As a pediatric pharmacist, Jordyn Foster Metcalf ’13 (Pharm.D) often finds her job cloaked in an extra layer of complexity. Children’s bodies usually react differently to medication than adults’ do, but most medical research is conducted on grown-ups.
It can seriously test pharmacists who are trying to find the right course of medicine for young patients.
“If we have studies of children, it’s maybe 10 patients,” says Metcalf, now in her eighth year working at Levine Children’s Hospital in Charlotte. “You’re like, ‘Great, great.’ These big adult trials have 10,000 people, and we have a case report of seven. There’s definitely a lot more to take into consideration with children.”
Metcalf is up to the challenge. Working as a Board Certified Pediatric Pharmacy Specialist, the North Wilkesboro native takes an active role in determining the course of treatment for many patients. She works closely with the hospital’s specialists, often being consulted before prescriptions are written. She even sometimes does rounds with attending physicians.
When members of the medical team put their heads together to come up with a treatment plan, the calculations often change markedly depending on the child. For example, hospital pharmacists are able to monitor all patients’ renal functions and are alerted if someone slips into dangerous territory, so they can adjust the medications accordingly. But making that adjustment isn’t always so straightforward when dealing with children.
“In pediatrics, it doesn’t work at all like it does in adults,” she says. “If you’re a 3-day-old baby, I expect your labs to look different from a 1-week-old versus a 1-year-old versus a 10-year-old.
“It’s just very different from what you learn in school, the things that you manage in pediatrics versus adults. We’re not doing high cholesterol and high blood pressure and heart attack, that kind of thing.”
Growing up in the foothills of North Carolina, Metcalf took an interest in medicine while tagging along as her mother took continuing-education courses to maintain her volunteer-EMT license. Metcalf’s desire to go into healthcare grew in her teen years, and by high school she’d settled on pharmacy.
When she graduated from North Wilkes High, in 2007, there were three pharmacy schools in North Carolina: UNC, Campbell and Wingate. The straight-A student applied to be an undergrad at all three institutions, got in all three, and received scholarship offers at all three.
But Wingate appealed to her the most. She loved that the campus had “a lot of character” and there was a lot to do there. But since she was aiming to get all of her prerequisites out of the way in two years and go straight to pharmacy school without a bachelor’s degree, she also wanted to go to a school where she could maintain a good balance between her class schedule and her social life.
“UNC felt a little overwhelming to me,” she says. “And I knew it was going to be a very hectic schedule to try to get into pharmacy school within a couple of years, so I felt like Wingate was the best of both worlds. It was still a little away from home, and it wasn’t the smallest campus in the world but it wasn’t this huge, overwhelming place where I felt like just being there was going to stress me out.”
Even taking the maximum number of class hours each semester, Metcalf was still able to pledge a sorority (Sigma Sigma Sigma), take part in student government and join the University Singers (one of the few non-music-majors to take part).
But getting to pharmacy school in two years wasn’t easy. She made her first B ever at Wingate (Dr. Chris Dahm’s chemistry class), and she was relieved to get a C in organic chemistry. “I called my mom crying,” Metcalf says. “She said, “Jordyn, it’s OK. If you got a C it’s not the end of the world.’ I said, ‘No. I’m crying because I’m so happy.’”
It only got tougher in pharmacy school. Taking Integrated Biological Sciences was a wake-up call. “That first test, when everybody got their grades back,” she says, “it was that reality check of, ‘Wow! We’re getting a doctoral degree. Now I see!’ It’s a big shift.”
Busy, gut-wrenching and fulfilling work
Always drawn to working with children, whether it was volunteering in the nursery at her church or teaching toddlers at Vacation Bible School, Metcalf found pediatric pharmacy a natural fit. She signed up for pediatric rotations during her clinical years at Wingate and took the pediatric pharmacy course the program offered.
But she knew she’d need more training than that if she wanted to feel comfortable working in a pediatric hospital, so she did a year-long residency at Le Bonheur Children’s Hospital in Memphis after graduating from pharmacy school. Working up to 80 hours a week (which included only two days off every two weeks), Metcalf went through a trial by fire that enabled her to put all that she’d learned at Wingate into practice in the type of setting she envisioned for herself while in pharmacy school.
In 2014, she joined a staff of 15 pharmacists at Levine Children’s Hospital, a 234-bed facility that is highly regarded nationally. It’s the biggest hospital of its kind in the region and therefore draws patients from a wide geographic area.
“It stays very busy,” Metcalf says. “It’s pretty rare that you have any downtime in a shift. There’s always a pretty steady stream of admissions. Our ICUs stay pretty full, because we’re really the main one in the area.”
Metcalf grew up surrounded by family: Her grandmother, great-aunts and great-uncle all lived within walking distance. Her grandmother cooked dinner for the family every night.
It was tempting for Metcalf to take her pharmacy degree back home to Wilkes County, but she felt compelled to be a difference-maker in a specific way.
“Obviously we can see family when we want to, but not having them right around the corner is something that I do miss,” she says. “I kind of knew when I was getting into, well, hospital pharmacy in general, but especially pediatrics, that it was a specialized kind of field. You don’t just go anywhere and find a big children’s hospital to work at.”
The work is equal parts gut-wrenching and inspiring. “It’s hard to see kids sick,” Metcalf says. “It breaks your heart to see them that way. But kids are so resilient compared with adults. If we had some of these diagnoses, we would lay around in bed all day and feel sorry for ourselves and ask ‘why me?’ and not really want to do anything. But the kids just want to know what time the playroom opens and what time bingo comes on TV.”
After so many years at Levine, Metcalf has a pretty good handle on the medicinal needs of her patients. And being a mother herself (of a 4-year-old and an 8-month-old) is part of the equation.
“You kind of know in your gut,” she says. “For most people, it’s a question of, if that was my child, what recommendation would I make? If I wouldn’t give it to my kid, I’m not going to give it to your kid. I think we all try to treat it that way.”
The hospital environment is intense, especially during Covid, but Metcalf finds the work meaningful and fulfilling.
“I could not picture doing anything else, even when you have those crazy, stressful days,” she says. “I can’t think of anything else that I would rather be doing. It’s been a great place to work.”