May Your Road be Rough!

MAY YOUR ROAD BE ROUGH by Tai Solarin(1922 – 1994).

 

I am not cursing you; I am wishing you what I wish myself every year. I therefore repeat, may you have a hard time this year, may there be plenty of troubles for you this year! If you are not so sure what you should say back, why not just say, ‘Same to you’? I ask for no more.

Our successes are conditioned by the amount of risk we are ready to take. Earlier on today I visited a local farmer about three miles from where I live. He could not have been more than fifty-five, but he said he was already too old to farm vigorously. He still suffered, he said, from the physical energy he displayed as a farmer in his younger days. Around his hut were two pepper bushes. There were kokoyams growing round him. There were snail shells which had given him meat. There must have been more around the banana trees I saw. He hardly ever went to town to buy things. He was self-sufficient. The car or the bus, the television or the telephone, the newspaper, Vietnam or Red China were nothing to him. He had no ambitions whatsoever, he told me. I am not sure if you are already envious of him, but were we all to revert to such a life, we would be practically driven back to cave dwelling. On the other hand, try to put yourself into the position of the Russian or the America astronaut. Any moment now the count, 3, 2, 1, is going to go, and you are going to be shot into the atmosphere and soon you will be whirling round our earth at the speed of six miles per second. If you get so fired into the atmosphere and you forget what to do to ensure return to earth, one of the things that might happen to you is that you could become forever satellite, going round the earth until you die of starvation and even then your body would continue the gyration!

When, therefore, you are being dressed up and padded to be shot into the sky, you know only too well that you are going on the roughest road man had ever trodden. The Americans and Russians who have gone were armed with the great belief that they would come back. But I cannot believe that they did not have some slight foreboding on the contingency of their non-return. It is their courage for going in spite of these apprehensions that makes the world hail them so loudly today.

The big fish is never caught in shallow waters. You have to go into the open sea for it. The biggest businessmen make decisions with lighting speed and carry them out with equal celerity. They do not dare delay or dally. Time would pass them by if they did. The biggest successes are preceded by the greatest of heart-burnings. You should read the stories of the bomber pilots of World War II. The Russian pilot, the German pilot, the American or the British pilot suffered exactly the same physical and mental tension the night before a raid on enemy territory. There were no alternative routes for those who most genuinely believed in victory for their side.

You cannot make omelettes without breaking eggs, throughout the world, there is no paean without pain. Jawaharlal Nehru has put it so well. I am paraphrasing him. He wants to meet his troubles in a frontal attack. He wants to see himself tossed into the aperture between the two horns of the bull. Being there, he determines he is going to win and, therefore, such a fight requires all his faculties.

When my sisters and I were young and we slept on our small mats round our mother, she always woke up at 6a.m. for morning prayers. She always said prayers on our behalf but always ended with something like this: ‘May we not enter into any dangers or get into any difficulties this day.’ It took me almost thirty years to dislodge the canker-worm in our mother’s sentiments. I found, by hard experience, that all that is noble and laudable was to be achieved only through difficulties and trials and tears and dangers. There are no other roads.

If I was born into a royal family and should one day become a constitutional king, I am inclined to think I should go crazy. How could I, from day to day, go on smiling and nodding approval at somebody else’s successes for an entire lifetime? When Edward the Eighth (now Duke of Windsor) was a young, sprightly Prince of Wales, he went to Canada and shook so many hands that his right arm nearly got pulled out of its socket. It went into a sling and he shook hands thenceforth with his left hand. It would appear he was trying his utmost to make a serious job out of downright sinecurism.

Life, if it is going to be abundant, must have plenty of hills and vales. It must have plenty of sunshine and rough weather. It must be rich in obfuscation and perspicacity. It must be packed with days of danger and of apprehension.

When I walk into the dry but certainly cool morning air of every January 1st, I wish myself plenty of tears and of laughter, plenty of happiness and unhappiness, plenty of failures and successes. Plenty of abuse and praise. It is impossible to win ultimately without a rich measure of intermixture in such a menu. Life would be worthless without the lot. We do not achieve much in this country because we are all so scared of taking risks. We all want the smooth and well-paved roads. While the reason the Americans and others succeeded so well is that they took such great risks.

If, therefore, you are out in this New Year 1964, to win any target you have set for yourself, please accept my prayers and your elixir. May your road be rough!

Tai Solarin (1922-1994) was one of Nigeria’s foremost social activists his legacy includes the famous Mayflower School, Ikenne and Mollusi College Ijebu-Ode. This article was published in Daily Times Newspaper of January 1st, 1964. 

 

 

This post is in Honor of a great Nigerian Patriot who lives on in spirit, wisdom and ideas past death this day 21 years ago.

Why are pharmacists so important when doctors can do their job?

Our pharmacy practice roles continues to expand, registered technicians are taking on technical roles, and we are focusing more on our cognitive responsibilities. Some of our patients don’t necessarily understand these changes. I’ve started to hear this question or various shades of it like … “Isn’t that my physician’s job?” “Shouldn’t that be my Physician’s problem?” “Why do you need to know that, you are just a pharmacist?”

In the epic battle of what a physician can do, a pharmacist can do too vs. what a pharmacist can do a physician can do better, neither profession wins. It is the very essence of division of labor for maximum productivity in our society that individuals specialize and cooperate for the synergistic benefit of all. Many smart people have recognized this, I think, after Plato who wrote in The Republic

“Well then, how will our state supply these needs? It will need a farmer, a builder, and a weaver, and also, I think a shoemaker and on or two others to provide for our bodily needs. So that the minimum state would consist of four or five men…”

We view things from different perspectives to improve the overall outcome for our patients, and neither profession bears any characterization of higher intellect/ morals. The truth is, pharmacists are trained to know a whole lot more about medications than physicians, and I certainly was not trained to complete physical assessments or diagnose complex care cases. Yet, it is fascinating to me how physicians and some patients get their panties in a bunch over this topic.

Case in point, is a letter I received from a physician 3 years ago, when I had merely pointed out that our mutual patient had a significantly elevated blood ethanol level (despite denying any alcohol consumption) and was experiencing several episodes of post prandial hypoglycemia (about 3 hours after several meals every week) despite several attempts at dose changes. I had merely suggested a switch from Insulin Toronto to a rapid acting insulin, and asked the physician if he could speak to the patient about alcohol consumption (because, the patient was obviously not being upfront with me; I had hoped both I and the physician could intervene).

Instead of collaboration, I received this letter>>
Ps: This letter is now a part of the tools used to prepare my students for the worst case scenarios in attempting to collaborate with other healthcare professionals as they go about caring for our patients.

Doctor's FaxThis patient spent another 2.5 years experiencing several bouts of hypoglycemia per week with hypoglycemic unawareness. At some point this year, another specialist recommended (as I had 2.5 years ago) rapid acting insulin with each meal. I am uncertain about his current alcohol consumption, but the number of hypoglycemic episodes dropped substantially.

As a side note about some of this particular physician’s comments:
On the comments about accessing Netcare: Our Standard of Pharmacist Practice actually requires that any reasonable Pharmacist would have, in this circumstance, considered appropriate information:
Standard 3.4 Appropriate information means the following information in relation to a patient: a) health condition to be treated and history of the condition; b) symptoms or signs to be treated; c) treatment history for the condition including drug therapy and outcomes; d) age; e) pregnancy or lactation status, if applicable; f) allergies or intolerances to drugs, excipients or other products that may affect drug therapy; g) other drugs or blood products being used; h) other health care products, aids and devices or other products being used that may affect the pharmacist’s decision; i) other health conditions that may affect the pharmacist’s decision; and j) any other information that a reasonable pharmacist would require to provide the pharmacist service.
Standard 3.6 When interaction with the patient or consideration of patient-specific information indicates that a pharmacist should review laboratory data and the data is not available, the pharmacist must:
a) order the appropriate laboratory test, or
b) contact an appropriate regulated health professional and request that the laboratory test be ordered.

On the comment about my inability to interpret lab data:
I am not entirely sure how else I could have interpreted a lab value of Blood Ethanol Level: 31 mmol/l and regular occurrences of FPG <4 several times in the week.

On the comment about Physician liability:
I am 100% liable for my decisions, actions, counseling, suggestions … etc. What I suspect is that many physicians do not recognize is that we are fully aware of the implications of our actions; we check and double check several studies and texts to back our suggestions up. The whole point of a pharmacist is essentially to mitigate medication risk to our patients and optimize pharmaceutical care, and we are fully aware about the implications of our interventions with regards to keeping our license.

Why are pharmacists so important?
Because, there is a good chance the pharmacist knows the time of onset, peak, duration and other such important pharmacokinetics as well as detailed mechanisms of action, interactions, clearance patterns etc about drugs. When pharmacists contribute such knowledge in their practice, it optimizes patient’s care for the best possible results. Pharmacists are here to provide great patient care in dispensing medications and optimizing pharmaceutical care through the various activities deemed now as our “expanded role” such as medication adaptations, prescribing, and medication assessments as advocates for our patients. This is our role: To dispense and manage medication use collaboratively for optimized patient care.

Can a physician do a pharmacists job?
First do no harm…

Asides from the obvious conflict of interests involved in having the diagnostician responsible for dispensing as well, pharmacists are the final check in the system to ensure that patients receive medications that are appropriate, safe and effective. We in addition, provide follow up counselling to ensure that medications are adhered to in order to reach treatment outcomes by monitoring our patients, and by being easily accessible to our patients. It is in fact impossible for physicians to do our jobs and ensure patient safety.

So, I thank you physicians who work with us collaboratively as we focus even more on our cognitive roles… and…

I beg the other physicians who currently do not understand us, do show us some love next time you receive our intentionally helpful messages. We really do not care for infringing on your territory, we just want to stay in our lane and optimize outcomes for our patients. Tis all!

Happy Aboriginal Day!

Honor the sacred.

Honor the Earth, our Mother.

Honor the Elders.

Honor all with whom we share the Earth:

Four-leggeds, two-leggeds, winged ones,

Swimmers, crawlers, plant and rock people.

Walk in balance and beauty.

 

Native American Elder

 

….to celebrate the cultures and contributions to Canada of First Nations, Métis and Inuit peoples….I thought I’d post in honor of indegenous peoples today.