It's now been a little over a month since I started on my direct inpatient care rotation in kidney/liver transplant, and I can say for certain that this rotation has strengthened me, challenged me, and inspired me. I started out being absolutely overwhelmed by my new role as an "APPE student", expected to make interventions/recommendations, talk to the team myself and not through my preceptor, and the scariest of all: talk to really sick patients. I've always admired nurses for their uncanny ability to make small talk and handle uncomfortable situations or disgruntled patients. During my IPPE rotations I could never imagine myself in their role of having to talk to and care for near strangers in such an intimate way. However, letting down that wall and throwing myself in has led me to learn how incredible my transplant patients are. I've seen such a beautiful display of courage, optimism, and hope from these people. Many times, I've noted how I would not be able to upkeep the same resilience that they do, especially when most of them are discharged and re-admitted frequently.

From a pharmacy perspective, they experience the worst of complicated drug regimens. Studies have shown that 1/3 of kidney transplant patients don't take their medications, which could lead to rejection. Rejection, where the host body attacks the new, foreign organ, then leads to poor graft survival, and even patient survival. I've counseled numerous new and old transplant patients on their regimens so believe me when I tell you: I don't blame those who don't want to take their medications (although the consequences break my heart). My patients leave the hospital on anywhere from 13-18 medications, sometimes more if that have preexisting co-morbidities. About 7 on the list are necessary for the transplant itself, 4 are life long, and the rest are essential to their overall good health. For the new transplant patients, their day of discharge is jam packed with nurses, diabetes educators and pharmacists trying to help them understand just how important this regimen is to their survival. We do blood pressure counseling, glucose meter teaching, medication list reviews, pill box filling, and everything else we possibly can to stress the importance of their adherence. Beyond their discharge, their first year is filled with twice weekly clinic visits to get their blood drawn, which is necessary to check drug levels and other labs to ensure rejection isn't happening. Most of my patients are trying their absolute best to live, despite the lifelong commitment they've made to spending time at our hospital/clinic. I admire all of them for the respect and trust they show their healthcare providers, especially my preceptor. Overall, the dedication put forth by this team of physicians, physician's assistants, pharmacists, nurses, physical therapists, and other hospital staff has inspired me to always go the extra mile for my patients. Existing in a working, efficient, inter-professional team is one of the best things you could hope for as a student on rotation. 

So, next week is my last week here, and although I'm sad to leave I have a feeling that I'll be considering transplant when I go to apply for residency this coming winter. The ability to be both outpatient, and inpatient is so ideal for pharmacists because we can counsel, make recommendations to our colleagues, answer drug information questions, and mediate drug related problems in both settings, improving the continuum of care. We'll see where the rest of the year takes me! On to emergency medicine next!

P.S. The little pins pictured above are usually our presents to new transplantees but one of the clinic coordinators snatched me two. A little reminder to always be grateful for the health you have, and for me, to never forget how much I loved this rotation.