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By Robert Ross Sally Guthrie remembers San Francisco as only an ex-mail carrier could. "You stick mail through the slot in somebody's door, hear a loud GRRRRRR! and the envelope is jerked from your hand," she recalls with a shudder. "You just hope it wasn't somebody's tax refund or one of those 'do not fold, spindle, or mutilate' forms." Lurking dogs, hidden mailboxes, and 80-pound bags of encyclopedias aside, she-admits she liked her first job out of high school. "It was 1969 and I was 19 years old," she explains. "San Francisco was the place to be." She adds, "I was probably in better physical condition in that job, too." Maybe so, but her pace today is every bit as exhausting as it was when she was lugging a full bag of mail up the streets of San Francisco. Only now, as Dr. Sally Guthrie, assistant professor of pharmacy at The University of Michigan, she is more likely to be dodging cars along Washtenaw and Geddes than dogs as she hurries about her appointed rounds between the College of Pharmacy on the Central Campus and University Hospitals on the Medical Campus. Dr. Guthrie arrived at her career in pharmacy by a serendipitous combination of trial and error. After a year with the Post Office, she could not picture herself delivering mail the rest of her life, so she moved back to her hometown, Sacramento. There, she took the first job she could get with her high school degree, as a nurse's aide in a convalescent home. She says she still has back trouble from the lifting she had to do in that job. Fed up with the strenuous work and low pay, she made up her mind to go back to school. "I was working with nurses," Dr. Guthrie says, "and I thought 'I can do as much as a nurse.'" So she enrolled in a two-year nursing program at American River College in Sacramento. "One of the prerequisites for getting into the program was chemistry. I was afraid I'd be too rusty, but I did quite well, so I started taking more chemistry courses." Enough that her counselor finally suggested maybe pharmacy was her true calling. "I had an image in my mind of the community pharmacist making up magic potions behind a partition," Dr. Guthrie recalls. "It appealed to me. I thought the ideal would be more chemistry and more research, that being a scientist would never be boring. I had no idea what a PharmD was." Nonetheless, she started classes that fall in the Doctor of Pharmacy degree program at the University of the Pacific School of Pharmacy in Stockton, California. In her last year there, she got hooked by her clerkship experience. "I started looking for a residency where I'd spend a lot of time on the floor and as little time as possible in drug distribution," she says. "Plus, I wanted to go somewhere else besides California." She chose Duke University Medical Center in Durham, North Carolina. The residency at Duke consisted of clinical rotations in internal medicine, cardiology, coronary care, oncology, total parenteral nutrition, infectious disease, and drug information services. A research project to identify pharmacological agents interacting with tricyclic antidepressant metabolism wrapped up her residency and resulted in her first two publications. After the residency, Dr. Guthrie stayed on at Duke for two more years, working in pediatric hemotology-oncology and adult parenteral nutrition. "We wrote the orders and the doctors co-signed them later," she says. "We followed patients throughout their whole stay. There were some 14-hour days. It was satisfying and demanding, but frustrating. Who wants to work 14-hour days the rest of her life? I felt like an intern." So she shifted direction with a move to the University of North Carolina's Orange-Chatham Comprehensive Health Services where, as assistant director of pharmacy, she ran three ambulatory care clinics. "It was more administrative than anything I'd ever done," she says. "I'd never been anyone's boss before." The job also involved a lot of counseling of patients - and deference to their doctors, family practice physicians who exercised more control over patient care than was the case at Duke, where it was a team effort on behalf of seriously ill, bed-bound patients. Meanwhile, Dr. Guthrie got a call from Markku Linnoila, the psychiatrist who had supervised her residency project at Duke. He had just taken a position with the National Institute on Alcoholism and Alcohol Abuse as director of a newly opened inpatient facility for the research and treatment of alcoholism in Bethesda, Maryland, and urged her to apply for a fellowship there. The door to her dream, research, had just opened a crack. She went to Bethesda, interviewed, and landed the job. There she picked up new research skills and bolstered her background in phar-macokinetics, which she felt was weak. "I was lucky to have taken the job," she reflects. "The trend today is for people with the PharmD degree to have a research background if they want to be on the tenure track." At NIAAA, Dr. Guthrie studied the effects of alcohol, alone and in combination with other drugs, on skilled performance, eye movements, and driving skills. She reported on her work in psychotropic drugs and traffic safety in 1983 at the Ninth International Conference on Alcohol, Drugs and Traffic Safety, sponsored by the National Highway and Traffic Safety Administration in Washington, DC. Based on her experience at NIAAA, Dr. Guthrie predicts that if highway speed limits are raised to 65 miles per hour, as is being proposed in some states, more traffic deaths will occur where rural roads, the scene of higher drunk driving and traffic fatality rates, meet city limits. At The University of Michigan, Dr. Guthrie's interest in the physiological aspects of psychiatric problems has continued. Currently, she is investigating how the steroid dexamethasone is metabolized in depressed patients during and after depression. So far, she says, early results indicate it may be handled differently in depressed people. She believes some people are biologically predisposed to certain psychiatric problems like depression, schizophrenia, alcoholism, and eating disorders. "It's becoming fairly obvious there's more than childhood background and environment at work," she says. "There are so many unanswered questions in psychiatry - lots of room for research and theorizing." She laughs. "Maybe that's why I like it." A typical working day for Dr. Guthrie is long. She arrives at her office in the College of Pharmacy a little after seven in the morning "to dump things," before heading over to the University Hospitals. There, she makes rounds on the psychiatric floor until ten, confers with PharmD students doing clerkships, meets with medical residents, and pores over patient charts. At noon, she hurries over to the College of Pharmacy to check her mailbox and then back again by one o'clock to her students at the hospital to discuss therapies, drug topics, and journal articles. By mid-afternoon, she either heads over to the Taubman Medical Library to research an article or work on a paper or returns to the College to put in a few hours in a laboratory she shares with another faculty member. "There's usually enough to keep me busy until five or six in the evening," she says. She commutes back and forth between the Central and the Medical campuses two or three times a day on one of the campus buses that make the trip or on foot if the weather is good and she has the time for a brisk twenty-minute walk. Walking is a habit she enjoys. It comes from her early childhood in McCloud, California, in the shadow of Mt. Shasta near the Oregon border, and growing up in a Sacramento that exists only in her memory. "It used to be a pleasant little area," she says sadly. "Now it's gotten congested, like a mini-L.A. The hiking trails have become freeways." Dr. Guthrie likes the Midwest, though, especially Ann Arbor. "It's a small but highly intellectual community," she enthuses. "I feel there's room to breathe here, especially compared to the congested traffic in Bethesda. And the people are friendly. My only complaint is that they drive so fast." This article first appeared in the Fall 1987 issue of INTERACTIONS, published by the University of Michigan College of Pharmacy. |
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