Sonny Rollins And The Candy Lady

There was a time in this country when Spam was mainstream. When middle class housewives across the country popped open a can and readied it for their husbands and children and the spam made them all feel like the very epitome of modernity. Before locally grown organic bought from the farmers market vine ripened tomatoes became our status symbol, we ate Campbell's tomato soup from the can, and pitied the poor slobs who had to make soup themselves. Before we had green tea organic natural nourishing shampoo we had Prell."You can be watching TV and see Coca-Cola," Andy Warhol once said, "and you know that the President drinks Coke, Liz Taylor drinks Coke, and just think, you can drink Coke, too. A Coke is a Coke and no amount of money can get you a better Coke than the one the bum on the corner is drinking."

Except Liz Taylor wouldn't be drinking Coke today. Anyone with even a little bit of status ambition would be drinking Fiji water, at the least.

I thought about this as I wandered down the main street of the quaint little Victorian-style town a little off the beaten path and into the candy store of the sad little old lady. She wasn't sad mind you, but seeing her behind the register would break your heart a little. Most of the town had been redone to create a tourist-friendly version of the past; "authentic" saloons, old style hotels that looked like they were ready for you to ride up on your horse and ask for a place to spend the night, restaurants that made you feel all 1875 while serving you up fair trade certified sweetbreads, it was a past in which we all can pretend we'd like to spend a little time, much like a Renaissance Fair.

The sad little old lady's candy store though, represented a past that actually was. Spartan, while tiled, and spare. Serving up Snickers, Three Musketeers, Jawbreakers, and Bazooka gum. A perfectly acceptable inventory for 1975, barely tolerable for a 7-11 today. The little old lady tried to talk you up as you looked over the Mars bars, but she was slightly out of touch in that unique way that the elderly become. She wouldn't be running her candy store much longer. She found her comfort zone sometime around the year I was born and never left it. I doubt though, if the sad little old lady has any regrets.

Earlier that weekend I saw Sonny Rollins headline one of the country's premier jazz festivals. For those of you who don't know, Sonny is the last echo of that golden jazz era that gave us the likes of Miles Davis and John Coltrane, which makes him of almost the same age as the candy store lady. He's lost a step or two physically, his voice is a little frail, but he still commands the stage in a way in which he won't for much longer. He sent his tunes around the arena that night like a boomerang, the notes coming back to their source so he could hurl them back around until they made us all dizzy with delight. He played like a man on fire, a man who knew he wouldn't be doing this many more times, a man who didn't want to let it go. He played and played for a good half hour longer than would have been considered giving the audience their money's worth.

I wondered, as I sat there,  if the intensity of the performance might be because of the time he spent in prison when he was young and an artists creativity is at its peak flow, the months or years it took him to break his heron habit. The frequent years-long stretches he took away from music when he was of strong body. If, looking forward and not seeing many years there, he regretted what he did with some of those in his rear-view mirror.

I doubt Sonny Rollins ever found his comfort zone. I doubt he ever will.

I've thought about Sonny and the Candy Lady ever since, and I'm not sure which way is the best way to be old; comfortable and irrelevant, or on fire and searching, until the last moment.

I Must Give Big Pharma Credit Where Credit Is Due. I'm Glad They Stopped The Corruption.

It's been almost three years now, and I can't tell you how much better I feel about myself. Today you see, I bought my own pack of pens. With my own money. I earned them, and I couldn't be happier. For the first time since I was in high school the marks I make will be my own, free of drug company influence. I am not proud of this, but for most of my career, I never told a drug company sales rep no. So the free pens came. Along with the T-shirts, ball caps, tape dispensers, a flash drive and a mouse pad, and probably a clock or two. With each plastic trinket I felt like a dirty whore. But I could not stop. The Vytorin tongue depressor was too important to me.

Not to mention the Actonel kitchen timer. I made cookies once using the Actonel kitchen timer and they turned out perfectly. They wouldn't have otherwise. Big Pharma corruption was improving the quality of my life, and I knew it even if I wouldn't admit it at the time.

Fortunately the pharmaceutical industry saw the tangled web they were weaving and saved me from myself. Its been almost three years now since they stopped the flow of pens, saving us both from even the appearance of impropriety.

Thank God. Now I am free to read the morning paper in peace.

Several companies, pressured by Congress or required by legal settlements, have started to reveal the names of the doctors they've paid to deliver promotional talks or serve as consultants.

What? Paid? Like money? Nooooooooooo....surely they mean things like Zantac toboggan hats .

Among the top-paid speakers from that sampling was Santa Monica pain physician Gerald Sacks. Since 2009, he has earned at least $522,113 giving promotional talks and consulting for four companies, according to the data.

Wait. That's half a million dollars.

Sacks, an anesthesiologist, isn't a leader in prominent pain medicine societies, and several top pain physicians told us they hadn't heard of him. He doesn't work in an academic medical center such as UCLA or USC. He hasn't published much research. We tried to talk to him about what he was paid for, but he didn't return numerous messages. 

Sacks' slides from a 2008 educational talk and 2009 presentation before the U.S. Food and Drug Administration describe him as the director of pain management at St. John's Health Center in Santa Monica. A hospital spokesman said Sacks has never held that title and that his pain clinic is not part of the hospital. He does have the ability to admit and treat patients at St. John's. 

Drug firms have a pretty fair idea of whether their investment in doctors like Sacks pays off. They pay millions to researchers who buy data from pharmacies and track the prescribing habits of doctors. Pfizer, which gave Sacks at least $318,250 for speaking in 2009 and 2010, according to its data, could find out if and how often he gave patients Lyrica and Celebrex, two of the company's pain medications. Firms can also track whether and how often the people who attended such talks prescribed the drugs that were discussed. 

Yet somehow the problem was my copy of 2000 World Series highlights with a Claritin sticker on the side. Dr. Christian Erik Sandrock of Sacramento gets $156,000 from Pfizer and I'm the one that has to be stopped.

Really.

So the post that I started in such a positive way, with a realization that a boost of self esteem was in order, ends with the realization that I am not even a good whore. I feel better at least, about the Whole Foods cupcakes my Lilly rep snuck in last week.

Go Humalog.

The Perfect 9/11 Poem. That Wasn't Written About 9/11. Or By Me.

It was actually written in 1984, By Depeche Mode, but it sums up 9/11 and the following Decade of Osama quite well:

 I don't want to start any blasphemous rumours/ 
But I think that God's got a sick sense of humor/ 
And when I die, I expect to find Him laughing 

Try to forget the 10 years that started on 9/12. And try to remember the best memorial we could build to the people that died in the twin towers and in that field in Pennsylvania is a world where neither Al-Qaeda or the United States military can find any recruits.

And maybe take a few minutes today to see if you can do a little to make it happen.

Highlights From Friday's Pill Counting Action

"I really hate western medicine" the customer started. "It's not about curing anything, just about making profits for the drug companies"

Blah blah blah....you hear this type of thing all the time on my side of the counter. Especially when that counter is located in affluent California. I tuned out and started to think about that hardest of choices. Would I have a tumbler of scotch or a giant martini after work to help me forget about all this? My psychology professor told me once the hardest choice to make is one between two positive outcomes, and I was starting to see what he meant all those years ago.

I tuned back in to see if anything important had come up. I heard the words "potassium iodide" and took the exit ramp right back off this conversation. I wondered if I had any olives in the fridge should I go the martini route. Put a little olive juice in your shaker and you've got you a dirty martini. That just might hit the spot right now.

I've been in the profession about twenty years, and it took me about fifteen to hone my spidey sense to the point where I magically know when to start listening to a customer again. I felt the force and tuned back in.

"So I should have three prescriptions ready" said the scientific skeptic. "And can I get a flu shot?" The Vicodin and Soma were too soon to be filled. Meaning Ms. Western Medicine Hater would be leaving the pharmacy this day with only her Ambien and a sore arm. The incredible disconnect between the words that came from her mouth and reality almost made me ask her if she'd be interested in sending in a resume' to corporate headquarters. I think she'd really fit in.

I stuck my head back into the prescription pile and was next startled by the sound of a woman berating her child.

"I know you can read!!" She told the little one. "You shouldn't need me to tell you what kind of battery you need"

Five seconds later, the same voice......"VISINE!!!!!!!!" I'll translate that for those of you still left with a modicum of etiquette. What the lady meant was "Excuse me, do you know where I could find the Visine?" People in affluent California though, are far too advanced to actually form a question, they simply boil it down to its essence and scream the one world really loud at the person they expect to answer it, regardless of any evidence that this person is aware they are there or may be doing something that requires paying attention.

"Under the sign in front of you that says eye care" I told the woman who had just stressed the importance of reading. The great thing about the affluent assholes is that as long as their child-like need for immediate gratification is satisfied, they rarely will pick up on things like irony or the fact that you just insulted them.

I took a phone call and was immediately met with a scream. "I PUT ACID IN MY MOUTH!!!!! I PUT ACID IN MY MOUTH!!!!!" The person seemed to be forming words pretty well for someone in the process of incinerating their upper GI tract. Still, I started to give her the number for poison control.

"I SHOULD HAVE KNOWN BETTER....THE TABLETS WERE DIFFERENT. I SHOULD HAVE ASKED YOU BEFORE I TOOK ONE"

Hmmmmm....now I was thinking LSD. But why would someone ask their pharmacist about that?

Turned out the woman had gotten a different brand of Ambien CR, and she thought they had a bit of an acidic taste. She was worked up enough about it I couldn't imagine her getting much sleep that night. Which means she'll be in soon to tell me this new brand doesn't work.

The day closed with a kid in the waiting room whose attention we couldn't get because he was listening to his iPhone. He sat there, looking down, texting away while Alice In Chains poured through his headphones, as my supertech, my keystone tech, and finally myself took turns trying to let him know his zit med was ready. I finally went out and waved my hand in front of his face. Not because of any type of commitment to customer service, but mostly to see if I could scare him. I failed. He just kinda wandered up to the counter like a zombie.

"Your prescription is $25" said Supertech. And there was nothing.

No protest that $25 was too much.

No questioning of how much the insurance covered.

Not even the dreaded "I have a coupon from my dermatologist." Which was what my spidey sense was telling me to expect.

Just a blank stare. For about 30 seconds I'd say. Followed by a little shuffle that kinda carried the kid out of the store like a piece of sea kelp drifting out into the world of the big blue ocean.

It was a martini. And it didn't work. Despite the fact I guzzled it all down with a dash of olive juice I can still remember the whole day. And after twenty years of this I'm starting to become not all that fond of western medicine myself.

Like the Vicodin/Soma/Ambien/Potassium Iodide lady though. I'll be back for more of it tomorrow

If You Listen Closely, You May Detect The Sound Of A State Board Growing A Pair.

"I thought I was too jaded to get excited by something like this, but I've got to admit it lights a fire under my balls to think a state board might have the cajones to step into the ring with any of the big retail chains." So says the alert reader who forwarded this copy of a survey sent out by the Iowa Board of Pharmacy. We shall see.........

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Please take a few minutes to fill out this opinion survey on pharmacy closing rules. The Iowa Board of Pharmacy welcomes your feedback and your answers will be kept confidential. Thank you for your participation.

All responses will remain anonymous and will only be reported in the aggregate.

Do certain pharmacy business practices (such as 15-minute prescription guarantees, incentive coupons to transfer prescriptions, quotas on # of prescriptions dispensed and time to complete DUR, and pharmacist/ technician staff cuts) interfere with the pharmacist's ability to serve as the safety net in the medication use process?

Should boards of pharmacy set a rate for maximum average number of prescriptions dispensed per pharmacist per hour?

Should boards of pharmacy require that individual pharmacies/pharmacists-in-charge determine and document, in policy, a pharmacy-specific maximum average number of prescriptions dispensed per pharmacist per hour?

If yes, should the pharmacy/PIC be required to regularly monitor that rate and make staffing adjustments as needed to comply with their own policy?

Should pharmacy companies be allowed to offer incentives (such as coupons and other promotions) to encourage customers to transfer prescriptions?

Should pharmacy companies be allowed to advertise guarantees on the amount of time in which prescriptions will be dispensed?

Should pharmacy companies be allowed to set quotas or time limits on the amount of time it takes a pharmacist to perform patient care responsibilities, such as DUR and patient counseling?

Agree/Disagree

Advertising or soliciting for patronage is not in the public interest and is a grounds for discipline if it offers bonuses or inducements in any form other than a discount or reduction in an established fee or price for a professional service or product.

Agree/Disagree

A pharmacy shall not guarantee, promise, advertise, or in any way promote the dispensing of a prescription within a specified time limit or period that would jeopardize the health, safety, and welfare of the patient or the ability of the pharmacist to complete the pharmacist's professional responsibilities including, but not limited to, drug use review, patient counseling, and verification of the accuracy of the prescription.

Describe your typical workload in the pharmacy:

Do working conditions adversely impact your ability to practice pharmacy safely?

How long is your typical work shift? Indicate time period in hours:

Do you receive a break during your shift? If yes, indicate length of break in minutes:

Should pharmacies have a required meal break for pharmacy staff?

Should pharmacies have policies regarding workload?

Should pharmacies have policies regarding working conditions?

Should pharmacies have policies regarding maximum work shifts? If yes, should pharmacies have a specified maximum shift for pharmacists?

What type of practice setting do you work in?

Mail (or fax) completed surveys to: Iowa Board of Pharmacy 400 SW Eighth Street, Suite E Des Moines, IA 50309-4688 FAX: 515-281-4609 http://www.iowa.gov/ibpe/index.htm

Today's Flu Shot Follies

The conference call. I don't have to explain to a good chunk of you the futility of the pharmacy conference call. A unique opportunity to touch base with the corporate mothership and cover important business issues of the day. A chance to listen and share with colleagues. To communicate and learn.

While filling your normal amount of prescriptions of course.

And fielding customer questions.

And taking phone calls. On the other line. While the conference call is going on. You get the picture now if you didn't before. Under the best of circumstances, you'll get about half of what is said on a conference call.

Now is the point where I would play you a sample of my District Manager's voice if I could. She has a very strong and unique accent the like of which I have never heard before. I have wondered at times if it isn't actually a speech impediment, but it would probably be rude to ask your boss if she's had a stroke or something. Anyway, under ideal conditions, I can understand about 70% of what this woman says, put her on a conference call, and that'll easily go to under half.

Which means, at best, I'll get about 25% of the information that goes out on a conference call. I'm just very lucky to work for a company that never says anything important.

Today's conference call started with something to do about trash I think. Sorting the right trash into the right containers or something. We've had to make sure any trash with anyone's name on it is separated from the regular trash for over 5 years now, so I'm not sure what might have changed. Good thing I don't care very much or I probably would have been upset I missed out on the whole trash conversation while trying to explain to a moron how they were to take their prednisone. The moron's doctor was really asking a lot of the moron with the instructions he came up with, but I think I got the moron straightened out. When I got back to within speakerphone range the subject had changed to flu shots.

And the flu shot quota, which I've noticed has changed three times since originally imposed.

"So when you're asking your customers if they'd like a flu shot, what kind of reasons to they give when they say no?" Asked my district manager.

I decided that she kinda sounds like a pirate.

"Some people are saying they're worried it's too early in the season." Piped up a pharmacist somewhere who was taking this way too seriously.

"A lot of people are telling me they've already got it at their doctor's office." said another.

"OK then" said the pirate. "Pharmacist Nerd, you've given out the most shots in the district so far, so you must have a lot of experience dealing with people's concerns. What do you say to your customers that say it's too early in the season?"

"I just tell them that we've checked with corporate and they say it's fine" said Pharmacist Nerd, giving us all some goddamn valuable insight.

I noticed now that my Supertech was starting the paperwork so we could actually give a flu shot to a customer while these numbnuts sat around and talked about it.

"Very well" goes the pirate. "And Pharmacist Nerd, what do you say to your customers who tell you they already got it at their doctors?"

Which was the point where I hung up. Which I regret. Because I would have loved to have heard Pharmacist Nerd's answer as to how we can sell a flu shot to someone who's already had one.

Only seven months of flu season to go.......

Of Puppies And Rainbows And Consequences And Reality

I remember the moment like it was only yesterday. It's not often you get the feeling that you're living in a world where things are breaking your way, especially if you're me, especially when I'm dealing in things work related. But there I was in a momentary place where every child has a puppy and rides around on a unicorn that shits out rainbows. Representatives of my employer were actually giving positive encouragement to rank and file employees. They had given them both a challenge and the tools to meet it, and most disorienting of all, had acted pleased when the challenge had been met. I had just graduated with the absolute last class of immunizing pharmacists in my company, and while there were smiles and back slaps all around, I knew what would be coming next.

I remember that moment like it was yesterday because it almost was. In less than three months the positive encouragement has morphed into business as usual. THE FLU SHOT NUMBERS SENT OUT IN LAST MEMO WERE NOT A GOAL, THEY WERE A MINIMUM!! ALL STORES ARE REQUIRED TO MEET THESE NUMBERS AND THERE WILL BE CONSEQUENCES FOR THOSE THAT DO NOT!!! I was genuinely shocked....that it took them this long to return to normal. I rolled my eyes, deleted the message, then walked over to the shelf and broke the seal on a bottle of Jalyn that had been gathering dust and was ready to be sent back to our wholesaler. A little harmless Lordstown syndrome is good for the soul when you work in retail pharmacy.

Thing is, it takes awhile to realize that being a retail pharmacy manager in turn of 21st century America is a setup for failure. That taking your corporate office seriously is a recipe for insanity. The game of unreasonable expectations is one that is played in every major chain, but it takes a few years of browbeating before it usually sinks in. My pharmacy manager isn't there yet, and I can see the stress on her face, aggravated by the fact she's here on a work visa. She's fired and she's also deported. So she's desperately toeing the company line, practically begging everyone who sets foot in the store to get a flu shot. I'm passive about the whole thing, if you want a flu shot, I'll make sure you don't leave without one, but I'm not about to bug your life to talk you into it. I've got plenty of other shit to do.

So far this week I have given 10 more shots than my stressed out, desperate pharmacy manager.

Because she also doesn't realize that the bullies from above, like most bullies, aren't very smart. That their suggested way of doing things rarely matches with what works in the real world. That if you really do want to give more flu shots, their MANDATORY PROCEDURE probably isn't the most effective way to do it.

So the pressure will build and the stress will rise, not only for my manager, but for like minded de-professionalized professionals throughout the company. We've had pharmacists crack under their pressure before, committing fraud regarding some sort of customer service survey and having to write a letter of apology in the company newsletter. Others that got fired over bending the rules when the frequent shopper card came out. If the bullies from above were able to break people over unimportant crap such as that, you know what's going to happen when the type of dollars to be made giving flu shots is on the line.

Someone, somewhere, is going to start making up false flu shot prescriptions to get the bullies from above off their back. I'm calling it right now. And if those false flu shots involve Medicare, which would be the easiest to do since Medicare flu shots have a zero co-pay, whoever does it will be aqua-fucked. Because that person will have just defrauded the federal government. That person will face fines and banishment from the Medicare program, making them unhirable, while the corporation that broke them with prescriptions on a time clock, lists of phone calls that MUST be made, staff cuts and sheets of unobtainable goals will at most, get a slap on the wrist.

It's not worth it. Learn to ignore them my friends, or at the very least, accidentally knock a few Lipitor tablets into the trash with every memo.

One More Reason I Am An Al Franken Groupie.

I think it's around a minute 30 I start to swoon. Oh to have an entire Democratic party of Al Frankens.....




 

A Random Speed Dating Story From Long Ago.

Those of you on the market know what it's like out there, and those of you who aren't probably aren't anxious to be reminded. The hard work, the constant pressure to perform, the degradation and humiliation, not to mention the expense. Trying to get laid my friends, is the hardest job you'll ever love. Kinda like being in sales with occasional orgasms.

The humiliation part was well in evidence as I walked into the kiddie club. The speed dating event was being held in a place that normally attracted a crowd that needed to be well versed in ways to trick a bartender into miscalculating the number 21, so it was incredibly obvious when one of us approached. "Upstairs and to the left" the bouncer said without looking up or so much as a word from myself. I shuffled up to the geriatric corner and hoped it wouldn't be as bad as I feared.

It was. Fat, old, weird, ugly and stupid filled the room. Everyone in this place had an obvious defect and I started to wonder to which category I belonged until I looked into the far corner and saw the exception. Long blond hair and the most elegant air about her you could imagine. Older, yes, but in a way that made you think classy. Worldly. Wise. And experienced in ways that would surely rock my world. The long sleek evening dress cried out to the world that she was the prize this night, and as I looked around at my male competition, a good portion of which was huddled in the opposite corner talking among themselves like this was a junior high dance, I was confident the prize was mine for the taking. I walked over and made a little small talk before the event officially started. It went well.

For those of you not familiar with how these speed dating things work, I'll give you a quick primer. Every lady sits at a table and every guy is assigned a number, guy number one goes to table number one, two to two, and so on. A bell is rung, and for five minutes each couple makes a little small talk until the bell is rung again, at which point the guys move along to the next table in line. It soon acquires the feel of a boxing match. My prize was to be the last lady I would talk to that evening, which would be perfect. I would look positively stunning after she sat through the other 12 numbnuts in the room, and the setup would be perfect for me to suggest we round out the evening by going to the grown up bar down the street. I don't have to tell the single among you what the dry spells are like, but when they break like a welcome drenching thunderstorm in the heat of July, I also don't have to tell you the feeling is among the most ego-gratifying in the universe.

I worked my way through the lesser women with the required subtle politeness. No use burning my bridges, even with the 280 pound redneck with eight... yes eight, children. Hope springs eternal, and she could lose custody of them and have a gastric bypass one day. The anticipation built as the night went on though, to the point where I admit it was hard to concentrate on the woman before the prize. I think she said she raced cars in her spare time, which under normal circumstances would have been pretty interesting. Tonight though, I was meant for more. The bell rang and my heart quickened.

I swear she looked even better than a mere hour ago. I hadn't noticed her smile and her perfect teeth. I realized that smile might be a sign she was glad to see me as I sat down. I was starting to feel something I hadn't in a long time. Happy.

The conversation started with the usual stuff. "So, where do you work?" naturally came up, and I told her about my exciting career in the happy pill room.

"Oh, I was in there once, I asked the pharmacist where the Q-Tips were and he was kinda rude"

"What were you doing asking the pharmacist about Q-Tips?" I instinctively shot back. I will mention here that I am the only man that works behind the pharmacy counter in my store.

The rest of the five minutes passed by in silence, and I went home alone and content.

An Ode To Darvocet, We Knew You Far Too Long.

I've never filled your space on my shelf, dear Darvocet. For so many years I knew that I could reach behind me, to my left and slightly above my head, and you would be there, ready to step into the battle against mild to moderate pain.

Not that you would do particularly well in that battle, but if they gave out grades for effort my darling Darvocet, we all know you'd get an A+

Maybe that's why people liked you so much. Kinda like Pete Rose, you took the limited talent you were given and mixed it with an oversized work ethic, jumping into the fray day after day to improve your skills and gain a competitive edge. Except Pete Rose was successful, eventually becoming baseball's all time hit leader, and you worked just a little better than Tylenol alone. Now that I think of it, your addictive properties probably had more to do with why you were so popular.

Habit forming as you were though, I always loved your sense of humor. The way you would change from white to pink periodically. I'm pretty sure you did that just to fuck with the amateur drug dealers, more than one of which I witnessed trying to scrape off your pink coating in an effort to convince their customers nothing had changed. With every change of color we would get a spike of phone calls on Friday night from people who "found some pills" and wanted to know if we could verify what they were. You mischievous little narcotic you. You'll be happy to know Norco picked up on that trick of yours and continues to pull it off to this very day.

I'll also admit the adverse safety profile that eventually did you in was like a security blanket to me. For the better part of two decades, I knew that if things got too tough, that if the absurdity of the general public or the pressures of life in general became too much to bear, I could always just reach behind me, to my left and slightly above my head, take a couple handfuls of you, and be at hell's front door in about 40 minutes. I always make a note of where the phenobarbital is these days for just that reason, but it's not the same. I don't know why. Maybe because the phenobarbital isn't pink.

I hope you're doing well wherever you are these days dear Darvocet, and that  retirement is as good to you as you were to my profit margins. Who knows, maybe if the teabaggers continue their rise to power it may be decided that the right to have a slightly effective, cardiotoxic pain reliever on the market is a matter of personal freedom, and that banning you from my shelves is akin to pissing on the grave of John Adams himself. Maybe that's why I've kept your spot open, because I wouldn't piss on the grave of John Adams.

I would recommend that people just use the Tylenol #3 though, or maybe some tramadol.