By: Stanley Saji, Pharm.D. Candidate c/o 2013
I had a preconceived notion that advanced pharmacy practice experiences (APPEs) were just an application of concepts and therapies learned in pharmacy school. Little did I know how real APPEs became…
During my third rotation, I worked with Dr. Maha Saad, Assistant Clinical Professor in the Department of Clinical Pharmacy Practice at St. John’s University College of Pharmacy and Health Sciences and clinical pharmacist on the Palliative Care / Geriatrics Consult Team at Long Island Jewish Medical Center (LIJMC). The rotation was emotionally challenging yet an enriching learning experience that opened my eyes to a side of healthcare rarely seen by students on rotations.
One key lesson I learned from the experience was that it is imperative to treat a patient with respect and compassion while simultaneously addressing their medical problems. Patients may not always opt for treatment but instead request comfort care to help ease terminal conditions so that they may pass away peacefully and painlessly. All parties involved must respect this choice. As a pharmacy student, I aim to help improve patients’ health and save lives, but in this area of medicine, I realized that a cure not always the goal of therapy. Sometimes the focus is on treating patients’ symptoms and ensuring that they are comfortable.
I saw patients diagnosed with end stage renal disease (ESRD), terminal cancer, and even such severe Alzheimer’s that they could not remember their own family members. I witnessed firsthand the potential severity of a deep vein thrombus (DVT) if a patient is immobile for an extended period of time; this justified the practice of providing DVT prophylaxis with heparin. There were also many sickle cell disease patients, some of whom presented to the hospital when they were in a pain crisis and actively dying. Sadly, I observed a patient pass away in a hospital bed, which was definitely a life-defining experience because the patient was around my age. It just went to show me how short and fleeting life can be…
Many patients admitted into the hospital were on extensive medication regimens (poly-pharmacy). As part of the Academic Service Learning component of my rotation, I screened patients’ regimens for any medication errors and contraindications, as well as correct indications, dosages, and other related issues. I made recommendations for adjusting doses and intervals of medications prescribed for pain, dementia, and depression. As Dr. Saad and I rounded on many cancer patients, counseling and consoling was a part of our daily activities. Moreover, we held family meetings to help form advance directives for loved ones who were incapacitated and unable to make independent decisions.
Working alongside the palliative care team was difficult at times due to the nature of the cases that I saw with my own eyes. However, this rotation greatly increased my knowledge of geriatric and end-of-life care. This rotation was a unique experience for me, providing insight on the process of death and understanding how patients prepare for their final moments. Caring for the geriatric and palliative population is not something anyone is cut out for; and those that choose to practice in this field warrant a certain level of respect from society.