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Wednesday, July 30, 2008

What A Weekend.....

Friday and Saturday were abnormally slow but by Sunday everything had gone tragically awry.

A guy gave my tech an rx for Percocet 5/325mg from the emergency room. The insurance rejected it "refill too soon" so the tech calls me over to look at the profile.

This guy has taken enough Tylenol/codeine #3, Vicodin ES, and Percocet 5/325mg in the last 25 days to kill a horse. The most recent prescription he filled was for a 5day supply of Percocet that he had conveniently already eaten in less than 48 hours then returned to the emergency room for another round. I refused to fill it because all of the previous prescriptions except #100 acetaminophen with codeine were from different emergency room physicians and filled at different McDruggie's each time.

Here's the icing on the cake: another pharmacist had driven him to my store because he closed his store at 10pm. How rude! Don't push an overdose risk onto another pharmacist because you either didn't want to fill it but didn't have the balls to say it or because you were too f*cking lazy to stay an extra ten minutes to fill the rx. McDruggie's policy is to serve the patient not yourself. The world will not end if you keep the pharmacy open until 10:10pm if you were really going to fill it.

So now I have the distinct honor of refusing to fill the rx and explaining to the patient that I cannot fill it based upon the recent rx history and that I do not want my name on the bottle that sends him to meet Jesus. So he tries to talk his way into the rx by saying "Don't you guys always give a 3 day early fill for pain meds?" Shot down again. "I thought I was supposed to take 5 tabs per day." The tech shot him down on that one because even at 5 tabs a day he should still have 2 days worth of pills left and no need for the emergency room because he could have seen his primary physician in the morning (Monday) for proper pain management. I have never met a primary care physician who could not squeeze in a patient in need for an infection or pain emergency. For all my courtesy I get a "Fuck You" from the patient. So I responded with an equally courteous "Eat me" and hoped they left so I did not need to have the manager throw both of them out.

F*cking rediculous!

So Monday rolls around and I am 10 hours from a week of freedom. Then it again gets a little weird. A patient I had not seen in 3 years shows up out of the blue. He used to see us for his pain management and diabetes prescriptions. He would come in on his motor scooter at night every 4 weeks for his meds and to hang out til midnight. He was struck by a car while on his scooter one night and disappeared from our pharmacy for a very long time.

He told me he now weighs 410lbs (he had lost 80lbs since the last time I saw him) but he is a petite 48 inch waist where normally a 400lb man should have a 60 inch waist. I guess it is all in the way you carry it... He also wanted to know if I knew a doctor that would give him female hormones because he wanted his breasts bigger and his waist smaller. I told him I didn't think female hormones would give him the exact results he was looking for but a plastic surgeon could. I told him to consult with a few doctors though and see what they thought.

I also told him female hormones might cause impotence but he said he was a "bottom" and hadn't been able to get an erection for many years because of his diabetic neuropathy and pitting edema so it didn't really matter to him. Then he asked me about how long before he could take his piercings out. Another patient walked up as he was stroking his nipple ring and saying that it was the most painful. I told him to wait at least 3 months because it needs time to heal completely. He then asked if it was midnight so he could go. It was so he left.

The customer that caught the end of the conversation wanted to know why he couldn't leave til midnight. I told her she didn't want to know. She really wanted to know so I told her. He was waiting for the discount cover charge at the bath house. She regretted that little tidbit of knowledge. I don't know about her but the thought of a 400lb naked man in a steam room with dark purple legs looking for someone to mount him made me sterile and a little nauseus...

Later in the evening I get "too much plastic surgery" elderly woman who needs her Betapace 80mg because she is getting atrial fibrillation from taking the Betapace AF that she had begged the doctor for two weeks ago because it has the letters AF for atrial fibrillation on it so it has to work better. She also swears she cannot take sotalol because it makes her sick.

Hmmmmm, let me see if I understand this. Betapace is the brand name of sotalol. Betapace AF 80mg is the same active ingredient and strength as Betapace 80mg just like the doctor told her but nooooooooo she has to have the one that says AF because that makes it work better. Her insurance obviously agrees with the doctor because they will not cover the Betapace for another 12 days because she got the AF not too long ago.

While I am dealing with her a guy on a bicycle pulls into the drive thru. I tell him I will be there in just a moment. While I am telling him this the lady's dog that has patiently been sitting in a shopping cart tries to attack the store manager and another employee while they are moving chairs and displays out of the waiting room so the floor guys can wash and wax. So now she is screaming for her son to come get the dog. I am through. I give her a couple of tablets of the Betapace that we will deduct from the approved fill and leave a note for someone to call and beg her insurance company to cover it so she doesn't "end up in the hospital" then send her and the dog on their merry way.

Finally I get to the guy on the bicycle and apologize for the wait. He just needed Cialis. He got his pills and went on his merry way also. Now I get to stay in the pharmacy and get slow poisoned by the floor chemicals while the other employees get to sit outside, poison free. I am so glad that weekend is o.v.e.r.

Saturday, July 26, 2008

The Economy Sucks When...

* We still have Diet Mountain Dew, or any soda for that matter, in stock by Saturday morning.

* The drive-thru line is only 2 cars long instead of the usual 10.

* Brand co pays skyrocket...

* Rx volumes plummet...

* The pharmacy is so quiet at night it feels like a zombie attack is imminent.

* Taxis and police sit in the parking lot with the engine off until they are called into action.

* The overnight staff has time to reenact the entire World Cup series (that's soccer) in the toy aisle.

* Someone stole the Drug Monkey's scotch.

* You didn't even notice staff cut backs because we still aren't busy...

* There are no more freebie drug rep pens...Where will my drug ad writing utensils come from now? (shaking fists at heaven) "Don't touch my pens you damn dirty cut backs!!" (Emmy nomination moment)

* Instead of eating at Burger King people are buying a $0.99 bag of "Whopper" flavored potato chips....I have witnessed them on the shelf at McDruggie's, they do exist and I fear them...and their "French Fries with Ketchup" counterpart...

* Fewer customers = shorter wait times!!!

* Hit and run accidents occur in the parking lot. We are so happy they finally got a digital surveillance system...hit and run is a felony...

* The phones are silent during the day.....the day the phones stood still....creepy stuff...

* You only put $30 worth of gasoline in your car at a time and are tempted to siphon the lawnmower and get a pet sheep. (To eat the grass, duh.)

* Fewer and fewer out of state, cash paying cuz they got a 30 day supply on insurance yesterday, oxycodone junkies are bothering you.

* E-prescribing finally takes off because it saves money on paper. Go green! Go legible!

* New bums (some of them aren't homeless) are begging for change in the parking lot. Move over guy who thinks he is Jesus, the competition is fierce. Stinky guy in a moo moo is taking over your 'hood and schizophrenic guy that lives across the street is taking over your racket for free cigarettes.

* People come inside wearing a crusty dusty pair of flip flops and walk out wearing a brand spanking new glittery pair they just swapped off the shelf...hobo chic is back...

* Employees don't call in sick.

* People are more adamant about paging their primary physician at all hours of the night instead of spending the copay to visit the emergency room. Note to physicians: I hope you remember what sleep was like.

* Everyone L.O.V.E.S. generics!!!!!!

* No more Hummers or Escalades pass through the drive-up.

* You consider walking to work at night in the ghetto.

* Every inch of the pharmacy is spotless.

* The doctor finally laid off that b*tch secretary with no education that treats you like fecal matter on the bottom of her shoe when she calls in a prescription and can't even pronounce the drug so you make her spell it and she throws attitude like it's your fault she only got the job because she had big boobs then lost it because she has the intelligence, personality, and likability of powdered milk.

* You actually get to talk to the doctor instead of having to call back with questions.

* Everyone pays with a credit card instead of a debit card.

* You only see 5 patients in 8 of your 10 hours on shift.

* You start singing Hall & Oates...

* Sales of Viagra are flaccid....and thus the weenies that need it are too...

* You have the time to discuss the nuances of The Dark Knight and why it is the BEST Batman film EVER!

* Medicare Part D patients expire before their "donut hole" does....

Thursday, July 17, 2008

Fear Factor

As the Olympics Games kick off in Beijing there will be millions of extra people to feed. Traditional Chinese street vendor fare contains some items other cultures, predominately U.S. cultures, would be disgusted to eat.

I have eaten some things other people may find gross. I was raised on a variety of German and Southern American cooking. We also ate "game" meats as many family members and friends were hunters. Some of the "game" included deer, geese, ducks, squirrels, rabbits, and pheasants. I remember one time my father brought home two pheasants he shot and my brother and I called him a murderer. He didn't bring home any kills for a long time after that. I was 5 and had a pet parakeet so it was terrible to see pretty birds that my father had killed. I got over it as I got older and realized the values of conservation versus overpopulation plus they were delicious. (I can hear the howls of outrage from my PETA friends...)

Other things people might find weird are blood sausage, fried chicken livers and hearts, or pretty much anything in sausage form that definitely contained non-Kosher parts. I had friends in school who ate pickled pigs feet, chitterlings, tripe, head cheese, etc. I also remember my great-grandmother and great-aunt would eat scrambled calf brains and eggs. It sounds weird but is a fantastic source of protein.

A lot of our food prejudices come from how we were raised. Older generations grew up in a time when we raised and slaughtered our own meat. They had no problem swinging a cleaver to remove the head from a chicken then boil it to remove the feathers, take out the guts, quarter it and fry it up for a homemade fried chicken dinner, yum, yum. The advent of slaughterhouses and grocery stores have removed the common man from his food. Most people would not be able to kill or clean their own meat. Hell, most people won't even fish because they don't want to have to clean and prepare it before cooking. It is considered a disgusting and unclean practice but I notice that most people still have not turned to veganism. For all their hoity-toity ideals they still eat meat.

I have no problem eating meat. I don't have a problem eating veal or fois gras even though the practices of raising and feeding animals for those two products stirs up quite a controversy. I do have a problem with raw flesh and things with a rubbery consistency, which is why I never did like the taste of squid even when my friends tell me it was the best squid they have ordered so far. I love fish but only if it is not overcooked, flaky and delicious is the best. I also eat lobster and crab depending on how they are prepared, not rubbery is delicious. But back to Beijing..

Much of the fare at street vendors is eels, starfish, insects, sharks (seriously, they are just fish), all types of fish, snakes, dog (something Americans would be abhorred to eat when they spend thousands on pet treats, toys, and spa treatments for them each year), brains and intestines of various creatures, etc. For the people raised in the "Far East" these items are normal treats and delicacies. When you are raised on something you have no problem eating it.

Thinking about it, it goes back to the old Native American way of not wasting any of the animal that you kill. It is conservation and recycling at its finest. The original "green" way of life. Think about how much edible animal parts we throw away on a daily basis because we think it is gross. Enough to feed a small country.

If we ate insects, amphibians, and reptiles we could diversify to things that would be cheaper to farm than pigs, cows, fowl, and fish. If we could just get over the "fear factor" of eating other things we could drastically reduce farming expenses and maybe appease some PETA efforts to end herd animal cruelty. I have eaten sauteed meal worms and they didn't really have a flavor to them they were just crunchy on the outside and chewy on the inside. They would be a nice high protein, low calorie crouton substitute on a salad. Another thing that would be great on a salad is wasabi coated edamame. They have a spicy kick with a satisfying crunch and they do a great job at opening up the sinuses.

In effect we need to be more in tune with our food, where it comes from, how we get it, and its impact on the environment and economy. I have friends who grow their own vegetables when weather permits and have chickens for fresh eggs. It is a growing trend that may expand as grocery prices are on the rise. Be adventurous. You never know what you might like and it could help you win a reality show challenge in the future.

Monday, July 14, 2008

Open Letter to Seth MacFarlane

I thoroughly enjoy the "Petarded" antics of your Family Guy characters. Some days random comedy does the trick after being frustrated dealing with a bunch of drug-seeking douche bags looking for Oxycontin, Roxicodone, and other fun items to get f*cked up on.

You seem to understand the plight of the lowly pharmacist. I was immediately charmed by the character Mort who does not really fit the new pharmacist module but does totally fit the old stereotype of what a pharmacist used to be.

I was charmed with his violation of patient privacy at Career Day when he told a story of how a boy's father had hemorrhoids so bad he got the cream and applied it with a sock in the car. I was equally charmed when Peter and his band of "hardies" pillaged the pharmacy and destroyed the toys sold there. We actually sell licensed name brand toys now in addition to the traditional busted fare.

My favorite pharmacy moment came from the ipecac incident where Peter, Stewie, Chris, and Brian were having a contest to see who puked last in order to get the final piece of pie. I love those kind of contests because it wallows in the stupidity and self-deprecation that makes humanity destined for failure.

If you need ideas for future skits just ask any pharmacist. We all have crazy stories that would be not-so-wholesome animated fun. You might even want to use McRPH's story of the lady that came in early on Easter Sunday with a Zip-Lock bag of feces in to see if it was abnormal for someone taking antibiotics. I would love to see Mort's reaction to that....

Mad props and I can't wait to see what future seasons hold!

Your tireless fan,

Big N Tasty

Saturday, July 12, 2008

Random Thoughts

If you are buying gifts for someone older than 6 years at McDruggie's do you really like that person?

Cheap flip flops fall apart in salt water and sand.

Why the F are you buying footwear at McDruggie's???

Honking the horn does not guarantee speedy smiling service.

Sometimes credit card companies cut you off because you are irresponsible with your credit not because your medications are expensive.

That song by Hall and Oates that talks about how "You're the only one I love and you can't change that." was either inspired by or resulted in a restraining order. Seriously, listen to the lyrics just once and see how creepy it is compared to the bouncy annoying music...."No you can't change that..."

The regular overnight manager is on vacation. The fill-in manager is supposed to clean the bathrooms. There has been a used tampon applicator sitting on top of the sh*t ticket dispenser for 4 days now and he has cleaned the bathroom every night. Is it going to be there forever?

If your "pain management" doctor's office is a 600 square foot building with a line around it and down the block, including a scuzzy woman with an infant on her arm, what are the odds any pharmacist is going to fill that roxicodone 30mg #270?

Mmmmmm, Diet Mountain Dew is delicious!

Why do I itch every time I get handed an rx for permethrin?

Some nights become easy listening karaoke.

Some nights we dedicate each other's least favorite songs over the intercom when they start to play....ie "BnT, this one's for you!" and the song playing is Hall and Oates "Man on a Mission."

Is is assault for punching a male tech for singing the aforementioned auditory torture to you?

Is it wrong to amuse oneself by repeating the poorly pronounced drug name exactly the same way when you confirm the order with the patient?

Is it wrong to amuse oneself by pronouncing the same drug a different way each time someone orders it?

Is it wrong to amuse ER physicians who call for a recommendation on what to do with a drug seeker at the hospital and you tell them to give a shot of Toradol in the arse because it hurts really bad and they think they are getting something really good?

The people who come up with formularies, input parameters, and copays should all go to hell. That's right, you go to hell and you die...die, die, die!!!

More hot policemen should come and hang out with me at work. I have had a gun in my face while there, it is the least the city could do to make me feel safe and have lots of fodder for dirty fantasies.

My dream man really exists. He is a policeman. I have met him and probably scared the crap out of him because I am intimidating and weird. Maybe "The Secret" will make him come to me or maybe just a call to 911 cuz "The Secret" is a load of horse sh*t...I wish I had written that...

I like to joke around with my patients who I know like a good joke.

You came in at 10pm and told the tech that you were coming back in the morning then get pissed off and scream 2 hours later when your prescription is not ready. Well a*s-hat, you said tomorrow morning. Ocho de manana, motherf*cker, it is written on your scrip. What the hell made you think it would be a priority? Perhaps next time you could explain the space-time continuum flux you live in when I am not ready to smack you for stupidity.

I like to joke around with people who take me completely serious.

Why did the manufacturers change again???? McDruggie's buyer, you can go to hell and die too! Did you really save that much money cuz if you did I would like a tech 7 on/7 off with me. I get busy and lonely all in the same shift.

I babysit machines.

Food poisoning calls and consults make me sympathetic. Puking and crapping at the same instant is no fun because most people don't keep a bucket or have a sink in front of the sh*tter.

Oh Diet Mountain Dew, if you were a small furry creature I would keep you as a pet and treat you like my princess kitty-kitty. She is more spoiled than Paris Hilton and has a better singing voice.

Spell check does not like the word "formularies" either.

When you are working, always park in good view of the security cameras. You never know when a drunken city employee in a street sweeper will smash your precious Beamer Z4 convertible, stumble over to look at it, crawl back in the city truck and drive off. It happened to a friend of mine 2 weeks ago. He is really happy we have digital surveillance. The city gets to pay for his bumper and quarter panel.

Why do I hate Hall and Oates so much?

Oh yeah, their greatest hits album poisoning the muzak ten times a day for the last 5 years...and that god-forsaken boat song from Titanic.....n-e-a-r-r f-a-r-r where-e-e-ver you are....I think I just threw up in my mouth a little...

Would stand-up comedy be a more fulfilling career?

I need a nap.

Friday, July 4, 2008

Summer Fun

It's that time of year again! The kids are out of school and you have to find something to do with them to keep your sanity until August rolls around to save you.

Summer sports are a great way to wear them out so they go to bed and you get some adult quiet time. Family trips may also be fun. A few small things to remember:

1. Sunscreen, so your kids don't end up looking like the lobster dinner you could afford before you had kids, unless you go to Red Lobster but they have magically ruined my food every time I ate there with my parents so I quit going. How do you ruin fried catfish????? They found a way.

2. Plenty of clear fluids like Pedialyte and water so they don't get dehydrated and end up like the kid I watched bagged (bagged = hooked up to a saline IV) and carted away at a concert the other day. Seriously. Soda, fruit juice, anything with alcohol in it is a no-no and in some cases I would not give children younger than 12 Gatorade because it has a lot of sugar and salt which causes diarrhea in children and leads to severe dehydration.

3. With a little pre-treating grass stains and blood do wash out of children's clothes.

4. The pedophile in the clown suit should be shot. Watch out, sex offenders like to attract children. Don't think for a second leaving kids unsupervised with Bozo is a good idea. Behind that happy fun makeup could be a child-killing devil. It may not be just clowns. If you don't want your family ending up as a movie of the week or an episode of Law and Order watch your kids at all times or make sure they are being supervised by someone trustworthy with children. Kids only die once...

5. Scrapes heal with a little cleaning, a band-aid, and a kiss. Mental scars may take a lifetime to heal.

6. Sometimes windows do get broken by baseballs.

7. Homeowners insurance is great.

8. Medical insurance is great too cuz sometimes arms, like windows, get broken.

9. Kids + fireworks = disaster waiting to happen. Please, please, please supervise kids with small explosives because stem cell research has not gotten to a place where where we can regrow an eyeball or a finger.

10. Swimming is dangerous. It takes less than five minutes for a child's lungs to fill with water. You went in the house to take a whiz, no one's watching, come back out and little Jimmy is at the bottom of the pool but you don't see him standing by the barbecue grill and little Jimmy has gone to meet Jesus. Little Jimmy could have survived if someone else had been watching the pool while you took a whiz. Trust me, you will see it on the news several times this summer. "I just turned away for a minute and then my baby was gone..." Don't let that be you and don't trust the teenager at the public pool because they are more interested in the bikini-clad teens than your little swimmer.

Now that I have ruined any hope of a peaceful summer with paranoia enjoy!