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.”

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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)

Joe’s Apartment video 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.

“When will my diarrhea go away?” Have you ever heard that one?

How about, “How long do I have to take this depression medicine? It is very expensive and I can’t afford it.”

“Can’t I just exercise and go on a diet? I hate taking drugs. I like the natural way.”

How many prescriptions are written per patient seen by a doctor? I think it is a lot more than the 66% that some “experts” claim. I personally thank that doctors would be looking like dears in the headlights if there were no pharmaceuticals. What would they do? Surgery? Laying on of hands? Play the flute? The chiropractors and osteopaths would take the number one spots. More people would practice yoga. When they realized that there were no drugs for anyone anymore, they’d eat as a popular book urges, “Eat food, not too much, mostly plants.” Very good advice, by the way. As a mature American male, I practice yoga and have not eaten beef for 20 years. But this paragraph is just an amusing digression.

People leave the doctor’s office with questions that have not been answered. Where do they go? Do I have to answer that one? THEY GO TO THE PHARMACIST and they ask questions that the pharmacist has no business answering. They ask questions about their health and medical conditions that have nothing to do with their drug therapy.

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“How long do I have to abstain from sex?” A frequent question when I am counseling a woman about metronidazole therapy.

“Forever if he continues to refuse to take this drug.”

“Serious?”

“He’s the one infecting you.” I shrug. “Maybe condoms.”

“He hates them.”

“Back to my original answer then. NEVER!”

You guys know the drill. That question should have been answered at the doctor’s office. Pharmacists are jammed with work. They don’t have to do the doctor’s job. But, we do. Like compliant little lemmings we take all of the detritus that falls through the funnel. We are at the end.

Some guy at Creighton University, Thomas Lenz, cheerily says, “Pharmacists are among the most accessible members of a patient’s health-care team.” This was included in an advertisement in a national magazine. “THEY ARE TRAINED TO HELP PATIENTS UNDERSTAND THEIR HEALTH PROBLEMS AND TREATMENTS… AND YOU DON’T NEED AN APPOINTMENT.”

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What the…? When was the last time that Doctor Lenz (Pharm.D) put in a shift with his feet on the floor in a retail pharmacy? When was the last time he had a backlog of 20 prescriptions to be checked, 3 patients to be counseled, 2 telephone lines ringing and the non-pharmacist store manger demanding to know why his tech hours went 10% over budget. Plus, he’s hungry, has to pee and that poor little lady out front wants to know if she should buy Aleve or Naproxen Sodium.

Then we have this professor of pharmacy practice at the University,Ph.D, R.Ph. complaining, “Often there is a physical barrier such as a counter or a glass partition. That does not promote communication.”

Well, harrumph back to you.  Thank gawd for a partition if you are lucky enough to have one. My name is not YOU. Like in, “Hey, YOU, where are the lawn chairs that are only $19.99?” Critics needs to put HIS feet on the floor in a pharmacy department, and during the week at 4:00PM. Not on the slow days, Saturday & Sunday, when pharmacy practice professors moonlight for the big bucks.

The Constant Gardener download Thomas Lenz continues, “99% of pharmacists want to talk with patients, The opportunity to use their training and interact with patients is what got them into pharmacy in the first place.”

You are right, Thomas. I love interacting with patients, but why is it the pharmacist’s job to counsel a metronidazole patient on her sex life?

Lenz said this. (Don’t laugh too hard. You will hurt yourself.) “Speak up (to get the pharmacist’s attention). A GOOD pharmacist will look up your file ahead of time and READ UP ON YOUR CONDITION.” He indicates they should consider switching pharmacists if you can’t get easy access. He trots in dangerous territory here. There are people who might talk to a corporate lawyer about that.

He lists seven questions that a patient needs to ask to get the most from medications. In my opinion, only three of them should be directed to the pharmacist. The other four are doctor’s questions. I’ll list them if you want.

How did we get into this thorny situation? Couldn’t our asses be grass if we get out of our area of knowledge and counsel on matters that are medical and not pharmaceutical. Man, this is a litigious society. They sue about anything.

If guys like Lenz & XXXXXXXX keep on with their pie-in-the-sky opinions being published to a national audience (It was a very slick advertisement. Think Big Pharma), it is going to be a hard haul.

I walked into the Kroger grocery store at the entrance where there is a full-size Starbucks. I got my shopping cart, disinfected it with the wipes that Kroger provides (I read with interest the book “The Great Influenza”. It is worth your time), scanned my shopping list and started to make my moves.

There were two people at the Starbucks with their backs turned to me. A woman wearing a very expensive business suit. Blond tinted hair and heels. A man beside her was trim and fit wearing slacks and a dress shirt. When they turned, I could see that she was attractive and wearing a pair of rimless, light weight glasses. The man wore a tie. He was younger, good-looking with the standard mussed up hair and the two day beard that I see on the President of Iran. Nothing to note. It was before they turned around that I saw something worth writing about.

Female pharmacists are often the boss these days. They are Pharmacy Supervisors with multiple stores to manage. They are Pharmacists in Charge who oversee male pharmacists and technicians. They are staff pharmacists who have to manage male technicians. This is dangerous territory.

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This young woman wearing the expensive business suit and the young man were fixing their coffees at the counter where Starbucks provides half & half and sugar. As I walked through the door, she reached down with her right hand and patted him on the fanny. He stepped back, clearly amused by the touch.

Her face darkened and she got a pouty look. She removed her glasses and scratched her forehead. “Don’t tell on the boss,” she said with a wink and a grin.

He smiled, but was that authentic good cheer that I saw on his face. His eyes indicated awkwardness. He said something I could not hear and she laughed.

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I had a hankering to whisper in his ear, “You got her, buddy. Document this and every incident like it. This is classic sexual harassment. Can you spell E E O C?” I would tell women employees the same thing.

I saw this woman again before I left the store. I took a good look. She was an absolute stunner, put together as well as any woman could manage. Hollywood attractive! So, I asked, why is she taking such a chance and hitting on an employee?

It has got to be power. Power is almost like a separate sex organ to some people. Power is an aphrodisiac, I think. Heady and seductive. It is risk-taking and epinephrine-pumping. I had to wonder if this woman was actually lobbying for some sack time at the San Luis Resort down the street or if it was simply the thrill of the chase. Good for the gander. Sadly, I will never know.

I have known a number of men pharmacists who dipped their pens in company ink. (Rule #2 in JP’s 20 Simple Rules is “DO NOT DIP YOUR PEN IN THE COMPANY INK”) I did it twice in my career. Married one for the wrong reasons and the other asked for a raise in bed at the NO TELL MOTEL in downtown San Diego. But I never imagined that a female pharmacy manager could possibly apply to Rule #2. Can this be? You can be anonymous here. Fess up with all of the juicy details.

V tells me that some women mistakenly think that men are supposed to like it when they get that kind of attention. Is that true?

I was a 26 year old pharmacist when the widow owner of the store hit on me. I was unable to respond. I must have looked like a mannequin in a sporting goods store. I acted like it never happened and she was damn graphic about what she was after. Since it never happened again, I thought it an aberration. Not anymore.

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I would bet the house that there are female pharmacy managers regularly engaged in sexual relations with “the help”. There are young, good looking, strong, healthy single women running pharmacies. Young women are not acquiescent, submissive like they were in my young days. In the 1960s, young women sat and waited until the clueless young man that had her eye woke up. Often, they never did. In the 21st Century, young women do not wait. Have you noticed?

There was nothing called “sexual harassment” in the 1960s. Women of all ages had to tolerate terrible behavior and the idea of a woman being the aggressor. Laughable. Not anymore.

Talk to us, ladies. Tell us about it. Also, watch your backs. If these “boys” get smart, your ass is grass.

It takes all kinds, you guys. They have been out there for over 40 years. There was no such thing as erectile dysfunction. It was called “impotence”. There was shame attached to it. Men who couldn’t do a “man’s job” kept it a secret. When they did get up the nerve to call us into a corner for a whispered discussion, they glanced around furtively.

40 years ago, during my first weeks as a registered man, I felt like a fraud when I was asked for a concoction called Doctor Hardy’s Hot Drops.

I was 25 years old and I suffered from a bad case of doctor syndrome. Dress shirt. Regimental tie. White lab coat. The leader of the pack! Hot Drops brought me back to Earth.

I asked the guy, a farmer, what these Hot Drops were for.

He gave me a stunned look and stuttered, “The drops. They help me do my husbandly duties for the missus.”

Remember, I was 25 years old. I did not have a missus yet. I said, “You mean the drops help you in bed?”

He blushed radish red and looked around, “Shhh,” he said, “Can you sell me some Drops or not?”

Men don’t need Doctor Hardy’s Hot Drops in the twenty first century. All they have to do is ask their doctor and they can get free samples of Cialis, Viagra and Levitra and there is no embarrassment.

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There was one notable exception. The guy had a fit when I said the word “Viagra” out loud. He frowned at me and said, “Shhhhh. Don’t say that word.”

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“I’m sorry,” I said, “There is no one here listening to me.”

“I don’t care. Don’t say it out loud.”

“There is nothing to be ashamed of.”

“That’s what you say.”

“You shouldn’t be embarrassed.”

“I am not embarrassed.”

I never saw the guy again. He took his six tablets of Viagra and disappeared into the murky world of sexual relations and humiliation. I am a quick learner. When I talk to patients about any of the big three, I always refer to it as the pill.
Then there are the guys who expect to be super studs. They hear on television about an erection that lasts so long that it requires a doctor’s intervention. They want some of that stuff. Here I am, baby. Come and get it.

I had a guy practically salivating as I filled his prescription. “Can I really get one that will just last and last?” He had a dopey grin on his face. I immediately felt very sorry for his missus or girl friend.

“I doubt it,” I said. This guy was a boomer throw back to the 80s. The top three buttons of his silk shirt were open at the neck. He wore a thick gold chain with a heavy Italian horn hanging from it. A vintage Joe Namath look. Mister Studly Taut Britches.

I told him, “I have seen the commercials too, but I just don’t think that the side effect of a dangerously prolonged erection is very common.”

“Why not?” He was chewing his gum furiously now. Snapping it and switching it from side to side. A young woman showing the jewelry in her belly button walked by and Mister Studly leered at her, nodding his head appreciatively.

I did not see him again until it was time for a refill. I asked him. “Did you get that hard on that lasted a day and a half?”

He puffed up like a rooster. “Close to it,” he said with that same dopey grin.

Erectile dysfunction has been an issue for decades. The difference is that it is now a problem for the baby boomers. $14.00 a tablet is just one small expenditure in the enormous keep me young industry. Did I hear super potent resveratrol on Rx?

Now, you are still asking, what are Doctor Hardy’s Hot Drops? I asked my boss the next day. He laughed and told me that they were just a very dilute solution of Nitric Acid. They irritated the urethra and caused the desired effect. He told me where to find the solution. A 60ml dropper bottle sold for $5.00 and that was when $5.00 was money.

I said, “$5.00? Why so much?”

He said, “Because they wouldn’t work if they were cheaper.”

If you ever need to negotiate a deal with a drug store company, I’d recommend that you talk with a guy I’ll call “Hard Rock”. I give him that nickname not because of his choice of music but because of the way this pharmacist pretty much gets it the way he wants it ….. in all ways.. at work. In other, away-from-the-drug-store matters, this gentleman is a very caring and gentle man. He just knows how to take care of himself at work.

I had a pleasant 20 minutes on the phone with “Hard Rock” this morning. He told me about a visit he had from a “big wig” from the corporate office of the drug store company he works for. One of the “Big Three”. “Big wig” had an agenda.

Victoria and I had a pleasant 2 hour lunch with “Hard Rock” and his wife in Birmingham, Alabama two days after Thanksgiving in 2005. We were on our way to live in Galveston. “Hard Rock” and I had been exchanging e-mails for a couple years and we thought it would be a good thing to meet. Birmingham was a good place to get together. “Hard Rock” lives an hour away and it was one of our planned stops.

“Hard Rock” is a Charter Member of The Pharmacy Alliance. A valued member because of the mentoring he can give us in negotiating with a drug store company. He works 12 hour days because he wants to. He likes working 15 days in a month and having 15 days off. He draws $60.00 an hour. This was a negotiated wage. He is the Pharmacist in Charge. They fill an average of 120 prescriptions in a day. He has adequate technician help.

“Hard Rock” always takes his vacation when he wants to. He never hesitates when his wife suggests that she is ready to make hotel reservations. This guy is a wonder to me. When a partner a year ago was looking at maternity leave, I wanted to know if he would have to work extra. I asked, “Is this going to be a problem?”

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“It won’t be my problem,” he answered with a smile to his tone. “It is their problem. My schedule won’t change a bit.” And it didn’t. He did not work one unscheduled shift. Oh, three years ago, he was offered an hourly wage of quadruple time to work Christmas Day. At his wage in 2005, that was $212.00 an hour and $1696.00 for the day. He refused. They offered more. He refused again.

So, this morning, “Hard Rock” said, “A Big Wig” from corporate was in yesterday.” He laughed.

I knew the story. The President of the company always goes to the pharmacy before any other department. Logical. The pharmacist is an educated professional and closer to the level of the President. The pharmacist is the most important employee in the company. Think about it, you guys who put up with the usual bellshit. The President actually might be interested in what the pharmacist has to say.

Here is what “Hard Rock” related to me this morning.

“‘Big Wig’ shook my hand and, after talking about the weather, he asked me where I wanted to be in five years. I knew what he wanted. He wanted me to project how the prescription business would be doing. I don’t play that game.”

“I don’t know,” Hard Rock told him. “I have not given it any thought.”

“Oh!” Silence. “Uh, what are your business goals?” Big Wig frowned, trying to look important. He stood there with his hands in his trouser pockets clinking some coins.

“I just work here,” Hard Rock answered. “I don’t have any business goals. I just do my job. I am just an employee.”

“Oh,” Big Wig looked at the Pharmacy District Manager who was staring at the floor.

“Hard Rock” said that he and “Big Wig” had a 30 second staring match. “Big Wig” looked away first. He turned, left the pharmacy and did not return.

I said into the telephone, “I’m proud of you.” I am always proud of “Hard Rock”. I’m sorry that he can’t make the meeting of The Pharmacy Alliance in Galveston. Some of us are in dire need of his guidance. He is the least institutionalized pharmacist I have ever known. We all need his guidance and advice at important times. I am fortunate. I have his cell phone number.