Spousal Support

I'm trying to think of a safe way to present what happened two nights ago. It involves a husband and wife, and both of them are prescribers of some sort. I don't want to give anyone away, so I won't say if they are doctors, nurse practitioners, dentists or physician assistants either retired or actively practicing. How's that? Because I work in several different towns, I won't disclose the location either.

Anyway, a guy (who is a prescriber of some sort, either retired or in active practice) brought a written prescription for himself. It was for Percocet, and it was written and signed by his wife. Do you think that's legal/ethical? I won't have you ponder that one for too long, and I'll just tell ya...it's not! There are a few instances where it's sort of okay. For example, if there is an emergency, and if it occurs isolatedly (it should be a word) then it's not totally unethical. We paged the fellow back so we could break the news to him about not being able to fill the prescription. While I awaited his return from a far corner of the store, I checked his profile and noticed that his wife had prescribed several other controlled substances for him over the past year or so, so we haven't been paying attention to these shenanigans as well as we should have. All of that made this seem like less of an isolated emergency. Most, if not all, prescribers should know that it's naughty to prescribe such things for a family member, let alone a spouse.

Once the gentleman returned to the pharmacy, I explained to him that I was unable to fill his prescription. He immediately called his wife and shoved the phone in my face, demanding that I speak to her. I don't usually talk on a patient's cell phone, but if this prescriber feels he's above the rules, then maybe I should feel that way too? Okay, so I talked to his wife and explained that maybe, perhaps, it wasn't a good idea to have to her name attached to so many controlled prescriptions for her husband, and I also reminded her that her husband signed a contract with a pain clinic stating he'd only do one-stop shopping with regard to his Percocet, so it's pretty bad to break that contract. She seemed grateful for my intervention in the matter, and I returned the written prescription to her husband at her request. As I was handing it over, he YANKED the paper out of my hands, walked over to the garbage can, ripped up the prescription with dramatic body movements and stomped out. Classy.

Bugs...They Bite

😲👈 That emoji right there represents the facial expression my brain wanted me to have during the following encounter. 😐👈 That emoji represents my actual facial expression, because over the years my talent has grown for making customers feel not quite as dumb as I think they are.

 A dude came to the consultation window at the pharmacy to show me some bug bites on his arms and to ask what he could do to alleviate the itching and "make the bite disappear." Then this conversation took place:

Itchy Bug Bite Buy: So, do you know what bit me?
Me: No.
IBBG: Would they (gestures to my coworkers) know?
Me: No.
IBBG: Well, maybe they would have an idea about what's going around biting people.
Me: I know what it is. Bugs. 
IBBG: But not here.
Me: (confused silence)
IBBG: I didn't think there was anything around here that bit people. Do you think we had a recent flock of bugs come into town?
Me: Well, we have various bugs on a regular basis, including mosquitoes.
IBBG: Well, it wasn't a mosquito.
Me: What was it then?
IBBG: I don't know.
Me: Have you gone anywhere? Walked through any brush or gone camping?
IBBG: No. I haven't left my house all weekend until now. I've been doing yard work all day.
Me: It was probably a bug from your yard then.
IBBG: I don't think so. I didn't see anything.
Me: If you had a lot of weeds to pull, several different bugs like to hide in weeds.
IBBG: Could you just ask the pharmacist what he thinks bit me?
Me: I am the pharmacist.
IBBG: Well, could you ask that other pharmacist?
Me: There wasn't really a bug class in pharmacy school. Also, the treatment is pretty much the same, no matter what bit you, unless it was a poisonous spider or some such thing.
IBBG: Wasn't a spider.
Me: Okay, great.

The Gator Ate It

I always like a good excuse from a customer. I forget to write them all down; otherwise, you'd be reading super awesome and hilarious excuses all day. Before I forget, I just need to share one excuse a customer shared with a colleague of mine, though it's not one I'll likely forget. A customer needed an early refill of a controlled substance, because he took his medication with him while flying his helicopter. He made the mistake of leaving the bottle on the dash, and it slid out the door and into the mouth of an alligator. I'm hoping it's a true story instead of an attempt to score extra meds, but I guess we'll never know.

Al Bundy Comes First

A lady came to the pharmacy requesting a 10-pack of insulin syringes. This particular pharmacy doesn't sell 10-packs anymore. If someone wants insulin syringes, they have to buy a box of 100. It's the pharmacy's way of fighting illegal substance abuse. The logic seems sound. (As a side story, I told a different lady she had to buy 100 instead of 10, and she showed up 4 hours later with a sock holding enough coins to make the purchase.) This woman didn't seem bothered by the requirement to purchase 100 syringes until I told her the price. Instead of the $2.50 for 10 she was used to, she would have to pay approximately $14 for 100. She said, "Are you kidding me?! That's outrageous! I need them for my cat, and you expect me to pay $14 for syringes? My cat will die without these. Fourteen dollars is crazy!" I thought about pointing out that 10 packs of 10 would end up costing $25 over time, but I didn't think she'd use that information wisely, since she didn't automatically do that basic math on her own. In case my readers don't like math either, I figure it's nice to mention that's a savings of $11. Anyway, I could understand her frustration, so I offered to call around and find a pharmacy that still sold 10-packs. Well that wasn't good enough! She continued, "What good is that going to do? Then I have to drive to another store!" I mean, if you love your cat, and if your cat is going to die, what's a little extra driving? While she continued her rant about how stupid I was and whatever, I noticed she had in her cart a box set of "Married With Children," a case of diet Pepsi, a jug of LA Looks hair gel and about nine candles. I almost suggested she put an item or two back in order to make the syringes seem more affordable, but how can I make someone choose between a beloved feline family member and Al Bundy? The choices some people have to make...

(Maybe "my cat" is code for black tar heroin. Don't know. Don't care.)

What's in a Name?

The following scene is real, but the names are not. Well, they're real names, but they aren't the names that fit the actual real-life story. Instead of the actual names, I will use some of the most common names in the Braid Brigade community:

At the drive-up window---

SUV #1: I need Esther Barlow's prescription.
Me: (After doing some research upon seeing that the prescription wasn't ready) It hasn't been filled yet. The problem is that the doctor requested brand name Synthroid, and Medicaid says it's not covered.
SUV #1: Okay, bye.

SUV #2 (about two hours later): I'm here to get Esther Barlow's Synthroid.
Me: Hmmm, someone asked about it a couple of hours ago, but I'll tell you what I told them. Medicaid doesn't pay for it, so unless you'd like to pay cash for it, it's not ready to pick up.
SUV#2: Well Medicaid should pay.
Me: It doesn't pay for brand on this particular medication.
SUV #2: Okay, I will call the doctor.

SUV #2 drives away, and then some soft-spoken woman calls from the doctor's office to let us know that they're okay if we don't fill brand name for Esther Barlow and that they've already spoken to the patient about it.

SUV #3: There should prescriptions for Miryam Jeffs, Edmund Barlow, and Esther Jeffs.
Me: I have Miryam's and Edmund's, but I don't have one for Esther Jeffs.
SUV #3: Well, I just talked to the doctor and they've been having a problem with not being able to get her Synthroid.
Me: Oh, you mean Esther BARLOW?!
SUV #3: No

SUV #3 drives away and returns 10 minutes later ---

SUV #3: You know, it is for Esther Barlow. Sorry about that. I need to get her Synthroid.
Me: Okay, I just finished getting it ready. We had to switch to levothyroxine, the generic for Synthroid.
SUV #3: She can't take that!
Me: Oh. The doctor said it was okay to switch and that they had let the patient know that they are okay with her taking generic.
SUV #3: Well let me call Miryam and ask her.
Me: You mean Esther?
SUV #3: NO!!!
Me: Okay. Well, I don't have Synthroid for Miryam. I have generic Synthroid for Esther Barlow, however.
SUV #3: Oh, that's the one I need.

If they can't keep it straight, how am I supposed to survive? Good grief.

Drugs of Our Lives

Occasionally I unintentionally embroil myself in drama at the pharm. One day, many years ago, an acquaintance from my youth (my more youthful youth, that is) was passing through town and decided to get her insomnia medication filled at my pharmacy. She had been using my pharmacy every few months, even though she didn't live in the area. Every time she came, she was accompanied by her husband and other family members, until that fateful day...when she came alone. All seemed well, as she joyfully and emphatically exclaimed her excitement at seeing me. (That should have been my first red flag, because am I sassy? Yes. Clumsily entertaining? Yes. Cuddly? Yes. Exciting? No.)

Anyway, I digress, per usual. This particular day, she got her fancy sleep aid prescription filled, and skipped along her merry way. Then, her husband called and asked for me. He wanted to know if his wife was at the pharmacy at that very moment. His question seemed to indicate that he knew she was planning to visit me. I told him he had just missed her. He thanked me and hung up. About 3 minutes later, chick from my childhood called me in a fit of hysteria and sobbing. "How could you tell my husband I was at the pharmacy? We are staying at a condo in town, and I left for just a few minutes while he was in the shower. He can't know I was there. Will you call him and tell him that I didn't pick up a prescription?" I never told him that she HAD picked up a prescription, so I wondered why I needed to perpetuate this lie. I wasn't planning to phone him; however, if I had planned to, he would have beaten me to the phone, because he called about 45 seconds after my conversation with this lady from my earlier life. He said, "I know my wife called you. I know she asked you to lie for her. Please don't lie for her. I am begging you. I have to know if she picked up a prescription." Dude, consent from the patient is not implied for this particular transaction, so I can't really tell you anything. At this point, do I lie? If I decide to lie to him, is there anything I could say that he would believe? Does a wife sneak out while her husband is in the shower just to go buy some bubble gum? Does she sneak out to get him a birthday gift? Is it even his birthday? No matter my choice of reply, nothing will keep my female friend out of trouble. So, I just told him that I can't inform him either way, whether or not she picked up some sleepy-time drugs, or anything else for that matter. That should have worked, right? Hmmm...

Once again, I got a highly emotional phone call begging me to please call the husband and tell him that she was there buying fingernail polish remover and NOT DRUGS! She explained her reasoning for such forceful pleading. "I went to rehab for 6 months because I was addicted to [the medication I picked up today] and I vowed to never use it again," she cried. "If [my husband] finds out I'm taking this medication, he will leave. HE WILL LEAVE ME, KRISTIN!" Neat. This girl has some serious issues. Before I even had a chance to consider calling her husband, he showed up at the pharmacy alone. I was in the back of the store when he arrived, attending to some administrative duties. One of my techs called me to tell me he was there, waiting. I figured the probability of being able to wait him out was low, yet I took my sweet time making my way back to the pharmacy. As I lingered in my safe place, I received another call from a tech in the pharmacy telling me that I needed to come up there, because they were both in front of the pharmacy. She was pulling on his arm, begging him to leave. He wasn't budging. She took off again, and he continued to wait for me. It's nice to have an experience that allowed me to measure my level of cowardice...or my lack of assertiveness. I decided I had better head back and talk to him. He didn't look furious, though his wife told me he would be. The fellow instead very calmly and sincerely professed that he loves his wife more than she realizes and that he would not be mad at her if he finds out the truth. At this point he was nearly in tears pleading with me to tell the truth and let him know what his wife has been up to. Well, can't do it. Pretty sure I've watched/read enough HIPAA training modules to know that I've got to keep my mouth shut. I thanked him for his caring concern for his woman, but once again, I couldn't say anything more regarding her actions that day. Then he REALLY laid on the pressure, and I had to kindly excuse myself and get back to work processing prescriptions, because that's what pays me. I'm not getting paid to mediate for these basket cases. After he left, I got another call from HER. She wasn't too pleased with me. She yelled, "Kristin, what have you done?! He's going to leave me!" I asked her if that's what he said he would do. She said that her husband told her he would be supportive, but he wants to hear the truth from her and wants her to get the help she needs. In her mind, that's the same as abandonment and divorce. I didn't get that vibe from him, but then again, maybe certain sleep meds give a person special powers of fabricating inferences. Gotta try it sometime maybe. Anyway, my hometown person pretty much told me I suck. I haven't seen her since. It's been years, but thanks to social media, I can see that she's still married. It's hard to tell through Facebook whether or not she's addicted to a pill, since I sort of got the boot as a Facebook friend. It's pretty sad story, but I hope there's a drugless happily ever after for her.