Proving myself...Rotation 2: Ambulatory Care

Hey everyone!
It has been a while since I posted. Just wanted to say hi and let you know I am hard at work on Rotation #2, Ambulatory Care. It has been a busy month so far. It is always tricky coming into a new place, meeting new people, figuring out how they "prefer" things to be done, and then trying to get a hang of things.

This month is at a doctor's office near Raleigh. They see adults only and manage chronic disease states like diabetes, hyperlipidemia, hypertension, atrial fibrilation...conditions that require meds each day, but the people are not sick enough to be in the hospital. So far, it seems to be a great office, and the pharmacist there is awesome.

He has a resident pharmacist too who graduated two years ago, and she is responsible for most of our "learning" this month. She is a very tough person to learn from. Unfortunately, it has been quite stressful, and most mornings I go in with this pit of anxiety in my stomach because I don't know what to expect from her on any given day. It is almost like her goal each day is to remind us of just how much we DON'T know. I have another student with me, and she is even harder on him than she is on me. Yesterday this is the question that had me stuttering...

I presented a patient that was 63 yo male who had uncontrolled diabetes on his current regimen. I made my recommendations based on what medications he has tried in the past, his current renal function, and what our blood glucose goals were for him at this time. I went through this whole spill and thought I had done a pretty good job presenting the patient. At the end she asks me several question about the medications, their side effects, how they are metabolized, and why the patient could not take certain medications due to his failing kidney function. I knew the answers! Then she says' " How do we know his pancreas is secreting any insulin at all? How do we know if his beta cells are completely burnt out at this point? What lab can we run to assess his insulin secretion now?"

This was my reply: "Ummmmmm, duhhhhhh, wellllllllll, uhhmmmmmmmmmmmm?!" Then I finally had to say those dreaded words, "I don't know." She says "C-peptide" and then gives me the most evil smile ever.

I won't say what thoughts went through my head at that time...I will say that I bit my tongue, and fire may have shot out of my ears. :) Anyway, I am working hard trying to prove myself, and tomorrow is another day! I need a hug. Thanks for listening to me vent.