The Fifteen Year Thank-You

To the Editor. Oftentimes as educators, we wonder what impact we have on our students. Through our passion and enthusiasm to inspire students to learn, we still ask ourselves, “Do they learn from our instruction and put into practice lessons learned during their days in the pharmacy program?” We periodically evaluate their understanding of lessons through examinations, but we know (as we were once students) that much of the information that was “crammed” is lost after the examination. My phrase for this process is “bulimic learning.” Additionally, we hope that during the introductory pharmacy practice experiences (IPPEs) and the advanced pharmacy practice experiences (APPEs) students will demonstrate that they know and can utilize the lessons learned for the benefit of the patients, consumers, and allied health care professionals they serve. In addition to students assimilating knowledge, we ask ourselves if we have inculcated in them the performance-based skills (eg, communication, problem solving, decision making, and societal responsibility) necessary to navigate the profession effectively and successfully. After all, part of our purpose as educators is to help our students create their professional futures.

Fifteen years ago, I stood before my first class of pharmacy students at Ohio Northern University (ONU). My new teaching assignment was to instruct the students in the pathophysiology and pharmacological management of myocardial infarction (MI). I knew this content with the therapeutics sequence would be difficult and not one which every student would embrace. Indeed, I told myself in all likelihood perhaps only a few students would remember what I taught. To facilitate student learning, I developed a mnemonic device for them.¹ Since then, I have tweaked my MI instructional plan based in part on constructive criticisms from students and incorporated new information, but I have always wondered about its value. What follows is a letter I recently received from an alumnus from that first class:

Dear Dr. Sprague:

I want to take an opportunity to praise ONU College of Pharmacy for the wonderful education I received. It has served me well in my professional career and most recently in my personal life. As I have been telling my story, I find myself referencing my education and specifically your cardiology class and needed to let you know what an impact it has made. As pharmacists, we are trained to serve our patients to extend and save their lives…I never dreamed it would be my own.

Seven months ago, at the age of 35, I had a heart attack while home with my two small children. It was acute, painful, frightening, and nothing I had ever felt before. I had some classic as well as atypical symptoms and at the time could not process what was happening. My husband arrived and called 911 after explaining how my chest pain and shortness of breath were not subsiding. The medics immediately treated me as a cardiac patient even though I did not “look the part.” I followed everything they said, giving [me] baby aspirin and oxygen. Once en route to the hospital, with the pain level still high, the medic gave me a nitroglycerin; almost immediately the pain reduced although it did not completely subside. At that moment, I knew it was my heart. At the local hospital, I was treated again as a cardiac patient and stabilized. I was being observed and waiting on my 2nd lab draw.

The ER physician was surprised to see that, though all my other labs were normal, my troponin had elevated. This marker is something I recalled specifically learning from your cardiology class. It was something you stressed we needed to comprehend when we reviewed the MI process. The physician was surprised that I knew what this meant. I explained I was a pharmacist and confident in knowing what this could indicate.

At the heart hospital, I was told by several people that I “did not look the part.” I was told there could be a lab error, but they would continue to draw labs and follow-up in the morning. Throughout the night, I would ask a nurse about my troponin levels. By morning I had a total of 4 results, all increasing with time. I wrote them down and tracked it. I needed to know, did I have a heart attack? The rounding cardiologist asked me to explain my symptoms; after detailing every sensation. I finally said “I felt like I was having a heart attack.” I figured I would make it as clear as possible. He said he doubted it and went on to explain stress and panic attacks. I then inquired about my troponin levels. I explained they had increased. He said “I will be right back…” He came back a few minutes later. “You're having a cardiac cath!”

I was taken aback by 2 things, the cath and the fact that I may have possibly been discharged if I had not inquired. The cath was scheduled for the next day—again, because I did not “look the part.” I spoke with another cardiologist the next day, again same scenario, I had to inquire about my troponin levels. He ruffled through some paperwork and then started to explain. My husband and I stopped him. We will wait for the cath results.

The cath results: right coronary artery aneurysm with a 90%-95% stenosis beyond with a possible dissection. Open heart surgery to perform CABG the next day.

After open heart surgery, I endured several weeks of home nursing and physical therapy and eventually cardiac rehab. It took me 14 weeks to complete rehab; along the way, people would say “How did you know something was wrong?” “What did it feel like?” “How did you know to ask and inquire about cardiac markers?” “Most people have no idea what troponin is.” I explained that I had the best cardiology professor in pharmacy school. The ironic part is, I have said that for years when faced with explaining a cardiac issue. Believe it or not, I have even kept my cardio p-col notes all these years because I would refer to them at times.

Recently, I have been asked by the American Heart Association to share my story at a GO RED luncheon in Columbus and at their Board Meeting in December. This is truly a positive opportunity to create awareness from my event. I just wanted to let you know how grateful I am for having such a wonderful knowledge and education from ONU....it allowed me to be confident in questioning my results, and my knowledge base truly saved my life!

In Family Man, Robert Fulghum wrote, “learn from them (one's children); they have much to teach you.”² When substituting “students” for children, the sentence would read “learn from students, they have much to teach you.” Certainly, through this letter, a former student has taught me why I am an educator. An educator's objective is to enhance their abilities as health care professionals and encourage caring for others. Caring is central to everything because it demonstrates how much we value our students, and our students can feel it emanating from us. Legendary basketball coach John Wooden often talks about the importance of caring in helping players, colleagues, students, and others. Further, he emphasizes actions, rather than words, demonstrate caring. The fact this former student cared enough to write this letter caused me to pause and reflect on why I became an educator. I thank her for caring and in turn teaching me.

As a dean of a college of pharmacy, my administrative duties do not allow me to teach as often as I would like. However, I sincerely cherish those times when I am able to do so. An occasional “escape” to the classroom can be extremely rewarding. My hope is all of us experience the joy of teaching and caring for our students and one day receiving a “15-year thank you.”

Jon E Sprague
The Raabe College of Pharmacy, Ohio Northern University