Monday Morning Mania

Okay, so not much, but this morning Don'tworryaboutit walked into the house at 7:30 and stated,

Jesus, what an awful day for a hangover.

Happy Easter.

Lonely Island Laugh Riot

If you haven't seen it yet, you need to:

It's a little sad that so many people are trapped in Cubeland that something like this is so horribly relevant.  One of these days, if a coworker of yours goes rambling around the office with a shotgun (not to mention the best of intentions), I wouldn't take the time to act surprised.  You can either hit the deck or pick up a weapon and join them.  Ah, freedom.

Scary Surgical Scandal

I'm very, very tired right now.  I'm sure I'll be asleep as soon as my head hits the pillow, but I had to get this on record first.  The quality of this stupid is quite staggering.

The career of pharmacy exposes the pharmacist to such a constant barrage of idiocy that I fear we begin to get desensitized.  I know that I don't write about many of the types of things I used to simply because I'm so used to them.  It's a sad day when all the stupid starts to seem normal, but it's the plain truth.

The phone rang at about 2 AM.  That's usually when I'm sitting down to lunch, and last night was no exception.  The woman on the line stated that needed a recommendation on pain medication.

Woman: I just had surgery and am experiencing some pain.  Ummm, can you tell me what I can take?

Me: Your doctor didn't send you home with a prescription for pain medication?

Woman: I'm not at home, I'm in the hospital.

Me: Sorry?

Admittedly, I was a bit nonplussed.  In fact, I was quite sure I was completely misunderstanding the entire situation.

Me: I'm sorry, I think I misunderstood.  Did you say you're still in the hospital?

Woman: Yes, I'm still here but I'm in pain.  I need to know what medication I can take.

I was completely speechless.  I've been at a loss for words at work before, but this time it was as though I'd been lobotomized.  I just sat there like an idiot until she started talking again, at which point I managed to formulate some questions.

Me: So you're still at the hospital?

Woman: Yes.

Me: You're admitted?  You're not sitting in a waiting room or something?

Woman: Yes.

Me: (long pause) So, why aren't you asking your nurse or a doctor about this?

Woman: Well, I'm allergic to some pain medications, and I just need to know what to ask for.

Me: Are your doctors aware of your medication allergies?

Woman: Yes.

Me: Ma'am, if you're admitted to the care of a hospital staff, they are the ones in charge of your medication therapy.  They decide what is appropriate for you to take.  I am not part of that team, and I can't make recommendations on a situation to which I am uninformed.

Woman: Well, what pain medications has my husband gotten lately?  Can I take those?

Just picture this situation.  This woman went to a hospital, had surgery, and then started making calls to Corpopharm in the middle of the night while she was still in the hospital trying to get me to tell her what pain medication she needed.  I would put that on par with the last time I saw a dog eat it's own vomit, with a few extra points to the dog for trying to recycle.

Me: Ma'am, you can't take your husbands medications, or anything that has been prescribed to someone else for that matter.

Woman: Well, I just don't know what to do.

I guess it must be a bitch to have to decide what medication you're going to take on a whim.  I mean, it's not like she was in a place surrounded by health care professionals that could make immediate interventions armed with with complete knowledge of her current medical situation.  Why not call the night pharmacist down the street who's totally ignorant of her recent surgery and any other medical interventions?

I think I'll go visit her today and bring a handful of the biggest, most colorful pills in the pharmacy that I can find.  I'm going to make her promise not to tell her doctors, though, because they clearly don't know what they're doing.  I'm done.

Haitian Hashish How-To

A quick note on Dominicans and Haitians: if you stroll along their beaches and have numerous visible tattoos, they think you love drugs.  Love them.

Here's the deal.  The Domincan Republic is pretty poor compared to American standards.  If what I'm told is correct, Haiti is even worse.  These people will naturally take any opportunity to make a buck, and American tourists look like big, fat, white piggy banks to them.  Unless it's day 2 of the vacation, in which case they look like a red piggy banks.

So, when you're down there on your expensive all inclusive vacation, they take the opportunity to squeeze even more green out of you.  The most common form of this is solicitors that hang out on the beach and try to get you to sign up for parasailing, boating excursions and in my case, illicit drugs.

So, if you're down in the Dominican and looking to score, here's a few tips:

1.  See the guys carying around the folders with parasailing/banana boat/snorkeling trip information?  They sell drugs.  All of them.  Even if you don't see them, they see you, and will be harassing you every hour you're on the beach.  Just listen for the guy yelling, "Looky looky!  Cheapy Cheapy!"

2.  Don't speak in code.  Most of these guys don't know English very well, and if you ask them for an ounce of their stickiest kind you may get something you're not bargaining for.  Weed is weed and cocaine is cocaine, you old degenerate.

3.  When negotiating price, pay no more than $75 USD for 7 grams of weed or 1 gram of coke.  Just because these guys live in huts doesn't mean you can come right out and lowball them.  Have some respect, white boy!

4.  Even better than buying from a beach vendor is buying from hotel staff.  Hotel staff need to protect their reputation, not to mention their turf.  Buying from the hotel staff will ensure you not only get quality swag, but protection from police should you be caught in the act.  As one staff member of a neighboring resort informed me, the local police could be bought for as little as $2 USD, or maybe $5 if he was having a bad day.  Not bad, gringo!

5.  Hablas Espanol!  Even if you're not fluent, a few Spanish phrases will help break the ice with your new amigo and show him you mean business.  Just don't get carried away and accidentally tell him he's got a funny face, or he'll slit your throat and drag you into the surf. Que lastima!

6.  Make sure you get all your partying done before you head back to the airport.  Those drug dogs are only sleepy if they don't smell that half ounce you decided to save.  Down boy.

There you have it.  Just because you have to pass a customs inspection doesn't mean your tropical vacation has to be lame (sober).

Please Read Carefully

I know nobody ever reads this, but there are times when I wish I could shove my prerogative up the ass of every man, woman, and Donkey in America.  This is one of those times.

To every nurse, doctor, and receptionist in clinics and hospitals across America: stop telling your patients how much their prescription will cost.  Stop immediately.  The second you open your mouth to say, "That's a four dollar prescription.  It will cost four dollars." you become a complete moron.  It doesn't matter how smart you were before you made that erroneous statement.  The second that oral diarrhea exits your orifice, you immediately transgress to the equivalent of a trisomy 21.  You're a monkey throwing feces, you're a post op lobotomy patient.  You're a dark ages trepanning victim, minus the spiritual enlightenment.  

I'm stating the obvious here, but all of these supposedly bright people don't seem to understand that they have no idea what will happen when their patient wanders into an apothecary to fill their script.  None.  How could they?  Unless they've got a crystal ball that shows them my workstation screen, they're making a blind assumption about something that they are woefully ignorant about.  It would be like me telling a patient at the pharmacy that a prostate exam will cost him $50 at Dr. X's office and that includes a happy (!) ending.  

Here's the bottom line.  You can't know what a prescription will cost until you take it to a pharmacy, enter it into the computer, and wait for the computer to spit out a price.  Period.  Cash prices are always changing,  insurance formularies are always changing, and trying to predict either of which is like trying to predict Gary Busey after an eight ball.  You just can't do it.

Then again, I'm the guy that made a lady cry this morning right before I left work.  It's a wonderful world.

Delinquent Drug Deniziens

Being a night pharmacist means you get to take care of a lot of custodial duties that the day staff may not have time for (or just don’t do because they’re lazy pigs).  Grunt work, in other words.  Some pharmacists feel above doing this kind of work (I don’t know why) and choose not to do it.  For the most part, I like it.  I’ll file scripts and count CIIs all night before I would work days again.  Most patients that come to me think that I have an undesirable job, or got demoted, or just drew the short straw.  Instead of telling them that I’d rather masturbate with sandpaper than interact with 99% of the public, I just fill their prescription.

One of the duties of the night pharmacist is returning unclaimed prescriptions to the shelves.  This is known as return to stock.  Every night around 1 AM the system prints off a list of filled prescriptions that have been waiting to be picked up for 2 weeks.  If you have not come to pick up your prescription for 14 days since it was filled, it is taken out of the waiting bin and returned to the shelf.  This means you have wasted a lot of the pharmacy’s time and should be shot.

Here’s the actual list of last nights return to stock.

Apri

This is birth control.  You know, that pill that keeps you from shitting out more hungry mouths.  If you’re a Medicaid patient, I don’t return this to stock.  I drive to your house and shove it down your throat so you don’t procreate.  Hey, I think that’s what Jesus would do.

Travatan Z

Glaucoma medication.  Do you like being able to see?  The next time you call me and harass me about not being able to read the pharmacy label, I’m going to make fun of you for not getting your eye drops, Gramma.

Humalog

Insulin!  This is for diabetes.  When your toes start falling off and you go blind, you may remember that insulin prevents your blood sugar from skyrocketing.  Guess in the mean time you’ll have to lay off the Twinkies, fatty

Blood Glucose Test strips

Allows you to see what your blood sugar level is.  Very handy for diabetics.  The same asshole that didn’t pick up their insulin also didn’t pick up their test strips.  Go figure.  I guess if you don’t know when your blood sugar is too high, then you don’t need insulin.  Right?  WRONG.

Cartia

Blood pressure medication.  You must like being a candidate for heart disease.  When your doctor asks you why your blood pressure is so high, just explain to them that you’re a worthless delinquent.  They will understand.

Cymbalta

Crazy pills.  You know, the ones that keep you from screamin’. 

Metformin

More diabetes medication.  See all the fat people walking around?

Fluconazole

For yeast infections (AKA nasty vag).  One time, a lady told me that she wouldn’t take fluconazole because she read it could damage your liver.  You only have one liver, she explained to me, and she didn’t feel it was worth the risk.  I almost asked her if she had more than one vagina.  I didn’t want a sexual harassment suit on my hands that badly.

Biaxin XL (name brand)

Antibiotic, used to treat your runny nose and bitchy demeanor.  This medication has a generic available.  This means that we had to special order this for the ungrateful asshole that decided to not even pick it up.  Moreover, it was a REFILL.  Antibiotics should NEVER have refills.  Allowing a layperson to decide if their cold requires an antibiotic is like allowing a hop-head free access to the narcotics safe.  BAD IDEA.  When our antibiotics no longer work because you’ve been overusing them, I’m going to come burn your house down.

Propecia

Prevents hair loss.  Guess you’re not getting laid tonight.

Viagra

We all know what this does.  Insert (ha!) your own joke here, there are a million shitty ones out there for this one.

Fluocinonide/coal tar compound

This one may be the worst offense.  Most medications at the pharmacy come made by the manufacturer.  A few (like this one) we have to mix up using eye of newt, hell’s bane, and a big black cauldron.  You also have to cackle really loud while you stir it or it doesn’t work.

In all seriousness, the pharmacist has to make this kind of medication from raw components, and it takes some time and effort.  They always tell people it takes 24 hours for a refill, so yours truly always makes the compounds overnight.  When I put in the time and effort to make this for you and you don’t come to get it, it pisses me off.  Although, I guess it does keep me from staring longingly at the booze aisle.

A side note on coal tar.  This stuff is the most foul smelling substance in the pharmacy, and there are some nasty ones.  Have you ever smelled fresh asphalt?  That’s what coal tar smells like.  One of the more common things it’s used in is dandruff shampoos like T/gel.  The shit is used topically, which I cannot imagine.  Smelling it while I’m working with it makes me want to run to the shower and scrub myself like a rape victim.  Gross.

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Last night of work for a week.  I'll be heading to Chicago for the weekend for a symposium being held by Dr. Warner on ethanol kinetics.  All reports indicate that it will be educational.

Don't Mess With Corpopharm

Every day, people walk into pharmacies across America and try to fill fake prescriptions.  What's a fake prescription?  It's a medication order that was written in the name of a physician by someone who is not that physician.  They're almost never a physician at all.  I'm sure you're asking yourself, 'Spiffy, why would someone do this?'  99 times out of 100, it's because they want a controlled substance (usually alprazolam or hydrocodone) and can't get a doctor to write them a prescription.  IE, a junkie trying to get their fix.  This is one of their stories.

As soon as I reported for duty last night my partner informed me that some fake scripts had been called in during the day. I asked him if he’d confirmed them with the doctor, and he said he had. I was a bit surprised. It’s pretty tough to get ahold of a doctor on any day, and most of them don’t work weekends. This particular doctor was at an urgent care facility that never closes. Rule number one for trying to call in fake scripts to the pharmacy: don’t imitate a doctor that I can contact with one phone call.

The doctor indeed verified that he had not called in the prescriptions, and no one at the facility had written them. This means that someone else entirely had called the scripts in to the pharmacy under the guise of being a physician. This is very illegal, and one of the best ways to piss off 1) the doctor and 2) the pharmacist. It’s illegal, it’s fraudulent, and it’s a HUGE waste of time for everyone involved. Plus, pharmacists hate junkies. Well, this pharmacist does.

The doctor agreed to help prosecute if we had the people arrested. As one of my technicians (Friendly) put it,

Friendly: Awww, Spiffy, it is ON!

If you want to make an arrest at the pharmacy for this sort of offense, here’s how it works. The alleged criminal usually calls in to the pharmacy before they come to pick up their fake scripts to make sure they are ready.  This is a pretty stupid mistake, because it prepares the pharmacy for their arrival. Once they call us, we call the to cops to let them know we would be needing their services within the next hour or so. Once the perpetrators arrive, the technician running the register stalls them out while another technician calls the police. The cops arrive, arrest the druggies, and the world is safe.

Last night worked out even more beautifully than we could have hoped. About a half hour before our fakers got the pharmacy, one of the front store employees witnessed a robbery and called the cops. A unit came down, and the officer was in back watching the security tape when the fakers arrived. That’s how dumb they were. There was a police cruiser in the parking lot, and they came inside anyway.

I actually happened to be the one to greet them at the register as my two techs were busy with people dropping off new prescriptions. I have to say, I wasn’t impressed. It was two older people of about 60 (I say older because they both looked about 80), both regular patients at the pharmacy. The guy even had an oxygen mask on. Picture that. Real hardcore criminals, these two. Just, uh, don’t forget to bring a spare oxygen tank on those extra long crime sprees. Christ.

I was pretty surprised because the guy had a bunch of scripts that were actually legitimate to pick up that we’d been working on the last few days. I pretended to go look for the scripts and winked at Friendly. These two criminal masterminds had picked about the worst time to show up. Friendly walked 50 feet to the back room where the policeman was watching our security tapes. It certainly was ON.

The actual arrest was pretty uneventful. The look on the couples face was fucking priceless, though. When the cops took them out of the pharmacy, it as about the saddest arrest in the history of arrests, I’m sure. The officers didn’t even bother to cuff them becase it was obvious they weren’t going to make a break for it. The old guy on his oxygen supply probably couldn’t break 2 MPH without wheezing and the old lady looked like she’d break a hip if she tried to juke left to avoid a tackle.

To me, the funniest part about the whole thing was that only one of them needed to come in to pick up the scripts. They had been called in in the old lady’s name, but that doesn’t mean that she had to be the one to pick them up. It did mean that she was already involved in the crime, so she should have been the obvious choice. Instead of just one going downtown they both got to spend the night in the clink. As far as I know, they’re still there. That’s rule number two. When attempting to fill fake prescriptions, bring as few accomplices as possible. Fewer people will get pinched that way.

Now, rule number three. As I stated above, the old lady was involved implicitly because they used her real name when calling in the scripts. It’s pretty tough to convince the district attorney that you weren’t involved when the scripts are in your name, Einstein.

Rule number four may be the most important. If you’re going to fill fake scripts, be sure to pay out of pocket for them instead of having them run through your insurance. Billing your insurance company for fraudulent prescriptions is, uh, fraud. Do you know anybody with larger litigation resources than insurance companies? I don’t. For whatever charges the doctor’s lawyer doesn’t level against you, the insurance company’s lawyers will. After they’re both through with you, the DEA gets a crack at you as well. You’re basically setting yourself up for a vicious gang rape by a gaggle of lawyers with no lube (not to mention no prayer).

So, there you have it. A perfect guide of what not to do when trying to illegally fill prescriptions. I wouldn’t recommend it, though. All the people that do try it are very stupid simply by virtue of the fact that they are attempting it (considering the legal ramifications involved). Stupid people are prone to make mistakes, especially concerning things they don’t know shit about. Like writing prescriptions. Feel free to give it a shot, but you’ll get caught. Just remember to lube up first.