Jim Plagakis

Triage:

The process of prioritizing sick or injured people for treatment according to the seriousness of the condition or injury.

Tuesday, around 2:00 PM, a woman interrupted what I was doing and begged me to help her find some “butterfly” bandages. Her neighbor had told her that “butterflies” would hit the spot. She was a little flustered and I had to settle her down.

“Who needs the butterflies?” I asked. “How deep is the wound? How long is the cut?”

She couldn’t stop stuttering. “I.. uh.. I.. there is a lot of blood.”

“Relax,” I said. “Tell me more.”

“My son. He was cutting a big chunk of Parmesan cheese into little chunks so I could shred it.”

A very rude customer butted in and asked me where the Huggies were located. I turned my back on him. “Where is your son now?” I asked.

“Huggies?” The guy was persistent. “I’m looking for Huggies.”

The woman gave the Huggies man a look. “My son is in the car bleeding.”

The Huggies guy turned and walked away on the word bleeding.

“You better bring your son into the store. I’ll look at the cut.”

Two minutes later this kid around fifteen years old came in with his mother. He had his hand wrapped in a terry cloth towel. I couldn’t see any blood until he released the towel. There was the wound, a cut to the quick of the ham part of his right palm. An inch and a half gash that was wide open. He had managed to get through the yellowy fat layer. He had gotten right down into the meat.

I gave my usual disclaimer, “I am not a doctor. I do not diagnose. But it looks to me that he will need some suturing and you better get him to the emergency room at UTMB.
”
“I’m just visiting my sister.” She stuttered again. My advice about the emergency room made her as jumpy as a bug on a hot pan.

“Go right down 4th Street to Harborside. Take a left and keep looking to your left. The entrance to emergency is less than a mile from 4th.”

“Okay.” They started to leave.

“Just a second,” I added. “I have some advice. You will have to wait in emergency. I think you better buy some Betadine Solution and squirt it all over that hand before wrap it up again.”

“You think?”

“Will it hurt?” A whine from the fifteen year old.

I told her that this Betadine step was very important. She followed my advice. I watched her apply the solution liberally. The kid cringed, then looked at me. “You’re right. It doesn’t hurt.”

This is TRIAGE. This happens thousands of times a day in pharmacies all over the United States.

Triage is a three point thing at the pharmacy.

1. ” THAT’S MOST LIKELY NOT A PROBLEM. I WOULDN’T WORRY ABOUT IT”. or 2. “I CAN HELP YOUR SYMPTOMS WITH AN OVER-THE-COUNTER PRODUCT”. or 3. “YOU BETTER GET YOUR ASS TO THE DOCTOR OR THE EMERGENCY ROOM”.

Have you noticed that #3 doesn’t happen that often? With numbers 1 & 2, pharmacists save the medical system millions of dollars… possibly every day. Otherwise, most of the #1 or #2 will end up in the emergency room to the tune of a few hundred bucks each.

What we do saves a ton of money and what do we get? We get absolutely NOTHING. And we keep on doing it. I like doing it. It has always felt good to use my knowledge to make a difference for someone. Is this perseveration? A bona fide mental condition. Where you keep on doing the same thing over and over expecting a more satisfying result.

THEY ARE NEVER GOING TO PAY US WILLINGLY… NEVER!

So, talk to me. What do we do?

I suggest you look to the right and click on the link to “The Pharmacy Alliance” website.

That’s the best advice I have. Individually, we can get nothing done.

Do you have your personal NPI# yet? Paul Trusten can tell you how. He is the person who got me started in the right direction. It will take only minutes.

An hour ago, I stood at the customer service desk of a department store and waited while three women, who spoke a language I did not recognize, returned a shopping cart full of bedroom goods. Pillows, sheets, blankets. They were, I would guess, not native Americans.

My grandparents were immigrants. They all came funneled through Ellis Island from four points in Europe. Spain, Switzerland, Finland and Greece. None of them spoke English right off the boats. They brought their treasures with them. A small suitcase, the clothes on their backs and whatever money they had saved. None of them were highly skilled professionals. I’m telling you that because I think that immigrants are okay.

The three women at the counter acted like they were afraid of being cheated by the store or they were out to cheat the store. I just know that I had to wait while they finished up their business. I thought to myself, “These women certainly aren’t acting like they are Americans.”

Last week, I got a copy from a pharmacist in Illinois. He had a thick accent and a name that indicated that he was a Bengali from India, probably Mumbai.

After all of the business was done, he said, “What are you doing the fourth?”

“Pardon me?” I didn’t understand.

“The fourth of July,” he said, “Independence Day.

“Oh, that fourth,” I said. I hadn’t realized. It had crept up on me. “I don’t know, man. Probably have a picnic on the beach or something.” The fourth of July had become just another day off. I was not really charmed by it.

“What are you doing?” I asked.

“All of it. A parade in the morning, a town picnic in the square, a baseball game.”

“Who are you going to see play?”

“Me. I’m playing. I pitch for the Red Birds. I was a cricketer in India. I threw a wicked googly.”

“Maybe I’ll go to the fireworks,” I said.

“Oh, for sure. I will take my wife and kids for the first time. This will be their first fourth. I am a citizen now and am sponsoring them.” There was a lilt to his voice. Like a man who had lived a long time with his family half a world away.

“Well, I wish you a great fourth,” I said, thinking, “He is certainly acting like an American.”

“The same to you, my friend, the same to you.”

After that phone conversation, I made it a point to find out about the Fourth of July parade in Galveston. My daughter-in-law, Ivana, has been here for only six weeks. My son-in-law met her in Afghanistan. They both worked for KBR. Their six month old son is an American citizen, born in Macedonia, with a USA Passport. That leaves Ivana on the outside.. for a little while… Frosty (my son-in-law’s real name) is sponsoring her and has hired an attorney for the job.

Next year, Ivana will be a Yankee, but this year will be her first fourth. We will make it memorable. We’ll do the parade, the picnic, the beach and the fireworks. People will say about Jim Plagakis, “He’s certainly acting like an American.”

Winston Churchill said that success is moving from failure to failure with enthusiasm. Elvis, Michael, Dr. Suess and Henry Ford all failed dramatically. Michael was cut from his high school basketball team. “Green eggs and ham” was rejected 23 times before a publisher said, “What the hell. What can I lose?” Elvis got an “F” in music and Henry Ford went bankrupt twice. Their vision was clear. It just took the rest of us a while to see what they saw. That dream of owning your own pharmacy? Protect it. Guard it. Wait until the time is right. Don’t ever give it up.

There are “self-corrective” forces at work in American pharmacy. Pharmacists are “pushing back” and asking that there be changes. After many years of never having an uninterrupted meal break, I now work for a major chain two days a week. My shifts are eight hours and I take 30 minutes to eat. This is routine policy. Nobody bothers me. The forces at work may be subtle, but they make any and all efforts to continue any repressive schemes very difficult. “Self-corrective”. That is how it should be.

There was a time not long ago that life could be very difficult for a single or divorced mother who was the sole support of her family. Not long ago, the only job Sandra Day O’Connor could get at law school graduation was the job of legal secretary. The days of the Age of Pisces is over. It is the Age of Aquarius and women will take their spots near the top of the pyramid. You are a pharmacist. You make enough money that if the bastard cheats on you, you can kick his ass out and never miss a beat.

The real battle is conquering yourselves. Think about it.

Don’t smoke. Don’t drink too much. Don’t text while you are driving. Do find a sport or exercise. I suggest yoga. These are your “yamas” and “Niyamas”. When you get together in ten years, take a look. You will know who took my advice.

Be present all the time. Stay wide awake. I think that you can do a whole day of pharmacy and never notice what is going on around you. You are the pharmacist. When that little old black lady who still believes that her red, white and blue Medicare card will get free prescriptions starts to cry from desperation, it is your job, not the technician’s job, to go out and serve her with all the compassion you have in your heart. Keep a soft heart, an open heart. A hard heart is very dangerous.

Get the hell out of the world of virtual reality a couple hours a week. Go to the beach and leave the cell phone at home. Virtual reality may seem to be huge, but, trust me, the real world is infinitely larger and infinitely more interesting. Drop to your knees in the surf and feel the waves surround you. Experience the power of nature and, please, take your kids with you. An hour or two , sitting on a bed of cedar needles, during a rain, in a hollow cedar tree in a Pacific Northwest forest, silently with your ten year old daughter, waiting for Raven, the creator, to appear is sublime. The bonds that grow from a silent experience will never be broken. Raven, by the way, did appear that day.

Just remember that the profession of pharmacy is fine. It is perfect just to way it is. It is the JOB of practicing pharmacy that can be a problem at times.

Of course, you will have people who don’t know, come to you and say, “Get real!” They will want you to march to the same drum beat that everyone else marches to. Very dangerous. You are young. You may think that you want to stretch out and do it your way. That is very good. I just have one thing to say:

IT IS BEST IF YOU RIDE THE HORSE IN THE DIRECTION IT IS GOING. 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