The Negatives and Positives of Remote Order Entry Jobs for Pharmacists

Just google "Remote Order Entry Pharmacist" and you will find that many well-known companies and hospitals employ a remote order entry type position (or contract out) within their organization.  The purpose initially originated in coverage at night in smaller hospitals probably in part to the pharmacist shortage and cost-savings.  It has grown into a position of pharmacists taking on the easier orders or "set" orders and leaving the questionable orders to the on-site staff.  The remote order entry pharmacist also frees up the on-site pharmacist to play a more active role in patient care and intervening whether due to patient care guidelines, hospital protocols, or saving money for the hospital. This is similar but different to CPOE or Centralized Provider (or physician) Order Entry where an order is communicated over a computer network to the medical staff or to the departments (pharmacy, laboratory, or radiology) responsible for fulfilling the order. CPOE decreases delay in order completion, reduces errors related to handwriting or transcription, allows order entry at the point of care or off-site, provides error-checking for duplicate or incorrect doses or tests, and simplifies inventory and posting of charges. CPOE is a form of patient management software.  In theory and practice, a remote order entry pharmacist could sit at home and VERIFY these CPOE orders and maybe even faster than entering them/verifying them alone from written/scanned orders.

Former remote order entry pharmacists can shed some light into this position and maybe give you information on making a decision to try out this interesting role at home:

Initially, when I first heard about remote order entry, I could not fathom sitting behind a screen at home and typing all day.  I am an extrovert by nature and found the thought of order entry from home seemingly isolating.  I went ahead and applied because at that moment in life my absolute goal was to start a family.  I had been married for a year, and we were in our mid-late thirties.  The fertility clock was ticking at a sonic boom volume.  The idea of sitting all day long with less stress seemed ideal.  I was not exactly having an easy go and becoming impregnated and keeping the baby, so it made sense.

I started out making the same hourly wage I had made seven years before (step backward) but was told my commute time was gone, and that I didn't have to worry about wearing scrubs to work!  That in itself was equal to a pay-cut.  I was in a place in my life for this change and agreed with eagerness.

Comparing the Negatives and Positives

Negatives:

1.  Lack of interaction with other clinical personnel.  We learn from one another.

2.  Lack of face-to-face management.  Performace is measured by orders-per-hour and error rate.  Lack of understanding in problem-solving with orders as they are punted back to the facility.

3.  Loss of self-confidence.  A manager would have to work very hard to ensure the only contact with staff is not in following numbers and errors.  Pharmacy order-entry cannot be so black-and-white to forget the complexities of patients, diseases, and drug interactions.

4.  Usually less pay.  It is actually a cost saving to the company, but in the current market where jobs are scarce, expect less for less driving and clothing though the company never paid for it in the first place.

5.  Inability to assess a patient or to see a patient if needed.

6.  Misperceived flexibility of job.  Shifts are still present.  Holidays and weekends are more common.

7.  Loss of patient-care in that numbers per hour and errors are the end measurement, not patient satisfaction, relationships with staff and outcomes.

8.  Lack of HIPAA and TJC guideline enforcement usually a struggle unless monitored.

Positives:

1.  No commute, uniform, or physical presence on-site.  Less overhead for company.

2.  Ability to log-on and quick prn on-call response time in regards to order entry.

 

What are your thoughts?

 

Ode to the Squatty Potty

In reference to the Squatty Potty.  Recommended by a friend, Chloe.  Healthy colon: Happy life! I have a coworker who was quite enthused about the squatty potty in normal conversation.  Being that I am in my forties now and ramping up for obsession with my stool, how often, and the not so wonderful effects of having two children, exercising quite a bit, AND crappy genetics in the tail-end (sorry Mom and Dad, but I do have vivid memories of keeping Preparation H stocked in our home as a child), I thought I'd give the ole squatter a try.

And in response to a wonderful product that could possibly change the world, I thought I would compose a poem right here and now:

Oh Squatty Potty!

My BMs are no longer so knotty!

I no longer need a hot totty

After going for a poop.

The angle is quite right

I often smile in delight

My BMs no longer have stage fright

I know you wanted the scoop!

We were designed to squat to eliminate

I don't want to discriminate

Let the video below illustrate

How we are SUPPOSED to poop!

 

And PS...

my colon (and the rest) thanks you, Chloe.

 

Doing What You Love

lifeThere is this paradox of thought that creeps in most days (if I allow it) and most of the time I will even ask a fellow coworker, "Do you love what you do?"  or "If you could go back in time, would you choose pharmacy again?" This article by Paul Graham found its way to my feed this morning through another reading, and though it took me all morning to read and digest the whole thing, I feel validated.  There are moments when I look at myself from another's point-of-view and think, "Is she happy?"  Happiness is the thing that I tend to search for... you see I couldn't tell you exactly how much money I make to the penny.  I have no idea to the hour how much PTO I have built up.  I can tell you I have been a drug expert since 1999 and only recently so feel I can use that term and MEAN it.

Would I do my job without pay?  That, according to the article, seems to be one of the qualifiers of finding and doing what you love.  Would I do right now for money for free?  Maybe.  I mean, I would definitely change the job.  First, I wouldn't sit in a room and just enter orders all day.  I would probably do more of a clinical job but not clinical that is defined in my current job today.

What would that look like?  More patient contact.  More ER contact.  More of a presence where knowledge is valued and needed in a moment's notice.  I have that to offer.  It would make me happy, even if momentarily in that the Sallie Mae bill I continue to pay monthly would see more worthy.

But, if I was really honest with myself I would stop and say I may find something else someday.  Even if it is something on the side.  Being in-demand was a lovely time when district managers valued your license (not so much your credentials) and would throw new cars, sign-on bonuses and time off your way.  They would appear like vultures outside the retail pharmacy with a suit on and ready to beg.

Today?  The students are graduating and learning the art of begging.

The creative life doesn't seem to coincide with making money.

"The most important thing a creative per­son can learn professionally is where to draw the red line that separates what you are willing to do, and what you are not.

Art suffers the moment other people start paying for it. The more you need the money, the more people will tell you what to do. The less control you will have. The more bullshit you will have to swallow. The less joy it will bring. Know this and plan accordingly.” - Hugh McLeod

And this one by him:

"The best way to get approval is not to need it.

This is equally true in art and business. And love. And sex. And just about everything else worth having.”

What about approval from myself because I am so excited to face the day and go to work because it is not work but my passion?  Is that possible?

Steve Jobs:

Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don’t settle.

What if that looking takes more than 20 years because quite honestly I am THERE.  20 years and able to say apologetically I am still seeking.

The bottom line is start doing the things you love.  What do I love?  Well, I do love medicine.  I would be lying if I didn't admit that.  I do like how convoluted and complicated it can get.  Throw in another disease state and another medication and a genetic tendency to metabolize differently and weight changes.  Throw in some food or no food or grapefruit juice (though in some medications you would have to drink about a quart a day maybe?) and complicate the black and white definition.

Then give it some time because years ago hormone replacement therapy was all the rage and now it's not.  Thank you Women's Health Initiative for that one.

Back to the question at hand...

The realization:  A 21-year-old chose this career path for me.  She, in her silver spoon mentality felt it was prestigious but not to a fault.  She could forsee perhaps having a family and not being on call.  Oh, and Todd Gean's house was close to the biggest house in Adamsville, TN.  He owned and still owns his own drugstore.  Guess what?  I never spent ONE SINGLE DAY in his pharmacy prior to going to pharmacy school.  I am not even sure I was aware what went on except he put pills in a bottle all day.

“If one wanted to crush and destroy a man entirely, to mete out to him the most terrible punishment,”wrote Dostoevsky“all one would have to do would be to make him do work that was completely and utterly devoid of usefulness and meaning.”

Yes, I am searching.

 

23andMe: Knowledge is Power

In 2008, Time magazine called 23andme the invention of the year!

imagesCall me a skeptic. I would have been that prior to the results I received in the mail from 23andme. You see several weeks prior to my results, I received this ambiguous kit in the mail where I had to submit a copious amount of saliva in a cup provided and return back to 23andme. Needless to say, I was ready for my results.

Not only do you obtain insight into your own ancestral history but also medical history. Given the recent decision by many women to have a mastectomy after finding out they are testing positive for one of the breast cancer genes, I wanted to see if I had any increased risks compared to others.

The information received was and is (still combing through all the material) overwhelming. I found out there is a particular enzyme I am deficient in that could pose a problem with a certain class of medications. I am a fast metabolizer of caffeine!

An example of some of the medical conditions seen (compared risk to average):

Name Confidence Your Risk Avg. Risk Compared to Average
Coronary Heart Disease
Established Research: Multiple studies with 750+ participants
29.3% 24.4% 1.20x
Age-related Macular Degeneration
Established Research: Multiple studies with 750+ participants
22.2% 7.0% 3.16x
Atrial Fibrillation
Established Research: Multiple studies with 750+ participants
20.5% 15.9% 1.29x
Venous Thromboembolism
Established Research: Multiple studies with 750+ participants
14.3% 9.7% 1.47x
Restless Legs Syndrome
Established Research: Multiple studies with 750+ participants
5.2% 4.2% 1.24x
Ulcerative Colitis
Established Research: Multiple studies with 750+ participants
0.66% 0.51% 1.30x
Celiac Disease
Established Research: Multiple studies with 750+ participants
0.42% 0.24% 1.77x
Lupus (Systemic Lupus Erythematosus)
Established Research: Multiple studies with 750+ participants
0.31% 0.25% 1.26x
Bipolar Disorder
Established Research: Multiple studies with 750+ participants
0.20% 0.14% 1.44x
Esophageal Squamous Cell Carcinoma (ESCC)
Established Research: Multiple studies with 750+ participants
0.09% 0.07% 1.21x
Stomach Cancer (Gastric Cardia Adenocarcinoma)
Established Research: Multiple studies with 750+ participants
0.08% 0.07% 1.22x
Abdominal Aortic Aneurysm
Preliminary Research: A single study with 750+ participants
Elevated risk
Alcohol Dependence
Preliminary Research: A single study with 750+ participants
Elevated risk
Alopecia Areata
Preliminary Research: A single study with 750+ participants
Elevated risk
Dupuytren's Disease
Preliminary Research: A single study with 750+ participants
Elevated risk
Hay Fever (Allergic Rhinitis)
Preliminary Research: A single study with 750+ participants
Elevated risk
Hodgkin Lymphoma
Preliminary Research: A single study with 750+ participants
Elevated risk
High Blood Pressure (Hypertension)
Preliminary Research: A single study with 750+ participants
Elevated risk
Hypothyroidism
Preliminary Research: A single study with 750+ participants
Elevated risk
Keloid
Preliminary Research: A single study with 750+ participants
Elevated risk
Narcolepsy
Preliminary Research: A single study with 750+ participants
Elevated risk
Primary Biliary Cirrhosis: Preliminary Research
Preliminary Research: A single study with 750+ participants
Elevated risk
Progressive Supranuclear Palsy
Preliminary Research: A single study with 750+ participants
Elevated risk
Restless Legs Syndrome: Preliminary Research
Preliminary Research: A single study with 750+ participants
Elevated risk
Sarcoidosis
Preliminary Research: A single study with 750+ participants
Elevated risk
Sarcoma
Preliminary Research: A single study with 750+ participants
Elevated risk
Stomach Cancer: Preliminary Research
Preliminary Research: A single study with 750+ participants
Elevated risk
Cleft Lip and Cleft Palate
Preliminary Research: Fewer than 750 people studied
Elevated risk
Hypertriglyceridemia
Preliminary Research: Fewer than 750 people studied
Elevated risk
Tourette's Syndrome

Very insightful! And there are many more diseases covered.

You can also connect with others who share DNA and are possible relatives. So far I see that I am matched with several 3rd-5th cousins.

There are a few videos you can investigate to obtain more information about this valuable service:

23andMe provides over 240 health reports

With over a quarter million members, 23andMe is the largest DNA-based ancestry service worldwide.

When 23andMe was founded, the price of the personal genetic service was $1,000 and over time they have been able to reduce it to $99, making it a widely available information tool

I cannot wait to see where these results take me. I have already been in touch with some potential relatives. I will update as to what knowledge is gained.

I was selected for this opportunity as a member of Clever Girls Collective and the content and opinions expressed here are all my own.

How One Patient Pharmacist Relationship Can Change Your Life

One patient can completely change your life.  Brenda was her name.   The website where there is an online cemetery mirroring how it looks in real life.  There are moments in my career where I sit back and remember the impact she had on my life.  Not only was she so vibrant (even over the phone) but she was also inspiring.  We were in the same generation though my life was about a young man I had met (and later married) and hers was about fighting for her life.  I was her pharmacist while she was at home battling breast cancer.  She had a boyfriend with the same maiden name as me, and well it was cool Brenda and I had the same initials. pharmacist patient relationshipI always want to connect with patients, but unfortunately my current job does not afford me the opportunity very often.  I lingered outside one patient's room at the hospital yesterday wanting to go in and introduce myself letting him know I wished him the best with his new situation and just say hello.  I have to do this more often.  There is nothing at work keeping me from opening the door and saying hello.  I guess I worry the patients are bothered enough all day and night by nursing and physicians and lab techs and all.  They get little rest, and they are sick.  Perhaps some would want a friendly face just saying hello and asking them if they need anything.

It was a little easier for me in home health because I had to call to find out how they were doing on their supplies, how nursing was handling things with the home IV antibiotics or TPN and it made it easier for me since I have this southern accent that sounds more southern even TO a southerner.  Ha!  That in itself was always an easy icebreaker.  "Where are you from?"  It always went from there.

Brenda wanted to go to Florida and jet ski.  With her pain pump.  We made it happen.  I'm proud of that memory.  I'm proud that I finally went out to meet her in person though I should have gone earlier when she was not in the final stage of life.  I saw a picture of her healthy.  Beautiful and full of life... same as most of us now.  We just can't waste this life we have!

I may have blogged about her before.  I haven't gone back to look because today I am thinking about her... it's been ten years, but I still think about how her life focus shifted with knowing she had little time left.  I am guilty of complaining quite a bit about my current job at times.  There are so many things that bug me mostly dealing with how things are handled, how pharmacists have those in control snowed, and how there's very little incentive (promotion, opportunities, salary increases, etc...) to even go above and beyond.  A new schedule comes out and I think why in the hell did I decide to do this job?  I mean, yes, it could be worse.  I know this.  But, could it not be better?

I think I am going to try to make these interactions with patients happen more often somehow.  If you have any ideas on how I can at the hospital, let me know... or if you have made it happen let me know.  These moments define major influences in my life (in the past), and I don't want to lose them by allowing my current situation to completely stifle who I am as a pharmacist.  Don't let your job dumb you down professionally or personally.

 

Pills, Thrills and Methadone Spills!

I have an exciting giveaway to mention!  A fellow twitter pharmacist has written a book available on amazon kindle!

Mr Dispenser is  a community pharmacist from England and has written a funny book about pharmacy called ‘Pills, Thrills and Methadone Spills: The Adventures of a Community Pharmacist’.
It’s a collection of the best blogs, tweets and anecdotes about the wonderful world of pharmacy.
There is a chapter of American anecdotes in there.

Get your Kindle version here: Paperback copy 

5% of sales are going to  Pharmacist Support which is a UK pharmacist charity.

Want to follow the author?

Blog

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Retweet this post or share on Facebook for a chance to win a free copy!  Winner will be decided this coming Monday at noon!  Post a comment on THIS POST saying you retweeted or shared.  Drawing will be random!

 

US News 100 Best Jobs of 2013 | Pharmacist is #3

BestJobs2013.jpg

I am a little baffled at Pharmacist being listed as #3 on this year's US News 100 Best Jobs because it seems to me that many of the pharmacists I read about on the internet are not very happy.  Personally pharmacy has been good to me.  I definitely would rather be a pharmacist than a dentist or an RN. BestJobs2013#1 - Dentist Overall Score: 8.4 | Median Salary $142,740 Ever heard the phrase "Your face is your fortune"? For dentists, our smile is their fortune. They earn their living diagnosing and treating teeth and gums, performing oral surgery, and counseling and educating us on maintaining proper oral health. The profession should grow 21.1 percent by 2020.

#2 - Registered Nurse Overall Score: 8.2 | Median Salary $65,690 The nursing profession will almost always have great hiring opportunity because of its expanse (from pediatric care to geriatric care, and everything in between). And as a substantial chunk of our population ages, the necessity for qualified RNs intensifies.

#3 - Pharmacist Overall Score: 8.2 | Median Salary $113,390 With excellent job prospects and a solid average salary, the pharmacist profession nabs the No. 3 spot on our list. Possessors of a Pharm.D can anticipate nearly 70,000 available jobs this decade—the brunt in physician offices, outpatient care centers, and nursing homes.

#4 - Computer Systems Analyst Overall Score: 8.2 | Median Salary $78,770 Think of a computer systems analyst as a tech project manager. He or she is often a liaison between the IT department and a client, and has influence over both the budgetary and technical considerations of a project.

#5 - Physician Overall Score: 8.2 | Median Salary $183,170 At the top of the medical food chain, physicians diagnose and treat patients, plus they instruct on proper diet, hygiene, and disease prevention. And like other jobs in the healthcare industry, physicians will see abundant job growth to 2020.

And because I love this link mostly because I am included on the page, I will repost.  You will notice though who #1 is:

The Angry Pharmacist: For opinionated posts about drugs, patients, and pharmacy in general, read through this blog and see how this blogger earned his name.

He's angry.  I bet he wouldn't say his procession should be listed #3.

Read more about the top pharmacy blogs out there.

 

BCPS 2013: Pediatrics

I feel I have a bit of insight into the test and can attest to what is needed to know in each section.  Keep in mind the guidelines could change between 2012 and 2013 along with the test questions, but for the most part I found the test to be incredibly fair though stressing areas more than others that I would have not expected. I want you to pass!  First attempt!

So what do you need to do to pass?  Start now.  I especially am talking to those with families and/or children and very little time to spare for sitting down and studying the traditional way.  Again, I did fail this past year, so I will disclose that immediately, but I do believe I have insight into the test and very much plan to pass it this fall.  It's a goal at this point for my own personal development.

So, ahead I will have some material presented that does come from the ACCP study material though reworded and simplified in more study form and perhaps some hints as to what was important on the test in each particular section.  I am hoping to not get in any sort of trouble by doing this as far as with the BPS, so if this is not appropriate, would someone from there contact me?  I do not plan on giving test questions per se' and I couldn't if I tried as there were far too many to memorize.

After two children I am convinced parts of my brain were delivered with the children as it is.

First up!  PEDIATRICS!BCPS pediatrics

This was always the topic that would terrify me prior to having children, but at this point besides missing one of the most common concepts of children and the very small amount of data on the test regarding pediatrics (at least in my opinion), pediatrics just doesn't seem so daunting.

Know the common pathogens of children in sepsis and meningitis.

0–1 month  

  • Group B streptococcus
  • Escherichia coli
  • Listeria monocytogenes
  • Viral (e.g., herpes simplex virus)
  • Coagulase-negative staphylococcus—nosocomial
  • Gram (−) bacteria (e.g., Pseudomonas spp., Enterobacter spp.)
  • nosocomial

1–3 months

  • Neonatal pathogens (see above)
  • Haemophilus influenzae type B
  • Neisseria meningitidis
  • Streptococcus pneumoniae

3 months–12 years

  • H. influenzae type Ba
  • N. meningitidis
  • S. pneumoniae

> 12 years

  • N. meningitidis
  • S. pneumonia

Not to hard to figure out correct?  Keep in mind that H. flu is less and less due to immunizations.  I suppose if you live in an area where vaccination is the devil, you may find more of this organism.

 

Potential Antibiotic Regimens

Age                                                                         Regimen

0–1 month                                                            Ampicillin + gentamicin OR ampicillin + cefotaxime

1–3 months                                                          Ampicillin + cefotaxime/ceftriaxone

3 months–12 years                                             Ceftriaxone ± vancomycina

> 12 years                                                             Ceftriaxone ± vancomycina

**Addition of vancomycin should be based on the regional incidence of resistant S. pneumoniae.

                               

Regimens for Chemoprophylaxis  (I will have to reformat this later)

Drug                      Neisseria meningitidis                                                                       Haemophilus influenzae

Rifampin            < 1 month old: 5 mg/kg/dose PO every 12 hours × 2 days                       20 mg/kg/dose (maximum 600 mg)

> 1 month old: 10 mg/kg/dose PO every 12 hours × 2 days                   daily x 4 days

Adults: 600 mg PO every 12 hours × 2 days

 

 

Ceftriaxone             < 15 years old: 125 mg IM × 1 dose                                                               Not indicated

> 15 years old: 250 mg IM × 1 dose

 

**Ciprofloxacin and azithromycin are possible alternatives although not routinely recommended.

 

RSV - Identify the drugs available for preventing and treating respiratory syncytial virus.

Prophylaxis

  1. Nonpharmacologic: Avoid crowds during RSV season and conscientiously use good hand-washing practice.
  2. RSV IVIG (RespiGam): No longer marketed in the United States (didn't see on the test ;))
  3. Palivizumab (Synagis)
  • a. Dosing: 15 mg/kg/dose intramuscularly; given monthly during RSV season
  • b. Effects on outcomes

i. A 55% reduction in hospitalizations for RSV

ii. Safe in patients with cyanotic congenital heart disease

iii. No reduction in overall mortality

iv. Does not interfere with the response to vaccines

v. Not recommended for the prevention of nosocomial transmission of RSV

Know this:  Supportive care.  Treatment is supportive care only.

 

American Academy of Pediatrics Palivizumab approval:  (you WILL see this)

 

i. Premature infants born before 32 weeks’ gestation (i.e., 31 weeks, 6 days or earlier) who are 6 months old or younger at the beginning of RSV season

(a) Infants born at less than 28 weeks’ gestation may benefit up to 12 months of age.

(b) Eligible for a maximum of five doses of palivizumab during RSV season

 

ii. Infants with chronic lung disease who are 2 years or younger and who required medical management of their chronic lung disease in the previous 6 months – Eligible for a maximum of five doses of palivizumab during RSV season

 

iii. 32 and 35 weeks’ gestation (i.e., 32 weeks, 0 days through 34 weeks, 6 days) who are 3 months or younger at the beginning of RSV season

(a) With at least one of the following risk factors may benefit: infant attends childcare or sibling younger than 5 yo in same household

(b) Eligible for a maximum of three doses of palivizumab during RSV season

 

iv. Infants 24 months and younger with hemodynamically significant congenital heart disease

(a) Eligible for a maximum of five doses of palivizumab during RSV season

(b) There is a 58% decrease in palivizumab serum concentration after cardiopulmonary bypass; therefore, a postoperative dose of palivizumab is recommended as soon as the patient is medically stable.

 

v. Infants 12 months and younger with congenital abnormalities of the airway or neuromuscular disease that compromises the handling of respiratory tract secretions – Eligible for a maximum of five doses of palivizumab during RSV

 

Tomorrow will continue with otitis media...

 

 

When People Fail

opi_lance-armstrong_12413.jpg

Handout photo of Lance Armstrong speaking with Oprah Winfrey in AustinI am personally struggling with two pieces of information today.  The first is that Lance Armstrong has come clean with Oprah about his doping scandal.  I had hoped that it was all fabricated by those who were jealous, but alas he is guilty.  I cannot even understand why the leagues (baseball, biking etc...) don't realize that the cost of winning is at ALL costs.  Why not just make these substances all legal and do away with that aspect of what we are capable of doing on our own.  This is 2013.  I would say at this point most sports has seen their very best without enhancement.  What is left?  Enhancement. I know that seems bizarre for a pharmacist to say publicly that doping for sports should be made legal, but that is what I am saying.  As long as it stays illegal, the coaches and trainers and others involved in making the best of the best will go at all lengths to find substances that are not yet known or tested and continue to dope.  It is inevitable.

The other piece of information that I am struggling with today is that a former classmate in pharmacy school (who I will call Ed for his own privacy) has made a deal in pleading guilty in a case that I have had a hard time understanding.

You see, Ed was the type of student in our class who was a man of character.  He was one of the good guys.  I believe he was already married and was in the pharmacy fraternity that was more studious and less partying.  You can imagine that I was in the partying one and you would imagine right.  Ed has a large family now; he has small children and a wife that need him.

Ed has had some legal trouble in which there was some sort of federal charge brought against him for distributing controlled substance (Oxycontin) from his pharmacy.  I don't know how this whole thing began, but apparently it began fairly innocent enough with perhaps one bad decision or perhaps another part of the story that I do not know.  Maybe it was driven by needing money.  Perhaps it was driven by a bad decision further snowballing into extortion by some drug addicted criminals.

Either way, Ed is going to likely go to prison for around five years or so, and my heart breaks for him.

I know that it is easy for many to condemn a man like Lance Armstrong for doping but the bigger offense being the lies he told over the years and nastiness that ensued.  He threatened, sued and was a bully for the most part.  He "beat" cancer of the brain metastasized from testicular cancer, and he founded Livestrong.  There was good to the fame and notoriety even if he came by it by cheating.  Does the means justify the end?  Sometimes?

Fifteen years ago I would have looked at both men making bad decisions and would have spewed my opinion, and it would have been quite judgmental.  I tend to not do that as much because the situation is much more complicated the older I get.  You see, people fail.  People are human - even the most trusted professional, the pharmacist.  The moment that I believe that I am infallible of filling will be the moment where I am the most vulnerable.  We must always strive to do our best.  Do not compromise even for a moment the integrity and good name you have.  It is all you have in the way of public opinion, and in the case of Ed, I was a little saddened to read that he has struck a deal with the government about pleading guilty to one count and going to prison.  He will be sentenced right before this summer, and I dread it for him and his sweet wife and children.

I do hope for a silver lining for Lance Armstrong somehow.  I hope that he is able to look back at his life and see his own shortcomings and how they shaped him into something even better.  Yes, he made a mistake and turned that mistake into a snowball of lies and more denials that took years for him to admit, but there are good things that he has done.

My friend made a mistake and is going to pay the consequence for it by missing five years of his children's lives.  Both of them still are men I can admire for good things in the past and I hope even better things in the future.  Somehow.