Regardless of how hard you try, as a resident there will come a point when you are trying to juggle so many balls that one of them drops.  As cliché as it sounds, one of the most important lessons I have learned in the last month of residency training is learning to forgive yourself for dropping the ball. I make mistakes, I sometimes cry after a bad day, and I am not always as prepared as I should be for a topic discussion.    Today, I had a topic discussion about Rapid Sequence Intubation as part of my Emergency Medicine Rotation.  I found articles and read about the topic, yet my mind completely blanked when it came time to discuss with my preceptor.  Once it became painfully obvious that I did not know the answer to most of her questions, we decided to call it quits and try again tomorrow.  She told me it was okay, and emphasized the importance of reviewing the material tonight.  I haven’t stopped beating myself up since.   You might be smiling right now that my learning to fail moment was not being as prepared as I should be for a topic discussion, but if you would have heard the deafening silence in the room during my failure to produce the correct answer, you would understand.

This is my declaration to the pharmacy world that I have let the ball drop, and I have forgiven myself for it.  I have picked up the ball, read more articles, made an outline of my notes, and reviewed the material with my supportive co-residents.  Tomorrow is a brand new day, and I am going to give the best topic discussion of my life.  Will I fail again?  Yes.  Have I started to develop the essential life skills to know how to handle a dropped ball? Absolutely.

So, I had to say that I honestly don’t know specifically where I will be in 5 years. I feel  like my whole life is in limbo until the Match in March, when I find out where I will be heading off to residency.

“A pulmonary embolism. She’d just had knee replacement surgery and was scheduled to go in for a follow-up procedure the day she died.” The last he’d heard from her was an e-mail that very morning—she wasn’t feeling well; her surgery might be delayed.

I was silent for a moment. Even as a health professional, it’s hard to know what to say. 

“I’m so very sorry.” Another moment of silence and then I added, “A large part of my job is helping to ensure that doesn't happen.”

Based on the evidence, I believe that most instances of pulmonary embolism or DVT following surgery or hospitalization are preventable. I'm not alone in this interpretation. CMS recently added these conditions to the list of hospital-acquired conditions for which facilities will not be reimbursed should they occur during hospitalization. A Joint Commission National Patient Safety Goal addresses the appropriate and safe use of anticoagulants.

I've shepherded a new writer through his paces, contacted members who have been highly involved in national reform efforts, worked with an illustrator to create a beautiful piece of art for the cover, and brought this jam-packed issue to a close.

And, on the very eve of publication, Scott Brown (R-Mass.) manages to take away a Senate seat that has been Democratic for 47 years. In that instant, he changes the national reform conversation, throws President Obama's legislative agenda into doubt, and threatens to derail the very issue that is the centerpiece of this edition of the magazine.

At first, I was dumbfounded. What was going to happen to health care reform, environmental policy, enhanced support for our nation's institutions of higher education? But more importantly (at least to me), what were we going to do about the cover story? How could we make it relevant for members?

And then, I took a breath. Health care reform will happen... it may not be exactly like the bills that passed both the Senate and the House, but the tide has turned. We have been talking, as a nation, for almost a year about inequities in coverage, about an inefficient and often wasteful health care system, about patients who often have to make agonizing choices between paying for needed medicines or buy groceries. That conversation will go on.

And President Obama's State of the Union address Jan. 27 supported that notion. He really threw down the guantlet, challenging Congress to get it done. So, the cover story, as written, is still incredibly relevant. The efforts of the ASHP members who have worked so hard educating their Congressmen and women about what pharmacists do every day have not been wasted. And I hope the story inspires you to pick up the mantle of reform and get involved.

And I'll move on, to the spring issue... and a cover story about ASHP's new national effort to develop pharmacy practice models that fit the needs of today's patients. (No Scott Brown here!)  

Then it occurs to me (yes, all good ideas do happen in the shower) that instead of trying to predict the future and acting on those predictions, we look to our past achievements as our guide to impact the future. 

So what does the “Massachusetts Message” and the resulting scramble on the Hill mean for health-system pharmacists?  The answer is actually pretty simple. The provisions in both the House and Senate bills that recognize the medication use expertise of pharmacists are non-partisan and non-controversial. They are considered by many to be common sense, workable solutions that everyone can get behind.  In fact, since we already have them written into legislative format, it appears that we have our legislative agenda for 2010 already written.

It’s an agenda that is supported by all pharmacy organizations and presents opportunities for all practice settings.  I am referring of course to the medical home model that includes medication services of pharmacists, the medication therapy management grant program, and efforts to reduce hospital readmissions and promote safer medication use.  Whatever fate the current bills suffer, these items were included in the proposals because Congress sees value in them.  Ideally, we’d probably like to add funding for second-year, specialty residencies or stronger payment mechanisms.  But these are mere tweaks to legislative proposals that we already support. 

The moral of the story: While Congress may need to go back to drawing board on the broader issues of health care reform, our agenda is still largely a finished product and should be considered a live wire.  While others regroup, we will be pushing on!