Getting In and Week 1

- Getting In and Week One

Ben and I had the fortune of drawing the Wind River rotation a week after a schoolwide off week in APPEs at the end of July, so we could make use of all of Friday, Saturday, and Sunday to drive about 8 hours a day for the ~24 hour drive from Birmingham. If you get this rotation without an off week in between your last rotation and this one, it’s a good idea to ask your preceptor if you can take off the last day of rotations to follow suit if you’re not comfortable with driving about 12 hours each day. Ben and I will attempt this on the way back, fingers crossed! We chose to stay at Hilton hotels for our two nights on the road, one in St. Charles (30 mins west of St. Louis) and one in Sidney, Nebreska (home to Cabela’s world headquarters). In my opinion, if you cross into Wyoming, you may as well try to make it all the way home to Fort Washakie since the hotel prices are much steeper in WY. What else is steeper in Wyoming are the gas prices, so it’s wise to fill up around Sidney if you go through Kansas City/Nebraska via I-80. An important note about buying gas at elevation - the 85 octane rating was ~$3.50 per gallon up here, but it may give pause to the consumer who has never bought gas at elevation and is used to the 87 octane rating being the lowest available around the south. It won’t hurt your car one bit to use 85 and saves about 25¢ a gallon, and so far my car has performed well even with the lower octane rating. I happen to drive a gorgeous 2007 Toyota Camry LE, which to my surprise isn’t the best vehicle in the world at making a cross country trip to a very outdoorsy destination. Ben and I packed multiple fishing rods, including a fly rod, and both of our golf bags in addition to several luggage bags for a rather tight squeeze, and were delighted on Sunday night to arrive to see our friend from Tennessee had brought his Tacoma like a competent adult. There’s a decent chance that this drive will be the longest of your life (true for me), so think twice about your comfort limits in terms of driving duration and frequency of breaks. And it comes to packing, it just depends on what types of experiences you want to squeeze out of your five weeks here. Wind River is close to good fishing, golfing, and of course, the world famous National Parks Yellowstone and Grand Teton (more about these later!), and you’ll get your fill of gorgeous vistas of the mountain ranges and picturesque lakes that form the “Prairie Pothole” region of the USA. Don’t let a little rain bog you down as it tends to knock down the haze from forest fires in Montana and California so that the mountains come in a lot clearer the next morning during your drive to clinic, which will be at least a half hour unless you’re working at Ethete. I’ll end with an obvious point - it’s probably also advisable to get in before we did on Sunday night (about 10 pm local time), and we were lucky to have a late first workday of clinic as we spent most of the time our first day holding COVID-19 vaccination clinic into the early evening.

Which brings me to another important point. Hopefully by the time you’re reading this or beginning your rotation in WY, the world and our country have a better grip on the pandemic that what was the case in August 2021. About 70-80% of our activities in our first week of clinic were directly devoted to addressing the ongoing pandemic, between two full days of working vaccine clinics and lots of billing and updating patient profiles in between. What also was introduced to us was the longitudinal effort to electronically reconcile patient medication profiles on the EHR, to correct therapeutic duplications, other related redundancies, and discrepancies between the dispensing software, especially for patients with multiple prescribers. One exciting aspect of this clinic being outpatient is that the proximity to prescribers tends to simplify pharmacy interventions, and it’s certainly satisfying to simply walk outside the pharmacy to ask, for example, to change a prescription to a formulary preferred item before the patient even receives the medication rather than be on hold with a doctor’s office for a long time while the patient waits. Even in the midst of the current coronavirus spike, there are still opportunities even in the first week to safely work on clinical skills and patient counseling, and we look forward to mentioning further updates to that end in the coming weeks.

    - John Parker