Tuesday, June 29, 2010

A special place

She reminded me of Tinkerbell, the Disney fairy from Peter Pan. Except that her hair had a little more of a strawberry blonde color. She was petite and full of life. She usually was bringing in a prescription for one of her two kids, both under the age of two. Typical stuff....amoxicillin, ear drops, eye drops. And she was so patient with the children. Nothing seemed to ruffle her feathers.

This time, however, she didn't look quite right. Her face was ashen. Her smile wasn't there today. She walked up to the counter and handed me three prescriptions.... Percocet, Phenergan, and Megace.

She had just been released from the hospital after a couple weeks in the cancer unit. She was diagnosed with cervical cancer at age 25.

Over the next few months I saw her on an all too frequent basis. More Phenergan. Some MS Contin. Zofran. Antibiotics. Some days she looked like her old self, other days she had that gray cast to her skin.

Then one day her mother stopped in with a prescription for one of the kids. That's when I realized that I hadn't seen her for several months. I pulled up her profile and saw that we hadn't filled anything in quite a while. Fearing the worst, I asked her mother what had happened.

She had been given a clean bill of health and had started part-time as a home health aid. That aching feeling in my gut went away. This is not the type of person who should die young.

Then I started seeing her in the pharmacy again. More stuff for the kids. She had that sparkle back.

A year or so later her mother stopped in again. The cancer was back, and it had spread. She battled for a few more months, but her body was beaten. She died at the age of 27, leaving a 3 and 4 year old behind for grandma and grandpa to raise.

* * * * *

Fast forward two more years. Grandma came in to fill her own prescriptions... Megace, OxyContin, and OxyIR. She had just been diagnosed with ovarian cancer.

That's just not fair. Those kids had lost their mother to cancer and now grandma was facing it.

Grandma tried radiation and chemotherapy, but they didn't help. The cancer had made it into her bones and lungs. Over the next few months, I saw her OxyContin dose grow until she was taking 160mg twice daily, with OxyIR for the breakthrough pain. I didn't think about the dosages because she had been titrated up and you could see the pain in her face.

Then one Friday she came in with a new OxyContin prescription. She had just filled it on Monday so I was curious as to why she needed it again. The dose and directions were the same. Then she produced the police report.

Her 17 year old granddaughter had stolen the entire bottle from her kitchen. One-hundred and twenty tablets. The police were able to recover most of the tablets, but were not able to return the tablets because they were now evidence in a narcotics trafficking case.

I tried to process the claim, but of course the PBM rejected it. I called to get an over-ride, offering to fax the entire police report to the PBM. They declined. No early narcotics. No exceptions. The insurance did let us know when the next available fill date was... 22 days from now.

We figured out how many tablets would be needed until the next available fill date from the insurance. Grandma paid full retail (over $1000) just to have relief from her cancer pain.

A note to the granddaughter and PBM..... there's a special corner of Hell for people like you.


RxKerBer said...

When I was doing my rotations, I worked at a consulting pharmacy for hospice patients. They reserved fentanyl patches mostly for patients with diversion in the home. It happened so often. I just cannot imagine how someone could take their dying loved one's pain meds.

Phathead said...

Seriously... what the hell?

Words escape me at the moment, which is not very easy to do.

Anonymous said...

When I worked in a hospital, there were three specific incidences with different nurses that 'took' their patient's medications. One was an orthopedic nurse who took the patient's take home prescription, another was an OB nurse whose patient was a doctor's wife, and the doctor became suspicious when his wife was not receiving adequate relief, and the third case was an ICU nurse whose patient(s) suffered variously from trauma to pulmonary hypertension to you name it for what patients are admitted to intensive care. Perhaps the 'loved' ones didn't really have a realistic view of how much pain was being experienced, but surely a nurse would know. Those nurses are already in a special hell.