Pharmacy. Jim Plagakis. Pharmacist

I was shopping at the local Target when I came upon a booth for Income Tax Preparation.  The guy was my age so I stopped and said, “Hello.  How’s business.”  He charged $35.00 to prepare a 1040EZ and some people say that pharmacists are robbers.

He was a retired Tax Attorney.  “I like people,” he said, “And my wife died a few months ago and I really needed to get out of the house.”

“Please accept my condolences.  Losing a spouse has to be a horrible experience.”

“Especially the way she died,” he said and his face darkened.  “She died from Xanax and Lithium.”  His whole body stiffened and his mouth hardened.

“Do you think the Xanax and Lithium were the cause of her death?”

“Of course.  There was nothing else.  I woke up one morning, rolled over to kiss her and her body was cold and stiff and hard.”  He gave me a look.  “The drugs killed my wife.”

I took a chance.  We did not have to be friends.  This guy did not have to like me.  “Did she overdose?”

“Hell NO!”  Any chance of friendship was forever gone.

Lithium, of course, can kill.

If you do a little search in the package insert for Xanax you will find the the LD50 for 6 week old rats is so high that it is reasonable to speculate that an adult human being could not get that many pills down, even if they hoarded their prescriptions for year.  Adding a few cocktails is a game changer.  I wondered if her pharmacist had gotten eye contact and had warned her about Martinis + Xanax.

“Did your wife drink?”  I cringed when I asked the question.  This was in Target.  I was not behind them counter.  I was a guy wearing khakis, a T-shirt and sandals (The uniform for the off duty professional in Galveston.  An island, just south of Texas) This question did not please the Tax Man. 

He crossed his arms over his chest.  His mouth moved circularly like a person suffering from extrapyramidal effects. 

I stepped back.  I nodded, said, “Have a good day” and split.

I can’t help myself.  That is what a pharmacist like me does.  My question was appropriate because I wanted to know.  I could use the information as anecdotal evidence when I counseled a drinking patient on benzos.

Here is an anecdote.  A delightful young woman in Pacheco, California was unlucky in love.  She had been used and was discarded.  She hoarded her Valium and took all of them one Saturday night.  She told me about 120 five mg tabs.

She had one terrific sleep and woke up alive.  After that event, she was in great shape psychologically.   She was happy to be alive.  Just the process of actually doing what she thought would end her life, ended her pain. 

I never warned her about Valium + Alcohol.  I worried that the information could be dangerous to her.  I have wondered, over the years, if that was the correct choice.

In this case, there is no right or wrong, I think.