Not a curse but it is a blessing to feel other people’s pain

(when we fall apart -Ryan Stevenson)

So in studying for the mpje I found this assignment from school…and I feel like it has been long enough since law class that I am not potentially giving anyone answers by posting this…not that anyone would want my answers…

premise: a pharmacist (Robert Courtney) was diluting drugs for cancer patients…

so yeah, I found this assignment and was like this is almost definitely not what my teacher was expecting to read…and probably a lot of teachers would have marked my answers as wrong…but reading it I had to admit that it does show exactly how I process problems…and while now I can recognize my answers may have been atypical, I don’t think I recognized my answers were a little weird until I read it today…

although, also a note on my ending statement of the second response, not so sure after a few years in practice that is always true…I’ve seen patients in whom everyone believed they just tolerated the med awesome or just didn’t respond well for some reason and chalked it up to interpatient variability when the reality discovered later was that they weren’t actually getting the med the team thought they were receiving…so great thought but maybe baby me was a little naive on that front.

• My initial reaction to reading about what Robert Courtney did is shock, followed by disgust. It is really hard to hear that someone who should have been looking out for people’s best interest was instead intentionally causing harm to them in a way it would not be immediately evident. I don’t think anyone could possibly have woken up one morning and thought it would be a good idea to hurt the very people you were supposed to be caring for, so I thought further and realized that after a possibly painful divorce, it would be natural that he would feel a sense of powerlessness and feel compelled to prove, even if only to himself, that he was just fine without his ex-wife and could be even better without her. From that standpoint, his actions begin to make sense. Using the grey market and diluting medication put a lot of control into his hands, and likely also allowed him a perverse sense of superiority that he could do this without being caught. This was also a solution to making himself appear well-off and to buy friends to further his image. Finally, his apparent kindness in keeping his patients served a twofold purpose of earning him further positive regard for taking care of people, and of keeping these patients from going to a pharmacy where they would get full strength drugs that may be noticeably different in their appearance and/or effects. While this explanation does not make his actions any less wrong and despicable, they do allow me to see him as a human who made a poor decision rather than a monster wreaking havoc for fun. Everyone makes mistakes, and it is quite unfortunate that he made a mistake that had such severe consequences not only for him, but for his patients, the medical community, and the public at large.

• I want to believe that no one would be able to get away with something like that today, but I fear that could be a naïve assumption. At my pharmacy all compounds must be checked before going out to patients, but that check occurs on a paper listing quantities and lot numbers, without anyone watching to see if I actually added the amounts that I said that I added. While I would like to believe that someone would notice if we had been making a certain compounded product and the shelf level didn’t appear to be decreasing as expected and it hadn’t come in an order in a while, but the reality is that it would likely take a while before anyone noticed that anything was strange and even longer before it was brought up, because we have had a lot of problems with our ordering system causing us to end up with way more than we expected of certain products and be lacking medications we expected to receive, and combine that with the fact that there tend to be different people working from one day to the next and the same person probably wouldn’t have put away the order two days in a row, it could be a possibility. I think, however, that there is likely a lot more computerization and automation in prescription drug purchasing and tracking now, so an issue like this would more likely be caught sooner rather than later. Additionally, as we learn more about treatment of disease, I would like to believe that both doctors and other pharmacists would more quickly realize that a patient was not responding as expected from the drugs.

• I think the ethical obligations that Courtney disregarded are more important than the laws he broke. Although following the laws is always the most advisable course of action, breaking the law does not seem to be the largest problem in this case. The reason he made headline news wasn’t because he broke the law, but because he broke the deep implicit trust of his patients, and as a result of many others. If the law he had broken was leaving the pharmacy open with just technicians working for a few minutes to run to the cafeteria and eat a salad before returning we would be much less likely to instinctively condemn him, because hunger and taking a break is a relatable need. The reason this was a big deal was because of the ethical obligations that he disregarded. While he should have been healing people he instead chose to deny them the drugs that were their glimmer of hope. The distrust he cultivated isn’t a field that can simply be cut down and forgotten; this distrust generated in people touched by the incident likely generalized and colored their view of other pharmacists and even medical professionals as a whole. It may have felt like a victimless crime at first while patients already on their death bed received drugs that weren’t going to help, but as the deception grew, the crime impacted many clear victims.

• I think if I suspected a peer of doing something similar that it would be really hard for me. I am a people pleaser who doesn’t want to hurt anyone—even the people hurting me, so I would be really worried about hurting that person and the ripples of hurt that would extend from that person outwards towards his or her family and friends. Ultimately, I think in this case I would end up writing a polite but forward email to the board of pharmacy to suggest they look into the area in which the questionable activity was occurring. This was the action I took this summer when, an admittedly less serious, piece of news broke that Target was being merged with CVS. I knew that CVS was likely to impose changes that would negatively impact Target pharmacists’ working conditions and in turn put patients in jeopardy. My letter the board resulted in them holding a forum to talk about imposing a mandated break away from the pharmacy for all pharmacists working a certain number of hours in a shift, and I don’t follow the news as well as I should, but I believe that they voted a couple weeks later in favor of this mandate, so it is possible to get the board to respond to safety concerns.

• Justice was not adequately served. Life is not fair, the sooner you realize it the happier you’ll be; the fair was in August and you missed it. There is no way that the harm he caused could be repaid. Punishing Courtney does not bring back the lives and/or quality of life he stole from his patients, nor does it restore people’s trust in the medical professions. Similarly, money is a poor substitute for a loved one lost due to Courtney’s actions, and money can’t buy trust. The pain he inflicted cannot be taken back. To me, especially judging from his reaction upon getting caught and trial, it doesn’t seem that Courtney had malicious intent. He simply made a mistake—something we all do on occasion. No one is perfect, and who are we to judge his mistake any worse than our own? Yes, his bad choice left a profound negative impact on the lives of his patients, but I am certain that I have unintentionally hurt a friend with careless words on occasion, and emotional wounds really aren’t any better in the long run than their physical counterparts. Is it really fair that a mistake that spiraled out of control should cost this man everything he has from his freedom to his assets to his money making potential? In a situation like this, I do not think it is possible for there to be justice for either party. It is my opinion that at the time of the trial hearing the anguish of the people he hurt was enough of a punishment for him to keep him from ever doing anything like that again and it is painful to see someone’s entire life taken away for the sake of a crime that is over and done. Taking away his livelihood won’t change the past. As a society, we like to think we are different than people “like that” who get caught making a spectacularly bad decision, which causes us to desire to see them hurt in exchange for the hurt that they inflicted, but in reality none of us are really that different from Robert Courtney, and perhaps a heartfelt apology would mean more than a trivial sum of money and go further toward healing the rift Robert Courtney created. So in short, how could justice be adequately served? It couldn’t.

The appetite of the flesh is louder

(Feed your soul – Christa Wells)

Because sometimes my life revolves around food…

I found this quote on Instagram maybe a week ago and it totally is why I stayed in soccer so long…”The thing that pumps me up most for soccer games is thinking about the snacks afterwards.” And let’s be honest…the only reason to go to your sibling’s game is the possibility that there will be enough snacks for the siblings…

Last year when I went to the residency banquet and heard that the residents selected the menu I was like how in the world did they come up with these weird foods? Now I know. Mostly because the list of foods the residents are allowed to pick from includes no normal foods except for in the dessert category. The menu we were picking from totally did have awesome and normal things like nachos and fresh fruit and fresh vegetables and macaroni, and cornbread, and fried chicken and meatloaf and fajitas, and a ton of pasta options, and breadsticks and ham sandwiches, and chips and mini muffins and bagels and cinnamon rolls and scrambled eggs and hash browns and French toast and sausage and also a ton of normal foods that I just don’t personally prefer such as ribs and barbecue…and then I got to the list of things we were allowed to pick from…and the only normal food choices were in the dessert category…so that is how such odd items were selected…’cause they were the only choices…

Maybe it is just me, but food falls into about four categories: 1. really like it, 2. like it, 3. don’t like it but will eat it if I have to in order to be polite or am hungry enough to get past my dislike, and 4. will struggle to eat it even if it is the only option. As I have gotten older I’ve greatly expanded what falls into categories one and two, and shrunk category 4, but having a list of weird and vaguely described foods is scary. I get that allowing seven girls free reign of a very long menu would be chaos, but limiting us to only one page was not exactly ideal either…it also bothers me when people respond “some people might not like that” instead of responding with what they themselves like and do not like…and so one of the items we ended up agreeing on is something only two people actually liked because one person was stuck on what other people theoretically might not like despite the fact that she liked it and no one else had said they didn’t like it. I think she thought that assertion would get her the dish that was her first choice, but instead it meant that a lot of us compromised on something we were okay with instead of something most of us actually wanted. Overall I think it could have been way worse and I am glad we have a no-nonsense thinker in the group who was able to re-direct away from the points of contention, because I think without her we could still be arguing for the next month. But it was really frustrating. I know I am picky, but I’m not arguing that I should love everything on the menu – I just wanted ONE item that I’d actually like instead of just tolerate. We finally got there, but oh man was it a painful series of emails…also I was proud of myself. Someone rejected my suggestion because they felt like we needed more vegetables in our meal and I held back from emailing back a notation that the only change I had suggested in that email was substituting one vegetable dish for a different vegetable dish and we already had confirmed three other dishes that were either exclusively or primarily vegetables…I like a lot of kinds of vegetables, but mushrooms and green beans are not on that list…if the selection had been green beans with bacon I would have been like fine whatever I’ll focus on the bacon, but that wasn’t the selection…and now I’m craving bacon…

LOL, I was 23 years old when I was staying with someone and noticed they had a ton of mandarin orange cups and wasn’t sure if that meant they served those a lot or just happened to have a lot of them, so to be safe I decided those needed to no longer be on my list of food that I am going to gag if I try to eat them…and I still do not like mandarin orange cups, but by starting with small amounts of the juice mixed with a lot of applesauce and gradually working up to drinking the juice alone and eventually eating the fruit itself I ultimately did reach a point where I *could* eat them without gagging or even making the “yucky” face…so yeah, I recognize that I have food issues. I love pizza and basically all Mexican food as long as no sour cream or fish is involved and pasta and hamburgers and fried rice and egg rolls and orange chicken and broccoli beef and macaroni and chicken strips and fries and sloppy joes and really a wide variety of foods at this point in my life (I’ve come a long way since the elementary school I have one food that I will eat and that is all days), but I also have a long list of things I can’t handle…and when the food I don’t like is also attached to a scary social situation it makes it even more stressful to figure out.

So yeah…I feel like my entire week revolved around food and I’m glad it is over…and then I found out I am scheduled to work during the banquet and was like why did I even bother trying to figure this out…and then I found out I wasn’t actually going to be working during the banquet…and so yeah…that happened…

Also, 100% off topic, but today I saw an advertisement that for like the first time in advertising history actually made me briefly be like I want that…it was called the LG tower. Which appears to be a really fancy looking washer and dryer unit…I do not actually want it…but the picture made it look super cool…lol…and even if I did want it, the only additional non-consumable products I want to bring into my home right now are boxes…Which speaking of boxes, I am going to need to start working a lot harder on finding them, because while it is true that I may be need slightly fewer boxes on the basis of not having a like 6-month supply of food to move with this time, it is also true that the like 10-15 boxes I have saved in my garage plus like 7 boxes I picked up from facebook marketplace are not going to be anywhere close to enough…also, I haven’t put anything in said boxes yet…I did buy tape on amazon though, so I haven’t completely failed at the whole getting ready to move thing…probably I need to ask for help again, because the last time I moved, people came and in maybe an hour or two had gotten more boxes packed than I had done in many many times that amount of time…

Back to on topic, I went grocery shopping this weekend and I am SO proud!!!!! I got everything on my list…I also wrote an incredibly generic list: protein, fruit/vegetable, maybe evaporated milk…so really I could have grabbed practically any two items and technically fulfilled the list, but not only did I buy a pineapple and a 2-pound bag of beans, I also bought a can of evaporated milk. I am already super excited about that. I don’t like cow milk, but I do like evaporated milk. I don’t really know why I thought a pineapple would be the best choice for a fruit or vegetable option though…the idea of having to figure out how to cut it up is kind of making me regret that decision a little bit…but I couldn’t get carrots like I did last time because someone was standing in front of the carrots so I couldn’t reach…and I needed to pick something and pineapples were easy to get to, so that’s what I got…side note, if you decide to wash your fruits and vegetables at the same time as your dishes maybe take the paper tag off of the pineapple before submersing it in the hot soapy water…the ink may leak out of the paper a little bit…