Makeovers and March rays

Since my last post, I got inspired to do a kitchen makeover. My dream is to one day add on a bigger kitchen/dining area, but that will probably be several years down the road. We've never updated the kitchen in our six years of living here, so I decided it was time for a new look. Ideally I should've started this project during the winter because now spring is just around the corner and as soon as it's warmer I'll want to spend every possible minute outside! Generally I'm not an impulsive person but sometimes when an idea hits me I pounce on it. This was one of those times! Enthusiastically I started ripping off wallpaper but soon realized it wouldn't come off without a fight. After much scraping and trying different methods I finally figured out what works best. In the process I nicked and tore the drywall in some places, much to Cliff's annoyance. His level of enthusiasm for the project was quite a bit lower than mine but he's been a champ and come around. There's still quite a bit of wallpaper to tear off but I'm hoping we can both work on it this Saturday. I'm having fun dreaming up new decor and looking at paint samples.

The spring peepers are here!! They make such a lovely night sound that means we've made it through winter and the earth is waking up. Near our house there's a swampy area where the sound comes from, getting noticeably louder every night. Robins are hopping around and in the morning I hear their song of spring. This time of year makes me yearn for my greenhouse days - the smell of fresh, wet soil and growing things, dirty hands, and warm sun beaming down on my neck.

When I explored my yard this afternoon I saw the deer have once again been devouring my plants. Ugh! I feel like I'm in a losing battle with those creatures.

Today was my much needed day off. It flew by too fast of course, but overall I had a relaxing day. This afternoon when the sun was streaming through the patio door I got an urge to lay down in that patch of sun. Ahhh, such bliss! The warmth and light felt heavenly on my skin, although I felt a little cat-like lying there.

My fresh line-dried sheets are waiting for me, so goodnight!

What's your style?

Recently my mom, sisters, and I were discussing home decorating on our chat. Some of us struggle with knowing how to create a cozy, beautiful home environment. Others don't worry about trying to be "in" and just use things we like to make our homes attractive. I love decorating but I certainly am not one who periodically redecorates with the latest fad. Farmhouse style? Nah. I don't live in a farmhouse so why try to make my home something it's not? Beach/tropical? Nope. I don't live in a beachy, tropical part of the world so that's ridiculous. Same goes for lake/cabin decor. The thing about fads is they quickly become outdated. Remember when Thomas Kinkade was all the rage? Not long ago, painting walls with vibrant colors was considered ideal. Now the neutrals have come back with the farmhouse style. I remember when neutrals were the fashion before. There's always a little different twist, just like with patterns and clothes, but the old becomes new again. Several years ago, country style decor was the trend. At that time, I was more into following the "in" thing, and my home probably reflects that style the most. However, I have a low tolerance for clutter and have never been one to cover every surface and corner with "stuff." I'm not very sentimental either, and don't have a problem getting rid of things. If you don't love it, why keep it?

I haven't read the wildly popular book The Life Changing Magic of Tidying Up, but have read some about the KonMari method and like what I hear. The rule of only having things that spark joy is a great way to make decisions. Occasionally I see something that instantly grabs me and I know it's perfect. That's what I think sparking joy is about. When I'm changing some of my decor or rearranging, I try different things until I hit upon the one that makes me feel the happiest.

I'm also not a fan of anything fake, although that doesn't mean there's no fakes in my house! Why buy a new item that's made to look vintage? Give me the real thing. Imperfect, scratched, rusty items have character and reflect the real struggle of living. Old items passed down through generations are far more valuable to those who know the story behind them. I treasure anything that was used or made by my grandmas. Several years ago at a Swarey reunion, we had an auction and Grandma sold a few of her things. There were several serving bowls that I remember eating browned butter noodles out of and I am happy to now own one! Recently I got a handmade rag rug from Grandma Byler that will always be cherished. Somehow I came into possession of a little suitcase owned by my Amish great-grandma, which I filled with old books. This is beginning to sound like I'm sentimental after all! As I get older, I value things I remember from my childhood because they are associated with good memories.

Having a classic, timeless style and surrounding myself with things I love is my goal. I want my home to be cozy, welcoming, and relaxing. In the larger scheme of life, these things are unimportant, yet I think we all want to make our homes a refuge and an "island of joy."

of Irish and Amish

Since St. Patrick's day is tomorrow, I've been thinking Irish! I'm lucky enough to know a little about my Irish heritage. In the book Rosanna of the Amish, the story is told how Bridget O'Connor and her brothers John and William came to America. Bridget married an Irishman, Pat McGonegal, and four children were born to them. Before Pat married he worked in Pennsylvania and boarded with an Amish woman. After their marriage, Pat and Bridget lived with this Amish woman, Elizabeth Yoder, until they were able to find a home of their own. They remained friends with Elizabeth, who taught Bridget many homemaking skills. Unfortunately, Bridget died after the birth of her fourth child, Rosanna. During her illness and death, Bridget was cared for by Elizabeth, who also took care of her baby. Pat decided to take his three oldest children to live with relatives in Philadelphia and leave Rosanna with Elizabeth. From time to time, Elizabeth would receive letters from Pat, but eventually they stopped coming and she felt something must have happened to him. When Rosanna was nine years old, her older brother William came to visit and confirmed that Pat was killed while working in a gravel mine. William intended to take Rosanna back with him, but Rosanna did not want to leave Elizabeth, whom she called "Momly" and the only home she had ever known. So she stayed and was raised as an Amish girl. At some point, they moved to the Amish settlement in the Big Valley (Belleville) where Rosanna married and had children of her own. Rosanna was my great-great-great-great grandmother. Her youngest son, Joseph, wrote the book Rosanna of the Amish, which is a very interesting story that gives a true view into Amish life.

When I was in 4th or 5th grade, my teacher read us this book, and it was arranged for our class to make a trip to Belleville and see some of the landmarks associated with Rosanna. One of the houses she lived in is still standing, and we also visited her gravesite. Afterwards, we went to my Grandma Byler's for a traditional Amish church meal of bean soup, moon pies, white pickles, and cold cuts. I grew up eating this food whenever we visited Grandpa Byler's, and to this day, I consider it delicious. To those who didn't grow up with it though, the bean soup can be rather off-putting. It's made with milk and white beans (no meat) and you put chunks of day-old dry bread in it as you eat it, along with a sprinkle of allspice, if you like. Moon pies are basically half moon shaped dried apple pies. My grandma makes the absolute best! 

I've always wanted to go to Ireland, and recently decided I'm going to do it! We're hoping to go sometime next year. I want to see Killarney, where my ancestors came from, and experience the Emerald Isle. 

According to legend, St. Patrick explained the holy Trinity using a shamrock, or young clover. It is rather disappointing that this missionary's life is celebrated among the world by drinking and partying. 

I'll end with an Irish blessing.

winter wonder

Yesterday morning we awoke to a white winter wonderland. Every tree, branch, and stick was coated with a puff of snow. To see the sun shining on all that whiteness was dazzling! Believe it or not, I'm actually enjoying winter this year. It's a slower-paced, cozy season. There's no outside work (Cliff takes care of the snow removal 😊) and long, dark evenings to be at home. In the past, that would make me depressed, but I've gradually come to see the pleasurable side of winter. One thing that has made a big difference in my feeling towards winter is having a warm house. Being cold makes me cranky. When our wood stove is going, it's often around 80 degrees in the house. We have to open windows because it gets too hot but I consider that a blessing!

I've been making an effort to go on a walk at least 5 times a week. It can be challenging with my work schedule and the weather, but I've managed to accomplish it! Getting outside and exercising is so much more appealing to me than walking on a treadmill or going to the gym. I believe the fresh air does wonders to clear your head and maybe even your skin! It's always invigorating even though some days I feel like I have to drag myself out there. It seems the air is beginning to have a touch of spring and the days are getting noticeably longer now. Soon the dark winter evenings will be over!

One of the pleasures of living in Pennsylvania is getting to experience all four seasons. My favorite is still spring, but I've come to love them all. Each one has a distinct smell, sound, and feel. In the beauty of nature is proof that God loves us.

Now, I'm going to get my walking shoes on and get that fresh air in my lungs before I have to leave for work!

Life is tough, but so are you

I've been wanting to write for a couple days but have been feeling a little negative about life and that takes away my enthusiasm for writing. I don't like to admit I have times like this and try to focus on positive things but the truth is I battle dark thoughts. A couple weeks ago I sat in Sunday school and began feeling like I live such a selfish life. The lesson was on using our talents and the ladies were discussing being ready to give when we see a need and other ways of reaching out. When I look at my life, it seems like it's all about me. Because I don't have children I'm not forced to be selfless like moms are. All I do is work and what good does that do anyone? Even this blog is all about me. Everywhere I look all I see is ugly selfishness. There probably is some truth in those thoughts but the devil quickly began using it to discourage me. When I realized those feelings were black and hopeless, I decided to believe they were not from God. Still, I'm not sure where to put all that because I do think I have a need in that area.

I've been inspired lately to be stronger emotionally and mentally. Not to be so easily shaken when faced with disappointment. To keep going, keep smiling, and trust that the trials I go through are meant to make me a better person.

I'm beginning to understand just a little that I can choose to think discouraging thoughts or believe they're not true and refuse to listen when they start bombarding me. Often the dark thoughts feel like the truth and it's so hard to think otherwise. This quote really spoke to me. 

I didn't want to write a negative post, but maybe saying some of these things will help me since I resist the idea of admitting I am this way. 

a day at H.O.M.E.

Today was one of those days that was as perfect as it can get for me! After working till 11:00 last night, I got to bed late and slept in late. Working weekends does have one benefit - a day off in the middle of the week! It feels luxurious to stay at home while everyone else is at work. Especially when I'm the one who has to go to work while others have snow days!

For breakfast, I made a recipe of banana chocolate chip muffins I've been hungry for, so now there's some in the freezer to pack in my lunch. Taking a walk was the next thing on my list. A few lazy snowflakes fluttered down as I went, but I was warm and it was refreshing. This is the first time I was able to walk this week because of bad weather. Amazingly enough, last week I made it 6 days in a row - yay!! My feet had really been suffering so a couple day's rest and some new shoes will hopefully put an end to that. I thought about taking a nap afterwards but decided to accomplish something worthwhile. Cleaning and reorganizing closets was on my February to-do list, so I proceeded to purge out a bunch of stuff. After that I allowed myself to take a nap and woke up feeling rested and content. One item was needed from Boyer's to make supper. I spent some time in the kitchen making a favorite meal - baked tilapia, rice pilaf, and steamed broccoli. It was incredibly yummy. We polished it off with whoopie pie bars for dessert. Cliff loves having them for his lunch and I had enough supper leftovers to make four lunch containers for him. When I'm not tired from work I do enjoy cooking, which I had almost forgotten. The rest of the evening was spent doing my favorite wintertime activity (can you guess it? 😆) putting puzzle together and listening to a book.

For those lucky(?) enough to be at home most of the time, a day like this is nothing special. Since I don't have that privilege, it's rejuvenating! But I'm still glad I have a job and wouldn't want to be at home every day.

a day in the life of a pharmacy tech - Part III

Part III - the anteroom

Now for the long overdue post describing the third position techs fill in the pharmacy! As the go-between the clean room and main pharmacy, some technicians say the anteroom is the hardest position and I tend to agree. Only one person per shift works in the anteroom. To keep things running smoothly takes multitasking, keeping calm under pressure, and staying on track amid many interruptions. A good anteroom tech can make everything go so much smoother for those working in the chemo and clean rooms.

The day shift anteroom person starts at 7 am. After changing into hospital scrubs, the first thing you do is scrub up and go into the clean room to make the morning doses of any special drugs that are not premade. When that's finished, the next job is deciding what IV medications need to be batched for the day. To figure this out, you look up in the computer system all the IV antibiotics that we make to see how many patients are on each one and how often they are taking it. Going by that, you can figure out how much you'll need for a day's supply. Next, go to the fridge and count how much we already have on hand, also checking expiration dates. Extra syringes of different medications are kept in the freezer so usually you have to pull some of those to fill the fridge. If there aren't many syringes left in the freezer, you'll be batching them today. The goal is to know what you will be batching by the time the clean room tech and pharmacist come in at 8:30. Once you decide what all you'll be making, pull the drugs and supplies and wipe them down before taking them into the anteroom. At this point, the clean room tech is probably there so they can help with dating the syringes that were pulled from the freezer and gathering supplies for stocking the anteroom and clean room. While the clean room tech covers for you, go to break. When you get back, the clean room tech goes on break and you finish setting up the cart with all the supplies needed for batching. Keep in mind that at any time you may be interrupted and have to make a stat drip or some IV medication a nurse calls for.

I don't think I've mentioned much about the chemo making process. The chemo room is a small closet-like room off the clean room. Since it is a negative pressure room, air flow is directed inward instead of outward so that all possible hazardous drug spores are vented to the outside. Being a chemo tech is about as high up the ladder a technician can get. Before you can be trained in mixing chemo, you need several year's experience in making IV drugs. We have one chemo tech and two oncology pharmacists. One of the oncology pharmacists works at the cancer center Monday through Friday. All pharmacists have been trained in mixing chemo, but there are two who rotate working in the chemo room most often. On a normal day, there will be anywhere from 10 to 18 patients scheduled for chemo. Getting the chemo out on time is one of the most important roles of the anteroom tech. When a patient arrives at the cancer center, the oncology pharmacist sends over the chemo order and prints labels in the main pharmacy. The anteroom tech gets the labels and if the drug is stored in the chemo fridge out front, pulls the correct dosage and drug to send back to the chemo room. In the anteroom, gather all other supplies they will need to make that specific chemo, then put it in the pass through window for the chemo tech or pharmacist. It can be frustrating to those making chemo if the wrong supplies or drug are sent back, so try to get it right! You always need to keep an eye on the pass through window in the anteroom so chemo gets quickly passed out to the front, where another tech will walk the chemo to the cancer center.

In between keeping an eye on the printer for chemo labels and watching the pass through, you need to make labels for all the drugs that are being batched in the clean room. You are also responsible for deciding what IV's and supplies need to be ordered and get the order in between 10:00 and 10:30. The morning hours are the most hectic part of the day for the anteroom tech. It feels like you have deadlines to make while being pulled in all different directions. The more organized and calm you stay under pressure makes a big difference in how your day goes! When the labels for batching have been made and order put in, it might be close to lunchtime. Until the clean room tech comes out to relieve you, keep working. Hopefully the anteroom tech gets to lunch before 1:00. At 1:30 labels print for 24 hours worth of antibiotics. This is usually a lot of labels that you are responsible to pull the drugs for. If the clean room tech has done most of the batching in the morning, they sometimes help label after their lunch break. When the clean room tech and pharmacist are at lunch, the anteroom tech is responsible for making stats, and sometimes that's all you do over their lunch break. Whenever there is someone in the clean room, stats get passed back to them. If the clean room still has a lot of batching to do, they will probably go right back after lunch. Whenever a batch is completed and checked by the pharmacist, it will be passed out for the anteroom tech to put away.

Sometime during the day the anteroom tech checks the monthly schedule or calls the OR to see if there are any hearts scheduled for the next day. If so, you need to gather everything needed for an open heart surgery and send it back so those working in the clean room can make the drips. At 3:00, the next day's OR schedule prints and a pharmacist will look it over to determine if any special OR solutions need to be made.

By this time, the order you put in will probably have arrived. The rest of your time is spent putting the order away and stocking the anteroom, still watching for chemo or any stats that need to go back. The second shift tech comes in at 2:30 or 3:30, depending on who's scheduled. Before you leave at 3:30, give them a brief report on what's going on in the clean room and anything else they need to know.

The evening shift anteroom tech has a totally different role than day shift. After 5:00, there is no one in the clean room so all special IV's are made by the anteroom tech. Some evenings a lot of time is spent making stats. You might get scrubbed up and make one drip, then go back out front. Ten minutes later, there may be another stat to make so you scrub up again. Working second shift anteroom is hard on the hands and skin from all the times you scrub up. During the day, the anteroom tech stays in the pharmacy, but on second shift, they are responsible for delivering certain things because there is only one tech out front. Usually you make three trips out with IV's and antibiotics. In between other duties, work on putting away that day's order and stocking the anteroom because often the day shift tech hasn't been able to do it. After 7:00 you make the radial cocktails for the next day. They are only good for 24 hours so the anteroom tech makes them every evening. When you're finished making radials and have done all your deliveries, it's time to clean the anteroom and clean room. The hoods get cleaned using the 3 step process, trash taken out, floors cleaned using a sticky roller and mopped with a decontaminant solution. By that time, it might be close to 11:00, depending on how busy an evening you've had or how often you're interrupted.

I prefer working day shift anteroom over evening shift. Evenings are usually calmer, but everything is up to you since you're the only IV tech. Also, I like working 7:00 - 3:30 and the day shift anteroom tech is the only one who has those hours. Time usually flies by because you're so busy. Since I like to be busy at work and enjoy working by myself, working in the anteroom has been mostly fun. There are times when it's almost too much, but eventually it will slow down and be more manageable.

This pretty much completes the description of my job. If there's anything else you want to know, comment or send me a message!

a goal without a plan is just a wish

I don't like that it's been over a week since my last post because I have things I want to write! Right now I should be sleeping but I'm not working this weekend so I'm giving myself permission to stay up late. Which brings me to something I've been pondering on... how to be self disciplined and get things done that need to be done instead of just doing what I want to do. I've gotten into a really bad groove of getting up at the last possible minute in the morning then coming home and flopping on the couch and relaxing most of the evening. After being on my feet for 8 hours (only sitting for break and lunch) I tell myself I deserve to take it easy. There are always things I could be doing but I usually push it off. I've noticed in other small areas I allow myself to take the easy way and I don't think it's good for me, but I haven't been able to find the incentive to make a change. Since I'm one of those people who can't seem to hold themselves accountable unless something or someone is holding me to it, I decided to buy a planner and make a schedule for myself. When I taught school I planned out my day and decided what time to have my classes, then tried to stick to the schedule. Of course, I had to be flexible and things often didn't go according to plan, but I think just having a plan held me accountable. Although I love organization, I'm not really a list maker and kind of float along and take things as they come. So I'm trying this planner/schedule idea and it's only been a few days, but I think it might work! I wrote down what time I need to get up and go to bed, planned when I would get groceries, scheduled in social plans, supper menus, and gave myself things to do in the evening after work. This week I had to get ready for weekend company and wedding activities, so that's part of the reason I didn't have a chance to blog! I wish I could say I got everything done ahead of time, but unfortunately I still have quite a list for tomorrow. One area I was hoping to make time for was exercise, but I'm still stuck on that one. I like to get outside and walk but there's not enough daylight hours before or after work during these short winter days. I've thought about going to a gym but that would really be out of my comfort zone!

Today we had a potluck at work. There was pizza rolls, barbecue smokies (my contribution), 7 layer dip, Cincinnati chili dip, spinach dip, deviled eggs, seasoned pretzels, cronuts, orange blossom cake, and bars. Tonight we went to folks to celebrate Shelby's and SaraBeth's birthday and Mom made a delicious meal of pepper steak. Kait brought an amazing Italian salad, SaraBeth made her yummy chocolate mousse pie and Mom had shoo fly pie too. Do you see why I need exercise??! Chad and Keela are here for the wedding this weekend and Derek and Camille are en route.

I hope my next post will be the third installment of "day in the life of a pharmacy tech." I'm ready to write it, so I'll put it in my schedule for next week!😉

Counting my blessings

Lately it seems it's been too easy for me to dwell on the negative parts of my life. By nature I tend to be pessimistic and melancholic, which I don't like. Thinking on the positive parts of my life and what I have to be thankful for is a good way for me to get my mind off the things that aren't so pleasant. I've found that writing and sharing my thoughts on this blog has been surprisingly therapeutic. So I decided it's time to straighten my crown and start counting my blessings!

A few things I'm thankful for

• A reliable vehicle that gets me to work 
• A happy childhood and good memories of family times
• A job I enjoy that keeps me busy
• A heated garage
• A mom who cuts out dresses for me and helps me with my patterns and sewing
• God, the church, and friends who care
• That I was born in a Christian home 
• My own home - my haven

A few things that make me happy

• Seeing the sunrise just as I pull into the parking lot to start my day at work 
• The giddy feeling the night before when I don't have to work the next day
• Being with my nieces and nephew - children are so innocent and funny!
• Listening to a book while putting a puzzle together 

Sometimes I feel guilty and selfish for doing things I enjoy to make me happy. I'm not exactly sure how God looks at it, but I've found that looking for joy in small, everyday things and doing little things I delight in does help me to feel better when I'm down. There's so many more big blessings I could add to my thankful list, but the little things are what impress me! I want to focus on the good instead of the bad.

once a teacher...

It's been almost three years since I taught school, and some days I miss it. Especially on Sundays when I'm at church and see the children and my former students, I find myself remembering. Although I have regrets and wish I could do some things over, I really loved teaching. I miss being involved with other teachers, children, and the school board. I miss having a classroom to decorate and dreaming up ideas for educational projects. I remember science fair, book study, social studies power points, map study, and caravans. I miss the thrill of explaining a lesson. I miss making lesson plans. I miss that amazing feeling of seeing a child progress and learn new skills and easily do math problems that were once hard for them. I miss seeing wonder and interest in their faces when presenting a fascinating history or science lesson. I miss introducing them to good books during story time. I miss all the breaks and summer vacation. But there's just about that many things I don't miss, too! When I compare my job now with teaching it's so much easier in some ways. At the end of the day I can go home, forget about work, and be free from responsibility. Also, I have better benefits and pay (not that I'm making so much money - Google "pharmacy technician salary" if you're curious). The medical world intrigues me and I genuinely enjoy my job.

As anyone who has been a teacher can probably tell you, teachers face criticism. I've learned I don't handle that very well. Another area I wish I was different in is being able to give correction without showing frustration. Being a teacher can be mentally and emotionally draining and I don't know if I'm really cut out for it. Part of me can't accept that my teaching days are over, though. Maybe I'll just always have this nostalgic feeling. I certainly will never regret the years I spent as a teacher!

the scoop on salsa

Yesterday I put a question on my WhatsApp status regarding what kind of salsa is good to buy for those of us who don't make homemade. I got quite a few answers and some told me they'd like to know too, so here's a report.

1. Chi Chi's

2. On the Border

3. Leal's (apparently not available in PA, but looks like it can be bought online)

4. Newman's Own medium, put in chopper to get rid of chunks

5. Penny's Salsa

6. fresh salsa from refrigerator/produce section

7. Pace - recommended by 3 people! One person blends it a bit and adds cilantro. Another person blends it and adds vinegar, salt, and garlic salt.

8. Two people sent me recipes using canned tomatoes

Yum! Some of the suggestions I've already tried and I'm looking forward to sampling new ones. Since I mostly shop at Sam's Club I've just been buying whatever they have - On the Border, Member's Mark, etc. Of course, it usually comes in a bigger container so I've had a problem with it going bad before the jar is empty. I kind of go through spurts where I eat a lot of it for awhile, then it sits in the fridge for a long time. Cliff rarely eats salsa (popcorn for him!) so I guess I need to start buying smaller jars. Thanks for sharing your favorites!

find your cozy nook of comfort

One of the things that gives me the greatest joy is coming home from work, lighting a good smelling candle, and working on a puzzle beside a warm wood fire. I feel like I don't have words to describe the pleasure I get from this simple activity! It's so relaxing and there's truly no place I'd rather be on a winter night than at home, by the fire, working on a puzzle. The calendar I have on the wall close by says "find your cozy nook of comfort" which is exactly what this is for me. 

my current puzzle - the one I got for Christmas

While I was working in the clean room today, I asked the pharmacist who was with me if she goes home and cooks every evening. She said most nights she does, it's how she relaxes! I. cannot. imagine. Usually the last thing I want to do when I get home from work is cooking a meal and it certainly is not the way I relax! I don't mind cooking if I'm at home all day, but I just don't have the energy after a day at work. This pharmacist has about an hour drive home so I asked what time they eat, and she said around 8:00 pm. By that time, I'm thinking about going to bed, not cleaning up after a meal! Her husband (also a pharmacist) likes to cook too, and they enjoy making elaborate meals together on the weekends.

I discovered Wal-Mart has some pretty good salads that come with dressing and toppings, all ready to mix and eat. We both like them, and for $2.98, it's cheaper and healthier than fast food! Although I am not a Wal-Mart fan and avoid going there if at all possible, I've been using their grocery pickup and am super impressed. For someone like me who doesn't enjoy shopping and would rather click and shop, it's fantastic! On my way home from work I can stop by, someone brings out my groceries and loads them up, and I'm on my way in a few minutes. I really hate to be promoting Wal-Mart, but I haven't found any other grocery store that has such great pickup service. If someone knows of a better place, please let me know! I do use Sam's Club pickup a lot too, but you have to go in the store to get your order (yes, I know this sounds lazy. I just think it's a waste of time going in stores!)

Now it's time to work on my puzzle! 😄

anecdotes from pharmacy life

It may be awhile until I write Part 3 of my "day in the life of a pharmacy tech" posts. I'm not officially trained in the anteroom for day shift, although I have covered other tech's breaks and lunches and been trained on weekends and second shift. Next week I start my day shift training and then I'll be in the anteroom for several weeks. In the meantime, I'll tell some other experiences of things that happen at work.

There's usually no one working in the clean room after 5:00 pm, so the second shift anteroom tech is the one who has to make any stat IV medications that get ordered. We have a small "stat" hood in the anteroom and do a shortened version of the garbing and scrubbing when we make things in there. Medications made in the stat hood are only good for 24 hours because it's not as sterile of an environment. I had one night of second shift anteroom training before I was on my own. 😒 Once you are familiar with how drips are made and have been trained in the clean room, working in the anteroom is not that difficult, though. The night I was training, I asked the tech I was working with what would happen if I ever had to do a stat open heart, and she said "there will be a pharmacist with you, so it will be fine." Usually when there's heart surgeries, we get everything together and prepare all the drips the day before. Sometimes a patient comes in who needs surgery immediately, or for some other reason the heart team gets called in to do a stat surgery, so we have to be ready for that. I never got a chance to prepare the heart supplies when I was working in the clean room, so I didn't even know what kinds of drips were needed. Soon after I started working second shift in the anteroom, one evening there was a code called in CCU. In the meantime, I went back to the clean room to make my radials (a cocktail of drugs we make every evening to have on hand for the cath lab) and while I was back there one of the pharmacists poked her head in and said "they're taking the patient who coded back to surgery." At the time I didn't know the story, but it was a patient who had open heart surgery about a week prior. Apparently there was a slow bleed that they weren't aware of until he coded that night. On second shift, we have a much smaller staff and that night there was only 3 pharmacists and 2 techs. One of the pharmacists was working in the ER, another was newer than me and hadn't been trained in the clean room yet, and the third was a per diem pharmacist who only works about 3 evenings a week. The per diem pharmacist had to figure out how to enter all the heart orders, and I didn't have a clue what I was supposed to do! I couldn't believe this was happening. Since I didn't know what kinds of drips to make, I waited until the orders were entered and I had labels telling me what they were. There's about 5 different ones and some of the IV bags look exactly the same, so unless a pharmacist watches you, they have to take your word that you put the correct drug and right amount in the bag. Because of who was working that night, no one was with me in the clean room, so I made those drips totally on my own!! It would've been so easy to make a mistake, but I tried to be extremely careful and can honestly say I believe they were made correctly. It took awhile to get everything figured out, but we did it! And the story has a good ending - THE PATIENT LIVED!!

Sometimes we have people come in who are overdoses or have a very grim outlook. It appears like some families want everything possible done for the patient even though the chances of survival are slim. There's times when we are making multiple doses of strong IV medications around the clock for a week, and you know most likely that patient is being kept alive by chemicals. Finally the meds are discontinued and a little while later you might see a litter being wheeled into the morgue, which is a short way down the hall from the pharmacy.

We had someone come in who tried to commit suicide by drinking antifreeze. Another person unintentionally drank formaldehyde. Apparently the patient had a cold, and someone gave it to him, saying it was something to help his cold. Needless to say, he soon began feeling much worse. One night a lady was brought in by EMS and her husband said she had been unresponsive for a day. The husband came in with another lady, who was his girlfriend. To not do anything for a day when someone is unresponsive seems irresponsible at the least and possibly criminal. We hear about these things but never really know the outcome as far as what happens to the people who are potentially responsible.

Working in a hospital opens your eyes to the fact that things can happen so quickly and just like that people's lives are changed. It's made me learn to appreciate what I have now, and not take good health for granted.

confessions of a melancholic

I'm so excited that it's Friday night and I have the weekend off! Truly, not having to set an alarm is one of the best feelings. Since I know I don't have to get up in the morning I'm wide awake!

As I mentioned before, I am genuinely surprised at how many people have told me they enjoy this blog. Thank you for the kind comments. It makes me feel a little guilty, though. I don't want to portray myself as something that I'm not, so I want to make it clear that my life is FAR from ideal or perfect. Although my writing may sound happy and positive, in reality I struggle with being the exact opposite. Since my life is different from most of my peers, I feel like I'm somehow missing the mark because I'm not a dutiful housewife. Most nights I'm too tired when I get home from work to prepare a decent meal. Having company looks impossible to me because if I'm not working I just want to spend time at home and get caught up on wash and things around the house. As an introvert, being with people can be exhausting and I feel like I don't know how to relate to others. Somehow I can write things that would be hard for me to say, but talking about my life and feelings seems self-centered and I didn't think people would want to hear about it anyway. That's why it's been surprising to hear that others find it interesting!

On the other hand, I do feel like I'm blessed and my life is rich in so many ways. I want to be the person God wants me to be, and accept who I am. That's something I need to grow in. I appreciate your encouragement!

a day in the life of a pharmacy tech - Part II

Part II - the clean room

This installment will describe what we technicians do on a typical day when we are assigned to work in the clean room.

Within the pharmacy, there's a room called the anteroom, which is where you scrub up and gather supplies before entering the clean room. In part 3 I will describe the anteroom in more detail. The clean room is where we make sterile products, like IV antibiotics. Since these products go directly into a patient's vein, proper hand washing and garbing is extremely important, as well as keeping the clean room free of contaminants and particles. Everything that is brought into the clean room is wiped down with antibacterial wipes. Garbing has to be done in a certain order, going from dirty to clean. These are the steps we follow.

bunny suit

surgical hand scrub

1. Put on booties, then bouffant cap. Enter anteroom.
2. Put on face mask.
3. Step into bunny suit (lint-free coveralls) and pull it up to your waist.
4. Scrub hands, including fingernails, and arms up to elbows with surgical scrub.
5. After drying hands and arms, finish putting on bunny suit.
6. Enter clean room and use hand sanitizer, then don sterile gloves.

If you go back into the anteroom for something, you have to change your gloves before working in the clean room again. While compounding sterile products, we periodically spray our gloves with alcohol to keep them sanitized.

The products are made in a laminar air flow hood, which uses filters and air flow to keep out particles. It is important to not block air flow to the "critical point" where you inject or withdraw the drug. Syringes have to be handled in such a way that you do not touch the main part of the plunger, which could contaminate the product in the syringe. Learning how to hold the vials so that you are not blocking air flow while at the same time using the syringe correctly is difficult at first. All products wrapped in sterile packaging, like needles and syringes, need to be opened in the hood. If you take your syringe out of the hood, you can no longer use it because it is contaminated. It needs to be drilled into your mind to "stay in the hood."

As for what kind of products we actually make, there are certain medications that we batch and always keep on hand. The tech working in the anteroom decides which medications need to be batched for the day. Many of the drugs come in powder form and we reconstitute them. They are then injected into an IV bag or syringe. Usually there is a pharmacist and a tech in the clean room. The pharmacist mostly watches the tech to make sure the correct sterile technique and right amount of drug is being used. This varies though depending on who your pharmacist is. Some pharmacists supervise and let the techs do the work, and others pitch in and help if there is a lot to get done. It is important to understand math and proportions when making IV medications. Here's an example: vancomycin powder is reconstituted with 100 mL of sterile water. The resulting concentration is 500 mg/10 mL. We are batching 1500 mg of vancomycin in 500 mL 0.9% sodium chloride. How many mL's do you inject into the 500 mL bag to result in 1500 mg of vancomycin? I'll let you tell me the answer. 😊 This is an actual drug and concentration that we do all the time.

Cleaning is another important part of working in the clean room. Before we start in the morning, we clean the hoods (we have a 4 ft. and a 6 ft. hood) using a 3 step process. It has to be done in a certain order because of the air flow - from back to front, and top to bottom. The process is repeated in the evening when we are done for the day. We also have to take out the trash and wipe down counters before we can exit and take off our garb. It gets hot wearing that suit, mask, cap, and gloves!

When I first started in the clean room I thought it was horrible. It's a small room with only a pass-through window looking into the anteroom. You have no way of knowing if it's a beautiful sunshiny day or cold, gray, and rainy. Drinks and phones of course are not allowed, and if you have to go to the bathroom or blow your nose, you have to go through the whole garbing and scrubbing process again. We are in there for hours at a time, mostly standing in one place, which can give you sore legs, feet, and back. Learning the sterile technique and how to manipulate a syringe and needle was so unnatural and awkward for me. After awhile, when I felt more comfortable and knew a little more what I was doing, I started liking it! There's no constantly ringing phones. The hoods make a calming droning sound and you can just kind of get in a zone and block everything out. At this point, I prefer the clean room over any other position! 

Sometimes crazy stuff happens and you have to do stat drips for someone who is coding, or a patient has an emergency surgery, etc. I have more stories to tell but I think this is long enough. Hopefully the details were not too monotonous!