One woman’s perspective: From Navy helicopter pilot to clinical pharmacy care for veterans

As one of a just a few women in her class at the United States Military Academy at West Point, Diana Cowell, PharmD ’14, MBA—who went on to become a helicopter pilot in the Navy and was deployed to hot spots around the world—was accustomed to challenges.

However, it was when she had no choice but to learn how to administer nebulizer treatments to her infant daughter during the 2009 H1N1—or swine flu—pandemic, that she found her post-military calling. It was a pharmacist that gave her reassurance and guidance, helping her face her fears that her daughter’s recovery lay in her own hands.

Today, Cowell is a clinical pharmacist practitioner specializing in pain management at New York’s Finger Lakes Veterans Affairs Health Care System. In her journey to this role, as a clinical pharmacist in the U.S. Navy Reserve, she found herself in many unexpected situations, including one deployment to Guantanamo Bay Naval Base, Cuba, and another where she faced pirates in Somalia in an effort to free hostages.

In March 2020, Cowell deployed with only 48 hours’ notice to report for duty aboard the 1000-bed USNS Comfort hospital ship in support of COVID-19 relief to New York City, which had become the hub of medical crisis during the earliest days of the pandemic.

“The stress level was through the roof. We went from having a couple of COVID patients here and there to getting 18 or 20 intubated patients in a 48-hour span,” said Cowell. “We came there with the intention of treating trauma patients, and the boat wasn’t really designed to handle respiratory illness because it had no ventilation system on board. But you just figure it out, because you have to.”

When personal becomes clinical

The same could be said of Cowell’s experience caring for her daughter back in 2009. Though she graduated from West Point with a degree in chemistry and once thought she might want to become a doctor, she says that the exceptionally caring pharmacist inspired her to pursue a career in pharmacy after the military.

No hospital beds were available for her daughter at the time, and the doctor had prescribed nebulizer treatments every hour throughout the night.

“It was the pharmacist who took the time to sit with me, making sure I understood the medications and showing me how to mix them, and also making sure I was calm enough to do it,” Cowell said. “Months later, when my daughter had fully recovered, I went back to the pharmacist and said, ‘So tell me about this pharmacy thing...’

“He inspired me to do more research and to figure out that there was a whole breadth to pharmacy and that you can do so many different things,” she continued. “And that was the springboard to applying to pharmacy school.”

Above and beyond pharmacy care

At that point, Cowell had already made the decision to leave the military, but when she began studying pharmacy at UCSF in 2010, she was still an active reservist. On her summer breaks, she returned to being a pilot for two weeks each year.

She completed a residency after pharmacy school that gave her some familiarity with intensive care units and emergency departments, but her early career as a pharmacist exposed her to a different set of skills. As a utilization specialist, she mostly found herself working on data mining, cost containment, shortage management, and budget planning—expertise that proved to be essential many times over.

Cowell recalls negotiating to save a patient’s life while triaging aboard the USNS Comfort. “One night we discovered that we had a patient who needed a specific medication that we didn’t stock on board, because the drugs we had were intended to manage trauma,” she said. “I remember calling up the director of a hospital in Queens, [where many of the ship’s patients had been sent from]. I told him the patient was going to die if we didn’t get the medication, and he literally drove this very expensive medication over to the pier himself.”

“We have that kind of relationship as pharmacists, where we trust each other to do the right things,” Cowell said. “It’s a pretty amazing community to be in.”

Connection and negotiation in service of effective treatment

The military community also provided Cowell with support as she navigated multiple moves and deployments, including those of her husband, who is now retired from the Coast Guard. She realized just how close-knit the community was when, during her first week of classes at UCSF, she ran into a former West Point classmate—another woman who, like herself, had played sports at the military academy.

While Cowell says being among the few women in her lengthy string of military roles was met with equal parts skepticism and support, she describes her situation as being “like anything else, where you have to ignore the critics and just do your job.”

In her case, “just” doing the job also meant dealing with workarounds for not having a women’s bathroom on board a ship or having to accommodate her breastfeeding and child care schedules while also serving her country.

However, as a Department of Veterans Affairs pharmacist specializing in pain management, she said she has mostly found an openness, particularly when patients realize that she spent 25 years in service before retiring from the military.

“Working with pain patients can be really challenging, because sometimes they have really fixed conceptions of how they should be treated,” Cowell said. “But sometimes having those military connections can help you have those tough conversations.”

Ultimately, Cowell has found that integrating her experience, in formulary standardization and what she calls the “minutia” of pharmacy, with her global travels and personal negotiations among both military and medical personnel, has been an advantage when it comes to administering the best possible care.

“I never would have predicted when I first entered college that this is where I would have ended up, from trying to find my way and switching gears,” she said. “It’s been a fun adventure.”