Ambulatory Care Clinic for the first time, shadowing a pharmacy resident counseling patients in a clinical setting.  Both of the patients who came to the Ambulatory Care Clinic that day were diabetic which, I was told, was commonly seen at the clinic.  The resident informed me that the first patient of the afternoon was one of her most memorable patients because, at his last visit, she was able to convince him to try injecting insulin to lower his blood sugar.  She explained that he had refused at first, but she eventually changed his mind by gradually building trust between the two of them and convincing him that it might be worth trying for the sake of his health. 

She stressed the importance of allowing the patient to decide for himself; it was not the pharmacist's place to force medical treatments on his or her patients.  She also described the process of teaching the patient how to inject insulin, underscoring the practice of "back-teaching."  In other words, to ensure that the patient retained the new information, he should be asked to repeat the steps he had learned back to the pharmacist.  This way, it will be clear to the pharmacist whether or not the patient truly understands his instructions.

When the first patient arrived, the resident showed me how she checked blood sugar levels by pricking the patient's finger and reading the result on the meter.  The monitor read 417, much higher than his ideal blood sugar level, which would have been around 180.  The patient was quite frustrated about not being able to lower his blood sugar despite his insulin injections.  After reviewing all of the patient's medications, a process that required asking the patient how much and how often each of his medications was taken and checking his responses with his records, the resident determined that all of his medication had been taken correctly.  She then asked the patient to explain to her how he had been injecting his insulin.  After going through the process of "back-teaching" again, she finally determined that the patient had been following the correct procedures.  She ultimately decided to increase the patient's dosage of insulin.  She asked the patient to describe to her his daily routines, and she suggested a few small lifestyle changes that could be made to help lower his blood sugar, such as adjustments to diet. 

The second patient was not as severely diabetic, so he did not require insulin.  He had come because he wanted to know what each of his medications was treating.  Thus, this visit mostly comprised going over the patient's medications and explaining their purposes, as well as updating his prescription.  This patient was significantly more knowledgeable in medicine than the first patient, so it was interesting to observe the resident's change in vocabulary; her explanations became much more thorough and specific.  Afterward, she asked the patient to explain the purpose of each of his medications to her to show that he understood.  That afternoon, I learned that the clinical setting certainly allowed the pharmacist to form a closer relationship with the patient than the busy, fast-paced hospital setting.  Clinics were also less chaotic than hospitals, but the cases seen in the clinic were much tamer than those seen in the hospital.

I returned to the Main Hospital for patient rounds on Sept. 2.  I was no longer shadowing Dr. Gravatt, but I did have the opportunity to go on rounds with another pharmacy resident and a couple of pharmacy students.  I joined a different medical team and spent the first half of the morning conducting "sitting" rounds, as opposed to the "walking" rounds I had previously been doing with Dr. Gravatt.  During sitting rounds, the team congregated in one room and stayed there for the entirety.  The medical students reviewed patient cases while the physicians asked questions and made adjustments as necessary.  Although sitting rounds was much less tiring than walking rounds, which required me to stay on my feet, I felt that it was a comparatively more tedious, and perhaps less thorough, process because it did not provide the team members with direct access of each patient they were reviewing. 

Afterward, the pharmacy resident and the pharmacy students left the other members of the team in order to conduct bedside counseling.  A patient required diabetes training and needed to be taught how to inject insulin, a topic with which I had gained familiarity at the Ambulatory Care Clinic a few days before.  I found that bedside counseling was very similar to the counseling process in the clinic; the only difference was that the pharmacists had to come to the patient instead of the other way around.  Before entering the patient's room, the resident quickly described the patient's loquacious nature and affinity to cats so that the students would not begin counseling without some background knowledge of the patient.  With this knowledge, the students were more easily able to connect with the patient, build trust between them, and begin counseling.

Today's Date: Aug. 24, 2011

Total Hours to Date: 30 hours

Mentorship Research Journal #2

My visits to the VCU Main Hospital have recently become nearly full-day expeditions.  This second journal entry will document the past two long but busy days spent with Dr. Gravatt.  My Aug. 23 visit to the hospital began with rounds, once again with the team.  That morning, we saw a total of 10 patients. 

Due to the fact that internal medicine deals with all types of diseases, the patients we saw were admitted for a wide variety of reasons, from heart failure to chronic kidney disease to hallucinations.  Thus, we were always on our feet, quickly moving from one hospital floor to another.  We only stopped to listen to the reports from the medical residents, who had come to the hospital very early in the morning in order to check on their designated patients and prepare a health report.  This typically required an overview of the patient's various lab test results and recent symptoms, as well as a recommendation from the student regarding further action.  The team's physicians would follow along, ask questions, and make amendments as needed.  Listening to each report, I was able to better understand the obligations that came with fulfilling a residency requirement. 

One patient of interest was a 31-year-old female who came into the hospital, like many other patients, with a history of drug abuse.  She had developed a fungal infection around her calves, so her doctors had prescribed antibiotics to treat it.  However, instead of taking the antibiotics as instructed, she injected heroin into her legs to ease the pain.  This case exemplified one of a doctor's many frustrations: a patient's refusal to follow his or her directions.  Thus, it is crucial that the doctor develop a good bed-side relationship with the patient.  If the patient feels she can trust her doctor, she will be more willing to do as he asks. 

Another recently admitted patient was a 60-year-old man.  His wife explained that he seemed to be suffering from acute depression and anxiety following his cancer diagnosis.  He had an extensive medical history, and some members of the team questioned the necessity of taking so many drugs.  Dr. Gravatt took notice of his use of the beta blocker propranolol, which serves to control anxiety, and wondered if it fed into the patient's depression due to its passing of the brain blood barrier.  She recommended that they take him off several drugs to see if his condition would improve.  This was a case in which a pharmacist could not only recommend prescribing certain medications, but take them away as well. In this situation, less medication would have been more beneficial, and the importance of knowing one's medical history became evident.

My afternoon consisted of attending lectures presented by both professors and students.  The first class took place in one of the main classrooms of the School of Pharmacy.  The lesson focused on different types of Gram positive bacterium.  Coincidentally, this topic correlated with what I had recently come across while on rounds, as mentioned in the first journal entry.  Dr. Gravatt had informed me beforehand of the two main types of Gram positive bacterium -- staph and strep.  Hence, the teacher began the lesson by presenting an NPR recording about MRSA, a bacterial infection that is particularly resistant to antibiotics.  The recording stated that by simply increasing the frequency of handwashing among the staff members, the number of MRSA cases declined.  She then proceeded to cover many types of staph and strep infections, such as streptococcus pyogenes, a tissue infection caused by a virus.  She explained that penicillin is the main treatment of choice for this for this disease, unless the patient is found to be allergic to it. 

The next set of lectures was presented by pharmacy students, who were expected to explain to the audience what they had learned through their experience with an assigned patient case.  Each presentation discussed the reasons the patient was admitted, assessment and lab results, treatment, and details on how the patient responded to said treatment.  These students' presentations were then analyzed by a panel of physicians and pharmacists.  For example, one student described a pharmacist's role in treating a woman's endocarditis, a heart inflammation, by prescribing Vancomycin, an antibiotic used to treat such inflammations. 

I finished that long day realizing that the residency programs truly prepare students for their careers, for their work in such programs closely resembles what they will probably face in the future.  Yet, I was certain there was much more to learn, both in the classroom and out in the field.

On Aug. 24, my day began at 8 a.m., reporting straight to class.  That day, Dr. Gravatt gave a lecture on the basics of infectious diseases.  She began by reviewing the concept of the normal flora, a name for the numerous microorganisms that regularly colonize the human body.  When normal flora is disturbed by immune system dysfunction, skin breakdown, etc., the bacterium can become pathogenic, which leads to infections.  She discussed how the immune system functions and possible causes for immune dysfunction.

Dr. Gravatt explained most of the lesson with theoretical patient cases; she would present a theoretical patient, then describe the step-by-step process students should follow.  She brought up details to be wary of, like the fact that it was possible to have an infection without having a fever.  Overall, I found the class much more direct than my high school classes, simply because the School of Pharmacy's teaching methods and materials are directly related to the challenges students would face in a hospital or clinical setting. 

The later part of the day was spent focusing my attention toward the students.  The resident pharmacy students had been assigned patients who had actually been recently admitted into the hospital.  The students were responsible for researching these patients' medical backgrounds and presenting them to Dr. Gravatt as patient cases.  This way, Dr. Gravatt was able to quickly gain information on her patients while teaching her students.  In one of these cases, a woman had been admitted to the hospital after experiencing a 20-pound weight gain.  More importantly, she suffered from heart failure in her right ventricle.  As a result, the left side of her heart had been working twice as hard, leaving this side much stronger than its counterpart.  This unbalance in the organ led to more issues, such as constriction of blood vessels.  A metal rod had been inserted into her chest to compensate for the right heart failure, and so it was imperative that her pharmacist prescribe an anticoagulant drug, or a blood thinner, to protect the patient against possible blood clotting.

All in all, during these past two days, I've had the fortune of observing an actual pharmacy class as well as learning exactly what completing a residency entails.  Although I sometimes felt overwhelmed by the medical terms, I found the use of patient cases an interesting method of teaching.  As Dr. Gravatt explained, treating a patient is much like solving a puzzle -- you often aren't entirely sure from what disease the patient suffers, so you must put the symptoms together to try and solve the problem from these clues.

Today's Date: Aug. 18, 2011

Total Mentorship Hours to Date: 18 hours

Mentorship Research Journal #1

This summer I officially began my quest to explore the pharmaceutical field through the mentorship program.  Dr. Ron Ballentine has been serving as my mentor during this time, but as assistant dean of admissions at the VCU School of Pharmacy, he has the means to connect me with several pharmacists in the area who were kind enough to agree to supervise me as well. 

One of these pharmacists was Dr. Tyler Stevens, who works as an assistant professor in the same building as Ballentine.  I worked with him in June to prepare a lesson for middle school students and, during the school year, he will allow me to observe labs conducted by second-year Pharm.D. students.  Dr. Ballentine also introduced me to Dr. Leigh Anne Gravatt, an assistant professor who also works as an internal medicine clinical pharmacy specialist in the school's medical campus.  Dr. Gravatt took me with her on patient rounds in the Main Hospital and allowed me to participate in one of her classes and watch presentations by pharmacy students.

Although this is merely my first journal entry, I have already had the privilege to observe both the application of pharmaceutical studies in the classrooms of the School of Pharmacy and in the VCU Main Hospital.  This experience has shown me how the material one learns in school can be directly applied out in the field.  My mentorship experience began on June 10, when I was informed that a group of middle school students would be touring VCU's MCV campus.  Dr. Stevens and Dr. Ballentine were placed in charge of introducing these students to the pharmaceutical field, and they wanted to brainstorm ideas to garner the students' attention during the allotted time.  They had prepared a 20-minute introductory video and several speeches for the students.  Dr. Ballentine assigned me the responsibility of delivering one of these speeches, suggesting that I present my story to the students as a high school student interested in the pharmaceutical field.  Additionally, they had planned an activity that would teach the students how to read prescriptions and sigs, which explain how one should take a certain medication.  I suggested that the students may be interested in role-playing, through which they could experience for themselves what it might be like as a pharmacist.  From this, our final plan was formed -- we would show students how a pharmacist would research a drug and counsel, or educate, their patients about that drug.

The morning of June 29, I expected to enter a classroom of sleepy students.  Instead, I was pleasantly surprised to find that many were willing to participate; a few were even lively.  First, Dr. Ballentine discussed the journey from college to pharmacy school.  I was surprised to learn that many students entering pharmacy school majored in a non-science subject.  What was actually more important was that the students take all the prerequisite courses before applying to the school. Following my speech, a couple of graduate students delivered speeches as well.  One of these students majored in French, while the other shadowed with many medical professionals before deciding that pharmacy was the best fit for her.  It was interesting how students could come from a variety of backgrounds before taking the same path. 

Dr. Stevens then gave an introductory lesson to counseling.  Clinical pharmacists conduct counseling sessions to ensure that the patients fully understand the drug for they take it.  During each counseling session, the pharmacist must introduce him or herself, explain the purpose of the session to the patient, and use open-ended questions to attain information from the patient and confirm that the patient knew what he needed to know about the drug.  The pharmacist must be able to explain what problem the medication was supposed to alleviate, as well as the correct dosage and frequency of consumption.  She should inform the patient of possible side effects of the drug and answer any question the patient might have.  From his speech I realized how important it was that a pharmacist possess both communication and research skills. 

Dr. Stevens displayed how a pharmacist effectively communicates and introduced the class to Lexi-Comp, VCU's online database on drugs.  Students and pharmacists use this program because it explains everything they would need to know about the medication in a very convenient fashion.  The students were then separated into groups and assigned a drug, which they then researched, using Lexi-Comp in a computer lab.  The students then showed the class what they learned by taking turns counseling each other.  I considered this experience an introduction to the pharmaceutical field for not only the middle school students, but for myself as well. 

My next mentorship opportunity would not arrive until August, but nevertheless, I was grateful when Dr. Gravatt allowed me to accompany her on rounds in the VCU Main Hospital.  However, I was required to pass a quick VCU course on HIPAA, the Health Insurance Portability and Accountability Act.  The training course serves to explain methods to secure patients' protected health information, known as PHI, through the Privacy and Security Rules.  Through the training course, I learned that the best way to protect a patient's information is by following the Minimum Necessary Standard, which requires that the medical worker be aware of exactly who needs the information and just how much to share.  I learned that if a patient does not wish to be included in the Facility Directory, the medical worker should not even acknowledge that the patient is in the healthcare center, even if a family member requests information.  I also learned the process of giving a patient access to his or her medical records and the process of securing these records.  After passing this course, I was permitted to meet Dr. Gravatt and begin my mentorship experience with her.  I was introduced to her August 15. 

Dr. Gravatt explained that she initially planned to major in biology, intending to work as a physical therapist.  After some shadowing, though, she quickly realized this occupation was not for her, so she switched her major and attended pharmacy school after two years as an undergraduate student.  We then talked about why we were interested in the pharmaceutical field.  The focus of our discussion was the variety of jobs in the field, that being a pharmacist did not necessarily restrict you to counting pills at Walgreens.  She also pointed out how the field was female-friendly, because it gave pharmacists the option of working part-time and thus spending more time with their families.  Because I personally cannot see myself tied to my job in 20 years' time, I felt that our conversation was definitely pertinent to my future goals and was reassured of my choice to explore this field.

My first day in the hospital began on August 17.  I arrived at 8:30 a.m. ready to begin rounds, which is essentially when the medical team travels around the hospital and visits patients one by one.   The team consisted of 10 members, much more than I had expected.  A pharmacy student explained that many of the hospital's patients did not have the financial means to stay in a private hospital. Thus, staying at a hospital in a learning institution gave them treatment at a lower cost, while giving an opportunity for students to apply their knowledge in the field and complete their residencies.  Although I was a bit overwhelmed by the amount of medical terms thrown about in the team's conversations, I was able to pick up certain terms as we traveled from patient to patient, such as A1C, which measures the extent at which glucose metabolism in the blood is controlled, and INR, which measures the how the blood clots. 

We visited several patients, but one memorable patient was a 53-year-old female who had developed pancreas inflammation due to excessive alcohol consumption.  She had experienced intense abdominal pain and cramping with urination.  The pharmacists on the team were in charge of monitoring her PCA, a machine that allows the patient to administer her own pain relief.  The pharmacists documented the number of attempts to attain pain relief and the amount of medication the patient actually received.  From this information, Dr. Gravatt and her students could deduce whether or not to increase the patient's current dosage.  Because the patient's attempts often did not match up with the amount of times medication was given, the team ultimately decided to increase her dosage of pain medication.  Because the team also noticed that the patient's glucose levels were high, Dr. Gravatt asked me to research diabetes and the functions of the pancreas and to be prepared to present my findings to her students the next day.

I arrived at the hospital at 8:30 the next morning and finished at 2:30 in the afternoon.  Again, rounding gave me a crash course on many medical processes, such as Gram staining, which can give pharmacists a clue as to what kind of infection the patient might have.  For example, a Gram positive result usually indicates strep or staph infection, and so a pharmacist would be able to prescribe a certain antibiotic to cover those areas.  During these rounds, I noticed that a majority of patients at the hospital suffered from an affliction that related to their history of drug abuse.  I found this observation surprising, as I had not considered this a prevalent problem in our community. By the time rounding was completed, I felt quite weary, largely due to the fact that rounding required that I stay on my feet at all times.  In the afternoon, I attended the students' presentations, in which they discussed different methods to treat AIDS and HIV.  From these two days at the hospital, I was able to observe a job option I hadn't considered before -- treating while educating.

We'd like to share four journal entries Aileen Bi wrote during her time with us. Aileen, a student at Maggie Walker High School in Richmond, was part of the high school mentorship program.

It is obvious from reading her journal entries that she benefited greatly from the time that she spent with pharmacy faculty, clinicians and residents. She has a much better understanding of what pharmacists can (and should) do.  

So easy a student pharmacist can do it!

Story and photos by Drew Kirk

Hummus is a popular Middle Eastern snack that is ideal for spreading or dipping. Although you can find it in most grocery stores, it's worth spending a few minutes in the kitchen to create this tasty treat.

The Capsule, VCU School of Pharmacy's student newsletter, made its online debut with its own Facebook page on Feb. 26, 2011.

It now continues its efforts to inform, entertain and reach out to all SOP students by establishing a blog presence, as well.

Faculty, alumni and friends, of course, are also welcome and are encouraged to read along!

The Capsule's editor is Cathy Arnatt (arnattcp@vcu.edu). Assistant editor is Laura-Hunter Ford (fordlh@vcu.edu). If you're interested in contributing, please contact an editor.

Lauren Lakdawala, Hillary Hudgins, Melissa Rees and Tyler Stevens -- and all those beautiful Grand Council awards!

The brothers of the Phi Delta Chi pharmacy fraternity, Alpha Delta chapter at VCU School of Pharmacy, attended their 68^th Grand Council meeting in Buffalo, N.Y., the first week of August.

Brothers Hillary Hudgins, Lauren Lakdawala, Melissa Rees and Tyler Stevens (chapter advisor) attended the national meeting, which occurs every other year. The Grand Council brings together collegiate and alumni brothers from 72 different chapters at pharmacy schools and colleges across the country. More than 300-plus brothers attended the five-day meeting, which focused on developing leadership skills, networking with other chapters and conducting business fraternity.

In addition to electing our national officers, Brother Melissa Rees was elected as the Mid-Atlantic Regional Correspondent for the upcoming year. The regional correspondent serves as a liaison between the national office and 12 regional chapters to promote achievement and foster brotherhood among chapters in the mid-Atlantic region (Virginia, Tennessee, Maryland and North Carolina).

To offset business meetings, numerous social outings around Buffalo took place, including a Niagara Falls trip, fraternity bar crawl and, of course, visits to Anchor Bar, the birthplace of the buffalo wing.

Current PDC President (Worthy Chief Counselor) Lauren Lakdawala reflected on her Grand Council experience as "nothing less than awesome! Meeting brothers from across the country only solidified the meaning of brotherhood upheld by Phi Delta Chi. I made connections both professionally and personally that will last a lifetime. I am truly honored to be a part of this fraternity, one that fosters future leaders in the pharmacy profession."

The awards banquet culminated the weeklong fun, honoring chapters for upholding the mission and values of Phi Delta Chi. Alpha Delta received The Dale W. Doerr 100% Achievement Award for the third consecutive year, which recognizes chapters for upholding the framework of the fraternity. For the second year in a row, the chapter received first place for the John D. Grabenstein Leadership Award, recognizing our individual and collective accomplishments that demonstrate leadership qualities.

These accomplishments, along with recognition for our chapter publication, scholastic development, brotherhood and professional projects, garnered Alpha Delta sixth place overall in The Emory W. Thurston Grand President's Award. Lastly, Tyler Stevens received the Chapter Advisor of the Year Award for his exemplary role in guiding collegiate brothers in their development of organizational skills, leadership ability and personal competence.

On receiving his award, Stevens said he found himself to be "very humbled and honored to be recognized.  During my tenure as PDC advisor, I have been blessed with having excellent students, friends and leadership within the organization."

The Phi Delta Chi brothers are very excited to be recognized for their contributions and are looking forward to another successful year!

<<< Bob McDonnell, Natalie Nguyen, Maureen McDonnell

Something really neat happened this weekend at RAM.   Virginia Secretary of Health and Human Resources Bill Hazel and his wife Cindy, Mrs. George Allen, Mrs. Jerry Kilgore and Gov. Bob McDonnell and his wife Maureen visited RAM on Saturday.  

Mrs. Allen and Mrs. Kilgore met some of the VCU School of Pharmacy students working at the smoking cessation booth and, even further, P2 Shaema George and I were able to have a long dialogue with the former first ladies about medication adherence and health prevention strategies.  And so, it was such a great feeling being able to represent VCU SOP in this way!

Editor's note:  Natalie Nguyen worked as a Virginia Governor's Fellow this summer with the Office of Health and Human Resources. She had been tapped for the RAM team before receiving the fellowship and was happy to find that Bill Hazel also would participate in RAM.

                                                                          ^^^ Susan Allen, Natalie Nguyen, Marty Kilgore (photos by Shaema George)