Here now, at the fork in the road

Robert Frost, the great American poet, lived through an interesting time. He was witness to the turn of the century, two world wars, the Wall Street crash and the Great Depression, the flight of the first airplane and just before he went out, the Cuban Missile Crisis. Somewhere in there, he must have sat down, turned a phrase over in his mind and wrote

Two roads diverged in a yellow wood

It’s a pretty simple phrase, but effective nonetheless, as the “fork in the road” exists for just about everyone. After all, life is a journey, and the damn road is littered with choices. Some of these “forks” are easy. Going right is much the same as going left, in terms of destination at least. Yes, what happens along the way might be different, but at some point the woods thin out and you find the paths join up again. And a part of you will think back to that choice in the road and surmise it never really mattered, while another part will look back along “the road not taken” and wonder what might have been, for better or for worse. Yet still, these are the routine decisions, and finding yourself exactly where you thought you’d be, your journey goes on.

The more difficult “forks” are the ones for which we cannot see beyond the first few steps on either road. Out there in the mist, only one thing is certain; these paths will never cross again.

No matter how confident you are in a choice, that fact can still haunt you. The concept of finality is daunting, but for most people it only becomes an issue when we feel it’s going to throw us off track. We all have a journey’s end in mind, a kind of hidden cottage, and though we’re happy to enjoy whatever the road has to offer us along the way, at some point we all want to turn a corner, see little puffs of smoke rising over the treetop and realize “I made it”.

Luckily for us, we have a rough map to guide us. Tracing our fingers over it, we can see a fork at age five, a fork at age twelve, a big fork at age eighteen and somewhere further along, a fork at twenty-two.

That last fork, the end of my college years, is where I find myself now. I think back to some smug lecturer saying “these years will fly”and now I, only one week away from finishing lectures, sigh and admit they were right. It’s like coming upon a crossroads long before the map says it was due. Now it’s there, and regardless of what that piece of paper says, you’re going to have to pick a lot sooner than you’d imagined.

In these situations us travellers often find comfort in “making camp for the night”, which is to say, sitting down with a decision and thinking about it. It’s a fairly good call. Taking the wrong road is bad; taking it in the dark is another matter entirely.

Unfortunately, the dawn waits for nobody, and soon we have to get up, put out our fires, throw on our packs and take that first wobbly step in what we hope is the right direction.

This particular fork, which I long thought of as nothing more than “that bit before my pre-reg year” is shaping up to be more climactic than I’d given it credit for. After all, it’s not often you move job, finish education, sit exams, say somewhat of a goodbye to friends and try figure out where you’re going all in one month. Taken one by one, these are all fairly benign. It’s together that they start to weigh more, and feel like one of those transition periods where you kind of watch yourself from the outside hoping you don’t fuck up.

And quite likely I, or you a person reading this in a similar situation, will fuck up. That’s not the end of the world, and it definitely isn’t the end to the journey.

What is perhaps more disturbing for me than the notion of failure is, as I’ve alluded to, the concept of finality. I’d like to think if I had a few shots at the start of what is basically my adult life that at least one time things would turn out like I want them to. But I definitely don’t have a “few shots”. This isn’t a Thursday for God’s sake.

And so the time I spend “making camp” over these next few months is likely going to be very important. The next year of my life is there for the taking, in so much as its routine contents are fairly set in stone and all I have to do is turn up and keep breathing. After that, the tent is going to have to come down, and I’m going to have to step out onto the road. A part of me sees myself back in UCC, edging forward into the vast forest of a PhD and taking comfort in the fact that though the road is long and arduous, it is still on the map. Depending on what day you ask me I might also muse that UCC isn’t the only college known to man, and though I’m a Cork City boy at heart, there’s a wide world about us. That would certainly be uncharted territory, where many a brave or foolhardy traveller has been lured by the promise of treasure.

Quite plainly, this next year might also stray me from the path, into a part of the profession I’ve always admired but never imagined myself at home. Community pharmacy isn’t where I see myself, but Christ knows I never saw myself learning about drugs when I was fifteen either.

Lastly, arguably least importantly, but most selfishly, I wonder about where this journey takes my writing. It will be a long night staring into the dying embers of the fire, and before the sun comes up this may be the only question I answer, or the only one that I don’t. However, if four years of college have thought me anything, it’s that at some point, I’ll have to answer it.

You can set up camp, but the dark is only fleeting.

You can stop to rest, but you are young, and you have no need of it.

You can dither, dawdle, pause and even doubt, but you cannot turn back.

The Journey’s End is far away yet, and there are many things on the road you have to see if you’re to reach it.

Many people, myself included, know that in many ways the journey is what matters, but though I can afford to get lost in it, I can’t forget that out there little puffs of smoke rise over the treetop.

And that in itself is why the journey matters.

As Robert Frost once quoted

I have promises to keep,

And miles to go before I sleep,

And miles to go before I sleep.

 

 

 

 

 

 

When the customer isn’t always right

So, I’ve probably got away with not posting for a long time, and got away for an even further length of time with not posting about my own college course. As some may know, I’m now in my second year of Pharmacy at UCC. Recently I also started part time work in a pharmacy, and through both of these aspects of my life have come to one conclusion: the customer is rarely right in a community pharmacy setting. Now, before people jump to conclusions about that kind of statement, it has to be said I mean not that there is a complete lack of knowledge on the part of the customer, but that there is a perceived “same level of knowledge” in the mind of the patient.

Let’s face it, pharmacists are one of the most undervalued people in the health sector. 99% of people outside of the industry (and about 90% of those still inside) would consider the job nothing more than standing behind a counter all day counting manufactured pills and following the instructions of the all-powerful, all-knowing doctor to the letter. It takes about ten minutes work experience to realise that is rarely the case. On a fundamental level, the job exists to provide a link between a doctor’s diagnosis and the resulting therapy for the patient. The doctor can tell what is wrong with someone, and based on their own studies suggest a suitable course of treatment. How that treatment works however is an area that falls far outside of the expertise of a general practitioner. Why is that?

Because, well really, it is far too unfair to demand a doctor to not only be able to come up with the causation and symptoms of an illness, but to then also have to be able to provide accurate and sufficient information on how the agents used in treating the problem will come into action. From a patient safety point of view, it is far too risky to shoulder that much responsibility onto one person. The biological aspect of a disease takes enough of a toll on somebody’s skill set. Having to mix this in with the chemical and pharmacological terms of a treatment requires large amounts of study. An inherent fault in our health system is the split that occurs in identifying our problem and then working against it. That being said, a far more catastrophic approach would be to demand the two jobs out of one person. In any case, an ample solution is to have both pharmacist and doctor have a key understanding of their own field, while also having a working understanding of the others. In my own course, the touches I’ve made into the fields of physiology and anatomy would not rival a doctor’s, where as their own studies in terms of drug action would also be far different and more diffuse to my own.

The real issue then is not the merits of both occupations, but the viewpoints of each and how the wider world thinks both fit into the system. Patients tend to place a far greater emphasis on the role of the practitioner, while only seeing the pharmacist as the hand with the drugs at the other side. As a result, it follows on that any attempt by a pharmacist to try mesh both sections of the person’s care comes off as flaky, interfering and just meddling where their intellect clearly can’t succeed. Any reasonable doctor/pharmacist knows that neither betters the other, but both have to be complementary; the vitality of this increasing as the disease state becomes more serious in nature. However, based on a patient’s above attitude in select cases, the problem then can become that the patient places the doctor in prime position, and then in a strange twist of faith elevates their own expertise to that of the pharmacist. This has come about in a number of ways.

Primarily, pharmacists are more readily available than doctors, and most will go there first for treatment of an acute, non-threatening ailment. As only painkillers, flu remedies etc are purchases, eventually a point is reached where someone questions what really is the purpose of the pharmacist, if they only really serve to hand out drugs that most shopping centers now have in stock. This increase in drug availability adds to the in-and-out nature of buying OTC products to give an image that pharmacists in general have it easy.

As well as this, a more dangerous and under recognised cause is the emergence of the internet as the new port of call. Nowadays, people will happily buy their medication online. Not only that, but a large part of the population now find it imperative to evaluate their own illness themselves, leading to huge misinterpretations, drug purchase and worry. Over the last century the number of new chemical entities available to regular sales has skyrocketed. This give the customer a bigger pool of potential toxins, while diluting their own knowledge to the point where Ibuprofen and Nurofen are very, very different in their eyes. The self evaluation problem has made pharmacist consultations far more tricky, and it is only a matter of time before the same scenario is widespread in the offices of GPs.

It comes to a stage where the battle is fought on two fronts. Beyond all else, it is vastly important that the patient has as much knowledge about their disease, treatment, and the drugs in question. That being said, the healthcare sector is now fighting a losing battle to prevent people sucking up as much misguiding information as possible, so much so that the nature of dispensary drugs has now been brought down to the general public’s view on illegal street drugs. With only snippets of info, a drug can come off as much more harmful than reality. Such is the case with narcotics, and now we see the same ghost haunting the legal sector.

Working both academically and on the scene, examples of where this misguidance leads us become increasingly apparent.

1. “My doctor knows what I am taking…”-Look, you need to tell the pharmacist what you are taking. A doctor’s job circles around treating whatever you have now. He can only make educated guesses as to whether whatever else you are taking interferes with that. If you went to a doctor and he told you had liver disease, you would never say “Nah pharmacist says it can’t be that”. Because that is their job. The doctor never asked you to champion him as a drug expert, and even if he did, a pharmacist would still demand to know what you were taking.

2. “I’ve been on those for years….” Things change. If you told me your car worked ten years ago, I’m not gonna take that as gold that it still runs now. Age changes drugs, and so does your condition, and if both the doctor and the pharmacist can see your dose or drug needs to change, you need to follow up on that advice.

3. “I don’t like the other ones, they are different…” Generics are the same thing my man, same drug made by a different company. Everyday you change water subtly, and food subtly and just about EVERYTHING else in your life. This is the one thing that is not changing, so stop trying to convince someone who is trying to give you your medication that they;re is a problem. In a select few rare cases, this is an issue. If it was, the pharmacist would tell you so.

4. “The internet told me…” The internet is as useful a back up as your “friend recommended them”- it counts for nothing. Your five minute google search before you went to the pharmacy does not suppress someone’s years of education and practical experience in the subject.

5. “The doctor said that strength…” God forbid the doctor was ever wrong about a field outside of his own. If the pharmacist says they’re wrong,they’re wrong, and yes..they will be wrong again. It’s nothing against their credentials, it just occurs now and then. You have to be on board with this.

STUDENT PATIENT BONUS ROUND

“So can I really not drink on these?”-Nobody is trying to be a buzz kill here. If it says no alcohol, don’t have your friend studying english literature you convince that of course “one or two will be fine”.

“I’ll just take five, not four”-The dose is the dose. Increasing it rarely is gonna work out for you. Otherwise I’m sure the really smart scientists who tested this for years would have told you so.

“I didn’t finish my antibiotics” Just finish the course. Please, just follow the instructions.

“I missed one, will I take two the next time”-unless the pharmacist told you to do that, you can assume it has absolutely no effect like the second question.

“Can I really, REALLY not drink on these?”-No….no you can’t.