Pharmacy. Jim Plagakis. Pharmacist

I finished Before the Rabbit-Hole this afternoon.
All four books will be available on the
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I’m glad the writing is over. These were not fun. Too much remembering.
If you have diverted controlled substances for your own use, these stories
will get your attention. If you have been tempted, perhaps you won’t.
These are good reading for any pharmacist. Students really need to
look these over.

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(327 pages. 166 of JP at Large columns since 1989) copy and paste this link
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I made the cover of Drug Topics magazine only once. A full cover picture of a very angry pharmacist. This was when the magazine was tabloid size, slick, but not quite the best quality paper. There were ads for Philip Morris brand cigarettes, Vergo for warts, Swedish condoms named “Jade”, “Profil” and “Nacken”, Mi-Cebrin T vitamins and Stix-A-Lot glue stick.

There were articles headlined: “Hot competition in hair dryers”, “The 120 mm cigarettes debut” and “Third party claims in Arkansas.” This issue was dated March 17, 1975. The magazine was 38 pages total. A faint image of what the magazine has become, but, hey, the editor liked my stuff enough to give me the cover. Tobacco was still an item, not a problem yet.

My article was entitled, “Pharmacy as Usual? Not for me?” So, you see that I am not a late bloomer. I started as a shit-disturber 30 years ago. What caught my attention, on page 38, was a letter to the editor. It came at a time when I have been reading GLOOM and DOOM warnings in 2007.

They have recently warned that a chain store is planning on having a central pharmacist do the work of ten, checking the work of the techs at out-lying locations by way of computer. They worry about kiosks dispensing Rx Only medications with no pharmacist participation. They hint that we may be kicked out of our jobs. I can almost feel the tension out there. They want to take our jobs is the worry. Make pharmacists redundant. It is fight or flight. There are big clumps of cortisol in the veins of our brothers and sisters.

Relax, you guys. That was a worry in 1975 too. A guy in Sutton, West Virginia wrote a letter that hung reams of black crepe over all of us. He was responding to an article that compared nurses with pharmacists

He wrote, “Nurses are not involved with giant chain operations, which would love to see ‘pharmacy technicians’ licensed so that RPhs could be dumped by the hundreds and replaced with low-cost help.” He went on, “We pharmacists have to begin considering our very survival.”

I was marching right beside this guy. I was a knee-jerk radical pharmacy defender in 1975. My rough edges had not yet been smoothed out. I jerked like Pinocchio on a string when I sensed danger to my profession.

I attended a meeting of the California State Board of Pharmacy and got in line for my chance at the microphone. I was going to help kill off the danger that was the dreaded technician. Passionately, I warned against the cheapening of pharmacy services if we allowed non-pharmacists any toehold behind OUR counter.

I came up right after the representative of the Retail Clerks union who was on my side and right before a mid-level management type for a chain who was for technicians. You could almost feel the inaudible hissing in the air when he spoke. We who suffered technician-phobia were like lemmings stampeding blindly to the edge. Dark days were ahead. Pharmacists would default on their mortgages and brand new Cadillacs would be repossessed.

The word that Washington state licensed their “A” technicians and that it was working fine had not gotten through the California cocoon.

Some say that there is a disastrous storm gathering right now. Robot pharmacists. Centralized prescription checking. What else? I can’t listen to stories of impending ruin, tragedy and catastrophe. I just do not believe we are in trouble.

We have a hard enough time as it is providing for the prescription appetites of 300 million Americans. Providing medications to growing families is the least of it. The baby boomer’s hunger for youth and health is just going to grow. You think the Rx crush is bad now? This is just the beginning. These people are sophisticated medical consumers compared to earlier generations. They have the money and are going to spend it to be vigorously healthy no matter what. How many dollars are spent just to keep old peckers firm and wrinkled faces botoxed?

Right now, today, we are close to being disabled. Mail order is a necessary pressure release. The pipes are close to bursting. Could we, in the communities, do all of the new prescriptions if mail order was dumped on us next Thursday. We can’t even find the time necessary to give attention to give proper attention to counseling. Perhaps we could actually do our jobs professionally if there was a remote pharmacist sitting in a comfortable chair, viewing a computer screen and checking the work of the technicians in 10 different stores. The days of the in-store pharmacist checking the work of technicians may soon be over. Not so bad. Think about it.

The West Virginia guy stirred up the pot in 1975. We all know now that he needn’t have gotten stressed. I hope he lived a good life, without constant worry and nervous trauma because it all worked out. Technicians are good.

Look forward, my friends. This is still, ultimately, our profession. We can have it any way we want it. We just gotta be smart about it.

Crazy does not mean anti-social. Crazy does not necessarily mean unkempt, unsanitary, offensive or mean-spirited. Crazy is not silly, laughable or entertainment. Crazy is definitely not stupid.

Ever since Ronald Reagan said, “We will no longer warehouse our mentally ill”, the pharmacy is the place where they get the gear needed to navigate in the world. We call it Clozaril, Seroquel, Abilify and Zyprexa… among others. These drugs have been called pharmaceutical straitjackets. The problem is that “chemical warehousing” with the best agents is ridiculously expensive. No insurance and the crazy person is fucked.

I have known Marilee ever since she introduced herself to me in April, 2006 when I was a new pharmacist at Mainland Pharmacy. Marilee is huge. She has packed on plenty of pounds due to her medications. It is something she lives with. Underneath that huge body on a small frame is an absolutely stunning woman.

She called me out front and introduced herself to me with these words, “I am just your neighborhood insane person.” She looked for a reaction and got nothing from me. After four plus decades, there is very little short of child abuse that can get a rise out of me.

Marilee went on, “I hope that you will be patient with me. I try really hard not to
but I can get a little obsessive with my drugs. I ask lots of questions.”

I assured her that it was okay, that my job was to answer questions and, every Friday, there were plenty of questions. After awhile, she lightened up. Maybe she began to trust me. I treat Marilee just as I treat anyone else. No prejudice against the crazy. No snide remarks to the tech. No hidden laughter. No making fun like an adolescent.

A few weeks ago, at 4:00 PM on a Friday, Marilee’s time and day, I looked out and watched her for awhile. There was something not right. For a crazy person, she had always been a picture of composure. This woman is dignified. She sat forward on her chair and glanced nervously to her left and right.

I walked out front and sat beside her. “Are you okay, Marilee?”

• Mr. Magorium’s Wonder Emporium trailer

“I am crazier than Jack Nicholson today. I hate days like this.”

“Oh,” I said. What do you say to that?

“You can’t see him, but that dumb sunuvabitch keeps telling me to do stupid things.”

“Are you having a schizoid episode, Marilee.” I have suspected other people at times, but this was the first time that a patient reported directly that she was having hallucinations.

“You are right about that.”

“What does he want you to do?”

She gave me a little smile. “I’d rather not say.” She looked to her left and
said out loud, “No, I am not.”

I asked her if she needed to discuss her medication with her psychiatrists.

“There is nothing they can do. I can’t afford the good medicine. I’m in the donut hole and the haloperidol is not doing the job.”

Now, I am not even going to comment on the calamity that is Plan D. You can discuss this nightmare, this national disaster, this shame if you want to. I’m out of it today. Marilee is a woman in her early 40s, disabled, unable to work right now. I’d like to ask Ronald Reagan if this is what he envisioned.

What could I do? I sat with her for awhile and she said that it was good to talk to a real person. She explained that her hallucinated person was forceful, clever and, get this, more real to her than I was. She had learned what was which and who was who.

Last week, I went out to say hello and sat down beside Marilee. She was her normal self. Smiling and friendly. She asked me how I was doing. I told her about my childhood polio and the muscle pains in my shoulders and neck that have persisted for years. “My shoulders are killing me today.”

“I can help that,” she said and proceeded to give me the best shoulder massage that I have ever had. I let her. I took it as a gift. I could not refuse this expression of love, if you will. I just sat there and accepted her acknowledgment that she likes me.

What do we do? As a culture, a society, a profession? Not much, I fear. It is all local, you guys. It is individual. There are no rules. All you can do is look up from your computer screen or counter once in awhile. I definitely do not like you very much if you make fun of the Marilees who come in your store. You have an opportunity, every day, to express your humanness. Just remember that Crazy does not mean Untouchable.

Imagine That divx