Pharmacy. Jim Plagakis. Pharmacist

The pharmacy smelled like sweat, dust and strong chemicals. The technician I had just hired was standing at the end of the counter. She was talking to her boyfriend on the telephone. It was against company policy to be on the phone while clocked in. I did not care.

“I can’t stand it,” she said, “I just want to quit right now. This is awful. I can’t work in a place like this.”

Her boyfriend calmed her down and I told her to go to lunch early. She was the noon to nine tech. The old veteran tech stayed with me. I could feel rivulets of sweat running down my ribs. The computer was very slow due to the heat. This was around 1982. Computers needed to stay very cool.

The air-conditioning was down. The pharmacy, because of the lower ceiling, was the hottest place in the store and I am not exaggerating when I said that it smelled like sweat. It was Pay ‘n Save in Pittsburg, California, a city close to the Sacramento Delta and far away from the cooling of the Pacific Ocean. It was the day after the 4th of July holiday and there had been rare episodes of lightning. The air-conditioning service men refused to get on the roof. 103 degrees outside, under the sky. I went and took a thermometer off the shelf. 105 degrees.

The store manager was not a pharmacist and he liked to micro-manage. He took me aside and I noted that the smell of body was worse on his short, corpulent figure. The computer, a DEC about the size of a large suitcase, moaned every once in awhile. I was secretly wishing that it would just die.

“Don’t tell these people how hot it is,” he said, then,”How hot is it?”

I told him and added, “We need to close. These conditions are intolerable. We can’t work in this heat.”

The veteran technician (actually a clerk who had been taught to input Rx information. There was no such thing as a technician in California in 1982) stepped up, “Jim is right. This heat is too much.”

“Mind your own business and go back to work.” He looked at me. You just fill prescriptions and gimme that thermometer.”

This incident was close to the time when I realized that I was institutionalized. There was no word for it then, but I exhibited an egregious inability to look out for myself and the ones I supervised. I hate writing this confession because I was such a wiener in those days. I had control of the Rx pricing and the pharmacy I managed produced the highest percentage gross profit in the entire chain. I liked the big quarterly bonuses. I liked it that I was known in Seattle. (It got me a transfer to Whidbey Island in 1984). I thought I was hot stuff. I was a slave who was dominated by his sense of duty. (One of Buddha’s four temptations)

I was so institutionalized that I cringe when I think about it. I never wanted to rock the boat. I wanted it to stay the same and I put up with an enormous amount of disrespect. There was no dignity there. I had self-respect only because I put so much importance on keeping that gross profit high and the bonuses. Integrity? Don’t ask.

That 5th of July in 1982 was a nightmare. The lightning stopped around dinner time and they fixed the air. It took all night to get the store cooled down. The second pharmacist was a large woman and she suffered until nine, taking my lead. I left at five exhausted. On my drive home, over the ridges to Pleasant Hill, I did not question my behavior. I was so institutionalized that I CONGRATULATED myself on toughing it out. I was a good soldier, one of the Pay ‘n Save battle troops.

I was not stupid. I was just as smart as I am now. I lacked the experience that helps me distinguish bad from good in the retail pharmacy world. I know what to look for now, but I am still institutionalized to a degree. If my employer said “no uninterrupted meal break.” I’d eat my salty snack standing up because that is what I have done most of the time for the last 40 years. I do get a meal break at my present job, by the way.

So… I’m still institutionalized, but I have learned how unhealthy it is, how undignified. There are things I will not tolerate. Being managed by a non-pharmacist, clueless store manager about pharmacy business for one and I dearly want another shot at locking the pharmacy up and walking out the door when the air-conditioning is bust.

“Jim, I will not talk to this man. He is impossible.” This technician is usually implacable. She is a veteran. She knows her job and for her to have to turn the phone over to me got my attention.

“What’s wrong?” I expected her to say that he was abusive or that he used bad language or personally insulted her.

“He says that his insurance should pay even though they say that he had the prescriptions filled in another drug store just five days ago.”

Hmmm. I drew a breath and picked up the telephone. I didn’t cock around. I just said, “Where did you have these medicines filled just five days ago?”

Silence. “Nowhere,” he said.

“Your insurance company thinks you had them filled at another drug store. If that is not the case, then someone is committing fraud in your name. I think that I better call the District Attorney about this since we are involved.”

“The who?”

“District Attorney”. I knew that I was just blowing smoke, but he didn’t.

“Well….. why?”

“To report that someone is using your identity to get drugs.” I paused. “You should get a visit from some detectives to file a report.”

“Oh… well.. does mail order count?”

“Of course it does. If mail order has filled them .. yes.. mail order is a drug store.”

“I need my medicine.”

“So, when did you place your order with the mail order drug store?”

“About three weeks ago.”

“Not about. Exactly.”

“I don’t know, but I still had three weeks of medicine when I sent in.”

“Three weeks and they haven’t gotten the medicine to you yet.”

I got his name and looked up his profile. He was a diabetic. (oral meds). He had high blood pressure. He was taking blood thinners.

“I can’t help you, sir. We’ll fill your prescriptions, but you’ll have to pay full price.. unless..”

“Unless what?” The sound of abject hope, ready to beg, is pathetic.

“Unless you get a special override from the insurance.”

“How can you do that?” More hope.

“I can’t, but YOU can.. maybe.”

“How?”

“You call them up and tell them that they have had three weeks and they have failed. You are not a well man and you absolutely refuse to pay full price when it is their responsibility to get the medicines to you in a timely manner. You tell them that you demand an override, that they have to call me because I will not call them.”

“Will it work?”

“I don’t know, but use these words, I HAVE BEEN ADVISED TO INFORM YOU THAT YOUR FAILURE TO DELIVER THE MEDICINES IN A TIMELY MANNER IS ACTIONABLE.”

“What?”

“Write it down.” I repeated it slowly.

Forty-five minutes later, his insurance company called and gave me the override codes, not just for a few days worth, but 90 days even though they already had it in the mail and gone.

I work in a pharmacy that does not have a whatever-you-call-it telephone answering system. You know, “Press one to leave refill requests. Press two if you are a doctor.”
So, often, I am the one answering the telephone at work. There are stores where pharmacists actually do that.

Today, I wanted to have a little fun. So, when a pharmacist identified herself as from CVS and that she wanted a transfer, I said, “Did you notice how long you had to wait for a pharmacist?”

“Pardon me?”

“Did you notice that I answered the phone and that I did not ask you to wait on hold?”

“Well, yes. What are you getting at?” Here we go. I had a smile on my face. I could hear that her face was firmly set, no hint of a grin. I had not accused her of anything and here she was acting like she was guilty of something.

“I just wanted you to notice that you did not have to wait at all. Of course, it is an easy jump to the many times that I have called CVS for a transfer and have had to wait on hold for minutes.”

“Do you use the doctor function, press two?”

“Always.”

“The pharmacist is always the one to answer the doctor line.”

“Oh!” This was not my experience. Perhaps she was referring only to herself, not the pharmacists who have the tech answer the doctor line and put me on hold. “Every pharmacist? Always?”

“Always,” she repeated.

“Okay. What do you need?” I had the damndest strong urge to put her on hold. Just for fun. I would only make her wait ten seconds. Ah, devil, get off my shoulder. I fought down that base impulse, but I want you know that there was a day, in my unseasoned years, when I would have put her on hold. Not for just ten seconds either.

“I just want some transfers.” She told me the patient’s name and then was silent.

“Prescription numbers.”

“I don’t have numbers. She said to get everything.”

Come on. You can’t be that ambiguous with me. That is what went through my head.
What I said was, “You are going to have to do better than that. I need the names of the drugs, at the very least. I’m not guessing and you shouldn’t either.”

“I beg your pardon.”

“Beg anything you want, but I don’t have the time at 3:15 PM on a Monday to act as a surrogate for the patient. How about if I fax you her entire record? You decide what drugs you want and be the patient’s proxy and call me back.”

“Better yet. I’ll get the names of the drugs and maybe even the numbers.”

“That’s a good idea.”

When she called back, I noticed that the drugs were three controlled drugs and carisoprodol. We had refused to fill them earlier in the day. Way too soon. I told this to the CVS pharmacist and suggested that the patient was trying to work the system.

“Well bullshit!” she said, “He will not get anything here.”

We could have saved a lot of time. Just the basics, maam. The prescription number certainly greases the transfer chute.

The Good! This felt very good, warm and fuzzy as we used to say in the 70s.

A nurse (I think she was a nurse. Maybe she was the doctor’s 15 year old daughter)
called in an Rx for a patient whom I always enjoy talking with. An older woman with limited resources. She is always very pleasant and respectful. Too much so. Do I deserve this kind of deference? Marion always buys a Milky Way bar. This candy bar is her weekly indulgence, just like you may go for a Carmel Macchiato at Starbucks to the tune of $5.00+ a few times a week. Marion treats herself to one Milky Way candy bar once a week.

The nurse ordered lovastatin. I took the Rx and said, “You might want to tell the doctor that simvastatin, generic Zocor, is available now and that it is dirt cheap.”

“Why would I want to do that?” A sort of huffy response. There was the sound of a slurp. Her Carmel Macchiato?

“Because simvastatin is a better drug than lovastatin.”

“I think that the doctor knows what drug is better.”

Oh for crissake. “Listen, just tell her what I said, okay.” I tried. We can do two things that can really be of assistance to poor patients. We can save them money and we can recommend better drugs that may be less expensive drugs when we can anticipate the outcome being better for less money. In this case, the cost was similar, but the drug is probably better.

Two hours later and a pleasant voice on the telephone introduced herself as the doctor.
“Thanks for looking out for my patient,” she said, “Change that Rx to the generic Zocor.
I’ll be changing all of my patients to it.”

Wow! All it takes is the trimtab to change the course of a monster ship, sometimes.

***************************
The Ugly! I filled two prescriptions for a woman of means who could afford practically anything. She was known to be cheap, very cheap. She had probably never even had a
Milky Way bar. The price of Carmel Macchiato would cause her to have a stroke.

The prescriptions were for lisinopril and HCTZ. She refused the lisinopril.

“Why don’t you want both prescriptions,” I asked her.

“I just want my blood pressure medicine, the little orange pills.”

“They are both for your blood pressure,” I said. “The lisinopril is more important than the HCTZ. You needed to be taking ……”

She dismissed me by turning her back on me. She actually spun around and put her hands akimbo on her hips. Who did this pharmacist think he is?

I tried one more time but it was like trying to sniff the perfume on your girl friend’s neck during a hurricane. She heard not a word. I was not a trained medical professional. I was not a pharmacist. I was not to be trusted. I was just some BOZO who filled her prescription.

Bullshit, I thought, I am going to be a tattle tail and call her doctor. Then she will find out which drug is the more important. Serve her for turning her back on me.

I took the time to track down the doctor on the phone and actually get him on the line.
He was an older guy and impatient. I quickly told him how this woman was sabotaging his therapeutic intentions and believed it was over a few bucks. I know, that business about the dollars was editorializing, but I couldn’t help but be a little petty. This woman would make King Midas look like an NFL football player with handfuls of cash in a strip club in Vegas.

Using the words “therapeutic intentions” may have been too complicated of a
distinction for this old guy.

“What do you want me to do about it?” he said.

“You are the doctor,” I said.

“And you are the pharmacist. Mind your own business.” Slam.

“Jim, this nurse wants you to loan some Dexedrine to this patient.” The technician stood with the phone in her hand. She knew that my rule on “loaners” was a 3 days supply and never controlled substances.

I took the phone with anticipation. This could be the kind of perverted fun that I like. I’d listen to her, but there was no chance for her request to come true.. I asked her what she proposed I do.

“The doctor is out of town until Monday. I want you to spot her a few capsules to get her by until the doctor can write a prescription.”

“I can’t do that,” I said.

“I’ll write you a letter,” she complained. I’ll write down anything you want.”

“Are you authorized by the doctor to make such requests.”

“Yes,” a haughty reply. “Of course I am authorized.” She made a whooshing sound as she exhaled.

“Are you a registered nurse or, perhaps, a nurse practitioner?”

A long silence. Another whooshing sound. “No, I am not a nurse. I am the doctor’s secretary and I am absolutely authorized. I am asking you to spot her just enough until the doctor gets back on Monday. I’ll fax you the letter.”

“I can’t advance a Schedule II drug,” I said. I stifled a laugh.

She tried the old “What is your name?” trick. Like she was going to be a tattle tail

with the doctor.

“My name is Jim,” I said.

“Your last name?”

“I’ll spell it. Pee Ell Ay Gee Ay Kay Aie Ess. Plagakis.”

“Well Mister Plagaski,…”

I interrupted her. “That is PLAGAKIS. It has a kiss at the end, not a ski.”

“Whatever!” She whooshed again. “You will be hearing from the doctor.”

About an hour later, the doctor called. I told him what had transpired and informed him
that I was not spotting anyone anything Schedule II. The law allowed me, however, to fill an emergency prescription for a weekend’s worth on the promise that he would get
the written triplicate to us within one week. That would be 3 capsules of Dextroamphetamine SR 10 mg. He had to proclaim an emergency.

“When did she get it last? I am in the car on the way to New Orleans and I don’t have her chart. Hardy har har har.

I looked. “Her last amphetamine Rx from us was in April, 2006.” BINGO, “but she regularly had Xanax, Vicodin and Soma filled here.

“I don’t write those drugs!”

“Three other doctors did,” I said.

“Don’t give her anything.”

“I didn’t intend to.”

“Will you print out her record and mail it to my office?”

“I will do that.”

“Thank you.”

I told him that I had a question. “Why do you give authority on prescriptions to a woman who is not even a Registered Nurse.”

A short silence. “I can trust her. She knows how I do things. Why do you ask?”

I didn’t tell him that my question was rhetorical. I asked just to give him the opportunity
to examine his procedures. “Just wanted to know,” I said.

Some things never change.

“Why isn’t my PERSCRIPTION ready? I called it in an hour ago.

“I’ll check, maam.”

” It should be ready.”
“We had to call your doctor for a new prescription.”
“Call the doctor?” An indignant look on her face. “Why did you have to call the doctor?”
“Because there were no additional refills.”
“That’s an ongoing PERSCRIPTION”
“You ran out of refills.”
“That PERSCRIPTIONnever runs out. It’s an ongoing one.”
“I’ll get the pharmacist, maam.”
“I can’t wait. I have a busy schedule.”
“We’re busy too.”
“Are you being smart with me?”
“Jim, you have to talk with her. I’m too busy to argue with her.”
“She said that I have no refills. It is an ongoing PERSCRIPTION”.
“Maam, there is no such thing as an ongoingprescription. All prescriptions have refill restrictions.”
“Call the doctor again. I can’t wait. I’m a busy woman.”
“We’re busy too.”
“Now, you’re being smart with me. Are you being smart wih me?”

“No, maam. I am not being smart.”
“Just call my doctor again. Right now, I can’t wait.”
“We have called once. It is now in your doctor’s court. You can call him yourself if you want.”
“I don’t have to. You’re supposed to call him.”
“We did.”
And on And on And on.
Finally, “Maam, we are notgoing to call again.”
“You have to.”
“If he doesn’t call back by tomorrow afternoon, we’ll call again.”
“That is an ongoing PERSCRIPTION”

What are we supposed to do?
Walk away?
That is what I did.