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If you, like me, spent years of training in the hospital before you met an in-the-flesh pharmacist, if the pharmacy to you became either a place to send your patients to have their prescriptions filled on the way out the door, or a basement stronghold from which disembodied medication dosing throw-downs were issued, if your pharmacist’s pages (unfairly) felt like yet another threat to your survival when you were already gasping for air on call, then you were probably unprepared, as I was, to meet your critical care pharmacist. If, when you did meet this person—let’s call her Theresa, because I like that name and it happens to belong to my pharmacist—when you met Theresa, you thought “Thanks, but I got this,” if you thought that your mastery of ACE inhibitor conversions on the floor had the slightest relevance to the hypertensive emergencies you were about to face in the ICU, if you wondered why Theresa was joining you on rounds, if you puzzled at the careful notes she was taking as you crafted your masterful plans for the day, then you were probably unprepared for the epic schooling that you were about to receive at the hands of your pharmacist. If you came in the next day suddenly unsure of many things, if on rounds that morning you had a hard time looking Theresa in the eyes, if at every patient’s bed you saw for yourself the beneficial effects of Theresa’s pharmaceutical superintendence, if you were forced to accept that, were you left to your own devices, bed 8 would have been under-treated while bed 14 would have been over-treated while bed 18, well let’s not talk about bed 18, if your fellows and residents never repeated your mistake because they (unlike you) learn quickly from an exceptional and nurturing educator like Theresa, then you were probably starting to come around to the importance of a critical care pharmacist in the Neuro ICU. If 2 days later you found that your entire team had turned over and no one knew the patients—except Theresa, if your team failed to remember the ICU protocol for the treatment of shivering and Theresa politely reminded you that she wrote that protocol so maybe she could help, if some variant of “I was on the QI committee that studied that problem,” or “I published 2 papers and an abstract on that last year,” came up more times than you can remember in response to questions from the team, from nurses, and from patients, if later that night a patient crashed (bed 18; why didn’t you listen?) and your fellow’s text to Theresa about the appropriate dose of TPA was answered in under 30 seconds, then you were probably thinking that critical care pharmacists in the Neuro ICU are kind of…well critical. If you went to your annual Society meeting prepared to dazzle your colleagues with your latest efforts to make mice find their way out of a wet pool a few seconds faster…only to find Theresa presenting 4 posters and a research seminar relevant to actually helping patients, if you wondered how you might serve your Society and started looking into joining a committee only to discover that Theresa is serving on 5 while chairing another (no joke!) and is on the Board of Directors and is leading courses, well then you might have had a few drinks alone in your hotel room that night and come to the belated conclusion that your field would have a hard time getting along without Theresa’s contributions and that of others like her. If, back on service, you burned yet another bridge with neurosurgery only to have Theresa help you repair it, if she humored you every time you suggested starting salt tabs, if her personality and charisma became a big part of why you looked forward to service time, even if she calls you “Dory” because people’s names are hard to remember dammit, if you realized one day that you couldn’t imagine taking care of patients without her, and that (though you thought yourself inscrutable) she knew and compensated for your thought patterns so well you’d have to pay her hush money if you ever ran for office, then maybe you finally learned your lesson: critical care pharmacists are an integral part of the Neuro ICU care team. “I love my PharmD.” Terrance Kummer, MD, PhD 24


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