Never will I claim to be the sharpest tool on the bench, but I continue to be amazed at how little sense some folks have. I have learned the hard way: common sense is non-existent, as I will illustrate with the following stories. The names have been changed to protect the storyteller. Otherwise, the stories are true. Trust me, I do not have the imagination to make this stuff up! The following does not include the mundane stupidity such as chewing and swalloing a rectal suppository or taking two of something a day when the label states otherwise. Except, I do remember one guy taking a handful of ibuprofen 600mg tablets at a water fountain when the label clearly instructed to "take one tablet with food."
As a colleague one pointed out: “Brains are not needed for reproduction. If fact, too much thought interferes with the ability to make babies.” The following are samples of how some of my past customers failed in the use of contraception.
While passing a nursery at a small community hospital in Vermont where I once worked, a nurse pointed out a new baby; “Mom was on the pill!.” What the nurse meant was the oral contraceptive was inserted vaginally. The tiny tablet was to form a barrier to the sperm? Sperm from baby's Dad, obviously smarter than Mom herself, easily overcame the obstruction. The couple was actually surprised that the method failed.
In the same Vermont nursery as above, the same nurse showed me another baby some months later. When the woman forgot or refused to take the oral contraceptive, the male partner took the dose. The intent was to prevent the male from ovulating. Unfortunately, the woman did!
This story comes from my wife... A woman comes into a hospital clinic with a massive vaginal infection. Upon interview, the discovery was made that the patient was recently given a diaphragm for birth control. Patient was instructed to use jelly with the diaphragm. The woman used; grape jelly! Yum!
I told the jelly story to friend who once worked as an obstetrician's nurse. She told of a tragic tale of a young woman following her mother's advice. The young woman douched herself with chlorine bleach (Clorox) after each sexual intercourse. The method proved to be a very effective contraceptive, but at a price. The woman died a horribly painful death while still in her twenties.
On a Saturday afternoon a young woman, aged 20, came to the pharmacy window bickering, loudly, with her mother.[I assume the more mature woman to be the mother.] In exasperation, the mother told the daughter, "The fault is yours, not mine!" Eventually the mother sheepishly asked for a package of Plan B emergency contraceptive. The young woman shouted at her mother the entire time both were in the window.
I had not thought much of the incident, until the "daughter" showed up at the same pharmacy window on the following Tuesday. She was my last customer, coming at 15 minutes before closing. The young woman was in a state of agitation and her voice became increasingly more shrill as she spoke.
"My boyfriend's a jerk! My boyfriend wanted it at 6 o'clock this morning. I need another Plan B. My mother wondered if I needed a second dose."
My unexpressed thought: "You had NO part in this?!"
I mentioned to the woman that Plan B is not meant as a routine contraceptive. and suggested Planned Parenthood."
In a voice that grew louder with each answer:Why should I do that?
"Planned Parenthood provides exams and birth control"
I see a doctor every two weeks. "I don't want to get pregnant!" What a smart ass know-it-all!
Does my insurance card cover it?
She was very annoyed and unconvinced at my answer: "Not without a prescription, since you don't have Medicaid"
I don't have enough money. She placed some crumpled bills on the counter, nowhere near enough to cover the price. The jerk boyfriend showed up without sufficient funds either.
Can I have a discount? She actually expected the product at less than half of our cost!
Does Rite Aid sell Plan B cheaper?
I answered that Rite Aid does carry Plan B, but cheaper? The young woman then left in a huff with the jerk boyfriend. That young bitch would not take responsibility for any of her actions. She was among the worst omniscient youth ever!
Fifteen minutes before closing a pharmacy outside of a Utica suburb, a customer wanted five prescriptions transferred from another local store and filled at her current location. To say that I was pleased, would be a lie. Yet, all the medication were for mental health drugs. and subsequently she brought enormous entertainment!
While preparing her medication, the customer with great fanfare followed the manager around the store. The conversation appeared to be lively when they approached the cosmetics department of the store. Soon thereafter, the manager placed a package of bath oil beads on the pharmacy bench. The beads were round with a diameter of about an inch across and came in different colors. “Don, I don't know what the customer wants....” the manager remarked.
The woman took a deep breath and loudly told the entire city of Utica, “I have painful hemorrhoids.”
The customer's plan? Go home and freeze the package of bath oil beads, then insert a frozen bead rectally to relieve her painful hemorrhoids. Laughter could be heard from the front of the large store.
I had to walk away from the bench to gain composure. Yea, bath beads broken in the rectum, while oozing frozen scented oil in her underwear should provide great relief for hemorrhoids. Oh, how I wanted to say, “Try the blue ones first!”
A few years ago, a drug chain was desperately seeking pharmacists to work in Norwich, New York. While a pleasant little town, one incident with a customer make me rethink about moving to Norwich.
In a Southern drawl, a woman called; “I haven't eaten for three days...When can I start eating?”
Customer: “The instructions inside the bottle said, 'Do not eat.'”
The instructions the southerner read was from a can of silica desiccant. This gave me one more reason to hate those little cans. Some drug manufacturers have found a way to seal the damned cans in the lid, but in the vast majority of bottles the desiccants are thrown in loosely with tablets or capsules. The cans tend to jam tablet counters. Worse, vision impaired patients have ingested the little cans, mistaking them for pills.
Often customers ask me about some miracle drug or supplement seen on TV. On the slim occasion that I watch a television program, I am grabbing a can of beer when commercials for these wonder cures come on. When asked about this stuff, I usually have no idea what customers are talking about. There are wonder cures for diabetes, arthritis, and obesity.
What I tell customers, "Weight loss plans work by making your wallet lighter."
Scary are the folks who read, or half-read (or usually just read the headline), health articles from major medical journals such as the Enquirer or the Star. Readers of these outstanding journals usually tell me “my doctor doesn't know anything!” A woman came to the prescription counter with a container of blueberry yogurt. The woman was slender, attractive, and well dressed; she appeared to be a business woman. Her question surprised me. "I have lots of yeast infections. I read somewhere that yogurt was good in preventing those infections. My doctor can't figure out how I get all these infections!
The business woman wanted to know if using the yogurt vaginally would stop her fungal infections. She looked at me with incredulity, when I suggested the article in whatever fine magazine meant for the yogurt to be eaten not inserted! She did not seem to believe when I said,“the blueberries and sugar will likely cause a worse infection.”
Oh, by the way, I hate Dr. Oz!
Usually related to "I read someplace..." above are those people who believe that natural products are helpful while overpriced "synthetic drugs: are not.
A Mom came into the pharmacy to pick up multivitamin plus fluoride for the child sitting in a shopping cart. Mom wanted to know if the chewable tablets had any artificial color, flavoring, or sugar. She was concerned about the fluoride in the tablets, afraid of poisoning her child. Anyway while this mother expressed her concern, I noticed a bag of M&Ms in the cart.
Speaking of vitamins, one mother decided it was my fault that her active, young, son of four climbed to the top of a kitchen cabinet and opened the cap to a container chewable multivitamins and fluoride. The boy chewed and swallowed each remaining, at least 20, tablets. She assumed that the child proof caps were defective. Obviously, Mom should bear no responsibility for her child ingesting medication on his own.
Some pharmacies push their flavoring service to cover bad tasting drugs. I am not a fan of this service. Most liquid antibiotics are refrigerated and within the reach of a small child who want their "candy." In my experience young children can act quickly even under supervision. Medication is NOT candy!
I am amazed how some people determine they are in need or are depleted of a vitamin (such as B6,) but nothing else.
I have tried to tell people that most "natural" or supplemental products are unproven and untested remedies, but most people buying this junk are unconvinced. The stimulant herbal product, promoted for weight loss, ma huang, resulted in strokes, heart attacks, and even death. Drug interactions with prescription drugs are unknown, as are side effects.
Red Yeast Rice is used to control cholesterol. Even though most people who take the product tell me, "I will not take the prescribed statin." Red yeast rice has lovastatin as the active ingredient. Lovastatin (Mevacor®) is a "statin" drug. The problem with Red Yeast Rice, along with other dietary supplements, is the lack of standardization of active components across brands or even among different batches from the same manufacturer. And the "natural" product tends to cost much more, especially for people with prescription insurance coverage.
In a small rural village, where inhabitants know each other by name, a teen aged blond walks to the pharmacy counter. The blond, slightly heavy, is wearing a tank top and shorts on the warm July day. The blond is accompanied by a friend, both are enjoying blowing and popping gum balloons. Until the teenagers arrived and shattered the sound barrier, it was another quiet July Saturday in the village pharmacy.
The blond's voice echoed loudly throughout the store. “It hurts when I do it with my boyfriend!,” The blond began between pops of bubble gum. The friend remained quiet, except for the pops from her delightful green gum. I was impressed with how the pops were synchronized.
“I want to please him, he is so hot!”
Somehow, I did not feel qualified to be a sex consoler. In fact I checked my license, it said “ pharmacist.” I meekly asked, “ Does your boyfriend know that your hurt every time you have intercourse?” The register operators could not hear my questions, but the staff heard every word the blond uttered!
“No, ” the blond answered multiple times to empathize the point.. “I don't want to take the chance in losing him. He's hot!
Blondie's friend remained quiet and calm except for gum popping. I, on the other hand, wanted to crawl in a garbage can as the blond went into great details about sex with her hot boyfriend. “Are you being too rough?” I asked.
“Are you using protection? ” I ventured to ask. The silence, except for increase in the amount of gum popping, was noted for this otherwise vociferous young woman
“It hurts every time I pee now!” Finally, an out of this wonderful conversation!“Did you speak to your gynaecologist about all this? It sounds like you have a urinary tract infection. The pill won't protect you if your friend carries something!” I sold the blond an over the counter product to relieve some discomfort. Her gynaecologist called a prescription a couple hours later for an antibacterial to treat her infection. The blond's mother purchased the prescription medication.
The assistant store manager stopped by the pharmacy when the blond and friend left the store. “Don, do you know how old that girl is? She's 14! Everyone in the store heard her! And her boyfriend is no angel! He's taking advantage of her! He has multiple girl friends. ”
I knew the blond's parents. Mom and Dad seem to be thoughtful and careful. Dad worked at volunteer fire company as an EMT. While the blond's questions and comments quickly circulated throughout the village, I doubt if the parents found out.
The State of New York has allowed the sale of syringes over the counter to provide sterile needles to addicts to counter the spread of AIDS, Hepatitis C, etc. How disruptive those customers can be! Addicts waiting for their drugs or syringes tend to pace the floor directly in front of the pharmacy. Patience is in short supply among these clients! Syringe purchasers want me to drop everything and expect immediate service. Who cares if a crying sick kid is waiting for medication! Our pharmacy used to sell syringes in single units, until one became abusive because waiting 10 minutes was too long. So we now sell them in bags of ten and make sure we charge more than our competitors.
Many syringe purchasers will attempt to hide the purpose of the hypodermics by pretending to have diabetes. So these idiots come in and ask for 100 cc syringes. Insulin is dosed in units; most insulin potency is 100 units per ml. The most popular syringe capacity is 100 units or 1cc. I would like to see a diabetic inject themselves with 100 cc of "insulin." Usually true diabetics buy their syringes on prescription by the box.
Used syringes can be found along roads, beside bike paths, and on village walkways! Imagine a small child picking up a syringe in a park, "Look what I found, Mommy." So much for New York's attempt at safeguarding the public!
With cheaply available heroin and hypodermic syringes readily available, drug overdose is now at epidemic levels. To save lives, elected officials want naloxone (Narcan ®) injections to be readily available to prevent deaths. One of my customers volunteers for a local rescue squad. A patient, fortunately tied to the gurney, was given an injection of naloxone, otherwise the patient would have died from a narcotic overdose. The patient so grateful to the ambulance service, that he wanted to "thank" them by beating on the staff. His high was gone!
A member of the New York Assembly wants pharmacists trained to use naloxone in case of emergency. Yes, I want some addict to beat the shit out of me, while I save his/her life treating an overdose!
A couple of years ago, I hurt my back lifting a 3 ounce knife. The pain was enough to keep me from work for a few days. So I went to Inconvenient Care to get a note, allowing me some rest. The provider asked a few times, "Do you need narcotics?" I answered each time, "No, I will do fine with ibuprofen. I just need a note from you." Why the need to prescribe hydrocodone when not needed? No wonder we have a drug abuse problem in this country. I have seen a large increase in the use of narcotics in the past ten years and the results are alarming with the addiction that causes.
In the past two years New York State has begun to require electronic prescriptions, with some exceptions, for controlled substances in attempt to cut down on forgeries and "shopping." Additionally, all New York pharmacies must send an electronic copy of all computer entries for those drugs to a State agency. In theory, physicians, nurse practitioners, and physician assistants must look at a State database before prescribing narcotic to see if the patient is a potential problem.
Still, with all the new regulations, and I'm sure more will be enacted, our prized narcotic shoppers will circumvent any obstacles. Highlights of prior problems follow...
We had a (now former) nurse arrested in the store for altering her script for oxycodone. Fired from her job because of her drug abuse, the nurse was on multiple narcotics. The nurse's sister, Big Bitch, said when the cops came, "I'll get you for what you did to my sister."
Big Bitch called the store claiming that I grabbed her and tried to take her in the "back room" for sex. I suppose no one would notice Big Bitch being dragged across the store! Having forced sex under security cameras would do wonders for my career. I did this from home as the incident occurred on my day off.
Big Bitch was reported to have been evicted from her apartment. Among her actions was taking a hammer to her head then phoning State Police in attempt to frame a neighbor.
I love the Medicaid patients who bring in a script for a narcotic with the benefit card and wonder how I know the prescription is way too early for fill; same drug being dispensed days prior elsewhere!
A few years ago, local policeman came to visit. A former store employee, leader of a gang of four, stole prescription blanks from his father's physician. This particular physician, who treats drug addicted patients, carelessly left presigned prescription blanks on the desk. The former employee wrote prescriptions in the same manner as the physician wrote for his parents. The former employee gave the bogus scripts to three of the buddies, and went throughout our region getting Dilaudid and other heavy duty narcotics. The boys then sold prescription drugs, using the proceeds to get heroin. The former employee got two of those prescriptions filled by me, by coming into our pharmacy when busy. At the time I had no help! The four spent six months in a county jail. One of the boys recently died of heroin overdose.
I am amazed how addicts with multiple health problems make damned sure they have a supply of narcotics, but not caring if they have insulin, heart meds, ets. One severe diabetic went without his insulin for two weeks, but made sure he had his morphine!
December 23rd should be declared National Controlled Substance Day demand for narcotics is very heavy. Pharmacies are closed Christmas, as are most clinics, and one cannot get by Christmas without being stoned.
There are serious ramifications for all this narcotic use. Someone at a local clinic pulled a gun, because he could not get a prescription for a controlled sedative [Ambien]. A pharmacy inside a grocery store, a short distance from my store was robbed at gunpoint, got all the narcotics, and the robbers were never caught.
The great State of New York, after years of pharmacy complaints and patient deaths, finally forced the surrender of a local physician's license. Running a clinic for the treatment of substance abuse, this doctor would write multiple prescriptions and in large quantities in order to treat narcotic addiction. Too often he would write for prescriptions for such substance far too early. We would see multiple scripts for benzodiazepines, such as diazepam (Valium®) AND alprazoplam (Xanax®) and large doses of narcotics (IE, 540 methadone 10mg tablets — enough to kill a horse — along with another narcotic (such as hydromorphone or Dilaudid®). The pharmacy location where I worked was some twenty miles away from this physician, so I did not get the bulk of his patients, but I saw too many! We lost one young dad who being treated for abuse went to bed and never awoken. I suspect other deaths from this physician's treatment in my location alone.
The cases cited by the State Bureau of Narcotic Control, were almost ten years old. One case was similar the young dad, I wrote above. Yet, it took ten years for the State to act.
By contrast, I worked in a pharmacy that allowed verbal orders from hospice nurses for terminal patients. I took in an order for what was understood to be a box of five fentanyl (Duragesic®) patches. The written cover from the attending physician was for 2 patches. Caremark, my favorite third party plan turned me into the State. In two weeks and after the patient died, I got a visit from the Bureau of Controlled Substance. The agent went through all the narcotic records. What I got, subsequently, in the mail was a letter stating that the State would take no action "at this time," but future offenses would carry a fine of $25,000. The result? When hospice called for any narcotics after this fun we were "out of stock."
In the past, almost forty years, working in various locations, I have witness many changes. I am unsure if we are all the better for it.
When I first got my pharmacy license, independent pharmacies were as ubiquitous as McDonalds restaurants are today. Each small town had its pharmacy, though changes were in the air back then. Chain pharmacies were rapidly moving in. Today, three major pharmacy chains control the bulk of the pharmacy market share and many hometown pharmacies are gone. In my adopted home county of Herkimer, there a no pharmacist owned pharmacies. Communities such as Frankfort, Mohawk, Ilion, Herkimer, Newport, and Old Forge all had pharmacies. Ilion now has two chain pharmacies and a franchise. Herkimer, Ilion, and Old Forge have chain pharmacies now. Newport and Mohawk have seen their pharmacies close shop. While the chains offer convenience of a drive-thru window and some cases one stop shopping, much of the personal service from these independents are gone. Try to call a CVS pharmacist in the middle of the night to fill an emergency prescription! High inventory cost of drugs coupled with lousy, late, insurance reimbursements have crippled independent pharmacies (and some chains as well!)
When I first went to work in a pharmacy in 1977, I used a manual typewriter to produce prescription labels. Some pharmacies actually had electric typewriters! Today, we use electronic keyboards attached to computers. These computers allows the pharmacist to bill insurance in real time; forty years ago prescription drug insurance was getting started and we billed by hand. An independent store, worked as a student, had upgraded from a rotary phone; now we send faxes and deal with voice-mail. In the late 70s pharmacies did not use bar codes at the register. All this evolving technology make it almost impossible for a pharmacist to start a business.
Computerized technology make it possible to transmit all kinds of data to government agencies, insurance companies, and physician offices. That prospect scares me. HIPPA aside, all kinds of personal health information goes who knows where. The sheer volume and speed of sharing personal health data did not exist when I got my license in 1980.
Sources of pharmaceuticals have changed in my years on the bench. Many drug companies no longer exist, most merged in large companies. Again, three or four pharmaceutical companies control the market. Cost of drugs have risen significantly over the years, the reasons are too numerous to mention here. However, since most people don't pay out of pocket for prescription drugs, insurance allows drug companies to charge large fees for new drugs. Sure, government regulations and product research affects drug prices, but if customers had to pay up front for their medication I suspect drug prices would come down.
State and Federal regulation has blossomed over the years. Boards of pharmacy, Drug Enforcement Agency, Health Department, Medicare, Medicaid, etc. have all increase their presence. The worst of all comes from insurance. Many insurance companies have market share agreements with pharmaceutical companies which results having to call physician offices because certain drugs are not covered. Pharmacies are subject to random audits of prescriptions by insurance; small errors can lead to big money losses for pharmacies.
In New York, Medicaid patients are typically charged a co-pay for prescriptions. The State of New York has mandated that patients should get their medication despite ability to pay. Many of these clients refuse to pay and the pharmacy loses the copay.
Pharmacy school, when I graduated, was a five year course. It took me fifteen years to pay off the loans. Today, six years of college is required to be a pharmacist. Some pharmacy schools, like Albany College of Pharmacy, are trying to mandate seven years of education. The tuition rates have skyrocketed. New pharmacy colleges have opened, resulting in too many pharmacists. Many pharmacies are closing, including chains (such as the one I worked the past dozen years.) Target sold their in-store pharmacies to CVS. Three large drug store chains control the market along with mail order firms. Pharmacists work in assembly line operations, with some stores filling over 300 prescriptions a day. Many pharmacies do not allow for set lunch or break times for pharmacists.
I have friends who say, "Pharmacists make too much money!" Really? Work twelve hours a day in a mill environment without stop. Make a mistake as a colleague pointed out,"You lose everything!" A mistake can cost a pharmacist his license, his home, and career.
When I first received my license, the main concern was check each physician prescription for errors and fill the script accurately. Today, pharmacists are required to do medication management. Now, pharmacists are expected to provide vaccinations. Chain pharmacies pressure pharmacists to give flu shots, because there is more reimbursement than for prescription drugs. A pharmacist is lucky to have a minute to check the accuracy of a prescription drug, filled by technicians.
Twenty five years ago, I met a colleague at a continuing education seminar at Lake George. His great grandfather had opened a small town apothecary, complete with a soda fountain. The business was passed down to generations: from grandfather, to father, and subsequently to him. Since the chains moved in his town, his store lost business and prescription insurance barely covered drug costs. He had to sell the store to Rite Aid and for the first time none of this man's offspring went to pharmacy school.
In mass retail establishments where pharmacy is not the major business, many store managers choose to make changes to the pharmacy without any idea of how that department is operated. In most cases managers at least make the attempt to be collaborative. However, there are notable exceptions. Those exceptions are like some customers who want their prescriptions filled without waiting, be accurate, and be free. Those managers seem to think that pharmacists just "count pills." A competent pharmacist checks the prescription for proper doses, potential interactions, therapy duplications, and patient allergy. The final product must match the physician prescription. In most cases, we also bill insurance. Managers who make abrupt changes in pharmacy personnel can create real havoc and put patients at jeopardy.
One store manager showed extra ignorance. I saw her walking around the Health and Beauty section of the store with a subordinate male area manager. The two would speak together in such professional manner that paint could curl off walls. The manager finally made it to the pharmacy counter with the male underling in tow. "Where's the Viagra? I don't see it anywhere!"
I said, "Viagra needs a prescription."
"Why do you need a prescription for something that makes you feel good!"
I responded, "Not everyone can take Viagra. Men with heart problems for example should not take the drug!"
"If the drug makes you feel good, why does it need a prescription? "
Exasperated, I said, "Hydrocodone makes you feel good why don't we just put it over the counter next to the aspirins?" She looked at me with her dark eyes, silently, then walked away with the male underling.