Tomorrow's Pharmacist (2004)

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A day in the life of a pharmacy student

By Charlotte Bell and John Minshull

Last year Tomorrow's Pharmacist ran a writing competition for pharmacy students and preregistration trainees, about the highs and lows of pharmacy training. We received two outstanding entries and both are published here

page 22-24

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Obviously the day starts with me jumping merrily out of bed, birds singing in the background and butterflies fluttering around my head! Okay, so it is actually a cold and grey October day in Woolwich and I have to get up at 7.30am — a bit of a shock after being a student for 4 years! So I am naturally a little disheartened.

One of the most enjoyable things about my prereg so far is the time that I am spending on the cardiology wards as I accompany the cardiology pharmacist most mornings. The ward round starts with the arrival of the cardiology consultant who is not wearing a bow tie and is shockingly friendly, if a little bizarre! As I listen to the different complications of various patients on the ward, bells do ring deep within my grey matter. Amiodarone and clopidogrel, digoxin and perindopril — in some dusty folder somewhere at home there will be copious notes on the different types of arrhythmias and the indicated drugs. The SHO will call out values for urea, creatinine and electrolytes and I surprise myself by being able to remember some of the range values!

As the ward round starts on the coronary care unit, I notice the patients are frequently in a mild state of post-MI shock. They hang on every word the consultant offers them. The only comfort I can give them is a friendly smile as an attempt at reassurance. No university can prepare you for the width of the cannula that a CCU patient has going into their neck nor the dilute-Ribena appearance of the contents of their catheter bags!

I have found my clinical knowledge to be better than I would have imagined and this I have to attribute to my lecturers. They endeavoured to make us aware of the practical aspects of pharmacy in relation to clinical signs and symptoms. My degree has set me in very good stead for my prereg year and the thing I have had to struggle with since starting has been a rather simple and obvious reality; attached to every drug chart, range of U&Es or ECG is a walking, talking, (hopefully breathing) patient!

No amount of role-plays in dispensing class can prepare you for the face that meets you when you stand on the inside of the curtain. A patient might stick in my memory because they have a “classic” case of heart failure or the “standard” post-MI drug regimen yet, more often than not, I find myself thinking about a particular patient because of their vulnerability and need for help of some sort.

So I think it’s fair to say that I have been well prepared by De Montfort University for my prereg year in many ways. I have a good grasp of pharmacology even though this was previously my weak spot. The attempts to drum values for LFTs and TFTs into me has actually paid off and it all seems much more relevant and purposeful when there is an actual patient rather than a pretend one with the name of an old Coronation Street character! After running home for a quick and cheap (please increase the pay!) lunch, I spend the afternoon in the medicines information department. I did not expect to enjoy this part of my rotation anywhere near as much as I have. I do not like to sit still and the responsibility of taking an enquiry really rather terrified me. After getting to know the key resources available I have actually answered a few enquiries. This has been fantastically rewarding, especially when an enquiry has been linked to a patient in the hospital and I can feel I have contributed to their pharmaceutical needs, albeit in a very small way.

Any spare time is filled with completing evidence forms, which are rapidly becoming the subject of my nightmares! Though at first I found these forms tedious and a waste of time, I am now starting to value them as an opportunity to show my tutors and myself what I am capable of. I often go home feeling that something has been achieved even if it is as inconsequential as completing an enquiry.

At about quarter past five I pick up the assortment of rubbish that I carry with me, including a cartoon diary and a very small handbag. The preregs tend to gather in what we have rather proprietorially named “our” office before walking home. The four of us chat about any exciting morsels from our day and usually manage to cram in a bit of gossip. Though I am still adjusting to keeping civilised hours, I find the routine of working a lot easier than being at university and there is also the money!

I thoroughly enjoyed university and will never forget my time there but my prereg is proving to be very satisfying and rewarding in many ways which I never thought it would be. University can only prepare you for the theoretical stuff, for the practical bit you have to throw yourself into the ward rounds and meeting patients. I am determined to get as much as I can from my prereg year. I do apologise to everyone in the pharmacy department at the Queen Elizabeth Hospital Woolwich; I think they expected me to be shy and retiring!
— Charlotte Bell

All early morning lectures are the same. They are never full. Some people take it in turn with friends to attend. Others just can’t be bothered to haul their lazy bodies out of bed on a cold, October morning and opt to download the lecture from the intranet. I wish I were in bed. Safe, beneath the duvet. Inhabiting a world of my own. Oblivious to impending coursework deadlines, examinations and this horrible weather.

My flatmate woke me up. I’m so lucky I don’t live with someone else who is lazy. She sees to it that I’m in attendance each morning, should the timetable demand it. Does it matter to her that I’m ill? Does she care that the PSA chair forced me to drink last night? I think not. If she can work through her hangover then she expects me to be able to as well.

Last night was the highlight of the Pharmacy Student Association’s annual social calendar: The Lab Coat Pub Crawl, which takes place each year, on a Wednesday night about a month into term. It is our society’s first social and somewhat of a freshers’ initiation. Almost four hundred pharmacy students last night descended on the city, attired in their pristine lab coats, ready to do what students do best: make their contribution to the local economy.

There was something fascinating about seeing so many students willing to look foolish in public for a cheap drink. Although everybody realises that you have to make the most of it as a student, because once you leave university and get a proper job you just look silly drinking in a lab coat.

Once this lecture is finished I have a break. From timetabled work, that is. My break will involve me heading towards the library and preparing from tomorrow’s lab session. Maybe I’ll grab a bacon roll before I worry about that. I’m starving; didn’t get the chance to have breakfast this morning. Was in too much of a rush. I can’t think straight when I’m this hungry.

Mmmmm ... that bacon was fantastic. Sorted out that evil hangover for me. Feel much more inclined to work now. I have my workbook and the B.P. on the desk in front of me. I wonder who else is in here. I bet I look really studious. I hope my tutor walks in right now. Maybe I should open one of them ... there we go: far more realistic.

I’ve been sitting in the library now for well over an hour. I’m very hungry again. Wonder what I’ll do for lunch. I need to meet the volunteer co-ordinator at some point today. Maybe I can fit that in before I eat. Shouldn’t take too long. I’d better put the B.P. back. I’m sure someone else will want it. I didn’t need it in the end. It turns out that I already have a copy of the relevant page. Who’d have thought it?

Managed to speak to the volunteer co-ordinator about becoming a “Science Ambassador” in the local schools. I will have to deliver a PowerPoint presentation to a group of 11- and 12-year-olds. Terrifying! We sat and had coffee and biscuits in her office. It was a good chat. She told me how to approach it and I’m a lot surer about what I’m meant to be doing. I think I’ll make a good ambassador: academic, yet cool enough for people to relate to me. Afterwards I managed to catch up with a couple of friends for lunch.

Yesterday I didn’t even get a lunch break. The “Staff Student Liaison Committee” was called for its first meeting this academic year. Two reps from each year are invited to sit in the meetings and air their grievances. Yesterday everyone wanted to complain about the timetabling problems we have. Amongst the problems I was asked to bring to the committee’s attention were the consistently early mornings, late evenings and large breaks in the middle of the day. I don’t know to what effect our diatribes will come, but it made me feel better.

Tomorrow I lose my lunch break to a tutorial. This is less of a problem than the SSLC meeting as it will be quite informal; it takes place in the common room and I’ll get to eat whilst my tutor is talking. I think it is listed as a “pastoral care” meeting rather than anything academic.

I’m sitting in another lecture now. This one seems a bit more lively and far better attended. Have forgotten to print out the handout for this lecture, so I’ve got to scribble faster just to keep up. I’m feeling a little drowsy after lunch. Though I didn’t drink, despite being tempted. I don’t really want to go to this afternoon’s workshop drunk. I’m sure they have regulations against this. I know they get upset about us attending labs under the influence.

Oh ... everyone in the theatre just gasped. What happened? Has he fallen over? NO, it is his slide. Oh dear: “Pre-reg pharmacist kills three month old baby.” The first time I’ve seen that slide this year. It featured in most of last year’s modules. A constant reminder of how much responsibility will one day be placed upon us. It scares me to think about it sometimes. I know it scares my mum and I would bet money on it worrying my tutor. What would happen if I were responsible for an accident like that?

On to the workshop now. About half the pharmacy students will be in this. It is already going dark. The wind is picking up outside and I get the impression that; should it try to rain the precipitation will fall in lumps of ice. I wish I were on my way home.

The workshop is called “Spectroscopy of Drug Metabolism”. We’ve been informed by the course converter that it is a requirement of the RPSGB, but few of us can work out why. We study NMR, IR and mass spec. Those planning to be employed by a high street pharmacy don’t think that any of these machines will feature in their store inventory. Not even those planning to work for a large chain. Yet there it is, two hours a week in workshops and about the same amount of time in lectures. In all honesty, the lectures are probably the best we’ve had this year or last. They are delivered by an entertaining lecturer; their content is understandable and relatively straight forward. The workshops are an absolute nightmare, but you can’t have everything.

Slowly the clock is ticking its way around to six o’clock. About two thirds of the class has already left. They claim to have finished, though it is incredibly unlikely. I’m sure that if we sit it out for long enough he’ll give us some extra help for showing willing. I’m very tired though. I’ll just sit and chat. Decide what I’m doing this weekend, I think.

It doesn’t surprise me that the bus is empty apart from me. It is now very dark outside. Winter is well on its way. The cold wind was blowing strong and freely all over campus. I wish I’d brought my scarf. The bus winds its way from the campus, into town and back out the other end. Eventually it reaches my stop and I jump off. The darkness has descended on my house, enveloping it in an eerie blanket. The park in front of me looks particularly uninviting. I can just about make out the shadows of swings and a slide. The leaves have fallen from the trees and the hardiest of squirrels are finishing their annual forage. I walk the long way around, by-passing the chance of bumping into any junkies who may be taking advantage of the shelter the park offers from the road. My detour gives me enough time to think of suitable “avoidance tasks” that might be able to save me from this dreaded application letter on my desk.

I’m applying for a summer vacation placement in the United States. Or at least I want to. I just need to get my application letter sorted out. It has been left on my desk, awaiting my critical red pen to run over it, for almost two weeks now. Sometimes I anger myself with my laziness. I just need to get focused tonight and it’ll get done. That and my workshop study. Oh ... and my essay for next week.

Mmmmm ... the flat is lovely and warm. My flatmate has had the heating on all afternoon! I think I’ll have tea, and then I’ll see how I feel about this application. I can’t think straight when I’m hungry.

Midnight already. I’ve managed to do the most urgent work. I got a phone call at nine o’clock tonight. Someone inviting me to the pub. I would have loved to go, but I succeeded in showing that will power I normally struggle to express. I’m really tired now. I wish I’d not gone out last night. Yet I know that whole circus will start again tomorrow: finding time to work and time to play, trying to rest and managing not to fall behind. They definitely make us work for the four years we are here.
— John Minshull