A timeline

A timeline

In 2015 I did not quite have my bachelors yet.

I had already walked in the ceremony and received an engraved blue diploma case empty of a diploma. I would pick up the real one at the end of the semester. During that semester I was living at home for the second year. It was also my second year of pharmacy school. My days were spent on campus in the same classroom with the same group of students that dwindled from forty to thirty-four. My evenings were spent at a dimly lit table across from my classmate who was also my roommate and also my best friend. We would quiz each other late into the night over the material we’d be tested on the next morning. We were competitive in our drive to memorize the most details, but we wanted each other to succeed. Every year we had lots of group projects. That particular year I was carrying most of the weight in my group. We were in this class called drug information where we were taught how to use various resources to answer the questions we couldn’t possibly memorize the answers to. One of the practice questions was about the proper anticoagulation for a patient with allergies to the first-line therapy.

At the end of the day, I drove home. I was tired when I walked through the front door. I didn’t take much time to survey the upstairs before sinking downstairs to the basement apartment I shared with my friend. I unpacked the contents of my backpack onto our kitchen table that was rarely used for eating. I was tired, but the incessant quizzes of our curriculum wouldn’t allow me the luxury of taking the break I wanted. So I was a few minutes into submerging myself in my notes before I realized that my mom hadn’t been upstairs when I came in. And she hadn’t come downstairs either. It was strange.

I trudged back up the stairs and looked into the kitchen. The stove wasn’t on, but a large pot of what was going to be soup sat on top of it. I opened the door to the garage, both cars gone. My pace started to quicken. I made my way down the stairs much faster than I had come up them. I grabbed my phone and pulled up my mom’s name. I was back upstairs standing in our entryway looking outside at the sunny evening as I pressed the phone to my ear and listened to the ringing. Voicemail. Redial. Voicemail again. I can’t remember who I called next, but the first person who picked up was my brother. I told him no one was home. I asked him if he had heard from Mom. He said he hadn’t. I told him I would let him know as soon as I found out what was going on. And then I felt a vibrating in my hand. My mom’s voice. Miami Valley Hospital. At his office at Athletes in Action. Went there but then followed the ambulance. Saw him come into the emergency room. Seizure. Wasn’t able to answer the questions. He had been on the ground. He was pacing and then he was on the ground. The person on the conference call had to figure out who to call for help. Jenna was with them at the hospital. A friend’s mom was there too and she would drop Jenna off. No you don’t need to come. Stay home. Help Jenna get some supper after she gets dropped off. I’ll let you know anything as soon as I can.

Jenna and I made Ramen when she got home. I put the ingredients of the soup my mom was making in a Tupperware and then in the refrigerator. I washed out the pot. I needed to get back to my notes laying on the table downstairs across from my roommate diligently preparing for the next day’s assessment. I couldn’t stop looking at my phone. It vibrated again. CT scan. MRI in the morning. Barely saw it, but two spots. Looks like a brain bleed. Solvable situation. Doctors say it is solvable.

I breathed out. I have done hundreds of problems – calculus, organic chemistry, physics. Sure problems can be difficult but there is always a solution. Solvable problems aren’t so bad. I actually kind of like them. That’s how I made it to my fifth consecutive year of college.

But we got bad information.

I spent the rest of that year and the next balancing two things – studying and cancer. It is probably a lot like you would think it would be. Each was time-consuming, tiresome, and emotionally draining. In both, I was trying to wrap my mind around an impossible concept. I succeeded and I failed.

My oncology module was a strange experience. In a pharmacology lecture I learned that temozolomide was an alkylating agent that could cross the blood brain barrier. I already knew that you had to take it on an empty stomach and shouldn’t eat two hours before and two hours after taking it. I knew this could be extremely difficult to achieve if you were on consistent high doses of steroids that also served as appetite stimulants. I knew that it was best to take before bed so you could sleep past any nausea. I knew that it could cause fatigue and constipation. The constipation you could circumvent with stool softeners but the fatigue was unavoidable. My professor didn’t mention any of those things in class. At the end of the year I received an award entitled, “The Leslie J. Crump Shila Faye Anderson Oncology Pharmacotherapy Award.” The description told me that I was being awarded for “excellence in the Oncology & Palliative Care Module and demonstration of outstanding ability in clinical pharmacy.” I am pretty certain I stood out as a candidate for what should have been a completely unrelated reason.

But then finally – my last year of school. My clinical rotations. My birth to freedom. Leaving the basement. Moving to a new city. No more quizzes every day and exams every Friday. I didn’t have to dread Thursday nights anymore.

My first rotation started in the month of May. I moved out of my parent’s house and in with a stranger I had connected with through a classmate’s recommendation. She had two dogs. The first night I curled up on the couch and covered my legs with a blanket that had been folded over the footrest. Later she told me that it was the dogs’ blanket. I thought it had smelled a little off. Eventually I told her about my dad. Not right away, but when I did she got really quiet. I never told the staff of the pharmacy where I was on rotation. I was excited to be there. I was working hard and doing really well. I didn’t want it to be touched by anything else.

I moved to Washington state for my next rotation. Again only a month. The mountains, the ocean, the desert, the orchards, the stars, the heat, the snow… it was perfection. So many strangers and having little to lose in four weeks, I made friends with all of them. I loved the clinic where I worked. The patients. The break room with a table incessantly filled with a revolving potluck feast. Sitting at that table, I told one of my preceptors about my dad’s diagnosis. My words were very factual and medical. He told me that his wife’s dad had lung cancer. He went into details about all the research he had been doing reading through NCCN guidelines. A few weeks earlier I had had a breakdown when my sister relayed the details of a trip to the emergency room. The doctors were having trouble balancing his blood thinner with the bleeding side effects of one of his cancer treatments. Apparently they hadn’t gotten the dosing quite right and they couldn’t get the nosebleeds to stop. I cried on my side, this pit in my stomach. I might have known. If I had been there at home I might have known. I know the risks on both sides. I would have pushed. I would have asked more questions. But I wasn’t. I was exploring the Pacific Northwest and loving every second and every breath of it.

Then I was in a hospital for the first time. August. Of course I had been in hospitals before. But never every day. Never with a badge that let me behind the locked doors. I spent most of my time looking up medical abbreviations so I could catch a sliver of the meaning in patient charts. I would type a string of letters into the Google search bar and then huff in frustration when I realized I had looked up that very sequence the day before but hadn’t retained its meaning. I think I told my preceptor about my dad because I got this text from my mom saying she had bought a walker for him. He hated using it, but my mom was making him. She was afraid he was going to fall. My preceptor’s eyes widened a little. But he was used to hearing the stories of sick people. It was his job. Immediately he started looking up literature on prognoses and treatments.

September. Thankfully this was the second month of a block. I was in the same hospital. I already knew the shuttle system, the hallways, the location of the water cooler. This time I didn’t feel like talking about it anymore. A couple times I walked to the parking garage with my preceptor. He was quiet and friendly. And kind. But I didn’t feel like talking about it. Not anymore.

October I was at Kroger. The lead pharmacist had an army of students rotating through. I was one of many. She liked me. All the other pharmacists and technicians liked me too because I answered the phone a lot. I had to ask her if I could take the day off on a Friday. I explained that my dad had a doctor’s appointment. He wasn’t walking very well and my mom needed help getting him in and out of the car. No one else was home to help her that day. She told me I could take off Friday and make up the hours the following Saturday. I said thank you. That Saturday she told me how nice it was to have a student working and how much time she had to organize scripts that had been piling up for weeks. She didn’t ask how the appointment went.

Then November. I was supposed to go to Milwaukee in November. I had set up an elective rotation at a hospital in the inner city through a connection I made with my brother. I e-mailed my experiential director and asked if he knew of anything I could switch to last minute so I could be home. He set me up at the same hospital where my dad was getting treated. The rotation was perfect – I only had to interact with one pharmacist and one physician. Most of the day I sat at a computer reading through patient charts and documenting anything pertinent to whatever infection the patient had contracted. A few weeks in, we had an antibiotic stewardship subcommittee meeting. I was surprised to see one of my classmates walk into the conference room. She was on rotation at a neighboring hospital and had come with a few of their staff members to observe. They were going to check out the new cancer center before heading back. She asked me if I wanted to join. I told her that I had been there already. That it was where my dad got his infusions. She swallowed slowly. Maybe I shouldn’t have said that. Later back in the office, my preceptor hinted at something and I knew she had overheard our conversation. I don’t know why I hadn’t told her already. It probably would have been the courteous thing to do, especially since she had taken me on as her student so last minute. But every night on my drive home, I knew what I was going home to. I could go home and live it, but I wasn’t strong enough to live it in the moments I wasn’t physically there. I took a breath and explained how I needed to move home for the month because my dad wasn’t doing well. I needed to be there because he was dying. I needed to be there because he couldn’t stand or get dressed or go to the bathroom or brush his teeth or get into bed on his own. I needed to be there because he wasn’t going to be there much longer. I told her all this on a Friday. He died the next day.

I was scheduled to have the month of December off. But I used some of the time off to make up the week and a day I had missed in November. I remember the drive the most. I remember looking into my rearview mirror and seeing my eyes. I wanted to see what the sadness in them looked like. I saw it. It was almost unbearable. I told my preceptor a few of the details. We were interrupted by one of her coworkers stopping in to chat. But my preceptor was tearing up, so the coworker asked her what was wrong. She explained that her student, me the body sitting in the chair next to her with two dry eyes, had lost her dad. The week and a day were long. They were the longest headaches I have ever had. On my last day, I gave a presentation on a new broad spectrum antibiotic on the market named Baxdela. I got feedback that my presentation was resident-level quality.

Then January. I was back at my hospital, this time in the surgical ICU. My first morning back, I walked through familiar hallways and down friendly old stairs. I scanned my badge at the door to the pharmacy in the basement. I sat down at a computer in the shared lounge to reset my login and password. While I was on hold with the IT department, my old preceptor, the one from August, walked in. He asked me how I was. I told him I had started a new diet and was eating a breakfast bar made out of dates. He asked me how my dad was. I reverted to using the phrase “passed away.” I have always disliked the phrase, but now I understand why people say it. It is not particularly pleasant to watch other people’s faces as they hear you say, “he died.” Later that same day during my lunch break, another pharmacist asked me what was new. I told her not much.

In February I had the month off again. I had six interviews in three different states for pharmacy residencies. Each of the interviews involved at least fifteen strangers and at minimum six hours of questions. During one of the interviews I was told to take a right at the end of the hallway. I turned left. That was where I matched for my residency.

In March I was back in my comfortable outpatient skin. My preceptor was one of my old professors. On a day about half-way through the rotation, we were eating lunch together. She asked me about where I had been living for the year. I explained that I had been moving around. Subconsciously I thought she probably already knew, that she had probably heard through an e-mail chain of faculty members or something. I told her how I had moved back home for a few months because of my dad. She hadn’t known. She told me she thought she sensed a difference in me. That of course I was still working hard and engaging well with patients. But that I seemed more reserved, a little less bubbly. My eyes filled and dripped over. Yes my effervescence has flattened. Does she mean I am less alive?

April I avoided the topic altogether. My last month. Only one more month. Four more weeks. Twenty-eight more days. This preceptor was very preoccupied with new staffing responsibilities. I kept myself busy with projects and impressed her with a very well-researched drug information question. I guess I must have learned something from that class two years ago after all. Despite the circumstances, I had learned something.

Learned. These years. All the things I was supposed to have learned. All the things I learned instead. Every fact colored with an overlapping reality. I cannot separate them. Together they have been my life. Two and a half years. Mostly studying and cancer.

I’m ready for the next chapter. I’m ready for something new.