Pharmacy but Faster: An Alumna’s Leap into Emergency Medicine

Isabella Tobin:

You are listening to Living the Pharm Life, the official podcast of Purdue University’s College of

Pharmacy. I’m your host, Isabella Tobin, a PharmD candidate with a passion for telling the stories of our college’s phenomenal and loyal students, faculty, staff, alumni, and friends who persistently pursue excellence in all they do.

Leslie Leins is a 2008 PharmD graduate of Purdue’s College of Pharmacy. She currently works at Lutheran Hospital in Fort Wayne, Indiana as an ER pharmacist. Leslie’s career is a powerful example of how pharmacy professionals can thrive in high pressure environments while still prioritizing compassionate patient-centered care. Listen to Leslie talk about her passion for bringing her best every day for her patients, fellow employees, and mentees.

Leslie Leins is joining us today on the Living the Pharm Life Podcast. I’m so excited you’re here.

Leslie Leins:

Thanks for having me, Isabella. I’m glad to be here.

Isabella Tobin:

Yeah. So to get us started, could you tell us about your journey finding pharmacy?

Leslie Leins:

Yeah. Math and science were always my best subjects in school. I don’t have a creative bone anywhere in my body. Even to this day with my kids, I cannot do Pinterest projects, I cannot create anything on the fly by any stretch. Math and science was always the way to go.

Math specifically. And math, if you’ve been in clinical practice, is something that nurses and providers and people really struggle with. So to be able to take that skill from a classroom level and really to apply it to a practical space is a skill that not everybody can do. So I think to be able to find a clinical role to do that and do that well was a cool calling. I was never going to be a boring math teacher, no offense to math teachers, but this has allowed me to do that in a fun way.

So as far as getting into emergency medicine and all of that, we’ll get into that I think a little bit later, but that was a passion I didn’t know I had. I didn’t really know what that meant when I was in pharmacy school. I didn’t really know that was an option for pharmacists. So it was something that I kind of found my way into later in my pharmacy career, and we’ll get to that in a little while. But yeah, emergency medicine snuck up on me. So pharmacy was a given from the start, but emergency medicine kind of snuck up on me.

Isabella Tobin:

So before finding emergency medicine, you had to end up at Purdue. How did you find your way to Purdue?

Leslie Leins:

Sure. I grew up in a small town actually in southern Illinois. My family friend, one of my parents’ family friends owned an independent pharmacy in our town, and that summer I was looking for a job. It was air-conditioned and it paid more than minimum wage, and so it was clutch. It was the best summer job there was.

I went into it, to be honest with you, for those two reasons and ended up loving it. The patient care and the camaraderie between the pharmacists, just the difference that they were making in patients’ lives. And again, is a small town, and so everybody knew everybody, and just to be able to make those differences in patients’ lives for people that I knew.

It turns out that that pharmacist was a Purdue grad, is still a Purdue grad. The other pharmacists that worked in that pharmacy were Purdue grads. My parents are from Indiana originally, and so I found myself at Purdue. It was the only option. It was presented to me as Purdue is where you will… Purdue is the only option, Purdue is where you go. I was given the swag. I was given old classic flags and foam fingers and all of the things. And I found myself at Purdue, and I have never, for one second, looked back.

I met my husband at Purdue. He’s a Purdue pharmacy grad also, which is not uncommon. I’m sure you know, Isabella, just in your classes, but that’s not uncommon. So yeah, I have never looked back.

But yeah, I credit that pharmacist, again, that job that I went to for the air conditioning and the pay at the time, and it changed my life. Purdue has changed my life.

Isabella Tobin:

Yeah. I’ll never turn down air conditioning and I’ll also never turn down swag, so I completely understand you better.

Leslie Leins:

And I still have it. That original Purdue sweatshirt that I got back in the year 2000 or whatever that now has holes, before thumb holes were cool. I still have it.

Isabella Tobin:

Yeah. Can you tell us more about the why behind what you do?

Leslie Leins:

Sure. Yeah. First of all, I think that’s a really important question, and not just in pharmacy, but in healthcare in general. Healthcare’s hard. The hours are hard, the work is hard, patients are hard, healthcare’s hard. And if there’s not a why behind what you’re doing, burnout happens very quickly. And that’s not just in pharmacy, that’s certainly not just in emergency medicine, that’s in healthcare across the board.

And I do think too, your why may change as your career progresses. The why whenever you’re 25 fresh out of school might be different than the why when you’re 41 in a career, a different career path.

So the why for me right now is the team that I work with. The last five years have been exceptionally hard in healthcare. COVID and short staffing and the nurse shortage and medication shortages and just various natural disasters that have led to different things, medication shortages here and there, the last five years have been really hard. And it has really brought us so close. And I don’t just mean my pharmacy team, my nursing team, my physician team. The why for me right now absolutely is the team that I work with every single day.

Isabella Tobin:

Yeah, that’s fantastic. Thank you for sharing that.

Leslie Leins:

Yeah. What about you, Isabella? What’s your why?

Isabella Tobin:

When I first started at pharmacy school, my why was really, I just wanted to help people, especially my grandmother. She recently passed. But she had all of these health problems and she wasn’t the best at remembering to take her medications. So actually she had, it was over winter break, I was at her house and she had stage four kidney disease, and I ended up confiscating six bottles of NSAIDs from her medicine cabinet.

Leslie Leins:

Oh, boy.

Isabella Tobin:

Yeah. And if for anyone that doesn’t know, you do not want to be taking NSAIDs if you have any type of kidney disease, much less stage four kidney disease. So my why was really I wanted to help her.

But now I think it’s also becoming, I want to help other pharmacists too. Actually, so today is Thursday, on Tuesday, my entire P3 class who went up to Indy for legislative day, and I had an incredible time. I was able to talk to Larry Anderson who’s doing Ashley’s Law, which I’m not sure, are you familiar with it?

Leslie Leins:

I’m not. I’m not.

Isabella Tobin:

I learned so much about it that day. And Ashley had been a pharmacist, she was a 2004 graduate and she had a heart attack and she passed away while working in a pharmacy. So just hearing the story from her dad and how he’s pushing to have better wellness for healthcare workers, it really stuck with me. And it’s been two days since then, but it’s something I’ve been thinking about this constantly since I was able to meet with him. And I really would love to help advocate more for healthcare workers, as well as for the patients we all support.

Leslie Leins:

Yeah. No, that’s powerful. Yeah, don’t lose that.

Isabella Tobin:

Yeah.

Leslie Leins:

That passion [inaudible 00:08:28].

Isabella Tobin:

I’ll try not to. I’ll try not to.

Leslie Leins:

Don’t lose those why’s. Yeah.

Isabella Tobin:

Yeah. I keep thinking about Mr. Anderson. He reminded me so much of my own dad. And I know every healthcare worker has their support system, and my dad has been such a big support for me, so it really stuck home with me.

And she was a Purdue graduate, so it was really… I think we could all see ourselves like that, so it was really touching for me, but sad at the same time.

Leslie Leins:

Sure. Sure.

Isabella Tobin:

Yeah. Yeah. So tell us more about what your patients look like on a daily basis while you’re in the emergency room at Lutheran.

Leslie Leins:

Yeah, sure. So my day changes day to day. Every single day’s a little bit different. We are a comprehensive stroke center, we are a level two trauma center for pediatrics and adults. We are a comprehensive cardiac center, which means we do AFib, chest pain, cath lab, fourth one, heart failure. So we really are a central location for a lot of the spoke facilities to send their patients to us.

My role in the day-to-day when I’m in the ED, it really is to be at the most acute patient’s bedside. So I will go from bed to bed really and facilitate nurse questions, physician questions. I titrate medications, I help with rapid sequence intubation, I make antibiotic suggestions in sepsis. Any and all of those things can happen at any time during any day.

We are a network, so we have other hospitals around Northeast Indiana. I don’t physically sit in those facilities, but I am available for questions and consults and those kinds of things if that’s needed. One of the other major things, and this was something that what little grasp I had on what emergency medicine was going to look like when I interviewed and took this position, I had no concept of this even happening. But part-time emergency care, which is what we offer here, I obviously don’t work 24/7, and I am the only one of my kind here at my hospital.

Isabella Tobin:

Okay.

Leslie Leins:

So when I’m not here, the idea is we would like patients to receive obviously the same level of care whether I’m here or not. Right?

Isabella Tobin:

Right.

Leslie Leins:

So there’s a lot of protocol building, a lot of order set standardization, a lot of physician, nurse, and pharmacist education. My rule is if I get two phone calls at home about something, I build a protocol for it, which happens pretty frequently. So I do a lot of that kind of work. That’s an ASHP recommendation for emergency medicine pharmacists. If you’re not able to provide 24/7 care, a good portion of your time should be spent on standardization of care to cover for those patients whenever you’re not on site.

So I guess in short, or in long, I spend a lot of my time in the emergency department bouncing from patient to patient, facilitating, again, the most acute patient. Or throughout the hospital if we have code blues or whatever, I do attend those. And then my off time or downtime is spent on that protocol management, that education, making sure that guidelines are reflected in our standardized order sets, again, so that when a patient comes in on a day or a time that I’m not here, that same level of care is provided, whether I’m there to oversee it or not.

That was something I didn’t really anticipate. Yeah, so there is some desk work involved, which to be honest, is a nice break sometimes.

Isabella Tobin:

Especially being on your feet all day, having a little bit of desk work sounds kind of nice.

Leslie Leins:

Yeah, it is. You know what? I don’t mind it. I don’t mind that part, but I didn’t necessarily see that coming or anticipate that as much. There’s a lot of meetings and some of that kind of thing too.

Isabella Tobin:

Yeah, I didn’t really even think about that, all the protocols that you would have to have implemented. What are other ways that working in the emergency department might be different than other areas of pharmacy?

Leslie Leins:

Sure. It actually is a complete culture change from other areas of pharmacy. In pharmacy, we are taught indication driven care. So we have an indication, we start a medication and we monitor for results. We write SOAP notes, we write treatment plans, all of the things that I’m sure you’re focusing a lot on in your schooling. And those are the things that will continue into your career. A lot of indication driven care. And that’s how pharmacy, the culture of pharmacy, that’s what we’re taught to do. They’re on lisinopril, well, what are we on it for? We have high blood pressure, we’re on lisinopril, we’re now going to measure and monitor for side effects and efficacy.

And emergency medicine just is not that way. The patient comes in and they’re short of breath. We’re not necessarily going to stop and have a long conversation about why they’re short of breath. We’re going to intubate them, right? We’re going to treat whatever that acute issue is. And then maybe after the fact stop and say, “Now, why do we think they were short of breath? Why do we think they were in complete respiratory collapse?” If they come in and they’re having stroke-like symptoms, we’re going to treat that stroke, and then maybe afterwards talk about indications and risk factors and all of those things.

So it’s a very distinct shift in pharmacy culture as far as what we were trained to do in school. It’s not that we don’t care about indications, don’t hear me say I don’t care about the why. But it’s a lot more treat now and evaluate the why afterwards. Stabilization is the name of our game versus truly indication driven care.

So for me, that was a huge shift. I go down there and I’m like, “Oh my goodness, this person has a fever. Let’s spend 10 minutes deciding why.” Well, their surviving sepsis campaign tells me that 10 minutes is very significant, and so in the meantime, let’s give an antibiotic and then we can talk about the why. So again, that’s just a very big shift in mindset. So I think that’s a very distinct difference from other areas of pharmacy.

Isabella Tobin:

Yeah, even just thinking about that compared to what I’ve been learning in classes, that’s a very distinct change. And I’m doing infectious diseases right now, and we’re talking about all the susceptibility tests. So when you just say, “Oh, we just give them an antibiotic,” I’m a little bit like, “Whoo.”

Leslie Leins:

Yeah. We get cultures first.

Isabella Tobin:

We haven’t done a susceptibility test.

Leslie Leins:

We get cultures first. Tell your ID-

Isabella Tobin:

Of course.

Leslie Leins:

… professor, “We get cultures first.” But then we give them an antibiotic, yeah, and we worry about what they grow later. Yeah.

Isabella Tobin:

Right. Right. Can you tell me about what are some of your favourite things about being an emergency room pharmacist? What’s the most fun part of your job?

Leslie Leins:

I love the variety from day to day. There is no sense of, “Ugh, this again.” And I don’t mean to make it sound like that’s the nature of pharmacy as a whole. Pharmacy in general is a variety profession. The day is different every day. But in the emergency department, the day is different every day, very different, vastly different every day. And not even… I share the different things that I do on the day-to-day, and so it’s not… Sometimes I’m in my office and sometimes I’m in the ER and sometimes I’m off site and sometimes I’m spending the day talking to you, Isabella. Sometimes there’s just really a variety of things to do.

The other thing is not a lot of pharmacists get a chance to spend as much one-on-one time with nurses that I do and really arm to arm with the providers that I do. So I really like that the camaraderie of interdisciplinary type healthcare, and I think it makes a big difference for the patients. I need something and the doctor’s sitting… My space in the ER is right next to him, him or her, and so we sit right next to each other. So if I need something, he’s right there. And I really like the team and the variety from day to day. Yeah.

Isabella Tobin:

Yeah. I know actually yesterday morning, I had a interprofessional experience and we worked with nursing students one-on-one in a small group. So it’s really great to hear that that will continue in some professions outside of just being at Purdue. How do you feel that being at Purdue prepared you for this role?

Leslie Leins:

Oh, one of my favorite classes at Purdue was a… And I know things have… It’s possible things have changed since 2008, so this may not still be an elective, but I took an elective at Purdue my third professional year that was a critical care focused elective. And the two professors that taught it… And we talked about critical care things, we talked about sedation and we talked about paralytics and we talked about vasoactive meds and all of the meds, and that was fine. I enjoyed that. But what I really enjoyed was the enthusiasm and the confidence and just the excitement for the profession that they brought to each lecture.

It was a, I don’t know what you’d call it, but not a podium based lecture. We were in a classroom and we sat in small groups. I don’t know what that is called. You know what I mean? It was a little less formal.

Isabella Tobin:

Right.

Leslie Leins:

And just the excitement that they had as they walked around, I thought, “These two love pharmacy.” This is not just, “I’m here to talk to you about this because they’re paying me to do it and I have…” You know what I mean? It was an exciting time for them. And I think the Purdue professors, that’s how I felt. They were excited to be there.

And I have taken that into how I precept students and residents. And sometimes I’m too much, I get it. They’re like, “Calm down a little bit about… It’s just pharmacy.” But I think that enthusiasm and that joy and that excitement for the profession was what Purdue gave me, and I think that’s irreplaceable. That’s important to me.

But what about you? Do you think, has Purdue changed that much since 2008? Or do you still feel excited?

Isabella Tobin:

I think we still have the critical care elective. I’m not in it, so-

Leslie Leins:

Which is fine. [inaudible 00:20:08].

Isabella Tobin:

… I can’t say 100%. Oh, yeah. But I think we might still have that. I think I saw on the list of electives that we offered. But I completely agree with you with the enthusiasm. I’m really interested in nuclear pharmacy, and so just being here on campus with that-

Leslie Leins:

Yeah. Dr. Weatherman, same thing.

Isabella Tobin:

Yes.

Leslie Leins:

Just the excitement that she brings and the enthusiasm. I’m sorry, I didn’t mean to interrupt you, Isabella.

Isabella Tobin:

No. No, completely, you are 100% correct. She’s always excited about all of the things. She tells me about different projects she’s doing, I do research with her. I’ve been a TA for some of our classes. And just in every single aspect I’ve been able to work with her, it’s so exciting. And all of her students get so excited to do it too.

And it’s also a lot less formal than some of the other courses that we have where sometimes she, it sounds bad, but she will deliberately set us up for failure in some of our lab courses in nuclear just to see how we turn around and make it positive. But she gets so excited when we fail, that it’s a wonderful experience. And I completely agree with you with the enthusiasm, it just makes me really excited to continue being in this profession.

Leslie Leins:

Yeah, I love that. It’s take it with you all the way into your career, 100%.

Isabella Tobin:

Yes.

Leslie Leins:

That’s perfect.

Isabella Tobin:

Yes.

Leslie Leins:

She’s a great example of what I’m saying.

Isabella Tobin:

It’s just I’m just very excited to… She is. And that’s, you were talking about the critical care. I said, “I have one of these too,” so it’s a wonderful… And it’s a great example of the different opportunities that Purdue offers that are outside some of those more traditional pathways for pharmacists.

So not only are you a pharmacist, but you mentioned you’re also a preceptor, so you do a lot of teaching. I hear you have some social media pages. Would you be interested in talking about those with me?

Leslie Leins:

You know what? Social media is such a funny thing. I do have a TikTok and an Instagram, which is so funny. If you had asked me that same question even, oh, I don’t know, three months ago, I would’ve said, “I don’t have a TikTok. I don’t really know what TikTok is except my children, my actual children talk about it.” But I had always had nurses or physicians or people say, “Oh, you just have a way of saying things or a way of explaining it that makes sense. You should have a TikTok channel.” And I would laugh, and that’s ridiculous. Who wants to listen to me talk?

Or I would share a clinical pearl or an anecdote. And then the next day, a nurse would say, “Hey, I heard you told so-and-so something that was super helpful. Can you tell me?” So I’m repeating myself over and over, the same little clinical pearl or the same little anecdote, and I thought, “You know what? I’m going to do it.” And I joke, this is going to pay the bills, right? I don’t don’t know about that.

Isabella Tobin:

Right.

Leslie Leins:

But yeah, so I started a TikTok channel, Pharm ER Life, and yeah, now I have like 2,300 followers, which my son thinks is cool. I don’t know if that’s a lot or a little, but yeah. And it’s geared towards nurses, pharmacy students, pharmacists that are interested in just learning a little bit more about emergency medicine. I do just little snippets about various things that come to mind. It’s fun. It’s been fun.

And I’m surprised the interactions that I have. People I know, but then people I don’t know that have questions, swoop in and [inaudible 00:23:57]. Yeah, social media is crazy.

Isabella Tobin:

I can’t say I follow you on TikTok because I don’t have one of those just yet, but I have been following you on Instagram ever since we had someone else on the podcast who talked about your page. So I’ve been following you for the last like month or two. So I’ve been enjoying your content.

Leslie Leins:

Oh, that’s so great.

Isabella Tobin:

I can’t speak for the rest of your 23,000 followers but-

Leslie Leins:

2,300. Don’t give me more credit than I deserve.

Isabella Tobin:

So it’ll be 23,000 soon.

Leslie Leins:

Oh, we’ll see. We’ll see.

Isabella Tobin:

Don’t you worry.

Leslie Leins:

[inaudible 00:24:32] retire. No, I’m just kidding. I’m just kidding.

Isabella Tobin:

Hey, I believe in you. And again, I’ve been really enjoying the content, so I’m going to be sharing this around, telling everybody I know, especially the people I know about to go on rotations. I know the TikTok page for you.

Leslie Leins:

It’s been fun.

Isabella Tobin:

Because it’s been really helpful for me, especially as I think about going on rotations because I’m kind of stressed about it. But watching some of your TikToks makes me feel a little more like, “Oh, I got this. I can do this.”

Leslie Leins:

I just think emergency medicine is not-

Isabella Tobin: So that’s been-

Leslie Leins:

Emergency medicine is just not something that, and even various levels of acute critical care medicine is just not something that we focus a lot on in pharmacy school. A lot of those orders, a lot of those medications, just a lot of that stuff happens before it ever crosses the screen of the inpatient pharmacist for data review or order entry review. Those are things that happen at the bedside, those are procedural meds, and so we don’t necessarily… We know what paralytics are, we know what sedatives are, we know those kinds of things, but we don’t necessarily know the doses, we don’t necessarily know contraindications. We don’t necessarily know why you might choose one over the other.

So I’ve kind of just tried to simplify all that a little bit. I just did, I’m on Z of A to Z of emergency medicine. Z is Zyprexa, just spoiler alert. But I [inaudible 00:26:03]-

Isabella Tobin:

I feel honored to get this spoiler.

Leslie Leins:

Yeah. Yeah. Yeah, sneak peeks, so yeah, I haven’t done that one yet. But yeah, and so it’s just the idea is just little snippets, little things that you don’t have to go super in depth. I’m not talking about the organic chemistry of it all or anything like that, but just little bits that maybe you might remember in the moment. I heard somewhere once someone said this little thing, but it’s been fun and I’ve been surprised at the amount of interactions that I’ve had.

Isabella Tobin:

Yeah, that’s really exciting. And again, as one of your followers, I can say I greatly appreciate you doing that.

All right, so I have one last question for before I wrap up this podcast. At the end of every episode, I like to ask a little fun question. So my fun question for you is what do you think the happiest color is and why?

Leslie Leins:

The happiest color is definitely blue. And I’m going to say any shade of blue.

Isabella Tobin:

Okay.

Leslie Leins:

And I think that’s controversial. I think people are going to say, if you took a poll, you might get yellows or oranges. People are going to think bright makes you happy, and I disagree and hear me out. Here’s why.

I’m 41 years old, and I think what makes me happy now is sleep. And I think that blue is relaxing and peaceful and blue induces calm and sleep, and sleep brings happiness. So I’m going to say blue. Final answer.

Isabella Tobin:

Okay. All right, I like it. I was definitely expecting yellow. But blue and your reasoning, I like it a lot.

Leslie Leins:

That’s what saying. I think if you took a poll, people are going to think yellow, but then I want you to give them my reasoning and I think people might feel differently.

Isabella Tobin:

Yeah. No, you’ve convinced me. All right. But it’s been so fun having me here today. Thank you for joining me on the Living the Pharm Life Podcast.

Leslie Leins:

Yes, thank you, Isabella. It was so nice chatting with you.