Pharmacy. Jim Plagakis. Pharmacist

John leans against the kitchen counter. His arms are crossed in front of his chest. He frowns. “We have a good life… right?” He empties the flying pan of the cold omelet he had prepared for Beverly. He pushes it into the disposal and starts the grind. He knows that Beverly is hungry. She worked twelve hours and it was almost ten.

Beverly says nothing. She is seated at the kitchen table. She is still wearing her white jacket from work. She is staring at her fingernails, then slowly looks up. She spits out, “You burned the toast.” She gives John an accusatory stare. “The smell of burnt toast makes me want to puke.”

“I didn’t do it on purpose.” He doesn’t add that the argument over the grocery list had stolen his attention. He puts the toast in the disposal and runs water over it. He keeps his back to Beverly.

“I did not say that you did it on purpose, John,” she says slowly. There is a pause. Loudly she adds, “Are you deaf, John? I said that it… makes…me…want…to…puke.”

John loses his patience for an instant. “And I asked you if we have a good life. I want an answer.”

“We have a damned good life.” Beverly is almost defiant when she says this. She is tapping the butter knife on the table.

Contact download “Then why are you so miserable so much of the time?” John’s eyes water. “We have two great kids. They go to the best school. We have a beautiful house. Two nice cars. Paid for. We took a couple good vacations. We don’t have any bills.” He paused and fails to smile. “Beverly, I love you. I hate seeing you so unhappy.”

Beverly stares at the plate on the table. John had carefully set a place for her. She glances at the clock. Then attacks, “John, you got home from work at five. You have had all evening to relax. I left the house at seven thirty this morning and just got home at nine thirty. Can’t you let me relax?”

“What did I do?” John throws his arms into the air. He does not tell Beverly that he spent three hours doing paperwork that he brought home.

“What did you do? You don’t even know?” Beverly is on her feet now. She takes a step forward.

“Yes, what did I do?” John’s voice rises. “All I did was make you a good omelet and some toast. You always come home ravished after a twelve hour day.” John throws the frying pan into the sink . It makes a loud clanging noise.

Never Surrender psp

“Yes, that is what you did. You made me a goddam omelet with peppers, onions and some cheese. You know that I don’t like peppers.”

“Since when? You loved them when you had fajitas at El Charro last Saturday?”

“That’s different.” Beverly flings the butter knife into the sink. It hits, leaps up and ends up on the floor.

“Why are you so miserable, Beverly? We have a good life.”

“And I pay for it,” she accuses.

John is silent. This is not a subject he will discuss. His law practice is slow starting, but showing hope. In college, he had promised Beverly that she could cut back after five years. It has been ten.

Beverly draws a deep breath and releases it with a pitiable sigh. “I’m sorry,” she whispers. “John, I’m so so sorry.”

“I know, baby, but why does this have to happen so often?” He steps forward and takes her hands in his. He wants to hold her, but knows that it has to be when she is ready.

Beverly starts to cry. “I worked twelve hours straight. No frikkin’ breaks. It was so busy that all I had to eat in twelve hours was one Snickers bar, gobbled while I worked and a Big Grab of Cheetos and a Diet Coke around five o’clock.” Her eyes beg John to understand. “Then some bitch patient dares to tell me that I have “a orange Cheetos mouth” when I go out to counsel her.

“Just a customer, Beverly. You can’t let that get to you.”

Beverly starts to laugh. “I told her to ‘Kiss my ass’ and she stormed to the manager on duty, that pimple-faced Tony who thinks he his Donald frikkin’ Trump. He comes back to the pharmacy and demands that I come to the office.” Beverly is laughing hard.

“That guy is a wimp,” John is laughing with her.

“I told him, ‘Kiss my ass, Tony. I have prescriptions to check’.”

He screams to me, “I am going to write you up.” Beverly is laughing so hard that there is spittle running down her cheek. John grabs a paper towel and wipes her face. He lets his hand linger. He looks into her eyes. “I love you, Beverly. I just wish we did not have to go through this once a week.”

“I know. I just get running so fast that I can’t stop and there is so much stored up resentment in me that it comes pouring out.” She relaxes into John’s arms. “I always take it out on you.”

“Get another job,” he suggests.

“They are all the same. The managers all think that they are prison guards and that the pharmacists are just over-paid convicts.”

“Won’t it ever change? Why don’t you guys do something about it?” John holds her tight. He whispers, “You are highly trained medical professionals. This is not right.” Throughout their ten years of marriage, John had heard stories that made his attorney hair stand on end.

“There is a chance,” Beverly says. She melts into John’s strong arms. She leans her head on his shoulder. “All we need is for a group of pharmacists to show some guts,” she says. “I’d join them, John. I really would. Somebody has to start it.”

Beverly leans back and looks into John’s eyes. “I’m sorry. I love you, John. That will never happen again. I’ll find a better way to vent.”

“Never say never,” John laughs. He places his hands on each side of her face. He looks into her eyes and then dips forward to kiss her. He holds her for a long time while Beverly softly weeps.

I am interested in the viewpoints of those of you who have been observing for awhile. Many years ago, amitriptyline products were the rage. Probably because there was not much else. Elavil, Etrafon, Triavil. I don’t know if they did much then, but a woman recently told me that 150mg of amitriptyline a day has handled her OCD quite nicely when none of the new drugs de jour helped at all. Her eyes widened happily as she exclaimed, “At a generic copay too.”

This is not good news to the manufacturers of the five dollar a dose “mental” drugs that we pour into vials every day to the tune of millions of dollars before noon. I have this idea that we are just pimps for Big Pharma.

It’s not just depressed middle aged housewives anymore, it is children too. You can’t help but notice that American children are right beside their parents in being overdiagnosed and overmedicated for exaggerated or fictitious mental disorders. This is becoming one of the defining characteristics of the there-is-a-drug-for-everything era.

The blues used to be a good thing. Your boyfriend dumps you, put some Roberta Flack on your i-pod and blues your way through a couple days. Feel it. Yes, it hurts, what the sunuvabitch did. A good lesson learned. Makes you stronger. You will never do that again.

That was then. Now, your mommy calls Doctor Family Practitioner and the guy goes out of bounds and calls in a prescription for Cymbalta. Not fluoxetine for pennies, but Cymbalta for many dollars. Who did you say the pimp is? You learn nothing if you don’t feel it.

People have been drugging themselves for as long as they have been capable of doing so. Cigarettes! If you have never smoked tobacco, you will never know the sublime euphoria you can get from a Marlboro. Cocktails. Lunch and dinner and bedtime. What the? This is healthy?

Before Durham-Humphrey, you could get almost anything from Doc the Druggist. Anyone remember Hadacol? After legend drugs, the era of proprietary drugs kicked in. They have taken 5 decades to get it down, but they run the place these days.

I’ve had fun writing this. If you have read my stuff for the last 20 years, you know that I have a strong narrow-mindedness about Big Pharma. I really think that the drug companies have their hand in a signature medical phenomenon of our times: The urge to manage real or imagined psychiatric pain through substance use.

Let’s stick with kids as a marketing group. You hit the wall with the adults, so you create a market by getting your drugs approved for use in young people and then you brainwash the prescribers.

Children were rarely given amitriptyline for their “pain”. We were given nothing in the 1950s and we lived through our emotional horrors just fine. I remember a girl, beautiful, who was nervous before a major beauty pageant. I was her pharmacist and I thought it strange that her doctor prescribed 12 Stelazine 2 mg. Nowadays, children are given a whole medicine chest of drugs.

Big Pharma is just better than they have ever been before in creating mental illnesses in healthy children. I know that this is not a clear cut matter. It is not as linear as I have portrayed it. There are many extenuating features. Latch key kids are ripe for Big Pharma. Their parents seek out drugs rather than give them hugs and kisses and just pay some attention to them. “Open your mouth, Junior and let me put an Effexor in it. There. Good boy. Go play Wii now, Mommy has things to do and she is tired.”

Big Pharma sees this. “This is a good, sustaining market. Let’s get it.” It is like Field of Dreams, “Market a new drug and they will prescribe it.”

I’ll tell you this little fable just to get you to take on some attitude right along with me.
Big Pharma Disrespect

The technician handed me the telephone. She didn’t say one word. She just leered at me with an irritating grin.

I gave her a look. “What?” I was compounding a 4% Thymol in Absolute Alcohol and she knew that the novelty of this task had run out a long time ago. I did not like being interrupted. “What’s so funny?” I added.

“Take this call, Jim. You are very 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.” I had honestly not heard a word she was saying. It was purposeful. I did not want anything to register.

“Do you want me to repeat something?” What a voice. Sweet like honey. I’d like her to call me at bedtime and just talk. I’d be asleep in seconds.

“No, I want you to just stop.”

“Pardon me.” Ah, did I sense an iciness in the supple voice?

“Just stop and listen to me. Okay?” My voice was firm. “You don’t have a time limit, do you?”

“No, I don’t have a time limit.”

“So, let me talk, okay?”

“Okay.” Her voice was back to very friendly and cooperative.

“Now, please don’t take this personally. I don’t want to hurt your feelings. Okay?”

“I won’t take it personal.”

“Promise?”

“I promise.”

“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 new product that our company will be marketing very soon.” 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 again.

“Your company is insulting me. 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.

“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.” Deep freeze, but she was a bulldog. “Can I just tell you the indication?”

“Nothing.” I was as pleasant as I could manage giving that kind of kiss my ass message. “Please pass what I have told you up the line.”

“I will,” she promised.

“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,” I promised. “We can do that.”