I remember when I joined the bachelor’s in pharmacy program, I made it a habit to read the pharmacy oath on a regular basis: “I promise to devote myself to a lifetime of service to others through the profession of pharmacy.”
Reality of the “real pharmacy practice” dawned upon me when I joined the profession as a trainee and subsequently a pharmacist. I consider myself lucky that had a research stint before re-joining as a practicing pharmacist, as it opened an uncharted yet very crucial territory for me.
It was during my research days at a local hospital in Karachi, where I was working on the effect of Vitamin-C on lead in the body. As per requirement of the research, I was always scanning for patients with lead toxicity through laboratory tests. Since my thesis was on effect of Vitamin-C on lead levels, I was always on the lookout for relevant cases. I had requested the laboratory to keep me posted in case they receive such a request.
It was after a few days that I received a call about an inpatient being requested a blood lead level by his attending physician. Elated to finally receive a case, I instantly traced the patient through his medical record number and went to see him. He was a 6–7-year-old boy, admitted into hospital for very high blood lead levels. The doctors had him on chelating agents.
I met his parents and took a casual history. I asked whether he had ingested paint, had been exposed to lead fumes, etc. From the information I collected, this was not a case of acute toxicity, but one of a gradual lead build up due to the child’s habits. I was told he was fond of chewing crayons and pencils and consuming wall paint by scratching off the flaky layers. Pencils and paint have high levels of lead - no wonder his levels are high!
The next step was to talk to his doctor and introduce myself as this smart research pharmacist and convince him to put him on Vitamin C, a task easier said than done! I remember showing him literature reviews and experiments showing the lead chelating effects of Vitamin-C. He half-listened and went away, but he did ask my designation and who my supervisor was. It was a setback and I felt small and silly, but I wasn’t going to give up – I had to remember the oath I used to read every day.
I visited the child every day, spoke to his mother and made sure I met his doctor, or the medical officer assigned. Every day I would check the MR of the patient to see if my intervention was accepted. To my surprise and happiness, the doctor had eventually added 500mg Vitamin C to the child's medications.
Since there was no way of collecting urine samples to assess lead excretion, I followed up on the child’s lead levels post-Vitamin C treatment through the lab. There was an improvement: the child was feeling better and had become livelier. The child’s mother’s happiness was difficult to express in words – the family, from interior Sindh, gifted me a traditional Sindhi outfit which I held on to for a very long time.
The fact that I stood by my convictions, pursued the case to the fullest and did what I could for the little boy, brought happiness to me as a research pharmacist and a human being. Overall conviction is required from a pharmacist to play active role for the patient’s benefit and as active member of health care team.
The mother's happiness and well wishes really stuck with me, since even a decade later, I am still recalling this!
And oh yes, I did send a thank you note to the doctor - after all, we are all in this together for the betterment of the patient, aren’t we?!
O.F
Superb article!