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Sometimes things aren’t always what they seem. 

I work as an ED pharmacist, and having patients surprise me unexpectedly is part of my normal day.  You are looking for a prescription for marijuana for your baby? You experimented with some of your neighbor’s insulin in order to control your diabetes?  You didn’t think your blood pressure meds were working, so you took the whole bottle?  You need more trazodone to sleep, even though you just overdosed on it?  Yikes.  I mean, really.  Yikes.

But away from work, I don’t always expect these kinds of surprises.  I work swing shift (12:30 pm to 11 pm), so the downtown area where I work is usually pretty quiet when I head home.  Yesterday, just a few blocks from the hospital where I work, a little bit after 11 pm, I saw a bicyclist down in the street, lying in the streetcar lane.  I stopped my car, turned on my hazard lights, and grabbed my phone.  Immediately my mind starting running through my BLS/CPR algorithms, and my heart started to race, as I prepared myself for the worst.  As I got out of the car, I started dialing 911, and my brain started putting the situation together.  What street was I on?  What was the closest cross street? Was the bicyclist alive or dead?  Bleeding?  But as I knelt down next to the man, who had his face turned into the street, I noticed the strangest thing:  the man was snoring.  Loudly. Mentally I checked the box that he was breathing, while I felt for a pulse. He was unresponsive to my efforts to rouse him at first, but eventually he opened his eyes and started moving around a little.  I told him to lie still, that the paramedics were coming, and he struggled to speak.  He was intoxicated and likely had gotten his bike tire caught in the streetcar track, as his bike was completely undamaged and he had no visible abrasions on his extremities that I could see.  The gentleman did not know what day it was, where he was, or where he lived.  He barely knew his name. But he was alive.  I expected the worst (and was prepared for the worst based on my training), but thankfully, the only skill I needed in this particular situation was the ability to dial 911.

My experience with the snoring, intoxicated bicyclist serves as an important reminder that things are often not what they seem.  I expected far worse than what I actually found (thankfully!).  As clinical practitioners, we often prepare ourselves for the worst case scenario, even though we seldom will experience things on a level as bad as our minds can conceive. This is the whole principle behind ACLS or PALS training for codes.  We train for the absolute worst, so that when called into a situation, we will be ready for whatever arises.  Everyone does this on some level, whether or not we work in the emergency room or not.  Think about an exam you took or a challenging task you prepared for recently:  Before the event, we often stress about the outcome, and this helps us anticipate the steps we need to take in order to be successful in whatever we are planning to do.  After the anticipated event is over, however, we usually have a more positive outlook on what we have experienced and a clearer perspective (e.g. the whole “hindsight is 20/20” argument).  But even the most difficult experiences in life are finite--they have a beginning, a middle, and, most importantly, an end. We may not wish to repeat the painful experiences in our lifetime, but we usually get through things better than we expect and often surprise ourselves in the process with resiliency we didn’t know we had. 

One good "real-world" pharmacy example of how things tend to work out better than expected is the BCPS exam I took last year (this is an important message because I know this topic is weighing heavily on the minds of people studying to take the exam THIS year).  Anybody who sits for the BCPS exam has heard the stories about how awful it is.   Pretty much everyone I talked to who took the exam before me told me they thought they most certainly failed and how terrible it was.  But my experience with the exam was very different than most of the stories I heard.  At the risk of going against the grain on this particular issue, the BCPS exam wasn’t that bad.  I think (I know!) I expected a lot worse based on all the horror stories I heard.  And I didn’t really know what the exam would be like because the modules I practiced with were very different than the actual exam (much harder and required a much more rigorous level of detail, I thought).  Perhaps after listening to all the gloom and doom, I was pleasantly surprised that I was still breathing afterwards.  Perhaps I am confusing my elation after completing the exam with relief at getting through a difficult experience.   Perhaps my previous experiences as a graduate student in chemistry biases me a little bit about what constitutes a difficult test.  Or maybe I am naturally more optimistic about things than most people. Whatever the reason, I am led to believe that our bad/difficult/challenging experiences almost always turn out a lot better than we expect them to.  And such was the case with BCPS last year. So if you are facing your BCPS moment this year (or the NAPLEX, or some other specialty exam, or applying for popular residency program) don’t listen to the gloom and doom too much--at least not to the point where it incapacitates you to do well.  Or prevents you from going after the things you want to achieve.  Just file it under “possible worst-case scenario” and then move on.  Just because it is other people’s “worst case scenario” doesn’t mean it has to be yours.

In the end, all the gloom and doom preparation is essential in helping us remodel our responses to real-world situations, as we encounter them.  If we can face the absolute worst case scenario, surely we can adapt almost any scenario in which we find ourselves with success.  The danger in being inexperienced as a student or new practitioner is in treating what we hear, read, or observe about our world to be absolute and immutable.  Remember that worst case scenarios seldom happen, and that even if they do, there are still options available to you to lessen their impact.  By way of the examples I have already used, you can always retake a test or reapply for a residency the following year.  The silver lining in these “worst-case” situations is that you now know what to expect (e.g. You know the actual structure of the exam, for example, or you know how the whole residency application process works.), and this is powerful information for creating a better outcome the next time around.  Truth be told, no matter how much we prepare, people and situations will always surprise us.  Sometimes not always for the better, but that is what makes life interesting.  Remember that things aren’t always as bleak or as bad as they seem (e.g. my bicyclist down in the middle of the street).  Resign yourself that no matter what the outcome, that you will find your way.  Your training has prepared you to make a way, even if the path isn’t obvious to you in the moment.  Prepare for the unexpected by training for the worst case scenario, but also don’t forget to let yourself still expect the best possible outcome in all things.