It’s december 3rd

 And a lot’s happened in the past few months. A lot. 

Canada post strike

Trump got re-elected

Things are still expensive

Another friend gone

Karaoke 2 times (3rd one coming up)

Met a new guy

Group therapy came and gone

November was the month of appointments. December so far has been the month of rest. 

Acid reflux

Travelled to hamilton and mtl amidst precipitous job and relationship situations

Back on EI i wonder if my life will be as tumultuous as my dad’s, who was also collecting EI between contracts at a time. 

Comedones and Coats

I feel like a pore that has been unclogged after a long time. The clog has been present for what feels like a long time. 

Unfortunately the pore must continue to be clogged until I extract the comedone.

Unfortunately. 

- - -

This is a good opportunity to practice holding my emotions. 

For example, I can say: I just bought a new winter coat. It looks and feels amazing, and I love it. 

I feel strongly possessive towards…this coat. Similarly, I am cherishing this protective feeling. It’s like, “finally, I have the thing I want!”

But right now, it’s not yet cold enough to wear this coat. But I know that when the weather becomes colder, I will enjoy wearing it. 

Pulling the sheets over

 I suddenly felt really old. And the familiar feeling of “oh, this again” hit me hard. 

Today it felt good to let my mind go and wander. Not moving against any mental resistance today felt great. 

Walking outside at 10:30 pm, i felt really grateful for living in a calm, safe, and scenic place. I could watch the city lights from across the lake here, and enjoy the bright half moon among the stars. I can actually see the stars here! 

 I feel non entitled and humble. I was let go and they are now holding me at “we’ll look into if you can stay.” Haven’t sent my laptop back, so i guess we’ll see later this week. 

Keep getting thoughts of “i felt productive when i was there”, “the pay isn’t much but it pays the bills”, “i’m glad i was able to help the team and be productive”. 

It may just be stockholm syndrome. Or, a japanese-esque way of life, where I am giving this job my 110%, no matter how unimportant or small it is. 

My mood is falling and i feel forces at work that are trying to take me away from feeling at home. 

just regular life, in no particular order

I finished eating my garlic chive microgreens today I bought from the farmer's market. I have also been eating maggi instant noodles with quail eggs. I need to make more new recipes such as fried rice, maybe japanese pasta again with seafood, and clams in sake. I have all those ingredients. 

I have a meeting tomorrow evening because I am looking for more work. Turns out working at a startup is unstable. Ha ha. Who knew. Things are getting more "negotiable" at work. Today I learned that my coworker got her salary reduced, but her contract converted to a full-time permanent position. I worriedly listened to her as she explained that project manager leads to  senior PM which then leads to director of operations, or Chief of Operations. Which is not really where I want to be because operations is too behind the scenes and stressful. I connected with a lot of people on LinkedIn today because I felt like it. And a lot of people are back from vacation. 

I feel bad for downloading 3 new epubs for free this month. Coco Mellors' Cleopatra and Frankenstein, Sally Rooney's Intermezzo (which I saw with Maya at Indigo), and Jenny Wang's Permission to Come Home (which I bought at Indigo). Apparently Coco Mellors was an alcoholic and didn't want to leave NY because of her support network. I read an article about how her story was rejected 30 times but she kept sending it to publishers, but kept thinking "this is not relatable. you probably have agents and people championing your book, and maybe you have the means to do this. you seem like an entitled caucasian woman because all your author photos are of you in fancy houses and in fancy clothing." Oh, and earlier this month, or around end of September, downloaded Ted Hughes' Birthday Letters.  Last month, I also bought Tao Lin's Leave Society on Amazon. I wish I could re-read normal people again. I started reading Permission to Come Home this week. It is very relatable. 

This weekend was thanksgiving. Quiet, and I need to text my mom back that I'm not going back to Calgary for the winter. I know she wants me to go back. I kind of want to go back to avoid a similar awkward christmas dinner with M that we had last year, but last year was great when I was living in it. I used D's car which he parked here over the weekend. His dad may be remarried soon to a wealthy Chinese woman, who I suspected may just want to move to Canada with him. I shared the story of my grandfather remarrying his nurse caregiver soon after my grandmother died from lung cancer (I forget which year), who is probably like 10-20 years younger than him according to my mom. In China there are different expectations. D said to his dad, if I brought a guy home and said I was marrying him in a week, how would you feel? His dad said nothing. An interesting way to parent the parent. We walked together along the lake for a little while and he gave me incense from Japan. I got a matcha latte from Cafe Boho.  D wanted bbt but they were closed. I got bubble tea tonight for myself. He left when I was in a catch up meeting so I didn't get to say bye. I hope his car smells better next time. 

My sister got her switch back, and I got a used ACNH themed switch from FBM. I don't like the led screen on it. I think having a wii would be cool. Maybe when I get another TV. Living at Fern was kind of nice because of my TV. But now I don't have Netflix and my monthly expenses have slightly increased due to rent and inflation of my tenant insurance, I feel. 

I also bought 2 new hobonichis, filled out the 5-year paper survey, and have set up my day-free already. I'm glad that the true prices for these books are not expensive. So in 2025, I will only use the 5-year and day-free as a planner. I think I need to do brain dumps more often. M has asked to keep my 5-year if I receive a better replacement, and I said yes. But now I'm not sure if I want to keep writing in it if I may eventually give it away. 

I also have a stye in my left eye that I'm using tobramycin eye drops for. Interesting that the prescription antibiotic eyedrops has a "narrower" spectrum of activity, targeting mostly gram positive bacteria which is the main culprit in eye infections. I guess it's because it comes from the skin? Scientific Knowledge feels endless. I have a feeling this stye was caused by my new prickly pear cactus, which I learned today releases its spikes when touched, even the short brown ones. I did feel excruciating pain when waiting for the streetcar after a wellness talk. I have had this stye and the foreign body sensation in my eye for about a week now, and it is very uncomfortable. I am trying to replant my cactus into a bigger pot using maybe a mix of bonsai soil and regular potting soil. I would use sand if it was easier to obtain. Having a new plant feels really good. My monstera and my yucca have been growing too, but slower. 

I finally got a heat gel pack that's perfect for my eye. It was $8 at the independent pharmacy. 

Interesting to remember that I curently live in the largest city in Canada. 2nd is Montreal, and 3rd in Calgary. 

occasionally I'll rent a car and go on a little outing by myself, or with my boyfriend. We'll visit supermarkets with dazzling arrays of fruit and meats, then stop by for some delicious chinese food in a small plaza up north. other times, I'll visit my friends and together we'll go to these same supermarkets to buy handfuls of big fruit and unique animals to cook a t home. after a tiring da y of spending money and hauling around bags, the route to go home is typically a darker and more isolated road by one of the major parks in the city. Driving the straight road by the park shrouded in darkness felt surreal. Calm, almost. There were animals quietly settling down in there for the sleep or the night-time guard . There were animals that had eyes that could see through the inky velvet darkness. In that forest I coudl have laid down on the dried leaves and twigs and dirt, roll ed around and stared up at the canopy , a dark circlet of branches ringing a murky blue-grey night sky. Driving away from the glittering lights o f the city was when I felt most alive. I had my own wits to rely on. And a comfortable seat to take in the open road and all sights my travels gave to me . The next day I'd be back in that mess, trying to figure out the next day and the next day like everyone else in that city. I remember stepping out of the train into the heart of downtown, with a hot, stinky musky wind blowing into my face as I tried to get my bearings and determine where I was to go next in my appointment schedule, lists seeming ly neverending and head constantly buzzing. Now I'd be driving by the lakeside , in full view of the apartments and trees and the gaping hole to my left that was supposed to be the lake. Homeward b ound, safe to see another day while the rest of us writhe on the cold pavement, imprisoned by our minds in a cage of our own making. Summer I seem to have lost the ability to copy and/or paste. Shame is an interesting thing. I felt it with my boyfriend, I feel it with my job and with my friends. In between long walks and occasional alcohol and marijuana-fueled rants, there’s some loving moments.

I think I'm being creative by posting the entire text in the title. Seems like having a blog is still an interesting medium, so I'll keep going. 

Decisions

 Should I keep blogging forever

Switching between the digital medium and physical is difficult. 

We’ve passed one half of 2024. Some exciting recent events: Alice Munro’s legacy is wrapped in drama, Trump got shot and lived, Scott Pilgrim cartoon is on netflix (and pretty good!), Kanye’s new wife is stirring up more controversy with her skimpy outfits, the AGO and LCBO were on strike this year, the Hobonichi 2025 designs got leaked and there were a lot of Spy x Family designs which I don’t care for, U of T sent me an email asking me to donate crypto.

Poetry from February 2024

I am a thin twig of a woman,

Beads on my neck and a rock on my hand

Weighing me down.

I am a woman

Breathing in the sunlight On a friday afternoon

I walk to church, wearing all black

I was the woman

Who blew away in a tropical typhoon

The background was blurry

And I am sharp.

history

No one tells you this fact about life. You make friends, and in between those long moments of solitude there are precious and exciting moments. People pass on, and before you know it, it's been 8 years. I've lost track of the numbers. 

Looking back at the photos I saved on my storage drive, I am realizing that a lot of people have probably blocked me online. But that's normal because I've dated so many people and broken a lot of hearts. In this running tally I call romance, I've lost the "most well-liked" contest. 

            

It takes two to experience vulnerability

In the Uber home, you felt an emotion

In your jail cell made of fibres

But it never broke the surface of your placid face

You voluntarily lie down

Let the waves crash upon you. 

When you look at the universe it doesn’t feel so bad

When you zoom into one piece of dust in this desert

You find a searing pain equal to the mass of a black hole.

Pour yourself a cup of coffee

Fingers and pens tapping on the desk

It is too bright outside to do anything.

Stop it, you think

Trying to erase yourself with willpower. 

It feels like forever

The bad memories stay, the good ones leak out like light

You can’t see the way out like you used to.

 

Current state of pharmacy in ontario

These are my thoughts in response to the recent series of events in the news about the Canadian pharmacy landscape. 

Background: the general public and pharmacists are unhappy about the cold calls coming from mostly shoppers employees, and CBC news has picked up the story, spreading the issue widely for awareness. As a pharmacist, this has been difficult to respond to in my practice setting.

This has been a long time coming. Even before COVID, SDM had quotas. Still, I imagine executives in the Ministry of Health, SDM head office, and Loblaws running into a meeting room together in desperation, saying "shit shit shit this is bad" then throwing together a pizza lunch disguised as an informal town hall. (And then pointing fingers afterward.) Obviously I don't have a very rosy impression of working in a corporate setting.

Quotas are not a problem at the front line staff pharmacist level, but a problem with the overall lack of funding to pharmacies at the government level. Since COVID restrictions were lessened, the need for in-store symptomatic testing for patients and prescription extensions (occasionally netting the store a $15 fee per prescription) disappeared, resulting in reduced billing of professional services to the government and thus less profit entering the pharmacy owner’s pockets. SDM corporate wanted to minimize this profit drop after the pandemic, so started  emphasizing the billing of Medscheck services at this point in time due to their profitability. This all happens because the government only reimburses the cost of the drug at the cost the pharmacy buys it at and returning a marginal profit back into the store owner’s pocket (*). Drug pricing in canada is another can of worms currently open to debate as well (look up PMPRB drug pricing reforms). 

(*) this actually depends on the class of drug (high-cost biologics vs. non-biologics) and is subject to changes in drug pricing and changes to the government formulary. 

(*) ALSO, this doesn't take into account the NEW updates to the Executive Officer Notice: Change in markup effective April 1, 2024: https://www.ontario.ca/files/2024-03/moh-executive-officer-notice-change-mark-ups-en-2024-03-28.pdf

TLDR: A Volume-based funding model is not profitable enough for corporate since the pandemic occurred, so they supplement it with additional services enforced with quotas. So you can see it is a chain reaction or a series of events that has led to the current state of pharmacy. The quotas issue does not exist in a vaccum. The ON government and OCP were doing nothing to address this issue, and unfortunately our voice is not heard.

General Timeline

July 2013
Loblaws acquires Shoppers.
Maple health gets funding from Loblaws and Jeff Leger used to be on their board of members (this is public knowledge). Loblaw also owns Medeo. And a lot of different grocery stores (another complaint).

The big question is, how close are Loblaw and the Ontario government? 

From 2019 to 2022
Proof #1 - Loblaws literally lobbies the Ford govt re: selling recreational weed at groceries/retail stores 

March 2020
Proof #2 - SDM lobbies the Ford govt during pandemic times 
Proof #3 - ON Govt makes deal with SDM re: free menstrual products in schools 
Additional proof? I got tired of looking for evidence and fear that this post is veering off into conspiracy land. But there is proof (an easy google search) that a) Loblaws is lobbying the government and making contact and b) these lobbying efforts are seen as changes to policy in real-time.

2024

Feb 5 

Manulife reversed the deal to cover specialty care drugs at select Loblaw-owned pharmacies (PPNs). CPhA (our national pharmacy advocate group) issues a statement on legislation concerning PPNs. 

Feb 28

CBC publishes an article about noise from current + past pharmacists of SDM on pressure to conduct medschecks. Jeff Leger (CEO of SDM) denies the truth about corporate targets for professional services.

March 1
- Associates make cringy linkedin posts stating the value medschecks and pharmacists have on patient care. No one buys it. 

- Jack Hauen, The Trillium reporter, posts on reddit asking for proof and information from pharmacists.

March 5
OCP, our regulatory body, conducts an anonymous survey about medscheck targets and plans to host a town hall for this issue. Ongoing negative sentiments about Jeff Leger and SDM online.

March 11
OCP opens registration for town halls from March 11-18. 

Notes after the recent town hall: OCP oversees malpractice, and the patient-related side of pharmacy practice, and should not care about the financial wellbeing of pharmacists and their corporations. But they have a direct role in pharmacy accreditation and regulating scope of practice, such as the ability of pharmacists to conduct virtual medschecks. It feels like a gray area, well summarized in the article, "Jurisdictions across North America are struggling to address the tension between profit and patient protection."

March 14
New article about how SDM continues to deny targets, as well as additional proof of targets from internal emails and associate testimonials. In one week, SDM stores in Ontario billed ~$1,400,000 worth of medschecks; each store conducting an average of 30 to 35 medscheck interviews during that week. To date, OCP has apparently received 4,000 responses to their anonymous practice survey and expects more than 500 attendees for the series of virtual town halls.

March 19
CBC reports on Telus and its new PPN policy. Employers that purchase Telus health insurance now must make their employees abide by its new policy of filling prescriptions at virtual pharmacies. I learned that ODB (healthcare branch of ON government) also uses Telus as its adjudicator. 

Mar 25 - OCP Board meeting focused on these 2 major issues 
package 

re: PPNs 
Recommendations: the board will be directing college management to move forward with a phased, multi-modal approach to addressing PPNs including short, medium and long-term regulatory initiatives: 

short-term action: position statement → PPN policy be integrated with broader business regulations (placeholder recommendation) → long term action: meet PPN regulatory goals; nothing we can do today to prevent pharmacies from entering into existing PPN contracts, but OCP's focus is the longer term for bigger impact

"PPN models were last discussed by the OCP Board in 2018. At the time, despite its concerns, OCP did not have the authority to intervene in the negotiation of PPN agreements by pharmacy owners and benefits providers. OCP raised the issue with the Minister of Health. No changes were made to the regulatory environment that would have increased OCP’s jurisdiction. Following an initial announcement earlier this year about a PPN between Manulife and Loblaw, and as indications suggest such models appear to be having an impact on more patients, this topic will be discussed at the March OCP Board meeting. In its most recent strategic plan, OCP committed to doing what it can to protect patients from the impact of any business model that increases risks to patient safety or gets in the way of a pharmacy professional’s ability to provide care in accordance with standards and their ethical responsibilities. OCP will re-examine its jurisdiction and the impact it can have within its mandate and will work with government and other partners to explore how to achieve this goal."

re: Corporate Quotas on patient/provider safety
How did we get here? College aware that this is a long term issue
esp. since 2017-2018 ESA call for change (pharmacist lunch breaks) were not changed

- OCP wanted to ensure autonomy of pharmacists to allow flexibility in practice

- the ongoing noise and concern about business decisions impacting pharmacy practice became Strategic Goal #1 for OCP's 2024 operational plan; OCP not ready to implement actions yet but needed jurisdictional environmental scan - will start this year

- OCP aware of the media and questions about why OCP wasn't doing anything. 

- Scope of OCP may be limited in this regard; OCP has jurisdiction over pharmacists and pharmacy accreditations; OCP can also propose legislation to government around scope of practice quality assurance, and registration.

The survey results were accurately summarized at the board meeting, and OCP is brainstorming session outcomes.

March 25

OCP issues a zero-tolerance statement on business practices that interrupt pharmacy/patient care, as part of the short-term 

March 27

CBC article on the outcomes of OCP's board meeting. 

******

And now it is April 2nd! In the hopes of publishing this timely blog post soon I have stopped doing research. Although the journey of reading through all these news articles and reddit posts was fun, it also brought me an underlying anxiety about the future of the profession. The future is uncertain, for now.

Extra reddit posts:

https://www.reddit.com/r/ShoppersDrugMart/comments/1anjst5/professional_services_in_pharmacy_has_gotten_out/

https://www.reddit.com/r/ontario/comments/1aznclx/how_can_ordinary_people_refuse_the_spam/

Snakes and Ladders

Small kindnesses are found every day. I am both a target and a victim of kindness. Sometimes I am the provider of kindness. But because I work in healthcare that cup tends to run empty most of the time, or so it feels recently. Today a stranger asked me how to get to Yonge and Wellesley, and I told her, "you have to walk in this direction" while pointing north. She didn't seem crazy, so I helped her. Kindness is withheld in stores. In clinics. Pharmacies. In any high-volume customer service setting really. Our cups do not fill for just anyone. 

Last week a stranger dropped all her change on the curb as she was about to cross the street. M and I along with some other strangers who were about to cross helped her pick up the change. She said gratefully, “you guys are AWESOME.” Also last week my Uber driver helped me load and unload my furniture into his car, even though I said I could handle it. Another kindness is being welcomed when visiting M’s mom’s place. As a kid, visiting friends’ places meant coming and going with politeness and hushed movements, not disturbing the tranquility and forced perfection of the asian household. There’s none of that now. Maybe it means I am growing up and slowly realizing that it is okay to accept the kindness of others. K helped me realize this, whether he knew it or not. 

The Toronto winds howl, and the people wander the street wear winter coats, light spring jackets, sweatpants and hoodies, the outfits as confusing as the weather itself.

We came across a vintage print of a snakes and ladders game in a bookstore during a 50% off sale day. Upon closer inspection, we found something interesting. Sympathy (bottom of the ladder) leads to Love (top of the ladder). Makes sense. Indulgence leads to illness. Indifference leads to Poverty.