Tuesday, February 23, 2010

Highlights From Friday's Pill Counting Action.

Five minutes after opening my keystone tech comes waltzing in and I just couldn't do it. It was witty maybe the first 25 times I said it, but the horse was just so dead that I would be beating. I sat in silence for maybe 30 seconds. Struggling. "Don't say it." I thought to myself. "Distract yourself with thoughts of scotch and such."

"I know, nice of me to join you." Blurted out my keystone tech as she put on her lab coat. We're getting to know each other too well I fear.  I need some new material, and she needs to stop coming in late.

First words out of the first customer of the day: "Three years ago I had all my teeth"  My hopes for the day soared.  How on earth can any day that starts with those words be a bad one?

I settled into the Friday double-V routine. Viagra and Vicodin. I have Friday regulars for each. One of my Viagra regulars came in this week with his wife. I understood his need for the V. My Supertech rings him up and wifey explodes.

"WHAT??????!!!!!! WE'RE NOT PAYING THAT.....FOR THIS??? THERE IS NO WAY ON EARTH HONEY!!!!"

My Supertech does what she usually does in price-complaint situations. Checks to see what they paid last time. She broke the news to wifey.

"YOU HAVE GOT TO BE KIDDING ME!!!!! FOR THIS????????"

I seriously think I saw the dude shrinking as he stood there next to his wife as she screamed that his intimate encounters were not worth $150 a month. I was distracted by the sound of the Red Hot Chili Peppers "Under The Bridge" wafting from the in-store radio system. I chuckled at the thought of a song about shooting heroin being played in the land of the squares where I now work. Later I hoped the shrunken dude didn't think I was chuckling at him. Uptight rich white people unwittingly listening to heroin music is way funnier than a guy who can't get it up.

Then the great bag crisis hit. It had been coming for some time.

My employer has a system that involves putting finished prescriptions and their paperwork in clear plastic bags to be hung up to await the customers arrival. Nothing fancy mind you, just a bag with a snap top closure. We've been running low for awhile and the pharmacy manager placed an order for more foolishly thinking that is how we would get more. It's not that simple with my employer, who has decided the bags are expensive. There are procedures to be followed. District Managers to get involved. "I"s to be dotted and "T"s to be crossed. My employer really doesn't have much money. We'd been going through the hoops for a month and now....there were no bags. I sent Supertech to the pickup wall to see if any customers had prescriptions in more than one bag. I imagined that my store's enforced bag frugality would be the one event that returned our company to profitability this quarter and felt good about my service to the corporation.

Is anyone else bummed out about how there is almost no classical music on the radio anymore? Back in the day you could count on National Public Radio to give you a fix in the afternoon or late at night, but then they discovered that more news = more dollars during pledge drives. So now in addition to the edition that comes out every morning and the consideration  we give all things in the late afternoon, we're on point and listening to the world and importing news from the BBC and breathing fresh air, which used to be a show about the arts, and whoever decided to let the nails screeching on a chalkboard that is Diane Rhem's voice to ever be broadcast on the radio should be waterboarded.

Where was I going with this? Oh...the classical music. I found a great way around this problem. Anytime you wanna hear some classical music just call your local CVS. You'll be treated to a good 20 minutes or so before a clerk picks up and puts you back on hold to talk to the pharmacist.

And by 20 minutes I mean half an hour.

Ten minutes into this I took a prescription from a doctor's office bimbo. Tussionex suspension, two teaspoonfuls twice a day. Exactly twice the maximum recommended daily dose of two teaspoons in 24 hours. I asked if the kindly bimbo might double check the directions with the doctor. Because I am a goddamn Superpharmacist and you don't get this shit past me.

The least of your problems if you take twice the recommended dose of a narcotic cough syrup like Tussionex would be some opioid-induced constipation. As I was waiting for the return of the Bimbo a customer coincidentally asked if there was something he could take to get his pipes flowing again while he took his Vicodin. Remember it was double-V Friday.

"Why don't you use some Senokot. You can find it down aisle 5"

"Well what do you recommend?"

Bimbo called back. "The doctor said to change the Tussionex to one to two teaspoons every four to six hours"

"So...four teaspoons a day was twice the maximum dose...and you solve the problem by prescribing up to twelve teaspoonfuls a day?"

"I'll just phone it in somewhere else!!" And my license jumped for joy. Pharmacy students take heed. Your head is being filled with clinical situations, pharmacokinetic equations and such, but the times you will actually be making a difference in the real world of retail will more often than not just involve grade school arithmetic and letting people know you just made a recommendation.

I ran out of bags two more times before my store manager brought up a case from the back. The sticker on the box showed they had been sitting back there for 2 years. My store manager is the most competent person I have ever seen in my organization. He is new and I suspect if he doesn't cut it out he will be fired.

I also wonder if I'll have all my teeth in three years. I'm going to go floss now.

Wednesday, February 17, 2010

I Can't Decide If This Is Hilarious Or Infuriating.


"Combines The Most Powerful Forces Of Heaven And Earth!" says the box in the upper right.

Snicker Snicker....

Do you believe? Wear this solid COPPER MAGNETIC THERAPY JESUS BRACELET for the most powerful healing and comfort you've ever experienced!

Oh my God this is comedy gold.

COPPER has been relied on for centuries to ease the pain of arthritis, bursitis, back pain, poor circulation, and more

Wait. The best line is coming up.

And faith in the miracles of JESUS can not only protect you from physical pain, but soothe your soul in times of stress!

BWWWWWWWAAAAAAAAAAAAHHHHHHAAAAAHHHHHAAAAHHHHHHHAAAAAAAAAA!!!!!!!!!!!!

Fully adjustable to fit most wrists.

I can just see that being the clincher for the 800 pound fatass whose back is killing him because a back was never meant to support 800 pounds. Getting ketchup on the form as he fills it out he is, then running the envelope to the mailbox on his riding mower. Because filling out a form for a copper Jesus bracelet is way easier than moving around or trying that goddamn diet his doctor gave him.

Ha ha ha ha ha ha ha......

I can also see the little old lady who's been battling cancer for a year putting her last ounce of faith in a scheister doing business out of some temporary warehouse space in Van Nuys, California. Then trying to take them up on the money back guarantee.

Ha ha ha.....wait...that's, um, not funny at all. Sigh.

So it would seem Jesus has created quite the schism in my brain tonight. It's far from the first schism for which he's been responsible.

Something tells me it's not even real copper.

Sunday, February 14, 2010

Texas, It's Like A Whole Other Country. Unfortunately, It Isn't

Let's say you're a nurse. A medical professional charged with keeping the well-being of the people whose care with which you have been entrusted a priority above all others. We can all agree that a nurse's first responsibility is the interests of their patients, yes?

Now let's say that you are not only are you a nurse, but you are the quality improvement officer of the hospital that employs you, which I think would mean that you are charged with improving patient outcomes at your hospital. After all, a hospital's business is patient care, right? And improving the quality of this type of business would mean taking the best possible care of patients. At least that's what I would assume.

Now let's say your day to day interactions at work give you reason to believe that a certain doctor on staff may be....how do we put this...not to insult any of my many duck readers... but... a quack. Maybe that he was operating in the hospital's emergency room, trying to do skin grafts and failing, when he had no surgical privileges, or maybe trying to sew rubber tips onto patient's fingers in a cockamanie attempt to protect them. He was also hitting up patients to buy herbal supplements he sold on the side.

What would you do? Well in The United States and most of the rest of the civilized world, it would be a no brainer. Address your concerns to the state medical board, which has the responsibility to ensure doctors are competent. "Good job!" your employer would say. "You are surely upholding your responsibility as our quality control officer. We will investigate this matter and strive for an outcome that is both fair to the doctor and ensures the protection of the public"

That's how it would work in The United States and the rest of the civilized world. Unfortunately, this nurse works in Texas.

KERMIT, Tex. — It occurred to Anne Mitchell as she was writing the letter that she might lose her job, which is why she chose not to sign it. But it was beyond her conception that she would be indicted and threatened with 10 years in prison for doing what she knew a nurse must: inform state regulators that a doctor at her rural hospital was practicing bad medicine.
When she was fingerprinted and photographed at the jail here last June, it felt as if she had entered a parallel universe, albeit one situated in this barren scrap of West Texas oil patch.
..in what may be an unprecedented prosecution, Mrs. Mitchell is scheduled to stand trial in state court on Monday for “misuse of official information,” a third-degree felony in Texas.

Not civil slander or libel mind you, which would be bullshit enough, but an actual criminal felony. Ten years hard time.

When the medical board notified Dr. Arafiles of the anonymous complaint, he protested to his friend, the Winkler County sheriff, that he was being harassed. The sheriff, an admiring patient who credits the doctor with saving him after a heart attack, obtained a search warrant to seize the two nurses’ work computers and found the letter.

I'll throw this in for good measure:

The nurses, who are highly regarded even by the administrator who dismissed them...

So the small town Bubba sheriff ready to silence any troublemakers, coupled with a 2003 medical tort "reform" bill, would seem to make Texas, whose own tourism slogan implies a wish to be separate from the rest of us, a wonderful place to practice medicine. If you don't know what you're doing. It's also a great place for a failed president to feel accepted.

Maybe not such a great place if you care about patients and the healing arts.

Sadly, no one has taken them up on their desire to leave us.

Thursday, February 11, 2010

His Was Not To Question Why.....

He struggled to get the proper grip around the Xanax. He wasn't sure if he could handle it. He wasn't sure he wanted to handle it. But the Xanax was there And there were needs for the Xanax.

Upward he went. Higher and higher. Above and away from the day to day minutia of the world, thinking only of the Xanax. How did it come to this point? Why was he doing this? The Xanax seemed to weigh him down as if he were carrying the entire universe beneath him. He thought about letting go and drifting towards the light.

He loved the light, but instead he beat his wings a little harder and carried on. He hoped a bat did not get him.

After what seemed like five eternities he was able to let go. To release himself from the burdens the Xanax had put upon him. He dropped it into the warm, wet cavern of darkness where it belonged and tried not to be overwhelmed by the stench of the person's recently eaten dinner. Garlic.....he was thankful he was not a vampire. Mission accomplished, the Xanax released, he went off to flutter towards the light, for he had earned it.

Two more times and he could call it a day.

At least that's how I imagined it as I looked at the label from my local CVS and its instructions: to "Take 1 tablet by moth three times a day" That's actually not too bad for those guys.

I dialed the phone to begin the transfer and settled in for what I knew would be a long wait.  

Wednesday, February 10, 2010

From The "I Really Wouldn't Be The World's Worst Parent" File.

Back in the darkest days of Bloodthirsty Bush, as this country was planning to go to war to supply his shits and giggles and I was one of 6 people who seemed to be arguing against it, one of the lines of logic I would try was that one of the reasons you should be very, very, deliberate before you committed to something like this was because it would break a good number of the people you sent over to do your fighting for you. That some of them, upon return, would be animals after what we were gonna put them through.

I never used the argument about how we were going to kill lots of innocent people who neither asked for this war nor voluntarily signed an enlistment contract. That argument never went anywhere. Sometimes though, in those dark days of 2003, the argument about breaking our fellow citizens would go forward an inch or two. Usually among people who had experience with vets who returned from Vietnam.

From Monday's news chatter:

An Army sergeant who served in Iraq for 15 months has been restricted to his Washington military base after being accused of waterboarding his 4-year-old daughter because she refused to recite her ABCs.
Joshua Ryan Tabor, 27, was arrested on Jan. 31 and charged with assaulting a child after police in Yelm, Wash., responded to a call of a disturbance at Tabor's home and then later found the little girl hiding in a locked bathroom, according to Police Chief Todd Stancil.
Both the girl and the father admitted to the torture, even detailing how Tabor would sit the girl on the edge of the bathroom sink and hold her head down until it was nearly submerged in water, dunking her if she refused to recite the alphabet, said Stancil.
In the police report, the girl told authorities that "Daddy was upset becuase she wouldn't say her letters" and that he then put her in the water.
"It was hot! The water was hot!" the girl told police, according to the incident report. "I told him I would say my letters then! My heart shirt got wet."
Tabor told authorities that "his purpose was to punish her by putting her in the water because he knows she is afraid of it and he wanted her to cooperate."
"She said her letters after that," Tabor told the cops.

"My heart shirt got wet." I just had to stop and pull myself together for a bit.

And where do you suppose this Sergeant America learned the techniques he used to secure the cooperation of a 4-year old girl?

The blood continues to soak into the palms of Mr. Bush. Ours and theirs. It will for some time.

I really rather would not have been proven right like this.

Tuesday, February 09, 2010

The Health Insurance Industry And President Obama Find Common Ground.

From yesterday's AFP newswire:

Last year, the insurance industry issued a report saying that health care reforms would lead to significantly higher insurance premiums. Obama dismissed the report as "bogus".

Huh. Well I guess that's the good part about the apparent collapse of this whole health insurance reform thing. At least we won't have to worry about those significantly higher insurance premiums. I mean, if there's any group of people who have established a record for honestly and integrity, it's health insurance company executives.

That was the end of the story. Here's the beginning:

US Health Secretary Kathleen Sebelius on Monday called on a health insurance company to publicly explain why it raised premiums for some customers by 39 percent.
"With so many families already affected by rising costs, I was very disturbed to learn through media accounts that Anthem Blue Cross plans to raise premiums for its California customers by as much as 39 percent," or 15 times faster than inflation, Sebelius said in a letter that was faxed to the insurer.
The rate hikes were "even more difficult to understand" in the light of soaring profits at Anthem Blue Cross's parent company, WellPoint Incorporated, Sebelius said.
Wellpoint earned 2.7 billion dollars in the last quarter of 2009, she said, calling on the insurance company to "provide a detailed justification" for the increase.

In an imaginary but quite plausible reply to Ms. Sebelius, Wellpoint CEO Angela Braly said the justification for the rate increase was quite simple.

"Oh, that report last year? The president was right, it was totally bogus. The very definition of bogus actually. We were quite surprised that anyone really believed it. Pleasantly surprised that is. We would like to take this opportunity to thank those crazy-ass teabaggers, and particularly those tools who voted in the Massachusetts special election for doing our bidding far more effectively than an army of K street lobbyists ever could."

"The amazing thing is, they did it all for no pay and in direct conflict to their own self interest, that's what I can't get over. Whatever. You're all our bitches now, and you better not do anything to annoy us ever again." Ms. Braly concluded. "Now beg us to cover your heart valve replacement. BEG US!!!!!!

Ms Braly then announced in my imagination that the 5 people who begged the hardest would have the procedure covered. At out of network rates. And if you didn't like it you could suck it.

I would just like to take this opportunity again to thank the voters of Massachusetts for fucking us all.

Monday, February 08, 2010

I Inspire The New Governor Of New Jersey.

I came very close to becoming a breeder, like most of the rest of my college classmates. Far too close for comfort to following the prefabricated path pharmacy graduates were expected to take back in the early 90's, which I can only assume still applies.

1) Buy a new car.

2) Get married.

3) Buy a new house.

4) Pump out the offspring. And cease to live for the rest of your physical existence.

Fortunately there was the bleach incident. Were it not for the bleach incident you might be reading about my little Tyler's basketball game, or perhaps about the unfairness of a school board's decision regarding bus routes. I would be writing to you from my aboveground coffin and you would be bored.

My post-graduation McMansion, however, was located in the middle of nowhere, which meant it got its water from a well. A brand new well. My crowd didn't do used houses. Thinking back, I can't recall one member of my old posse that bought themselves a used house.  New wells have to be sanitized, which is done by pouring a gallon of bleach down them, running the water in your brand-new house until you smell bleach coming from your brand new pipes, leaving the bleachy water in your pipes overnight, then flushing out the system in the morning. Simple enough. Unless you decide you're thirsty in the middle of the night like I did. I went to get me a drink of water and it wasn't until the feeling of my esophagus being on fire about a minute later that I remembered. My last thoughts would have gone something like this:

Crap, the bleach water.

I remember I'm not supposed to throw up. I think I'm supposed to eat bread or something.

I should call poison contr.....ZZZZZZZzzzzzzzzz...........

And off to sleepyland the king of the McMansion went. Fortunately a painful esophagus for the next week or so was the worst I had to show for my absent-mindedness and preference of sleep to action. It did give me a chance to reflect a bit though, on what I would have left behind if that really would have been the end. I always credited the bleach incident with being the genesis of the process that ended with me making a break for the coast and you being able to read about Mom's who force their children to kill pet hamsters with hammers instead of little Tyler.

I was reminded of the bleach incident today as I read about the new Governor of New Jersey's plan to eliminate that state's poison control center in a bid to save the state all of $529,000. The Governor obviously has gotten wind of the bleach incident story, and has come to the conclusion that all anyone needs to do in the event of a poisoning is sleep it off, like I did.

The Governor needs to realize that I am a extraordinary individual. Superhuman almost. And that most people in New Jersey are of a weaker constitution than me.

He also should know that had I stayed awake, I, a licensed pharmacist, would have called a poison control center. And if they disappear, we will be reliant on the judgement of emergency room doctors like the one I saw in college who made a man throw up after accidentally ingesting 60 mg of nifedipine two hours ago.

Sixty milligrams of nifedipine is well within the normal adult dose if you're playing along at home, and after two hours, it was already in his bloodstream.

So do the people of New Jersey a favor and sign the online petition to save their poison control center. Because there's no way that stench along the turnpike is gonna get any better if we start adding in the smell of rotting corpses of people who've poisoned themselves.

Not even bleach would cover that up.

Wednesday, February 03, 2010

Highlights From Friday's Pill Counting Action.

They will fight like dogs for a dollar off of a bottle of Advil. The dogs of Michael Vick. Suggest that they might have seen the wrong price tag and they will respond as if you had insulted all that is decent and just. It will not matter if you have the machine read the bar code once or twice or a thousand times, for they have no faith in machinery. They saw the price tag, and the price tag says it should be a dollar less.

They saw the price tag, and what it said was that they have to send away for their dollar. It's a mail-in rebate. If they trust the machinery enough they can do it online. Unlike the dogs of Michael Vick however, this defeated mongrel will walk away only slightly humiliated. If she were capable of humility that is. In her eyes the whole episode is the fault of my employer. Listening to this battle raging at the front register as I opened the pharmacy was how I started my day, and it made me glad for the time I put in college, for the time I put in college keeps me away from such things for the most part.

My joy was short lived however, as the first caller of the day asked if I was from the south. It was my accent she said, and now it was I  whose sense of decency and justice had been shat upon, as I would rather be in Michael Vick's doghouse than to ever have resided below the Mason-Dixon line. The tone was set. It was gonna be a "Highlights From Today's Pill Counting Action" kinda day.

The two Vicodin prescriptions in front of me marked the beginning of a journey for the dopey-ass kid who just dropped them off. Each paired with a different antibiotic, they were written on consecutive days from two different dentists. The dopey-ass kid had embarked down the road of drug-seeking dishonesty, and he would someday get better at it, assuming he applied himself. As he came to the register to receive his haul this day however, looked at me, and said, "there were two Vicodins," lesson number one on his journey to addiction sunk in. Namely, that pharmacies keep track of these type of things, and will call your doctor to have Vicodin prescriptions cancelled if you're too lazy to have them filled separately.

No concern was expressed for the lost antibiotic, and Mac Davis' "Baby Don't get Hooked On Me" played over the store's radio as the dopy-ass kid absorbed his first lesson in drug seeking, thereby confirming my knowledge that Mac Davis is an omnipotent being far closer to spiritual nirvana than most of us can ever hope to be.

A guy on his cellphone walked by and said into it, "yeah, I'm at the DMV." An outright lie which further lowered my faith in humanity. I spent most of the next hour wondering what circumstances could possibly make it necessary to lie about being at the DMV.

I think we broke the record for number of labels plastered on a metered-dose inhaler spacer. For the love of God all you PA's and nurse practitioners out there, please stop writing for spacers to go with the albuterol you give for acute bronchitis. They never get filled. Ever.

I stopped an azithromucin/flecanide interaction and 30 seconds later fielded a call as to the price of Welch's grape jelly. I made up a number. I think saving someone's heart from exploding entitles me to do that. I think Welch's grape jelly was 99 cents last Friday if I remember right. I hope I didn't just show my age by quoting a rediculously  low price for grape jelly.

I do know that my favorite scotch is now $32.99 a bottle, up from $29.99 last week. I wonder if that would prompt Mac Davis to sing to me.

I watched a guy try to pick up a chick wearing black fuck-me boots as a kid with a giant afro jogged by chanting, "I love my ball.....I love my ball.....I love my ball ball ball ball ball...." The chant faded into the background...."I love my ball ball ball ball ball....." as the guy crashed and burned. Fuck-me boots chick was just messing with him, like a cat messes with a mouse before dealing a death blow. As I watched I decided I could easily go another month without cable with this type of entertainment in front of me, and that fuck-me boots are the greatest invention ever.

The day ended with a couple having a knock-down, drag-out fight over who was going to sign the credit card slip. It wasn't a matter of which credit card would be used mind you, only over which of them would have the honor of signing the paper that would never be looked at again. Part of me thought being rejected by fuck-me boots chick, and thereby avoiding these types of intra-relationship power struggles, might have been best for that guy in the long run. Part of me couldn't get that chant out of my head, "I love my ball....I love my ball....I love my ball ball ball ball ball...." it really was quite rhythmic.

Most of me though, just wished the two people fighting in front of me like two of Michael Vick's dogs would just wrap it up already so I could go home. I ended the day feeling not quite as good about my college education as when the day began.