Wednesday, June 30, 2010 stink

Let's say that you are a 19 year old male who works in a grocery store.

Let's say that this past summer you had several incidents over a two week period where you had difficulty breathing and required transport to the local ER, as you were not well enough to drive there yourself.

Let's say that the company footed the bill for your little trips to the ER and even gave you paid time off as it could not be determined if your breathing incidents were related to your job.

When you come to the pharmacy to get your anti-depressant refilled, don't smell of cigarettes so strongly that it burns my nose when I am six feet away from you.

Your odor totally interfered with the scent of garlic bread that was wafting in from our restaurant.

I had to blow my nose twice and wait 15 minutes before I could get your smell out of my sinuses.

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.

Monday, June 28, 2010

e-prescribing....can't wait for C-IIs to come this way

Dear Doctor,

When the whole e-prescribing thing was introduced, the intention was for you to be able to transmit information directly to me (the pharmacist) without having an intermediary involved who might mess-up the process.

The idea was for you to select the patient, medication, strength, directions, and refill information directly to me thru the computer.

When you give your little hand-held unit to your office staff to send prescriptions to me, it defeats the whole purpose of e-prescribing. What makes me laugh is when one of your staff members calls me because they can't find Metarpalol in your unit and want to know what it is.

Seriously, is it that hard to use the e-prescribing software? Or do you enjoy telling your office staff what to put in the unit two or three times for each prescription?

Eric, RPh

Friday, June 25, 2010

Our eyes met......... (for Brande)

In between scripts the other day I ran over to the self checkout to buy myself a Coke. I looked up after inserting my dollar and that is when I made eye contact with her.

She was standing at the service center. I quickly averted my eyes so that the glance would not become a gaze.

You see, a couple days earlier I had made eye contact with her after the pharmacy had closed and I was picking up a few items in the store. I quickly looked away and moved into the nearest aisle.

No, it's not some ultra-hot babe.

It's our own unmedicated crazy woman.

Every pharmacy has one. The patient/caregiver that nobody wants to interact with. Mrs Crow (not her real name.... HIPAA) is one for the books. It's both comical and sad to watch this woman. She is obsessive-compulsive to the n-th degree. When she comes in to pick up her husband's diabetic prescriptions, it can be a major hassle. Since he gets both needles and test strips, we need to use a grocery bag to bag his meds. The area in will-call for these bags is the bottom shelf with over-flow on the floor. But not for Mr Crow. His bag must always be on the shelf, having never touched the floor.

When we grab his insulin out of the fridge, we need to place the insulin boxes in their own bag, apart from his other medications. Mrs Crow then will open the bag and place all of her husband's medications on the counter to check them. This usually takes her about 5 minutes. After checking his meds, she wants us to staple shut both the bag holding the insulin and the grocery bag.

While she is checking the meds, she asks (every friggin' month) if we can recommend a good physician for her husband. Because they have been released from 4 different offices over the last 18 months due to her constant questioning and antics. When she speaks, her thoughts are not organized and she keeps rambling on and on and on and on and on and on. You can't counsel her because she cuts you off after your third word. I can understand why the physicians don't want to be in the same room as her.

And she is paranoid about germs. She can't stand to be around anybody with a cough/sneeze/ you name it. But she is also afraid of cleaning solutions. If she can smell cleaning solution around the counter, neither she nor the prescription bags can touch it. It's comical because she wears an old yarn hat that has about 15 years worth of grease on it. She is not a very clean person. I can only imagine what the house looks like.

One slow Saturday afternoon, Mrs Crow called with a question about Mr Crow's insulin. He has been taking Humulin-N and Humulin-R for years and his blood glucose is always high. His newest physician wanted to switch him to Lantus and Humalog. After 15 minutes of explaining how the new insulins were supposed to work and how he should get better blood glucose control, Mr Crow picked up on another phone and I had to go thru the whole thing again. That's when I realized that crazy old Mrs Crow is the sane one in her house.

How these two people hooked up, I have no idea. How they function as a couple is even more of a mystery.

And he's due for a refill on his insulin soon. I can only hope Mrs Crow comes in on my day off.

This is a repeat post from my old blog. I filled in at that pharmacy today and saw Mrs. Crow. If you follow my Twitter updates, you'll see how I tried to hide from her today.

Monday, June 21, 2010

Summer with Aunt Sara and Mabel

Summer is here, officially. For a lot of people, Memorial Day marks the beginning of summer. Where I live, it can stay cool for a couple more weeks. So the official start of summer is, well, the official start of summer.

Since the weather has finally been warm for an extended period of time, all of the "poisons" (ivy, oak, sumac) have had a chance to start growing. So have all of the bugs. Mosquitoes and bees/wasps/hornets are starting to have their way.

There's a campground not far from my pharmacy. From Memorial Day until Labor Day the campground sends a fair number of people into the pharmacy over the weekends. Half of my time is spent trying to figure out what caused the rash on any given body part and recommending an appropriate over the counter remedy. Sometimes the remedy is a trip to the local urgent care center or emergency department to get a course of steroids prescribed.

I don't mind helping people out in these situations. They have specific complaints and come to me directly to get my expert opinion on the best over the counter medications to alleviate their symptoms. Over ninety percent of the time the people select one of the products that I choose for them. With all of the OTC counseling sessions for rashes, bug bites, and sunburns, I can keep busy.

But there is one thing that absolutely burns my butt. People coming in after they have taken the advice of their Aunt Sara's friend Mabel's first-cousin's mother-in-law who used to be a nurse's aid at the now-closed-down hospital two towns down the road.

One of my favorite pieces of advice from Aunt Sara's friend Mabel's first-cousin's mother-in-law who used to be a nurse's aid at the now-closed-down hospital two towns down the road is to pour bleach, yes bleach, on the skin to cure poison ivy.

At least three times a week I have somebody come into the pharmacy who is wondering why their skin is itching like crazy. After two or three questions they reveal that they poured bleach all over their arms/legs/you-name-it in an attempt to cure their poison ivy.

Then I ask why they would do that. They always answer Aunt Sara's........down the road said to try this. I then explain to them that they are now dealing with both their poison ivy AND a chemical burn on their skin caused by pouring the bleach on it.

I think Aunt Sara ought to stay away from Mabel during the summer. It makes my job more difficult.

Saturday, June 19, 2010

Only read this if you are cool

I try to keep away from the rants on this blog, I want to keep this blog oriented to issue that advance the profession with an occassional aside on topics that I want to share.

But I do rant occassionally.....on Twitter.

Follow me on Twitter to see my rants in 140 characters or less.

I know you will....all the cool kids are doing it. haha

Friday, June 18, 2010


Two weeks ago was a typical Saturday afternoon in my region of Ohio. It had been a rainy week and Saturday was turning out to be a decent day. The weather forecast called for isolated thunderstorms in the afternoon, so I decided that we needed to get our yard work done early.

I spent the better part of the morning hauling truckloads of mulch to my house and spreading it in the landscaping around my house. I finished a load around 1:30 and debated if I wanted to go get another one. The mulch place is about twenty minutes away from my house and it closes at two on Saturdays. I decided to call it a day.

By the time I cleaned up the yard, put away the shovels and rakes, and cleaned up our walkway it was about two. I decided that it was time to get cleaned up before deciding what to do next.

I stepped out of the shower about twenty minutes later, dried myself off, and put on some shorts. As I was drying my hair my wife came up to our bathroom and said that we needed to get to the basement. My wife gets a little anxious when the weather gets stormy, so I went into our bedroom to see what the weather guy on the television said. When the TV came on, it said TORNADO WARNING for my town. So I walked back to my closet to grab a shirt, slap on some deodorant, and head to the basement.

As I was doing this, a strong wind and heavy rain started pelting our bathroom windows. We walked down the two sets of stairs to join our kids in the basement. The strong wind and heavy rain persisted for about ten minutes, then all was quiet. I glanced at my watch, the tornado warning had expired.

Now I'm a severe weather junkie, so I hurried upstairs so I could run outside and see what, if anything, had happened outside. There were a couple firetrucks at a business that is about 600 yards from my house. It's not uncommon for firetrucks to be there, so I didn't think much of it.

Then I looked at the tree line on the opposite side of our valley and noticed something different.

There were gaps in the tree line that had not been there before.

Then I looked at the neighbor's house about 200 yards away from my house. The barn behind his house had lost some of its roof

and a couple of his smaller farm buildings had sustained some damage.

After confirming that there were no injuries or danger at the neighbor's, my oldest son and I drove to the other end of our road. We saw that some businesses down at that end took more damage from whatever came through.

After a couple days, we learned that the National Weather Service decided that an F1 tornado had come through our valley. Fortunately the only damage was to property. No injuries to any people.

As a result of the tornado, I lost internet and phone service to my house. Kinda weird since the lines that service my side of the valley were not in the path of the storm.

But anyhow, now that service has been restored I'm able to get back to the blogging.

Thursday, June 17, 2010

One Saturday night

She walked up to the pharmacy window and handed me three prescriptions. She was crying and in obvious pain. It was 8:45 on a Saturday night and I was cleaning up the day’s messes.

She baby-stepped over to our waiting area with the assistance of her friend and sat down gingerly on one of the chairs.

I had worked with her before. When I started with the company the previous summer, I trained at the pharmacy she worked at. She was one of the two lead technicians. If you had a question about the dispensing system, Lucia knew the answer. At that time, the pharmacy was filling 600 scripts a day with only one pharmacist. When she was gone, you knew it. She held the pharmacy together.

She was a student at the university two blocks away from my pharmacy. She carried just enough hours to be considered a full-time student. She was an attractive girl. Hadn’t decided what she wanted to do when she grew up, but she just knew that she needed an education to do it.

She was known for her antics when she wasn’t at work. She could party hard. You could even say that she abused her body with all of the booze, drugs, and men. You wondered how she could function on Monday after Lucia told the stories of what she experienced over the previous weekend.

Sometimes I have trouble reading people, but I think the pharmacy manager had a little crush on her. I think that he imagined that he was the object of her affections as she shared about her weekends. She never came to work under the influence, so I think that he let things slide.

I walked over to the computer to input the three prescriptions. They were written by the doctor over at the women’s health clinic that was located just off campus.




A couple months prior, Lucia had another one of her wild evenings where she enjoyed the company of more than one man. Not all of her partners that evening had used a condom. Not knowing that she was pregnant, Lucia continued to party hard.

Until two weeks ago when she took the pregnancy test. That’s when reality struck.

Lucia was a pregnant 22 year-old who had no idea who had impregnated her. Her family was over 200 miles away in her hometown. She was up to her eyeballs in student loan debt. At the time, she was making 10 bucks an hour as a pharmacy technician. And she was getting loaded every weekend, as well as an occasional weeknight.

What was she doing to her body?

To her baby?

Lucia made a decision.

She decided to terminate the pregnancy.


She was able to get a friend to drive her home from the clinic. She stopped by her pharmacy to get the prescriptions filled, but the staff pharmacist who was working didn’t approve of her decision and refused to fill the scripts.

So Lucia came to my pharmacy to get them. Although I personally don’t agree with abortion, it’s not my place to refuse to fill prescriptions after the abortion has taken place based on my moral beliefs. Lucia was a patient who needed care, not a lecture.

She sat in the chair as I filled the prescriptions, holding both of her hands over her lower abdomen. I don’t know if was from the physical pain or if she was grieving the loss of her baby, but you could clearly see that she was hurting.

Her friend came up to the counter to sign for the prescriptions and walked with her out to the car. They were still in the parking lot as I exited the building after my shift was over. I helped her into her seat and gave her hand a little squeeze to let her know that things would be alright.

Over the years I’ve filled too many of those prescriptions. Each time I do, my heart is saddened. Both for the baby who will never be and for the girl who has had to make the decision to end the pregnancy.

Tuesday, June 1, 2010

Frustrated with pharmacy management

A couple months ago I came upon an advertisement in one of the pharmacy magazines that caught my eye. It was for an electronic unit that could be placed in the OTC aisle of a pharmacy. Basically the patient would input their symptoms and voila! the computer program would recommend the appropriate OTC product.

My first thought was what right-minded pharmacist would put that in their pharmacy? People already think that all we do is put pills on a bottle and slap a label on it. Now the clinical expertise for selecting the correct over-the-counter medication is being reduced to a few taps on a touch screen.

I can tell you which pharmacist decides to put that in the pharmacy. The one who hasn't actually practiced pharmacy in 15-plus years. The one who forgot about the profession as he/she advanced up the corporate ladder, striving for a more prestigious title/position within the corporate hierarchy. The type of pharmacist who decides that, rather than freeing up the pharmacist to counsel patients on OTC products over the weekend, the pharmacist (and pharmacist only) should be calling patients on Saturday afternoons to remind them that there are medications that they haven't picked up yet.

Basically the corporate yes-man who happens to have RPh after their name.

It saddens me that pharmacists who are promoted beyond the store level seem to forget how pharmacy actually operates. But that seems to be the norm for pharmacists who are not actually practicing pharmacy. They think of ideas that might have worked back when they were in a pharmacy, but have no chance of working now.

I recently filled in at a pharmacy in my chain that fills five or six hundred prescriptions per day. The pharmacy was attempting to counsel each and every new prescription that came through. My state only requires the pharmacy staff to offer counseling on new prescriptions. But this pharmacy was doing it for all of them in response to a directive from above. That means Mrs. Johnson was being detailed on the digoxin and furosemide that she has been on for the past seventeen years.

Now we did have three pharmacists working ten-hour shifts that day. That is about the only positive thing I can say. But on a day when there are 300 hundred new prescriptions going through the pharmacy, it's going to be hard to counsel each one.

In my experience, it takes four or five minutes to counsel a patient adequately. Using four minutes for the math, we would spend 1200 minutes counseling patients during the day. Twenty hours of counseling. That leaves ten hours for pharmacists to fill the 500-600 scripts. That works out to 20 scripts/hour/pharmacist. And that's not allowing time to consult on OTCs, call physicians, go to the restroom, etc... I think you get the picture.

Maybe in a pharmacy that fills 125 scripts per day. You know, the kind of volume the former-pharmacists-now-managers were filling 15 years ago before they abandoned the profession. But not in today's pharmacy where, thanks to poor third-party reimbursements and $4/free prescriptions, we are forced to crank out the script volume just to keep the pharmacy in the black.

I don't know.... I'm just getting extremely frustrated with the job. Non-pharmacists telling pharmacists how to practice pharmacy (I have a specific example in my local area that I might expand upon later... it will make your blood boil). State boards of pharmacy bowing to the pressure put on them by corporate entities. Pharmacist organizations totally ignoring the realities faced by the majority of pharmacists in the work force.

Maybe I need to change professions and take on something with a little less stress. Anybody know what it takes to be an air traffic controller?