Cheers!

Alas, my time in the UK has come to an end. We have made it safely back to US soil, and it is good to be here! Our trip home was not quite as eventful as the journey to get to England, although it did involve dragging massive amounts of luggage through the streets of Bath, followed by a train ride, a shuttle ride, an 8 & 1/2 hour airplane ride, and nearly an hour in line at Immigration & Customs. But we made it!

I am truly blessed to have had the opportunity to spend time living and working in the UK. I have returned to the US with an appreciation for the strengths of a nationalized healthcare system, as well as an understanding of its weaknesses. That said, I also have gained additional insight into the benefits and shortcomings of our own healthcare system. My experiences in the pharmacies and at the hospital are guaranteed to come in handy as I start my own career and strive to make my own impact on the practice of pharmacy.

I've absorbed a bit of the British culture itself, as well. I am committed to incorporating words like "rubbish" and "cheers" into my daily vocabulary, and I'm not sure I will be able to eat "chips" (fries) without vinegar ever again. I have a new-found love for proper curry, and a hatred for microwaveable rice. I will probably start adding sweet corn to my tuna, but I will not start putting milk in my tea...so I guess that means I escaped complete acclimation :)

Thank you for following my blog...I'm so happy to have been able to share this experience with you!

Dublin

"Dublin had lots of beer. There were also many places to get beer for us to drink. There were places that made beer, as well as locations where beer could be found. Beer. I liked Dublin very much."

That's Nick's account of our trip to Dublin...I'll try to elaborate a bit :)

We flew to Dublin on Tuesday afternoon. I found a fantastic deal on tickets with RyanAir, a price which came with only a couple of minor inconveniences. When we got to the airport, we stood in line at the check-in desk only to be told that since we had already printed our boarding passes and weren't checking any luggage, we could go straight upstairs to security. The security man checked our passports, signed his initials, and sent us through. We waited an hour or so before we were asked to line up to board. RyanAir does not assign seats, so it is something of a free-for-all once boarding begins. We finally made it to the front of the line, only to be told that since we were non-EU citizens, we required an additional passport check. We had to go back out through security and back downstairs to get a silly little stamp...they didn't even look at our passports...then up, through security again and back to the end of the line. We made the flight an were even able to find seats together...but I was not a happy camper!

The flight was short, and the views out of England and into Ireland were fantastic!

After we landed, we took a shuttle from the airport to the train station near our hotel. We had another minor setback when the hotel couldn't find Nick's reservation...this was eventually resolved when we realized he had booked it on my account! We decided things would be much easier if we had the same last name :) Since it was getting late, we decided to just walk down the street to a nearby pub. We intended to enjoy a pint and some good Irish food, then call it a night...but Nick got pulled into a football (soccer) match on the telly and we ended up staying for quite a while.

The next morning we got up and boarded the Dublin Hop-On Hop-Off Bus Tour. These buses proved to be well worth the money during our stay...they ran all through the "touristy" part of the city, and the live commentary was laced with sarcasm and highly entertaining. We got off at Temple Bar and explored a bit, stopping at a cafe for breakfast. We then walked over to Trinity College, where we wandered through campus and visited the old library. The campus was lovely, but I think it would drive me crazy to have tourists all over the place when I was trying to get to class! The library houses the Book of Kells, a richly and intricately decorated manuscript containing the four Gospels in Latin thought to have been copied by monks around 806 AD. The books were amazing and the Old Library was absolutely spectacular...unfortunately, we weren't allowed to take pictures in either.

When we left the college, I drug Nick on "A 90-minute Walk Through Literary and Georgian Dublin" courtesy of our tour book. This took us through gardens, along a canal, and past several notable (but not necessarily picture-worthy) sites, including the childhood home of Oscar Wilde and several of the settings from James Joyce's Ulysses.

At the end of our walking tour, we again "hopped-on" a bus and headed for the Guinness Storehouse. About halfway there, our tour guide broke some bad news...the Storehouse was closed to visitors due to a function for employees. I wish I could have gotten a picture of the look on Nick's face...disappointment like I had never seen before! Fortunately, the driver was joking, and he dropped us off at the entrance a short time after. The Guinness Storehouse was remodelled around a huge pint glass atrium. In the center is a copy of the original lease signed by Arthur Guinness for 9000 years at 45 pounds per year. Now that's foresight!

The tour took us up seven floors, starting with the ingredients section which included a waterfall, a giant vat of barley, cases of hops, and the safe where Arthur Guinness kept his secret line of yeast, part of which is still used in every batch of Guinness.

We learned about the brewing process and the historical development of Guinness, and we saw displays of the different bottles and advertising campaigns used. The highlight of the tour, however, was when Nick got to learn How to Pour the Perfect Pint!

Once Nick was satisfied and could die happy, we took the bus tour of the west side of the city, passing Kilmainham Gaol and the Dublin Zoo. We hopped off in time to catch the last tour of the Old Jameson Whiskey Distillery. The guided tour took us through the distilling process and pointed out all the ways that Irish whiskey is different than Scotch or Bourbon. At the end, I has the opportunity to become a Qualified Irish Whiskey Taster...unfortunately the camera died and we have no pictures of the event, but I do have a diploma to prove it!

We had dinner at an Irish pub in the Temple Bar district, then stopped for an Irish coffee at another pub on our way back to the hotel...had to make the most of our short time there!

Thursday was a whirlwind of trying to squeeze in as much as possible before heading back to the airport. We followed another tour in the guidebook, this one taking us around the original Viking town. We started at Christ Church, a beautiful cathedral with 12th-century crypts underneath.

Attached to the church is the Synod Hall, which houses the Dublinia exhibition covering the formative period of Dublin starting with the Vikings. Looking back, I think the exhibit was designed for a younger crowd, but we enjoyed ourselves!

The tour also took us past St Audoen's Church (the oldest in Ireland), the last intact piece of the wall around Dublin, St Patrick's Cathedral, and Dublin Castle (which is NOT a proper castle, in my opinion!).

After lunch (at an Irish pub, obviously) we decided to hit up the National Museum circuit. We walked through the National Gallery, the Museum of Natural History, and the Museum of Archaeology. All were very nice...and free!

Like all good things, our trip had to come to an end. We said goodbye to Ireland (and our last few euros!) with a half pint of Guinness and a pint of Bulmers Irish Cider in the airport pub.

We saw and did a lot in Dublin in just two days, and we agreed that it is definitely worth a trip back some day!

Nick's First Day

Nick and I made the most of his first full day here in Bath. After he got a full 14 hours of sleep in attempt to recover from jet lag, we went into town and walked through the Roman Baths. Nick is a big fan of ancient history, so he enjoyed it...and I thought it was just as interesting the second time through!

We had walked by a pub called "The Pig & Fiddle" on Sunday afternoon, and we wanted to try it out at some point before we left. We had a little extra time Monday before our tour to Stonehenge, so we decided to go there for a pint...and it turned out to be even better than we anticipated! They had Murphy's Irish Stout on draft (for Nick) AND they had a PUB CAT! We're getting one. Maybe two.

We booked a tour of Stonehenge for Monday afternoon. Our tour guide, Dan, drove us the 45-minutes to the site in a big purple van. On the way, we got a beautiful view of the English countryside, along with entertaining commentary.

At Stonehenge, we were given an audio tour of the site and surrounding area. The history was interesting...Stonehenge was built about 1000 years before Celtic civilization, which was long before the Romans had arrived in Britain. Its origin and purpose are unknown, but several intriguing theories exist. It was definitely worth the visit...but probably not somewhere we'll have to rush back to!

Nick is here!

This morning I got up early and caught the first train to London Paddington. About 15 minutes after I got there, I received the best present ever...Nick! He left Chicago last night and arrived at Heathrow Airport at about 8am London time (that's 3am Gaylord time!), then hopped on the Heathrow Express to meet me at Paddington. We had a cup of coffee at the station and then grabbed the next train back to Bath.

It is so good to have him here after 2 loooooong months apart! After we got his luggage back to my room and got him changed out of his "flying pants" we attended to the first order of business...lunch and a pint at a local pub :) We walked around Bath for a bit and I showed him some of the places where I've worked, as well as some of the more "famous" Bath sites. He's a pretty tired puppy, so we're back in for the evening. Full night's sleep tonight and he should hopefully be good to go tomorrow. Lots planned for the next few days!

Thanks to all who were praying for safe, volcano-free travels for Nick...we'll keep you updated on our adventures!

Placement #5 - South West Medicines Information at Bristol Royal Infirmary

Today I finished up my last placement...crazy! I spent this week in the South West Medicines Information office at the Bristol Royal Infirmary...which I will for obvious reasons be referring to as the SWMI and BRI from here on out.

This was a very different experience than my weeks in the community pharmacies. The UK has a very structured Medicines Information service. There are about 250 local MI centers and 16 regional centers, and some centers offer specialty answering services. For example, the BRI has a local MI center that serves the hospital; the SWMI office (which is in the BRI, but not the BRI MI center) is a regional center, and is also responsible for answering questions regarding drugs in renal disease for the entire UK. The main role of the MI service is to answer enquiries, mostly from healthcare professionals. They also publish guidelines and new medication reviews, provide training for pharmacy staff, and sit on Drug & Therapeutics committees.

This week, I spent the majority of my time in the MI office. One of the ladies who works there is on maternity leave, so I got my own desk...it was so nice! They gave me a training workbook that is a sort of "guide" to MI in the UK, so I went through parts of that to learn about the types of questions that are most commonly asked, and what resources are recommended for finding the answers. The NHS has a really nice program for documenting enquiries and responses, and it has a training version, so I got to use that to practice answering queries. I will admit that I thought I would be bored going into this, since Drug Information isn't really my thing, but I actually enjoyed it! It was good practice to have to answer MI questions in a timely manner, and the examples they gave me were practical...a lot of them were actual enquiries they had received...everything from adverse drug reactions and interactions to routes of administration, drugs in pregnancy, and IV compatibility. I actually feel like I am more efficient at answering MI questions now than I was on Monday!

On Tuesday afternoon I rounded on the Care of the Elderly ward with Emma S, the pharmacist who was "in charge" of me for the week. We saw a lot of patients, mostly post-stroke. It was very interesting...the setting and work flow are so much different than in the US! In this particular ward, there are two "bays" (male and female) and about twelve beds lining the outside of each, with blue curtains that can be pulled around the bed when the patient is being bathed. Not a whole lot of privacy...or peace & quiet, for that matter! Suffice it to say that I do not want to end up in the hospital here.

I visited the post-thoracic surgery ward with Julia on Wednesday morning. Most of the patients here had lung cancer and were status-post lobectomy. This ward was set up a little bit differently, with about six rooms and only four patients per room. They also had a couple of private rooms reserved for patients who needed to be isolated due to infection. We rounded on every patient, which took a long time because their information is way spread out. Each patient has a binder at the end of their bed that holds their medication list and daily flow sheets (heart rate, BP, glucose, etc). All of the rest of the information is in the patient file, which is kept at the nurses' station. The only thing on the computer is the patient's labs. A little inefficient, in my opinion, but it seems to work for them.

That afternoon was spent in the cardiac/cardiac surgery ward with Emma T. This ward is in the NEW Bristol Heart Hospital, which was much more pleasant and aesthetically pleasing. The set up was similar to the surgical ward, but the rooms were bigger and each one had a desk and a computer...much more work space, which was nice. On all of the services, we went to each patient's bedside and looked over the medication list to screen for interactions, check renal function, make sure an accurate drug history had been obtained, etc. Very much like what we do in the States. It was funny to see how freely the pharmacists write all over the med list and administration record...notes to the nurses for administration, questions for the doctor to review the indication or duration of therapy, clarifications of the patient's home meds. And when a drug is discontinued...they draw a scribble through it! Some of the charts were an absolute mess! I am pretty sure that if I worked there, I would either go crazy or spend all of my time rewriting medication charts.

I was really happy with my time at the BRI. The time spent on the wards was a real eye-opener, and I very much enjoyed the time in the MI office. Overall, it was a very well-rounded experience and I am taking a ton away from it!

Bath Abbey Tower Tour

Bath Abbey stands at the heart of the city of Bath. It stands on the site of the original Anglo-Saxon Abbey Church, built in the 8th century, and the Norman Cathedral that replaced it around the 12th century. The present Abbey was finished in 1611 and is really quite beautiful.

I attended Palm Sunday service at the Abbey a few weeks back (obviously!). It was "A Dramatic Procession of Readings and Music"...very interesting and not at all what I anticipated...but a very cool experience! It involved a lot of movement...of the Bible, the Choir, the Clergy, the congregation...yes, at one point we all had to get up out of our seats and move to the East end of the church! It was a very unique and symbolic way to celebrate the beginning of Holy Week, and I'm glad I went.

My friend Julia, a pharmacy student at the University of Bath who will be coming to Ferris in the fall (not sure if I've mentioned her before?), leads tours of the Abbey Tower on weekends. We've been trying to get one of her tours since we met her, but it has never worked out...either we're out of town, or she's not working, or something else has come up. Finally, on Saturday, we got the Tower Tour...and we couldn't have picked a better day to do it! The sun was shining and it was just lovely.

The tour goes up a total of 212 steps arranged in 2 spiral staircases. At the top of the first staircase, we walked through the Bellringer's Chamber where we could see all the different methods and mechanisms for ringing the bells. There was a little room off of that where we got to go and sit right behind the clock face.

Halfway up the second staircase took us to the bells themselves. The Tenor Bell is the big one (3721 lbs of big) that rings on the hour and the Baby Bells are responsible for most of the other chimes.

We finished the climb and were rewarded with a spectacular view of the city in all 4 compass directions. So worth it, and we couldn't have picked a more glorious day!

Many thanks to our terrific tour guide...