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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.


Sazymae said...

I think your patients are crazier than mine... and that's saying something. Was it a full moon this weekend?

The Chick in the White Coat said...

Loved the post. I can really relate to floor cleaning--I was made to stay from the end of my shift (10pm) until well after 1am one spectacular Saturday night so the floors could be waxed. Do you suppose I got overtime or the next day off? Nah, I open on Sundays at 10am so I get to 'sleep in' as the store manager put it. Bear in mind this little babysitting mission was sprun on me an hour before I closed that night.

The Chick in the White Coat said...

By the way, enjoy your vacation!

Anonymous said...

thanks for this, it made me laugh so hard! Where in the world do they still have bath houses, still in San Fran???

Big 'N Tasty RPH said...

Bath houses are everywhere, you just have to look...