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Wednesday, September 23, 2009

Here In My Car

You all know how much I love love love that convenient outlet for the uber-lazy, the drive by...I mean drive thru. I always feel one paper hat away from asking if you want fries with that instead of asking if you have any questions. I meant medical questions a-hole! I do not have the winning lottery numbers, do not know the proper sequence of equations to build your time machine, the large white paper bag I gave the person in front of you was not garlic rolls, I do not have more garlic rolls, I will not call you if we ever start serving garlic rolls, I do not know the score of the game (no matter which sport is in play that evening), I am not a Dolphins/Marlins/Hurricanes/whatever other Florida team exists fan, I do not schedule nor give flu shots so come back between 10am and 4pm like the marquee and adverts say, we will not give a flu shot thru the drive thru drawer but I have a few places where I would like to tell you to stick the needle, many stores have an urgent care clinic to look at that oozing puss filled lesion you have there so you can be prescribed an antibiotic because this is not whatever foreign country you are from we can't just give you something at the pharmacy our system and laws require you to see a practitioner licensed to diagnose and prescribe and I ain't it, and whatever other stupid request you have that is not remotely appropriate for a drive-thru drawer opening.

In my hood their are lots of tourists so it is not out of the ordinary that a taxi with a t*tty bar ad pulls up with a Viagra/Levitra/Cialis patient who needs "just one pill" immediately. They are a lot of my late night business. I also get a lot of talk time with the police because sometimes t*tty bar fights end up with shots being fired in other places, like behind our pharmacy or a fight breaks out with the crack heads at the hopefully soon to be condemned motel across the street where they all stay which is where the Nude Dude probably came from (several posts ago). We always know who the crack heads are because they usually buy batteries, Chore Boy metal scrubbing pads, baking soda, etc and steal many of these items along the way along with candy, sodas, chips, etc because even a crack head's body will want food eventually but they can't possibly spare a dime for a snack with a rock so close at hand.

My favorite drive thru kids are the ones wanting Class II drugs or as they like to call it "The Good Stuff." The first of these encounters this week was a guy and girl in a taxi. He gives my tech a photo ID, insurance card and two rxs, one for Lyrica and one for Vyvanse so the tech brings them to me for an okay to fill them. I look at the guys profile and here is why I don't fill either of them.

1. He took this taxi ride from a city one hour away from us to get here.
2. His profile shows #70 Ritalin 20mg cash from Doctor A on 8/23 at store A, #80 Ritalin 20mg cash from Doc A on 8/28 at store B, #110 Ritalin 20mg insurance from Doc B on 9/8 at store C, #90 generic Ritalin 20mg cash from Doc B at store A on 9/15, #90 generic Ritalin 20mg cash from Doc B at store D on 9/15/09 and all say sold in the computer which is over 400 tablets in less than 30 days.
3. The rx for Vyvanse was either 30mg or 40mg, #120, taking two in the morning and two in the evening on a patient who has never been on Vyvanse according to our records. The maximum FDA approved "safe" dose for Vyvanse is 70mg once daily.
4. I go over this information with him and he states that this is not doctor shopping so I told him that until I spoke with his doctor no pharmacist was going to fill it because the dose was way over what is legally allowed as "safe".
5. He told me he hoped "I was operating within the law and that to deny this prescription from his doctor who was the head of Harvard Neurology that I was going to kill him." The doc on the rx was from the city one hour away and according to the state MD registry was only registered to that particular practice site. I have great doubts that the head of Neurology at Harvard would hold a full time private practice several states away from his university.
6. He was so f*cked up on something that he could not form a coherent sentence.
7. He continued to argue with me even as I handed everything back to him. Don't f*ck with me cuz I am not gonna humor your bullsh*t and I cannot be bullied into filling ANYTHING that is not within the limit of the law. I do not cave in like the other pharmacies you conned into filling your Ritalin bullsh*t.

In the words of Suzie Orman: DENIED!

The other girl and guy that came in to the drive-thru at 4am for #60 Vicodin ES and #60 Xanax 2mg were also from an hour away and had prescriptions from an office with two mds that both had "Verify all controls, stolen rx pads" in their office listing in our computer. I explained to them that the docs want us to verify all control rxs with them for this reason. She was giving me an "I am so much pain" speech but she was smiling real big and giggling when she handed me the rxs. Sorry, not until their office opens. Again: DENIED!

The piece de resistance was not in the drive thru but still involved a car. An elderly gentlemen came in with his wife's insulin. They needed something for travel that would keep insulin cold for 3 to 4 hours. I sold him an insulated lunch bag with some reusable freezer cold packs which should do the trick. While I was ringing him out the manager paged for me to pick up the phone. I usually let the phone ring until I am finished with a patient because that type of multitasking is rude and I want the patient to feel comfortable and assured that they have my undivided attention. The elderly gentleman had hit a girl in the knee with his car in the parking lot and they had called the police.

My first thought was "That's why we have sidewalks." It was a little more complicated than that. There were several teens getting into an SUV in a parking space. The elderly gentleman drove through the row of parking spaces and turned when he almost hit the truck. This is where he hit the girl in the knee. We watched the video. The elderly guy came within INCHES of crushing 3 people to death. He didn't seem chemically impaired but he was mentally confused and very slow on movement so he should not be driving a car. This is the prime example of why people over the age of 60 should have a mandatory driving test every year in order to have driving privileges.

The most dangerous thing we do every day is drive or ride in a motorized vehicle. You are more likely to die in a vehicle related accident than any other accident or type of cancer. Hell you could play any lottery game once weekly and would be more likely to die in a car than win the lottery. It's just that dangerous. With people texting, intoxicated, illegally unlicensed and uninsured, putting on makeup, doing crossword puzzles, computing, etc while driving it is very dangerous because it may not be you that causes the accident but it may be you that gets killed in one. Be careful out there!!


was1 said...

very good point on retesting drivers. i'd be in favor of retesting every driver (eye test, written test, road test) every time you get your license renewed, not just the old ones. and no politician would support retesting old folks only so it would have to be inclusive of all.

Big 'N Tasty RPH said...

I am all for that! I would take a driving test every renewal especially if it meant that car insurance premiums would decrease.

Big 'N Tasty RPH said...

Oh, and I forgot to mention that would create hundreds of jobs for the DMV nationwide.

Grumpy, M.D. said...

I hate revoking licenses, but I have to do it a few times a year. Almost always for the reason you listed.

I just remind that I'm doing this to protect my own kids, too. And that makes it easier.

As for Vynase junkie... That's amazing. Especially given how expensive Vynase is compared to cheap generic ampethamines of various types.