A Bad Hair Crazy Day

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. The problem is that “chemical warehousing” with the best agents is ridiculously expensive.  No insurance and the crazy person is hung out to dry. 

 

Think homeless. 

 

I was called out front and this older woman introduced herself to me with these words, “I am just your neighborhood insane person.”  She looked for a reaction and got nothing from me. 

 

I nodded, “We’re all a little bit crazy.”

 

“I am talking insane,” she added.  “There is no little bit about it.”

 

There is very little short of child abuse that can get a rise out of me. I didn’t

take the bait.

 

She gave me a winning smile and I thought, she’s flirting with me.

         

“All right, you feel crazy today.”

 

She frowned and 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.  There were plenty of questions.  After awhile, she lightened up.  Maybe she began to trust me.  I treated her just as I would treat anyone else.  No prejudice against the crazy.  No snide remarks to the tech.  No hidden laughter.

         

One day, I looked out and there she was.   There was something not right. 

         

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

         

“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?”  That response was weak, but this doesn’t happen every day.  I have suspected other people at times, but this was the first time that a patient reported directly that she was having hallucinations.

Cabin Pressure the movie

 

“I am really crazy today.”

 

I didn’t know that crazy came like a bad hair day.

 

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 doughnut hole.”

         

The Part D shame.   A right wing slanted committee in bed with Big Pharma and the insurance companies wrote the Part D bill.

          Another Cinderella Story dvd

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.

         

What do we do as a culture, a society?  What can we do as an individual practitioner?  Will voting right help?  Or do we just look away and think about the hard-to-get squash court reservation after work? 

  

I think it is time that I settled up with you guys.   The memoirs I share with you almost always portray me in a good light.  They are all spot on accurate and factual.  I enjoy letting you in on my druggist chronicles.

The genuine, actual and authentic stories that make me look bad, I don’t tell very often, but the reality is that there is a Mister Hyde in JP.

Office Depot “screwed the goose” on an order that was already two weeks late.  I demanded that they fix it by giving me the “goose that they screwed”  for free.

First, I worked the Assistant Manager over well enough that she asked me to leave the store.  Was I inappropriate?  I don’t think so.

Then, I talked to the store manager and reminded him that when I buy HP Laser Printer cartridges I usually spend over $500.00 at a pop.  I told him that I can get the cartridges from HP over night FedEx.

The question only amounted to a little over twenty bucks.  I got the “goose” for free.

The other day, at work, a guy standing by the register hollered, “Hey you!  Do you actually work here or do you just stand back there scratching your ass?”  He thought that was a good show of his manhood for the sluttishly bikini garbed out-of-town tourist trailer trash that he had picked up on Stewart Beach.  She hung on him and was giggling so hard her fat shook.  Get his nose too wrapped up in this babe and he’d suffocate to death.

He was at the register.  He did not need a prescription, but I recognized him.  He was a regular and had actually asked my advice in the past.  He wanted me to ring up the crap in his basket.

So…. I did it.  It was painless, but I was getting irritated at his act.  Make- jokes-about-the-pharmacist-so-he-would-be-sure-to-get-laid Tuesday night.

Pillow talk in the 1960s Beach Side Motel.  “What a jerk that pharmacist is.”

I knew that he was going to pay for his Coca-Cola, snacks and condoms with an American Express card.  So, I made sure that when the spot came for his billing Zip Code, I put it in wrong.

“Oh, man, I am really sorry.  I put in 77500 when it should have been 77550.  What a dope I am.”

“Well, do it right, man.”  He kissed the girl and nuzzled his mouth against the skin of her neck.  “Well?”

“Well what?”

“Put the number in right. 77550.  Okay?”

“I can’t, man. Do you have another card?”

He stuttered, “Um, uh, well, not with me.  Why another card?”

Samson and Delilah movies

I shrugged.  “Am Ex believes that this card has been stolen.  It is done for the day, maybe longer.”

 

“That’s what CVS said too,” the young woman looked at me.  “What am I going to do?”  She was biting her lip. 

At first glance the prescriptions looked normal.  Pantoprazole 20 mg and Trimethoprim 100 mg.   Both indicated Disp 60.  What she wanted was the price.  I stopped at the Protonix 20mg.  Why bother pricing the trimethoprim?  I didn’t think she could afford the first Rx.

“Listen,” I said, “If you can’t afford that, you can buy omeprazole over the counter and the store brand is on sale this week.  You can call the doctor on Monday and discuss the medications he wants and how they fit in your budget.”

Ever helpful, JP.  When am I going to wise up?  It takes time and some effort to actually try to assist a person who is asking for help.  And, I really do try.  Especially when the matter is price.  These are tough times and people often just don’t have the money.

A boy, about 14 years old, was sent by his aunt for a packet of 8 tablets of Zantac 150mg.  I showed the kid the store brand and explained that she could get 24 tablets for only $2.00 more than the Zantac.

For this young man, it was a no-brainer.  He bought the private label version of Zantac.  Right about the time that alligators were up to my ass, I get a phone call from the aunt.  She tried to work me over, but I was too busy to listen.  She pissed me off.  No trust.  No sense.  I told her to send the boy back and we’d make an exchange.  A half dozen other similar incidents about price last evening and the customers thanked me.

Back to the pantoprazole.  Alien download “You can’t change it.  My baby has to have that.  Nothing else.  It is what they gave him in the hospital.”

Egads!  The prescriptions were for a 2 month old.  Had I gone beyond price, I would have looked at the Sig and would have known.  The dose was tiny.  The doctor, however, did not indicate that she wanted liquids.  She didn’t say 20mg or 100mg per what ml.  I explained that we could not compound these two prescriptions, but I could send them off to a compounding store in Houston.  That is what CVS told her, but apparently I was not dismissive as the CVS RPh had been.  I told her the doctor could have written discharge prescriptions to be filled at the hospital before her baby was released.

I had to put up with the doctor next.  “Why can’t you mix those prescriptions?  You are a pharmacist, aren’t you?”

Now that irritates me.  Should I ask, “You’re a doctor, aren’t you?”

“Because we do not have pantoprazole powder or trimethoprim powder in stock.”

“Why not?”

I do not like “WHY” questions.  They indicate that the questioner does not trust me.  In this case, it was the young doctor using a trial lawyer’s trick.  Put me on the defensive.

I did not bite.  “Doctor, why couldn’t you have given this young mother a thirty days supply at discharge?  You had to know that retail pharmacies do not do specialized compounds such as these.”

“I asked you a question.” 

What?  Did she think that I was on the witness stand?

I said, “about that discharge supply, doctor.”  Is this where I should have said it, “You’re a doctor, aren’t you?”

“What about it?”  She was huffing and puffing.

I said it gently, “It is too late now isn’t it?  You can’t go back.  This baby may have to go without.”

• Shoot ‘Em Up

She ended the conversation abruptly.  Her ass was grass and she knew it.

Answer this question:  Why do I believe that most pharmacy students are indifferent to the state of the “JOB” of working in a retail pharmacy?  Why does it look as if they are not the least bit challenged by the working conditions that prevail?   Most of these people have at the least 50 years with their feet on a pharmacy floor ahead of them.  Is it the sign on bonus?   Is it the student loan they need to pay off?  Is it that they just do not care?

Or do they just think that they are bullet-proof?  They see that 50 year old preceptor walking with a limp as the end of the day closes in and cannot even imagine that what has happened to her after all of those years on her feet can happen to them.  Kids can get by on a salty snack, a Snickers bar and a Coke, but do it for 2 decades and tell me what it is like.

Twelve hour shifts!  It is getting to the point where the 50 year old preceptor won’t be able to do it anymore.  The 27 year old?  String a few together and get the really big bucks. 

Can you spell V-E-G-A-S?

Is the average student’s dorsal lateral prefrontal cortex still not fully developed?  The cortex is where the ability to see consequences for actions lies as well as impulse control.   Twenty four year olds are still like teenagers in many respects.

It is too bad that the pharmacy schools do not address the state of the “JOB”.   I don’t think it is enough to prepare these students to practice the “High Art” when in real life, they are expected to work the “Low Art”.  If you don’t know the difference you are in a terrific job or you own your own store.

The Pharmacy Alliance is dedicated to dignity, self-respect and integrity in the “JOB” of working in a pharmacy.  Shoot ‘Em Up download  I’d think that most students might want those attributes in their future job.  Only a handful of students have joined and future pharmacists are outnumbered 2 to 1 by technicians.   This evidence is not anecdotal.  This is an accurate ratio.  Two techs for every one pharmacy student.

 The annual dues for both are way less than dinner, drinks and a movie.  The dinner being at the pizza joint and the drinks draft beer.

Students can see veteran pharmacists yawning, “Ho Hum”.  They can see the old hands taking their paychecks and not considering that they have a duty to both the profession as well as themselves bothers me.  The experience RPhs must take some responsibility for the lack of awareness among the students.

If you are a student, you might want to consider that there is something to fight for.  It might be good to get some steel in your spine because, listen, you are going to need it.   Your career starts now.  You cannot escape.  Give up childish notions.