Pharmacy. Jim Plagakis. Pharmacist

I do not mean any disrespect. Honestly! Absolutely NO DISRESPECT, but I want to report some observations. According to the Encarta Dictionary, the word FOREIGNER
is defined like this: Somebody who was born in or comes from a country other than your own.

That’s good, but I want to present a definition that fits in pharmacy in the 21st century.
I made this one up: A FOREIGNER is someone who speaks with an accent so thick that you don’t have a clue as to what they are trying to say. AGAIN. ABSOLUTELY NO DISRESPECT. I’m just reporting what’s so these days.

I will not even go to that idea I have heard that foreign pharmacists and doctors go get help with the English language. Their English is fine. It is the accents. I moved down from New England to southeastern gulf coast Texas over a year ago and I still have problems with the accents of nurses who were born and raised in La Marque, Texas.

Yesterday, a doctor whose native language is Tagalog (The Philippines) called in a prescription for Bictor Pranks. “I would like Bictor to hab Bicodin por da pain.”
Tagalog has no vee sounds, they use bee instead. Effs come out as pees.

“The patient’s name is Victor right?” I was good with a Tagalog accent after 37 years on the west coast. “And you want Vicodin for his pain.”

The second prescription. “He needs Balium por his nerbs.” That was easy too. You guys who are not accomplished in a Tagalog accent might be stymied.

Another one from yesterday. A nurse said that her name was Fajita, I thought.
“Is that Fah-heeta, like the Mexican food?”

“No!” A little hint of indigation. “My name is Fah-Heeta.”

“That’s what I said, Fah-Heeta.”

“No! My name is Fah-Heeta. Not like the Mexican food.”

“How do you spell it? I have to note your name on the prescription.”

“Eff – Arr- Eye– Tee- Ae” Fah-Heeta!

“Oh, your name is Free-Tah.” I wrote it down. Frita.

“That’s right. Fah-Heeta”

This is nothing new. You have all been there. Just be patient, you guys. The medical system in this country would grind to a halt if we didn’t have these foreigners working as
pharmacists, doctors and nurses. Without foreign pharmacists, we could not get the job done. The number of prescriptions to fill would crush us if we had only American born
pharmacists. Our country needs foreign pharmacists. We need doctors from Pakistan and China. Some of the best patient-care nurses are Filipinos.

A digression coming up. Our USA born teenagers seem to be unable to focus on the future. They live for the kicks of life, it seems. No sociology lecture here. I don’t know enough. It just seems that the kids with names like Nadeen Prakash and Robert Thanh Nguyen, no matter where they are born, manage to focus on their future just fine. The kids with names like Armstrong or Bello can’t get into medical or pharmacy school. They never focused on their grades. End of digression.

Back to accents. Chain stores would have to reduce the pharmacy’s hours or even close the departments without foreigners who immigrated here just for the good job and the
life in America.

There is a local pharmacist who always bitches when I ask for a transfer and the doctor is a Quarshi or Saeed. “Why don’t they either learn English or go back to where they came from. We don’t need them here. This is America.”

I don’t say it, but I always form the words in my mouth: We DO need them.

I digress again. My big concern is our kids. They speak perfectly accented English, but they either don’t want to go to a professional school or they can’t get in. The taffy colored young boy named Gulshan Shah, whose parents run the convenience store, gets in with straight As. He disciplines himself to do homework because his parents are never home. End of digression.

I started this to tell you that you need to be patient. I am very patient with foreigners, but THEY BETTER BE PATIENT WITH ME. When I tell them that I want everything spelled, I mean EVERYTHING. And I want it SLOWLY. And there better not be any attitude or grumbling or deep sighs. Your accent is perfectly okay with me. But we are gonna make sure that the patient gets the right drug in the correct dose with accurate instructions. Enough! Come on. Tell me where I am wrong.

I was filling this guy’s Rx for Suboxone 2 mg. He kept smiling at me. I tried not to look at him. I know that eye contact can be deadly. Once you lock eyes, you are done for. He’ll take it as an invitation to talk. And, once I met his eyes, he stood and came over to the counter.

“Can I talk with you?”

“Sure. Let me finish with your prescription.” I then went out front and motioned for him to stay seated. This was a chance to rest my legs.

He smiled and offered his hand. “How long did your benzo withdrawal take?”

“Did I tell you about that?” I can’t remember everyone. My diazepam use is no secret. I often share my experience with patients who
have been taking benzodiazepines much too long. It seems like the right thing to do.

“Yeah. A few months ago. I took your advice and asked my psychiatrist to help me taper to nothing. I got to one and a half tablets and
figured that that was good. So, I just quit.” He rolled his eyes.

“What happened?” Now he was going to tell me about the withdrawal.

“Shit. I was okay for 4 days.” He smiled grimly. “I thought that this would be easy. Then I got up on the 5th morning.” His eyes got really

big, like golf balls. “My heart was racing and fluttering and bumping. I thought I was dying. Then I remembered our talk and I knew what
was happening. I finally called my psychiatrist after a couple weeks and he told me to start taking just one tablet a day for a month, then we’ll go to one-half a tablet before I try to quit for good again.”

Boarding Gate the movie “You’ll still probably have some withdrawal,” I said.

“I hope not. I was even scared of everyone I saw. I thought that everyone at work was watching me. Is that called paranoia?”

I just nodded. I knew all about it.

“I called in sick for a whole week. When I went back to work, I couldn’t write. Man, I couldn’t even sign a check.” At least this guy had a smile on his face. “I really want to get off of this stuff forever. The nightmares. I couldn’t even sleep. I’ve never been in the military and
I dreamt that I was in a firefight in Iraq and they were going to kidnap me and chop off my head.”

“Be patient,” I said. Ipatted him on the forearm. I smiled. This was a courageous, committed man.

“How long did it take you to taper off?”

“I did not taper off.”

“You went cold turkey?” His mouth dropped.

“Yes, but you need to taper off and do it carefully. No extra doses, man. None!” I started for the pharmacy. There comes a moment when you gotta go back to work.

“No extra doses! None! I promise. I’ll never forget what you told me before”

I stopped and turned. He had me again. He had set the hook and was reeling me in. “What did I tell you?”

“You told be that the best ten pecent of you, your personality, was missing for 10 years because of using benzos”.

“The very best of me was gone, you are right, for 10 years I was not fully Jim Plagakis and I did not even know it.”

He gave me a long thoughtful look. “I want that back,” he said, “I want all of me back.”

I patted him on the shoulder. “You are well on your way, man. Well on your way. Intention is everything. Just be smart about it. Work with your psychiatrist.”

I have had all of me back for over seven years. It was not easy, but it was worth every fibrillation, every cold sweat, every unreasonable fear, every desperate night wide-eyed watching the moon. I got all of me back and I’m gonna keep all of me.

Officially, you know, that was a counseling session. Just my job, man. Just my job.

Last week, I was handed the phone, “Take this one, Jim. You are good with these people.”
It was moderately busy and I really did not have time to waste, but I said, “Hello”.
The caller was very talented. A pleasant, casual and forthcoming woman. She made me feel warm, but she was still a telephone solicitor. She was not trying to sell me anything. She was trying to detail me on a pharmaceutical product over the telephone. She represented one of the jewels of BIG PHARMA. A major company that sells billion dollar drugs. They were not about to hire someone to read a script. This woman was winging it and she was very good at what she did. I believed that she actually knew about the drug she wanted to talk about.
“Stop,” I said, “Slow down.”
“Do you want me to repeat something?”
“No, I want you to just stop.”

“Pardon me.”
“Just stop and listen to me. Okay?”
“Okay.” Her voice was still very friendly, cooperative.
“Now, please don’t take this personally. I have an attitude about what you are doing. I do not like it and I’m going to say goodbye very soon.”
“All I’m doing is trying to give you important information on a product.” Still very friendly.
“I know. It’s your job and you are good at it, but my fondest wish for you is that every pharmacist you talk to just says NO.”
“Pardon me.” A hint of ice in her voice now.
“I am insulted. Your calling me at 1:00 PM on a busy day to try to educate me on one of your company’s products is an insult. It is disrespectful.”
“How is that?” A chill.
“Put it this way. If your company wants to get my attention it will have to send a representative right through the front door of this pharmacy. Your company will have to send an educated, professional man or woman for some live face time.”
“Oh, I see. I’ll pass that on.” Deep freeze.
“I will always give a detail person a few minutes. I don’t want pens or sticky pads. What I want is: What does the drug do? What are the dangers? Why is it better than the other guy’s? That’s all I want.”
“I can tell you all of that.”
“Nope! I’m stubborn about this. You have competitors. I play favorites. A small company that couldn’t afford to pay for your company’s toilet paper sent in a pleasant young lady a few weeks ago. I’ll favor them every chance I get. Her little line of prescription products will be prescribed.”
“How can a pharmacist do that?”
“We have influence. We can do that.”
********************************
Yesterday, I found E-Detailing in my e-mail in box. This was an even more
out of place and inappropriate attempt to get my attention. This is an over-the-top egregious insult. This marketing company offered me a $10 gift certificate to DO A SHORT CE COURSE on this drug. No ACPE credit, just 10 dollars. Give me a break. Ten bucks for that much of my time? I’m a pharmacist. What do they think I work for?

Perhaps, you do not agree. I still think that detail people offer a great deal of value to us. We’re gonna lose them. If we continue to blow them off when they come in,
we’ll lose them. If we listen to telephone detailing, they’ll be gone. If we actually do these ridiculous E-detailing questionnaires, we’ll never see detail people from BIG PHARMA ever again. Little companies still send in human beings. I WILL favor them. I will give them the time to answer my three questions. I will be patient and I will listen for a few minutes. They are honoring us. We are important enough to pay a real human being to talk to US.

Update. 1/31/2007
A pleasant and attractive young woman was in. I had seen her within the last month. She works for Hawthorn Pharmaceuticals and
wanted to talk about her Dytan family of products Boarding Gate divx . The are for cough, cold, etc. Symptomatic relief. Big Pharma could not care less. The big money is in niche products for a relatively small audience, but at ridiculously inflated prices. Anyway, I was pleased to tell her that we were getting a half dozen Rxs for the Dytan family. I told her in advance that I only had 2 minutes. And…. she was done in
those 2 minutes. Face time. It is important. Hawthorn honors us. I have not seen a Lilly person or a Merck person for 6 years.

Recently, an elderly couple came into Mainland Pharmacy. She had a prescription written by her husband. It was for Niaminicin 500mg with a Sig that ordered
it taken 1 tab qid. The quantity was 16.

I went out front to talk to the patient. We sat down and I asked her, “What is this prescription for.”

She looked at me densely. Her mouth flapped open. “Do I know you?”

Then her husband interceded, “You can ask me the questions. I am her doctor.”
He tried to puff himself up, bless him, but he failed. His hair was uncombed. His shirt was pulled part way out of his pants. A deer in the headlights!

“Yes! I know that you are a doctor. I was just wondering what this medicine is for.” I did not believe that this doctor had a valid license to practice. I was a bit uncomfortable. I did not want to challenge him for a look at his wallet card.

“She has the croup. She has bad croup.”

The wife piped up. “I have the croup. Bad croup!”

“I’m not familiar with this drug, Doctor. What exactly is Niaminacin?” His handwriting by the way was impeccable. He wrote the quantity in Roman Numerals
and I could actually read his signature.

“I told you that it is croup medicine.”

“I see that your wife has been seeing Doctor Nelson regularly. Don’t you think you should take her to see Doctor Nelson?”

“There is no need to bother him for the croup. You know that I am a doctor, don’t you?”

“I do, Sir, but I am going to have to decline to fill this prescription.” I repeated it in very clear language. “I am not going to fill this prescription.”

He looked at me and blinked. “You will fill our other prescriptions, won’t you?”

“I have bad croup.” She waved at me. “Are you Johnny?”

Their other prescriptions were ready. Aricept for him. Namenda for her.
“No,” I said sadly, “I’m not Johnny. I’m Jim.”

“Oh, Jimmy, of course. I remember you.”

“Are you driving?” I asked the husband.

This has been bothering me for a couple weeks. The patient was not even directly involved. The patient’s daughter wanted to have her mother’s doctor cut off the patient’s clonazepam supply because, “My mother is a strong woman. She does not need to take
drugs. Any drug!”

Back story! You all know about my personal benzodiazepine use and dependency. If you do not. Keep scrolling down. You’ll find it. Anyway, I don’t just think, I know how brutal benzodiazepine withdrawal can be, at any dose. I am the last person who will encourage anyone to continue taking benzodiazepines, but, in this case, it could be life or death.

The patient is a 73 year old widow. She is reasonably healthy. Her drugs have been HCTZ, atenolol and clonazepam for many years. Unfortunately, she fell down on her way to the bathroom and broke her arm. This caused a very put out New York ad agency executive daughter to have to interrupt her busy life to attend to her mother’s needs. The conversation went something like this:

“Are you trying to tell me that the damned Klonopin is not the reason my mother fell down. She is lucky that she did not break a hip. And if you think I’m going to stand by and watch that happen, you are wrong, buddy.”

“I just don’t think that precipitously stopping the clonazepam is a very good idea. She could suffer some awful withdrawal symptoms. It won’t be pretty and you won’t be here to see it.”

Oh, a stare that could kill. This painfully thin woman, her cheek bones protruding, scowled at me. “My mother is a strong woman. I take after her.”

“It has nothing to do with your mother’s character or her strength. Withdrawal from this drug can cause autonomic….”

“…. What does that mean? Speak English!”

“It means that her heart rate could be affected. Her blood pressure. Her heart rhythm. She could have cardiac fibrillations.”

Stargate: The Ark of Truth dvdrip

This woman stared at her fingernails. “My mother is a strong woman.” She looked at me and smiled. “I have had friends who have taken Klonopin. It is just a tranquilizer. You should know that.”

Now, I gave her a stare. “Your mother’s life could be in danger if you talk the doctor into an abrupt discontinuation of this drug.”

“Oh, puke. Can you be more of a drama king?”

I quit arguing with her. Instead, I lectured her. “It seems that I am a better advocate for your mother’s well-being than you are. You do not know about clonazepam. You are not supposed to know about it. That’s why I am here. You come in here and have the temerity to demand that I stop filling your mother’s legal prescription. When I say that I can’t do that, you insult me. You tell me that you’ll see to it that the doctor DCs the Rx.
If that happens, I will advocate for your mother. I will argue with the doctor until the 4th of July. He has a lot of work to do if he thinks he’s going to take her off of this drug.”

“I think I will get an attorney.” Her eyes were blazing.

“An attorney is not going to care for your mother.”

“Who is, may I ask?”

“Me!”

“You will hear from the attorney.”

“That’s fine with me, deary.”

“You can’t call me deary.”

“I just did.”

Two days later, the mother called, “Do I really have to stop taking my nerve pills?”

“As long as you have a legal prescription, no!”

And that, is where it stands.