The Cinema

Nathan & I decided to see Alice in Wonderland in 3D last night. It was a last-minute decision after we finished dinner, and we got to the cinema just 15 minutes before the show was supposed to start. There was a sign at the entrance informing us that the 19:45 showing of Alice in Wonderland was sold out, but a handwritten note at the bottom of the sign indicated that seats were available in the front row only. Unlike the US, where you purchase a general ticket and can sit wherever you'd like, here they give reserved seats. However, the concept of charging a ridiculously high price for tickets to the cinema (especially 3D movies), justs because you can, appears to be universal. We decided to go for it and forked out 9.90 each...that's almost $15, for those of you who aren't as phenomenal at converting currency in your heads as I am! ;) Luckily, the movie was quite enjoyable...the front row seats in the theatre here are not nearly as close to the screen as they are in the States. Plus, I always get a little extra kick out of seeing a show close to where it is supposed to be set!

Placement #2 - Lifestyle Pharmacy

Last week I completed my second placement, at Lifestyle Pharmacy. Lifestyle is located right in the centre of the city, so the shop is generally quite busy and the majority of their sales come from the front-end, rather than prescription dispensing. The shop is situated on a corner, has an upstairs and a downstairs, and is not large...yet they have a huge selection of products! More than once we had customers come in for some obscure product and proclaim, "I've looked everywhere for this, and the only place I can find it is here!" And I totally believe it...there is not a single spot in the store that isn't overloaded with medications, toothbrushes, bandages, herbal supplements, cosmetic creams, shampoos, scented oils, hair accessories, or something. And just to round it out, they take passport photos in the back corner of the basement.

I found it a little bit difficult to work at Lifestyle, partly because there was no possible way to learn all of the products in one week and partly because with that much stock, it is nearly impossible to be organized. The dispensary area is incredibly tiny, with essentially no free counter-space and drugs stashed wherever they fit...when I was in the back with the pharmacist and the dispensing assistant, there was really no room to move, let alone work. Fortunately, the ladies I worked with were all incredibly nice (with a side of workplace drama which I have quickly found to transcend border and culture) and willing to jump in when a customer asked me for help locating a product I had never heard of, much less knew where to find. We also had mandatory tea breaks every afternoon, and more often than not someone would supply "cakes" or "biscuits" to go with tea. I also really enjoyed the patient interaction that I got at Lifestyle...with most of the sales being from in front of the counter, I got to do a lot with helping customers select the appropriate cold medicine, eye drop, pain medication, etc. Codeine is available over-the-counter here, in low doses combined with paracetamol (acetaminophen) and other drugs, so we were constantly counseling patients on the importance of limiting use to 3 days to avoid rebound symptoms and dependence (guess how many listened?)

Mair, the main pharmacist, was fantastic about finding opportunities during "down-time" to teach me about pharmacy practice in the UK. She let me dig around in their Drug Tariff, a book updated and circulated monthly by the NHS that tells pharmacies how much they will be reimbursed for the various items they dispense. I also spent a couple hours one afternoon looking through the training modules that all of the assistants are required to complete. I was really impressed...their training is quite thorough and equips them with the knowledge to handle most basic self-care questions, without having to involve the pharmacist if she is busy and there are no complicating factors. On Wednesday I sat down with Lin, a counter assistant who went through training to be able to provide smoking cessation counseling. This is one of the "enhanced services" that pharmacies can apply to their Primary Care Trust (local division of the NHS) and receive authorization to provide. They get reimbursed for the time spent with the patient, and Lin is also allowed to prescribe nicotine replacement therapies (gum, lozenge, patch, or inhaler) which the pharmacy will be reimbursed for dispensing. There are several "advanced" and "enhanced" services that pharmacists can undertake to extend their scope of practice and provide for their communities...pretty awesome, if you ask me!

Cardiff...What if?

Thursday afternoon, Nathan and I realized that our week off was quickly coming to a close, and we wanted to try to fit in one more trip. After a little bit of research and some suggestions from friends, we decided on Cardiff, Wales...just an hour train ride away, tickets for Saturday were reasonable, and there were several castles, museums, and tours in the area that looked interesting. And...that's pretty much all we thought about. Admittedly, we didn't take the time to consider some of the "what-ifs"...

- What if there was a 90% chance of precipitation in Cardiff on Saturday? All day?

- What if Nathan's alarm didn't wake him up? What if he missed the train? What if I had to wait at the train station in Cardiff with no means of communication, hoping (but not knowing) that he caught the next train from Bath?

- What if there was an International Rugby Championship match between Wales and Italy in Cardiff on Saturday? What if an extra 80,000 people flocked the city for the game?

- What if the aforementioned event and sudden influx of visitors caused streets to be closed, busses to be re-routed, and tours to be cancelled?

- What if the bus driver neglected to inform us when we had reached the stop for Castell Coch, even after I butchered the pronunciation of the name when I asked if the bus even went there, clearly establishing myself as a know-nothing tourist? What if this caused us to take the extra-extra-long-scenic-route to the castle?


In spite of some minor setbacks, we tried to make the most of our day in Cardiff. We did eventually make it to Castell Coch, which was quite lovely to walk around. It was originally built in the Middle Ages, but the inside was renovated during the Victorian era. Funded by the 3rd marquess of Bute (cha-ching!) and designed by an "eccentric genius" of an architect, the place was incredibly detailed and extravagant. I'm including several pictures here so you can get a good idea of just how ornate the inside was...

The outside retains much of its Medieval charm...


Kitchen, drawing room, and Lord Bute's bedroom...


Three views of Lady Bute's room...by far the most fantastic!



After exploring Castell Coch and making our way back into the city, we had just enough time to check out the National Museum Cardiff (left). Admission to the museum is free, and they have some spectacular exhibits. We spent most of our time in the Origins exhibit, which details the story of the history of Wales. I also had time to catch part of the "Artes Mundi" exhibit in the art gallery, which is an international celebration of select artists, only in Wales for a short time. The other pictures below are of the Millenium Center (right) and fountain in front of it (center) that we stumbled across earlier in the day while trying to figure out our plan of attack (pre-"sorry all the city tours are closed for the game" and "sorry all the busses are being re-routed because the main streets through the city are closed")!

Day trip to Glastonbury

We've had this week off again, so we've taken the opportunity to do quite a bit of site-seeing, both in Bath and in surrounding areas. Consequently, I've gotten a little behind in my blogging...sorry!

Tuesday we took a bus from Bath to Bristol to Wells to Glastonbury. Travel by bus is not nearly as comfortable as that by train, but it is cheaper and got us where we wanted to be. Glastonbury is an interesting town...very "touristy" and quite "new-agey"...the kind of place that makes you stop and think, "Wait...people actually LIVE here?" Not really my cup of tea, but it was fun to walk around for the day!

Our first stop was the Chalice Well Gardens. Legend has it that Joseph of Arimathea hid the Chalice of the Last Supper beneath the waters of this natural spring, after which these waters began to flow red. It is now considered a "sacred place" and is well-equipped with signs instructing visitors to participate in "quiet reflection". The gardens around the spring were not in full bloom yet, but the whole area was quite lovely. There is a place where the water is drinkable, so of course we had to try...the taste was strangely familiar, almost reminded me of Pump Room water, only colder... :)

A short walk from the Chalice Well was the base of the Glastonbury Tor...and a long, windy walk from the base was the tower. The tower sits 521 feet above sea level and was originally built in the 14th century. We heard a rumor that the slopes of the Tor are maintained by grazing sheep and cattle; although there were no animals on the hill to confirm that during our visit, an overabundance of sheep, um, "poo" provided ample evidence that this is indeed the case.

After the hike up to the Tor, we wandered through the Rural Life Museum and then made our way back into town to visit the Glastonbury Abbey ruins. Parts of the abbey date back to 1186, and it holds the tombs of King Arthur and Lady Guinevere. Within the complex is also one of two "Holy Thorn" trees. Another legend indicates that the original Thorn Tree was the staff of Joseph of Arimathea which he placed in the ground upon his arrival in Glastonbury in the first century AD.

Our final adventure in Glastonbury involved a long and treacherous walk along a poorly-mapped route to reach Gog & Magog. This journey took us along backroads and muddy paths, over fences, and directly across a field of cows (who graciously opted to continue eating and ignore our presence) to two ancient oak trees. By ancient, I mean one is dead (Gog) and the other, if not also dead, painfully close (Magog). Let's just say I'm glad I saw it once and took pictures, so that I never feel the need to return.

Roman Baths

We did the "audio" tour of the Roman Baths last weekend. That means I walked around the baths and the attached museum carrying a device frighteningly reminiscent of my first cell phone and which provided background information and explanations of most of the exhibits. It was actually quite nice, because I learned a lot and was able to take the tour at my own pace.

Although I am nowhere near the "history buff" that some of the men in my life might wish, I do find the architecture in these places absolutely fantastic, and the stories and traditions fascinating. If you're at all interested in the Roman Baths, I'd encourage you to check out their website: http://www.romanbaths.co.uk/. I especially like the "Walkthrough" section...it has a lot of the history and some phenomenal pictures. Here are just a few of the pictures I took...

As part of the admission price, after the tour we had the "privilege" of visiting the fancy-schmancy Pump Room and "enjoying" a free sample of spa water. As you can perhaps imagine, the water is quite warm and tastes like minerals. Mmmmm. My face says it all...and Nathan's face says "I'm not even drinking it because I'm too busy laughing at Katie." To think they actually charge 50p for a glass if you didn't take the tour...

Week 2 Highlights?

Not sure these stories all qualify as "highlights"...but they're definitely worth sharing!

#1 - Monday morning I make it to my first day of work plenty early...actually end up sitting outside the store for about 10 minutes with one of the technicians while we wait for the pharmacist to show. After work, it is a bit chilly so I opt to take the bus going away from town and ride for an extra 15 minutes, rather than stand out in the cold waiting for my bus. I get a tour of Whiteway...no biggie. Tuesday morning, I bring a book to read on the bus on my ride to work. Apparently it was a very interesting chapter, because I completely miss my stop. Second tour of Whiteway...and I tell you, it's not worth a second visit if you don't live there. I end up 15 minutes late for work, and not only do I have to explain why, I have to try to convince the tech I closed with that I got on the wrong bus ON PURPOSE the night before. Think she believed me?

#2 - Tuesday night I go to bed around 11pm. Some time later, I awake to my alarm signalling time to get up. As per typical Katie fashion, I reach for the alarm to hit the "snooze" button...but it doesn't stop. In fact, it continues to get louder and louder, until I wake up and realize that it is actually the fire alarm. I slip on my slippers, grab my keys, and head out of the building along with the other residents. Still groggy, I am incredibly confused as to why it is still dark outside, until I look down at my phone and realize that it is 2am...lovely. We end up standing outside for about 20minutes waiting for the "fire brigade" to okay the building. Side note: someone in Nathan's flat left a pan of grease on the stove...smooth.

#3 - Thursday morning I am walking to the bus stop when I suddenly hear a commotion behind me. I turn to find a car stopped diagonally across the road, in front of a bus, with the front tire of the car on top of a bicycle. Fortunately, the cyclist appears to be okay; as I turn around, he stands up, takes his metal U-lock in his hand, and proceeds to smash the windshield of the car. The driver is frantically trying to back up off the bike, while the cyclist walks around the car and attempts to open the passenger side door. Noting several people in the area, I opt to turn and walk quickly to the bus station.

#4 - Friday night I convince Nathan to take the bus to a show at the Southdown Labour Club. The pharmacist I worked with all week is in a band, and one of the lead technicians sings. Not having the slightest idea of what to expect, we arrive and find the British version of the Elks, Eagles, or Moose...it was fantastic. The band was decent, but the second act was phenomenal. This technician, who comes across as a little harsh and intense in conversation, has an absolutely spectacular voice. Best 3quid I've spent in a long time.

Placement #1 - Boots Pharmacy

Last week was my first pharmacy rotation, or "placement" as they are called here. I worked at a Boots pharmacy in Twerton, a small community a bit south and west of the city centre. Boots is the British equivalent of Walgreens or CVS in the States...however, this particular pharmacy was previously independent, only recently came under Boots ownership, and has managed to retain a lot of the "independent" feel. At this point, it's difficult to use my experiences to compare pharmacy in Britain versus the US, because I don't know what is store-specific rather than practice-specific. But here are some of my observations nonetheless...for those of you who may actually be interested in nerdy pharmacy stuff!

- Everything is much more standardized here (because of the NHS)...for example, all prescriptions are written on the same paper, regardless of the doctor's office.

- The majority of drugs come in "calendar packs" of 28, and doctors actually write for the correct amount. Thus, minimal counting is required.

- If you DO need to count out of a stock bottle, the counting trays are triangular and I have yet to come across a spatula. I still have not figured out the appropriate technique for using this device...

- We dispense massive quantities of bendroflumathiazide and almost no hydrochlorothiazide. Same goes for zopiclone versus zolpidem. And I didn't once dispense Vicodin.

- Pharmacists dispense and supervise methadone for heroin detox. So, about 25 times a day, recovering addicts come in to the pharmacy and the pharmacist measures out the prescribed dose of methadone, then pours it into a plastic cup. He hands the cup of green liquid to the patient, says "Cheers!", and watches him/her down it. Repeat tomorrow. Bizarre.

- Most people do not pay for prescriptions. For the few who do, each script costs 7.20, regardless of item or quantity.

All in all, I had a great experience. The people were really nice to me and hilariously British. I got to do a lot of different things, from order entry to dispensing, filling dossette boxes to administering methadone, and even walking down the street to a patient's home to measure his legs for compression stockings. I was impressed by the services they offered, although again I still don't know if those are services offered throughout the UK, or just in small community pharmacies. I'm looking forward to my next placement at an independent pharmacy in the city centre, which I suspect will be quite different!

London Bridge is...

...not all that impressive. However, the rest of London is quite enjoyable! Nathan & I took a train from Bath Spa to London-Paddington and spent a day and a half wandering around the city, hitting all of the major tourist attractions and nearly wearing out our legs. I found the city of London to be quite interesting...a lot of fascinating history, but at the same time very modernized and bustling! We took a lot of pictures...I'm posting just a few for you here now!

First stop was Buckingham Palace, which was fun to see but also not all it's cracked up to be. The queen was not there (as evidenced by the Union Jack flying on top of the palace), and we missed the changing of the guards by 2 hours! We were also unable to get close enough to pester the guards...you can just barely see the little guy over my shoulder...

We met up with Nathan's Uncle Bob and took the Tube to Big Ben and Westminster Abbey. Unfortunately the Abbey was closed, so we couldn't go inside...but both are pretty amazing from the outside!

Uncle Bob treated us to a ferry ride down the River Thames from Westminster Bridge to Tower Bridge. When we got off the ferry and made the short hike to the London Tower, it too was closed (bugger!). We went back on Saturday for the tour, led by an entertaining Yeoman Warder (aka Beefeater)...got to hear a lot of English history, complete with all the beheadings one could imagine. Also got to see the Royal Jewels, which are absolutely fabulous...unfortunately no cameras were allowed in the vault where they are kept :(

The rest of the day Saturday was spent hauling around and working the Tube system to get to random tourist traps. We walked across the London Bridge and saw Shakespeare's Globe Theatre. We also visited Platform 9&3/4 at King's Cross so that Nathan could die happy...in return, I drug him all the way out to Abbey Road!