A Mix of Sunshine and Rain

Like the weather about deciding whether this was a week of gloom or sun, I also was equally as ambivalent about whether this was one of the better or worst weeks of the quarter. We had a guest lecturer in biochem who outlined the mechanisms of lipid metabolism and cholesterol synthesis. Since the last time I have taken biochem, it seems there has been progress towards understanding how cholesterol negatively feedbacks on the rate limiting step in cholesterol synthesis and a certain type of lipoprotein receptors. He seemed to have a wicked sense of humor: the whole room was laughing when he enthusiatically talked about how cool this unusual sequential cyclization step of squalene toward cholesterol involved atmospheric oxygen and an epoxide. We could have been delirious from sleep deprivation as well.

The downpoint was Clinical Pharmacy when we had to endure physical assessment, psychiatric assessment, and patient adherence lectures. And these series of lectures are just too vague to really apply seriously. (Example: What do you think the condition of a woman with a large belly is? Pregnant). Currently, pharmacists are not be able to diagnose so we are all wondering why he is teaching us these semi-common sense methods of assessing people's condition. I mean Ron Finley seems like an alright guy, but we need a very structured style of lecture to know specific material we need to study and retain for our future careers.

In contrast to Finley, we were lucky enough to participate in a Pulmonary inhalation workshop held by the renown Robin Corelli. I thought it was a great idea for each of us to have the opportunity to counsel faculty members and be critiqued about our performances. I honestly that I can speak for my classmates that we all can counsel patients on the differences between using the albuterol pressurized metered dose inhalers from Advair diskus from handihalers.

In APha, we met with Lori Rice and shuffled ideas for ledge day, to educate pharmacy students about current developments in pharmacy law. Rice is quite brilliant with knowing how to create a vision and taking steps to drive it forward. She took our brainstorm of topics like direct to consumer marketing or universal health care. She may even be able to get Gavin Newson to come and speak to UCSF, which would really let students participate in the policy process. Hopefully, he has an interest in getting our support since we are all old enough to vote. Hopefully we can show him and the city that we are not too busy filling prescriptions to speak up about our views about whether we should be selecting which drugs will be blockbusters or which will be recalled simply by making recommendations, conflict of interest between promoting a retail store generics vs. the brand name, and what should be done to formalize a reuse program to take care of the unexpired unused drugs in the city. A lot of ideas in the works.

A number of us attended a lecture held about emergency contraception and how to legally dispense it in California. Since the beginning of 2007, we can dispense Plan B OTC to anyone over 18 years. For minors, we have to be trained and pass a test online to prove it. We would have to register our pharmcy on the Pharmacy Access Partnership website so that women could find which pharmacies sell it. But the trick is that our supervising pharmacist must also be EC trained if we want to do the counseling. Since this med is somewhat controversial, the curriculum does not include certification and we must go through our student organizations to arrange training outside of class.

Beyond anxiety over transitioning to becoming pharmacists, I am visiting my friend in the hospital after his surgery virtually every day until 8 or 9pm at Mount Zion. I saw such an improvement in his condition when he was switched from morphine to toradol. But the impact on your body after this kind of major surgery is the equivalent of having the pick up truck slammed into your abdomen. I just imagine having my organs readjusting in position and how the strain on the nerves attached to your internal organs can be mindblowingly painful. Painkillers could not deaden every single one of those nerves, at the most like 30-40% of them. And I even talked to my parents afterwards about how difficult it was for me to see my friend so helpless at a grown age and struggling sustain even the shallowest breath. I am not sure if I could be around people in this condition every day in my life, which would be my life if I wanted to be a clinical pharmacist.

Week 3 of Winter Quarter

Peugeot 404

It was nice to have MLK off but it really meant condensing all the events and business and studying that we had to do in a limited amount of time. Some of my classmates are doing introductory pharmacy practice experiences, like following around our past Clinical Pharmacy professor, Kathy Dennehi, while taking medical histories/ screening for immunization eligibility. It is apparently a pilot program that was jumpstarted so that UCSF Pharmacy School could claim that at least 5% of its curriculum is dedicated to IPPE's. They can use this to leverage with the Board of Pharmacy to get reaccredited. I think that it is a great idea to have something in the pharm.D. program to introduce students to applying these skills that they teach you in school about patient assessment and counseling. From my experience in retail, you will eventually learn some patient counseling, but IPPE's can give you a much easier time during rotations and not have to climb such a rough transition from textbooks and lecture notes to real life therapeutics and patient interaction.

We took our first midterm today and it was not too bad. I actually had a harder version of biochemistry in undergrad and this class was more emphasized on getting you to understand the clinical correlate of biochemistry instead of learning every annoying enzyme for those who want to become lab scientists. Our professor is really great; her name is Tracy Fulton. One class that I really enjoyed was the clinical correlate taught by our Dean, Mary Anne Koda Kimble in conjunction with Tracy Fulton. She had a mock interview with a diabetes patient while we learned about insulin and glucagon control of metabolism. One interesting point was on sulfonylureas, which increase insulin secretion from pancreatic beta cells by blocking membrane bound potassium leak channels. She even went on to explain how diabetes patients often get foot ulcers, from poor circulation and poorly functioning clotting factors.
APhA had its first legislative committee meeting which assigned us first year members our own projects towards promoting the profession.

My second visit as a volunteer to Laguna Honda Hospital was much longer than the first and incredibly worthwhile. I walked in to the main hall feeling like a thousand eyes upon me, knowing that I was out of place in a room of elderly patients with dimentia. I was silent as he played Bingo for about half an hour because I was afraid if he could speak coherently, percieve and be capable of interacting with me, or even have a shred of short term memory. To my surprise, he asked me very clearly what my name was and proceeded to enter a perfectly normal conversation. He was able to respond and converse with me more capablely than many of my contemporaries.

So apparently, Robert was first admitted into LHH when he overdosed on alcohol. Ever since he's been residing there. In the past, he recieved his first dirtbike at the age of 11 and rode on racetracks and jumps while attending a baptist church. Throughout his life, he has traveled the entire country. Born in Chicago, he was raised on a farm in Arkansas by Swedish and Irish parents. He became a professional motorcycle racer and came in 3rd nationally in 1968. Behind the public image, many bikers spent their play money to shoot up on heroine and coke, and he was not exception. Then he moved to Riverside as a car mechanic for peugeot. Check out their website. It's a beautiful european car. After splitting with his ex-wife, he hitchhiked to New Orleans. I'm not sure about what he did in New Orleans but eventually he made his way to San Francisco. He tells me that his Swedish father, a retired stockbroker, is still alive somewhere in America.

So hearing him recall his life as a hyperkinetic zigzagging path, transcending state lines, dotted with 151 proof rum, irish carbombs, and car girls. It was a perfect description of an existence that epitomized the American ideal. Living with the freedom to be susceptible to sin, ut have enough of a safety net to recover, roam but always have ties with loved ones in the past, and connect with the land but not to be tied down to it. And I think it is such an important concept to travel in order to understand America but not objectify it. His middle class values reminded me of my own father. I haven't heard anyone say the word America so many times with such gravity and with such respect that only the wise can grace upon it. It was not a conversation of problem solving or thesis writing, but it was the most intellectually stimulating conversation that I have had in a while, much moreso than with classmates whom have master's and all sorts of degrees and scholarships under their belts.

His gaze started to drift and his attention dissipated as he felt a craving for a cigarrette. He bummed one off of another resident and we stepped outside so he could smoke it. He began to repeat his entire story to me as if I had never heard it before. Then I suddenly got the sense that he was not as aware of me as I was of him; the feeling you get when the person you are trying to interact with does not remember you hurts. I was subconsciously assessing his disorder in order to cover up my own emotions. He had dimentia.

First Visit in Laguna Honda Hospital Project

I returned to Laguna Honda hospital for the second time to begin my Clinical Pharmacy 112 volunteer project, but this time I met with the volunteer coordinator about my resident and visitations. I was introduced to Araceli, my coordinator, who seemed welcoming and competent. She warned me about my resident, whom she said may give me a hard time. Initially, she said that the residents, including mine, would be quarantined for the rest of the week until the nurses disinfected the ward and contained the norovirus epidemic. She explained that the virus was responsible for a type of stomach flu that included symptoms such as diarrhea.

This detail shocked me somewhat because it brought forth in my mind how easy nosocomial infections spread in hospital environments in the immunization reading to reality. This was an unfortunate circumstance of day care centers, residential homes, or any living spaces where people lived in close quarters. It is easy to breeze past this detail when you are cramming for a test, but it is much more difficult and fearful to have to live with it for the rest of your life in a hospital. Two elderly gentlemen were sitting outside in the cold and gazed at us while we walked by.

Next to them, we felt young.
To us, their sun-tanned skin and white hair made them seem old.
We are continuously being educated in one of the world’s top health sciences institutions.
They have been out of school for decades.
Many of us are working and serving patients as interns in pharmacies, encountering a flux of new faces every day.
They were the ones whom are served.
Our presence disrupted their routine lives confined to this one building.
We were moving. They were still.

My thoughts were disrupted once Araceli questioned why we were volunteering at LHH. At that moment, I felt that my answer to her question would shape her perception and the perceptions of the people she talked to about the profession of pharmacy. I told her that historically pharmacists were not trained to be sensitive, develop relationships with patients and UCSF is trying to lead a new generation of clinical pharmacists whom are capable and willing to give better quality patient counseling by learning how to care about them. This was an effort to develop our introductory pharmacy practice experience before our advanced rotations during our third year. She returned a smile and a gaze of understanding about the importance of having pharmacists volunteering in hospitals, more so than the degree to which I substantiated my claim. It was odd for me to so fervently defend the institution that I have spent the entire quarter severely criticizing.

My resident, R.L., happened to be in the lobby and Araceli introduced me to him. He was too focused on his video card game to respond immediately, but when he managed to step away from it to shake my hand. He wore a beanie and a thin flannel over a t-shirt. He had sharp eyebrows and gave me a quick smile before returning to his game. I sat next to him for the remainder of the hour just learning how this game worked. He selected his hand so fast, I kept inquiring to figure out how he determined which would give the most points. He tried to tell me that it was like second nature after playing it so many times. He was much more pleasant than his description stated: “sarcastic, likes to mock others, may be difficult. Likes Ferraris and fast cars.” This paper description seemed so far from my own interests, and I was unsure about how I would approach relating to him. But this first meeting made me not want to just give up but instead try to find something else that we could bond over.

When we were leaving, I told him that I would be back to visit perhaps on a Sunday when I am not working.

First Pharmacy Class of 2010 Tahoe Ski Trip

I drove into SF tuesday night after working all day and started class on wednesday at 8am the next day. We were all somewhat hesitant in participating in the Laguna Honda Project, which involves volunteering to visit a resident every other week in the hospital. Dr. Finley assigned each of us to a resident and mine in particular was described as sarcastic and enjoyed mocking people. We were kind of scared about the innappropriate behavior of some of these residents. For example, some residents liked to run away while others were described to behave innappropriately sexually. We will meet them next week and continue visiting them and documenting our experiences for the better or for the worse.
Human metabolism (BC112) or biochemistry is taught by the popular and renowned Tracy Fulton. We heard from the P2 class that she is a really good professor because she cuts out the minute details and regurgitative memorization. She instead supposedly focuses on the important overall concepts.

Advanced organic chemistry (PC113) for the most part does not particularly seem to venture beyond the reaches of our undergrad experiences. The syllabus for the most part is just condensing a year of organic chemistry into a quarter. So, the proper title should have been "Organic Chemistry Review." It is slow so far and she has barely brushed the surface of stereochemistry, optical rotation, and recognition of basic functional groups. A good number of classmates with a masters in organic chemistry were able to waive out of the class.

I allowed myself one last escape before I really had to break into those textbooks...and was it worth it? Yes!
















25 of the more sporty or crazy first year pharmacy students bundled up in our winter jackets and rented 2 suv's to transport the remaining students and their baggage. We drove almost 4 hours to Lake Tahoe. The drive was more like a crawl since it seemed we were not the only ones who realized fresh powder offered the promise of a good slope the next morning. Grabbing In and Out along the way and stopping by an authentic burger joint in Auburn made the trip more enjoyable.


It was my first time in ages since I have ever been to Tahoe and my first time snowboarding. The 2 story UCSF cabin with 2 car garage and driveway was really nice It was equipped with linens, dishes, cookware, games, cleaning supplies, and of course a hot shower after being in the snow the whole day. It was like living in a dorm all over again, except with board games. It really looked like a winter wonderland complete with treacherous mountain ranges and towering pine trees. We took a midnight walk under the full moon that night which was comparable to being surreal. We visited the P2s next door to join in on the festivities. The next morning we managed to get everyone out the door by 8am that morning to Alpine Meadows. Some of us took major tumbles and few attempted the diamond peak ski lift. Whether we were skiing or snowboarding, I think we can all concur that it was a hell of a workout. I wish we had another day, but by 4pm, we had to return to the cabin.


A few of us went with the P2's to Reno to go clubbing and gambling. The more conservative majority spent Saturday night watching Chronicles of Narnia, playing blackjack, and telling fortunes. Before we went to bed, we spontaneously started telling ghost stories in the dark. One particular story scared us straight, which involved her true experience with seeing a ghost. Having heard that after research universities have shaped my core understanding through empirical evidence and the material world was jolting. We had a hell of a time though and really had an opportunity to bond with each other outside of such a stressful school or urban environment. We even had two guests who were significant others of members of the first year class, who fit in quite nicely.