Tuesday, May 24, 2011

Writing to Keep My Mind Sharp

For the past couple of weeks, I've felt an urge to write. The only problem is that I can't think of suitable topics. Therefore, I've produced nothing. Basically, the intent of this post is to just write for a little bit to see if something worthwhile comes out of it.

I've always said that I used writing as not only a means of expression but also as a way to try to make sense of the jumbled thoughts in my mind. Writing also serves another purpose for me. I find it very intellectually stimulating.

A lot of my blog posts were about my feelings at certain times of my life. However, there were also many posts where I would give my opinions on a specific topic. These posts could be looked at almost like persuasive writing. I'd put out an assertion and then try to back it up using logic or evidence.

I find those kind of posts the most intellectually stimulating. As I'm writing them, I can literally feel different areas of my brain come to life. Working through the logic and creating my argument kind of feels like an adrenaline rush. It's a challenge, and even though I'm the one who made the particular assertion in the first place, I feel like I'm teaching myself about it. It's hard to explain.

It's also hard to get that kind of stimulation anywhere else. At work, I have to constantly defer to other people. Corporate makes a new policy, and I'm expected to carry it out. There's no room for argument, no room for disagreement. If corporate wants to give out free antibiotics, no amount of persuasive logic is going to change their minds.

With customers, I'm either the drug expert who dispenses medical advice, or I'm the customer service representative who has to basically kiss ass. There's not a whole lot of genuine back and forth. The customers don't challenge my knowledge, and I can't challenge them when I think they're being stupid.

My girlfriend and I hardly ever argue. I know; most people would consider that a good thing. And it is. Sometimes though, I feel like there's something missing if there's no arguing. I feel like neither of us are challenging each other. We certainly can't agree on everything, so if we're not arguing at least sometimes, then we really aren't being completely honest.

However when it comes to my blog, anyone reading is free to fire back at me. They can agree, disagree, or bring up another point that I never considered. I crave that back and forth. It keeps my mind moving. It keeps me from getting complacent. I need my beliefs to be challenged occasionally.

That's why I haven't quite given up this blog. I don't write very often anymore, but I like leaving open the option to write. I've thought about starting a new, non-anonymous blog, but then I have to come up with some kind of clear narrative. For example, I can't bitch about how an absent coworker made for a shitty day at work when everyone at work could read about it. I'd have to only write about certain things. I'm sure I could do still get some good writing done, but it wouldn't feel quite as authentic.

For example, if everyone knew about my blog, then I couldn't write about how sometimes I think I'd be better off single than in a relationship. I'm sure my girlfriend wouldn't be too pleased by that entry. Sometimes I do feel that way though. It doesn't mean I want to break up with her. It just means that I'm not entirely sure what I want just yet. Or maybe it means that even people in committed, caring relationships sometimes wish they could have the personal space of a single person. It doesn't mean they don't leave their significant others. Sometimes it just feels good to be your own person and not have your entire identity intertwined with someone else.

I can't have that conversation without this blog though. However, I crave that kind of conversation. I like examining those deep thoughts and putting them out there for people to think about and comment on.

Anyway... I just wanted to get something written. Maybe that will spur some more writing in the near future.

Monday, April 11, 2011

This Is Why Pharmacists Are Suspicious of ALL Narcotic Prescriptions

A couple weeks ago a woman called our pharmacy asking if we had Oxycontin 60 mg in stock. We informed her that we did, but the only tablets we had were of the old formulation.

I swear that she couldn't have been more excited if she shouted Eureka! into the phone. "I'll be right down," she said.

A few minutes later, this perfectly able-bodied woman shows up at our pharmacy counter with a prescription in hand for the Oxycontin. "How much is it for 30 tablets?" she inquired. Surprise, surprise... She wanted to pay cash for them.

We looked it up, and she decided 30 was too expensive for her, and she wanted to know the price for 25. Apparently, 25 tablets wouldn't completely wipe her out, so she then asked us to fill it for 26 tablets.

To enlighten those of you who might be uninformed about drug prices, 26 tablets of Oxycontin cost in the neighborhood of $200. Moreover, the script was from a doctor's office located over an hour away, and she was a new customer to us. There was no way this prescription could be legit. Therefore, we called the office to find out just what was going on.

The nurse gets on the phone and she listens as we tell her how shady this woman appears to be. The nurse checks with the doctor and a couple minutes later, she returns to tell us, "Dr. Dipshit said you can definitely trust her."

OK... Whatever he says. So we document the shit out of the situation, and fill the script for her 26 Oxycontin. Several minutes later, she returns to the pharmacy counter holding about $200 in cash, and proceeds to slap $20 after $20 on the counter as she pays for the prescription.

Yeah... Really trustworthy.

A couple weeks later, the woman calls our pharmacy inquiring once again if we had Oxycontin in stock. Once again, we did, and once again, she gleefully remarked that she'd be down in a few minutes.

Same prescription from the same doctor, only this time, the full 30 tablets would be just fine. Little did she know, she had nearly wiped us out of the old formulation last time, so we had to dispense the new formulation to her. I decided not to tell her this little fact because I was curious to see what would happen when she found out.

The technician went to ring her up at the register, and she almost had a heart attack because the price of the tablets was $22 more expensive than she thought it would be. "That must be some kind of mistake," she proclaimed. "Is that the new formulation?"

I confirmed her suspicion, and she immediately asked whether we had any of the old formulation left. Alas, we only had 10 tablets left, not enough to fill her script.

"No problem. I'll just take the 10," she responded.

Yup... completely trustworthy.

In the end, she did us a favor because she helped us get rid of all the old formulation tablets we had left. In addition, I'm reasonably sure that she'll never come to our pharmacy ever again.

Here's the thing though... All you people out there who have legitimate reasons for taking narcotics don't realize that these kinds of stories are closer to the norm than the exception. We fill ridiculous amounts of Oxycontin and oxycodone prescriptions and a good majority of them are for very sketchy people. However, every time we call the physician, we get the same response. "Yes, fill the prescriptions."

Just recently we had a guy and his buddy come to the pharmacy both presenting prescriptions for 240 tablets of Oxycodone written on the same day by the same out of state doctor. We called the office, and they didn't understand why we'd be questioning it. Yeah... two well built young men who happen to be friends getting the same narcotic prescription for massive quantities from the same out of state doctor on the same day. I have no idea why that's suspicious at all.

How about the woman who takes Percocet 7.5, Avinza (extended release morphine), and Exalgo (extended release hydromorphone) twice daily? We called the office wanting to know not only why she's taking two different 24 hour extended release narcotics, but also why she's taking one of them twice daily. Moreover, she has a sister that goes to the same office, and the doctor writes Avinza, Percocet, and Tylenol with Codeine prescriptions for her as well. The nurse didn't take too kindly to us questioning these pain management regimens. In fact, she was quite annoyed.

How about the woman who was getting 120 Vicodin a month from one doctor and also getting 90 Percocet a month from another doctor? We called to let one doctor know she was getting pain meds from another doctor, and we were told that they were aware of the situation. You see... She's taking the Vicodin during the day, and the Percocet when she needs pain relief at night. Oh, I see... I totally should have figured that one out. After all, it's not at all unusual for someone to chew through 120 Vicodin and 90 Percocet per month, especially if the Percocet is only supposed to be taken at night. Completely normal.

See... the biggest drug dealers in this country aren't slinging dope on the streets or cooking up meth in a basement laboratory. They're actually the doctors who will write for whatever narcotic patients ask for as long as they say they're in pain. As pharmacists, we're told that we have to be constantly vigilant for signs of drug abuse and misuse. We're forced to keep tabs on pseudoephedrine because it's apparently OUR job to stop meth junkies and sellers from cooking up meth in their basement laboratories. We're encouraged to use controlled substance databases to help reduce doctor shoppers and people who pay with cash at multiple pharmacies. Our license could be on the line if we don't document that we at least tried to verify any suspicious prescriptions. However, prescribers have free reign to allow patients to basically write their own prescriptions for narcotics.

My biggest issue is if doctors don't care, then why do I have to care? If they're prescribing habits are going to facilitate drug abuse, then why do I have to try to clean it up? I just can't seem to figure it out.

Tuesday, April 5, 2011

My Technician's Kid Gets Sick Means I Work More

This is a serious question to all you working parents out there: What do you do when your kids get sick?

I need to know how the normal person handles this situation because I can't imagine that every single time one of your kids get sick, you call out of work to take care of them. That's what happens with one of our technicians though. She has 3 kids, and every single time one of them has a sniffle, she has to stay at home and take care of the little cretin. She only works 3 six hour days per week, and I can't even remember the last time she went 3 weeks in a row without calling out at least once.

As you can imagine, a technician constantly calling out in a busy retail pharmacy kind of sucks. In fact, it pretty much screws the rest of the staff. Case in point, the last 2 days, I've had to stay well past when my shift was supposed to end because we were short staffed all day and constantly behind.

This really pisses me off. Why does her kid getting sick mean I have to work my ass off even more than I usually do in order to pick up the slack left by our absent employee? I've written before about how much I hate when people call out sick. However, this is even worse because she's not even sick and calling out. It's her fucking kid!

The kid is 13 years old by the way. I just wanted to give additional context. To me, a 13 year old is perfectly capable of taking care of himself at home for a few hours. I know I did when I was 13. However, her 13 year old isn't allowed to be home alone.

While I'm ranting and raving here, let me state as clearly as I possibly can that I don't care about anyone else's kids. They're not my kids. I don't care what they do. I don't care if they suddenly drop dead. However, despite my not wanting to have anything to do with them, they certainly seem to be able to interfere in my life. If I wanted to worry about and be inconvenienced by kids, I'd have some of my own.

Oh, by the way... Driving kids from one activity to another is not hard work! And every time I hear someone complain about having to spend all day playing taxi for their kids' extra curricular activities, I have to fight the urge to unleash an expletive laced tirade. You think driving a car from one place to another is hard work? TRY MY JOB! Try standing on your feet for 12 straight hours with barely a 10 minute lunch break (if I'm lucky) while trying to do 5 things at the same time with the phone ringing all fucking day long. Carting your fucking kids around would be a goddamn vacation for me.

I'm just tired of this shit. I killed myself at work the past 2 days (and have done so plenty of other times over the past 4 years) simply to cover for someone else. Where is the reward in all of this? Most of those extra hours go unpaid, so it's not like it benefits me financially. I don't get extra time off to compensate for working so damn hard. My job is only as secure as the amount of seniority I have in the company (which isn't a whole lot). There are no promotions, so there's no room for advancement.

You want to know the worst part though? The harder I work, the less everyone else works. I used to think there was such a thing as leading by example. You work hard, and everyone else will see your example and do their best to match it. That doesn't really happen though. If people see me constantly do something, they just assume that I will always do it. Therefore, instead of doing it themselves, they'll just leave it for me to do for them. And I always fucking do because I know it has to be done, and it bothers me to not do the absolute best I can.

I'm telling you... I'm getting closer and closer to the breaking point. If I do snap one of these days, I just hope whatever I do really inconveniences someone who has kids.

Tuesday, March 15, 2011

"You're Lucky to Have a Job"

I should be sleeping right now. I have to get up less than 6 hours from now in order to get ready to open the pharmacy tomorrow morning. I just really felt I had to get this post done. I've been wanting to write it for a week now, but I've been putting it off for various reasons. Anyway...

A couple weeks ago, I had a particularly rough day at the pharmacy. Nothing went right. A technician called out. We were incredibly busy. There was one insurance problem after another, and the phone would just not stop ringing! I was going insane.

Finally, with about 30 minutes left in the day, things started to settle down, and I got a little quiet time to finish up some paperwork that I didn't get a chance to do earlier. I started ranting to one of our technicians about how something has to change in this pharmacy because I don't know how much longer I can deal with all this crap.

She listened for about 30 seconds before saying, "well, just be happy you have a job." You see, working at the pharmacy is her second job, and she doesn't get paid particularly well for it. It was supposed to be something to supplement her income. However, she's getting laid off at her primary job. Without her primary source of income, she's unsure if she can make ends meet.

This made me feel kind of stupid for ranting about my situation to her. After all, she was right. I do have a job, and I get paid quite well. A lot of people would kill to have my salary, especially at my age.

However, later that night, I got to thinking that there has to be a point where "you're lucky to have a job" no longer applies. I understand that a lot of people don't have jobs. I understand I'm very fortunate to be paid very decently. However, just having a job and being paid decently shouldn't preclude me from complaining about shitty work conditions.

By the "lucky to have a job logic," my company could force me to fill 1,000 prescriptions per day by myself without any help at all while dealing with all the customer complaints and all the phone calls, and I'd have no reason to complain because at least I'm employed and making 6-figures. At some point, the stress reaches a level where it doesn't matter how much damn money I make, I'd rather be unemployed and broke than be treated like shit.

I can't think of a single profession that forces you to multi-task more than a pharmacist does on a daily basis. At a busy pharmacy, there's always 5 or 6 things going on at the same time, and the pharmacist is responsible for directly supervising EVERYTHING. While we're trying to fill prescriptions, the phone is ringing. It's a doctor calling in a script, and only a pharmacist can take that call. However, there's also a customer at the counter that wants to ask a question that only the pharmacist can answer. While trying to decide which to attend to first, the prescription for Celebrex you were typing into the computer just came up "prior authorization required," which means that you have to send a fax over to the doctor's office in order to let them know they either need to call the insurance company or switch it to something else. Naturally, the guy in line after the customer asking the question is looking to pick up that Celebrex prescription...

This goes on ALL DAY LONG, and it happens EVERY DAY. Oh yeah, and while you're trying to handle these pharmacy tasks, you just got an email saying another drug has been recalled. It's the third one of the day, which means for the third time, you have to check your shelves, quarantine the recalled product, and fill out the paperwork that corporate requires. The next email is telling you about the Aetna audit that's taking place next week. You have to make sure to make all those prescription files available for the auditor. And the warehouse is out of vial caps for the second time this week, and since you're running extremely low on them, you have to call a bunch of other stores to hunt down some that you can borrow.

Between filling prescriptions, dealing with customers, dealing with doctors, handling insurance issues, and following corporate policies, you're head is spinning all day long. You're constantly racing around. You work 12 hours without a proper break. You just briefly pause for 5 to 10 minutes to scarf down a sandwich, and then it's back to the grind.

And know what your reward is for busting your ass all day? Customers complaining, "20 minutes???? Is it really going to take THAT long??!?!?"

However, community pharmacists can't complain about this because, hey, at least we have a job, and we make over $100,000 per year. We should just shut up and take it because we're "lucky" to have the opportunity to be overworked and overstressed.

That's what the chains count on though. The reason they can get away with this crap is because, at the end of the day, most of us subscribe to this lucky to have a well paying job mentality. We hate the work, but we're addicted to the money, so even though we may complain, we won't do anything to really rock the boat and risk that paycheck.

I'm guilty of this. I want to quit my job so bad. Sometimes I actually get a little giddy imagining myself just walking right out of work one day and never coming back. I'm scared to death to do it though. I've become accustomed to my paycheck. I'm used to not having to pinch pennies. I'm used to just going out and buying what I want without having to worry about whether I can afford it or not. I'm addicted to the money.

Because of this addiction, my employer has me by the balls. They know that as long as they keep the money coming, I'll put up with whatever extra responsibilities they throw at me. The money provides an illusion of freedom when in reality, it is the thing that imprisons me.

However, I feel like I'm very close to boiling over. I'm not quite there yet, but I feel like soon, I'll reach the point where the money just isn't worth it anymore. It would be scary, but losing this job might be the best thing that could happen to me. It would be the kick in the ass that I need to find something that I'm happier doing.

***I said I was done writing here. However, I guess I haven't quite run out of things to say. I'm sort of feeling the urge to write recently, which is probably a sign of mind not being at ease. In any case, if I have something to write about, I'll write about it.***

Wednesday, March 9, 2011

Another Prescription Error That Could Have Easily Been Avoided

I'm going to turn this blog into ranting and raving against the forces in our profession that seek to put the public in danger. My focus will be on prescription errors, and how often the simplest of things can help avoid them.

Our pharmacy had another prescription error last week. This one, to my knowledge hasn't been reported to the Board of Pharmacy. Although, I almost wish they would report it because I would go before the board intent on kicking up a shit storm.

A customer presented to our pharmacy counter carrying 3 prescriptions. For the sake of this entry, we'll say this customer's name was Thomas Richards. Thomas has been on pain medication for quite some time. He's had several recent procedures that have required him to get a number of different pain meds. His need for opioid pain medication is perfectly legitimate. He is not the problem here.

The 3 prescriptions were for 3 different pain medications. They were from the same doctor's office, written in the same pen, and given to the patient at the same time. The technician at the drop-off counter, added Mr. Richards' date of birth and address to all 3 prescriptions, and told him the scripts will be ready for pick up in about 20 minutes. Everything was seemingly going smoothly.

The other pharmacist on duty was the one who inputted the prescriptions into the computer. He noticed that the doctor had given Mr. Richards prescriptions for MS Contin, Dilaudid, and Percocet. He wondered out loud why the doctor would give this patient both Dilaudid and Percocet. However, since that office is an orthopedic group, and we see a ton of interesting pain med combinations from them, we just kind of shrugged it off. I've seen patients get prescriptions for Percocet designated for moderate pain and Dilaudid designated for severe pain. It's not that common, but not unheard of. Therefore, we decided to just let it go. After all, it wasn't like they wrote the scripts for large quantities, and Mr. Richards was certainly in pain.

Twenty minutes later, Mr. Richards comes back and his prescriptions are all set for him. He pays and goes on his merry way. Several hours later, he calls the pharmacy saying we made a mistake. He said that the prescription couldn't have been for Percocet because he gets very ill when taking it. The doctors know that and wouldn't prescribe him that. The script was supposed to be for Flexeril.

I look back and double check the prescription. It most certainly said Percocet 5/325. I quickly checked the name and date of birth (that we had to write on the prescription when he dropped it off). Yes, it was filled correctly. Mr. Richards sighed and muttered something about the dumb doctor's office, and hung up. A little later the prescription for Flexeril was callled in to us. I guessed that he must have let the office know of the mistake.

Several days later, we get a call from that office. "The prescription you filled for Thomas Richards for Percocet was filled in error," proclaimed one of the nurses. "Mr. Richards was never prescribed Percocet. That prescription was for Thomas RICHARDSON."

Sure enough, when I went back and triple checked the script, the name on the top was Thomas Richardson, not Thomas Richards. It was a prescription error.

However, let's back things up just a little bit. How the hell did Thomas Richards get Thomas Richardson's prescription?

You see... This is a practice that I think is unfamiliar to the general public. Doctors don't actually physically write most of their prescriptions. They usually have a nurse write them, and then they sign their names at the bottom. We see it ALL THE TIME. The patient's name and all other prescription info will be written in these big, bubbly, girly looking letters, and the doctors signature is scribbled at the bottom. It doesn't matter whether we're talking about prescriptions for blood pressure medications or for Oxycontin. Many doctors don't write their own scripts.

Secondly, the only conceivable way that Mr. Richards was given Mr. Richardson's prescription was if the prescription was written out ahead of time and stored in some kind of file at the doctor's office. Obviously, the doctor or nurse did not see Mr. Richards and Mr. Richardson at the same time. If he was only writing for one patient at a time, there's no way that one patient could have come into contact with another patient's prescription. The only possible way was if a nurse had to sift through a file to find Mr. Richards prescriptions, and it just so happened that Mr. Richardson's script was mistakenly filed under the wrong name.

Moreover, the patient's address and date of birth was not written on ANY of the 3 prescriptions for schedule II controlled substances that Mr. Richards dropped off. The technician at drop-off had to inquire to the patient's address and DOB, and she was the one that wrote them on all 3 prescriptions.

Therefore, when the scripts finally made it to the pharmacy, all 3 of them were written in the same pen, from the same doctor's office, on the same prescription blanks, dropped off at the same time by Mr. Richards, and all had the same address and DOB on them (because the tech wrote them in on all 3). However, one was for Mr. Richardson instead of Mr. Richards.

The nurse who called to tell us about the error gave me the "YOU FILLED IT WRONG!" attitude, and quite frankly it really pissed me off. Yes, I suppose ultimately, it was a pharmacy error. However, the patient, the technician, and 2 pharmacists both looked at these scripts and didn't notice the slight difference in the name on one of the prescriptions.

It goes down as a pharmacy error, but if the doctor had A) not written the prescriptions ahead of time, and B) had included the patient's address and DOB on every prescription (which by LAW, they are supposed to), we would have easily caught the mistake.

It's just another incidence when pharmacies are the ones getting shit on for prescription errors, even though we're seemingly the only entity in all of health care the gives a shit about doing things to prevent them. Every time a doctor writes sloppily, every time he uses unapproved abbreviations, every time he doesn't include the patients date of birth and address on the prescription, and every time he doesn't provide his DEA #, there is a chance for a prescription to be either misfilled or therapy to be delayed to a patient due to the pharmacy's attempt to try to fill in the missing information.

Everyone laughs about doctors' messy handwriting. It's a big fucking joke. The public just assumes that's the way it is, and it isn't going to change. If the pharmacy can't read what the doctor writes and has to call to verify a prescription, the patient gets mad at us and not the doctor. The public jumps all over pharmacy mistakes, but the doctor can write illegibly, prescribe the wrong dose, wrong drug, or a medication with a significant drug interaction, and the public just shrugs it off.

Why is everyone so afraid of doctors and people in their offices? People come in and treat the pharmacists and pharmacy staff like dirt on a regular basis. They yell and scream about customer service. They look to us to fix everyone else's mistakes, and then get mad at us when it can't be done in 5 fucking minutes.

I'm sick and tired of it. I really am. I can't be the customer service representative, insurance trouble shooter, I.T. help desk, store printer technician, cashier, secretary, business manager, AND pharmacist at the same time. Every time you interrupt me with something that isn't related to verifying the safety and accuracy of prescription orders, the chances of someone being harmed by a pharmacy error increases. Every time my District Manager requires me to personally walk customers directly to any item in the store that they might be looking for, I'm interrupted from possibly teaching someone how to use an inhaler or inject insulin.

I'm a pharmacist. I'm not a fucking customer service rep. I'm not a fucking cashier. I make sure prescriptions are safe, accurate, and that patients know how to use them. Everything else is superfluous. I don't give a shit about the fucking inventory being over budget. Get an ordering department. I don't have time to spend 2 hours on the phone with an insurance company to get a claim to go through that provides a $2.50 profit. Get a billing department.

I know I'm kind of ranting off topic now, but my overarching point is that we're asked to do too many things at one time, and even asking other medical professionals to take literally a few extra seconds to write patients' addresses, DOB's, and prescribers DEA #s on prescriptions seems to be too much of a hassle for them. It would literally take 5 extra seconds, but they can't be bothered, and because they can't be bothered, the chances of pharmacy prescription errors increase.

If you're a prescriber reading this, and you're one of these fucks that don't take those 5 extra seconds, FUCK YOU! Seriously, you're scum. You make pharmacists lives miserable because you're too fucking lazy to do what you're supposed to.

Tuesday, January 11, 2011

The Anatomy of a Prescription Error

It should be an easy day. It's a Thursday. Thursdays are never really that busy in this pharmacy. The big order doesn't come until tomorrow. You don't have to create an order. It's in the middle of October, and while flu shots are really starting to pick up, you haven't had enough of them to really impact your work day.

You're scheduled to be at the pharmacy at 10, so you have plenty of time to sleep in. You get up at a decent time, have a nice breakfast, and even get some exercise in before showering and getting ready for work. You're nice and relaxed, and you truly feel that this will be a good day.

When you arrive at the pharmacy and take that first step through the door, you come upon what looks like a disaster area. Labels are all over the place. There's a long line at the register. The other pharmacist is hung up on a phone call, and the lone technician is getting frustrated dealing with a customer. No, the customer is not being rude. He's simply having an insurance problem that the technician, despite working in the store for 25 years, has no idea how to solve... mostly because she's completely computer illiterate.

You see... The pharmacist scheduled to open the store that Thursday got there 10 minutes late. Therefore at 10:00, a full 2 hours after we open, all the scripts that were left on the refill line overnight still were not finished, and those labels were in no particular order all over the pharmacy counter. That one technician, despite having all that experience and being full-time, has never counted a prescription or typed a new prescription. She's basically a highly paid cashier.

Before even taking off your jacket, you walk over to the computer to help the technician. It takes you less than 30 seconds to solve the problem that had frustrated her for the last 5 minutes. Afterwards, you hang up your jacket, take a deep breath, and get to work. No time for pleasantries. No time to get settled. You jump right into the fray in an attempt to get the pharmacy to the point it should have been over an hour ago.

However, it's never as easy as just putting your head down and filling scripts. The second technician was supposed to be in at 10:00, but at 10:20, she's still not there. Therefore, you're forced to constantly jump between being a pharmacist and the world's highest paid cashier. Finally, at 10:30 the second technician strolls in. There's no explanation for the tardiness, and quite frankly, you don't have the time to listen even if there was one, so you just keep chugging along.

Just when it looks like you're starting to gain some control, the phone calls start coming. The other pharmacist (the one that showed up 10 minutes late), is the floater scheduler for the district. He has to get that floater schedule out by Thursday of every week. However, the stores for which he schedules and the floaters that work in them are such major pains in the ass that he has to constantly revise the schedule all week. Therefore, in the middle of this crazy Thursday, he has to stop for 10 to 20 minutes at a time to handle scheduling emergencies. That leaves you to work the bench alone.

The scripts keep piling up, and on this day, the customers seem to be in extra need for pharmacist attention. You do your best, but you're only one pharmacist trying to do the work of two without much help from your cashier-level technicians. Now, the other pharmacist gets called upstairs to speak to the main store manager, so he disappears for a good 20 minutes. At this point, frustration is really starting to set in.

The wait time at the pharmacy is usually no more than 20 minutes, so when dropping off scripts, the techs/clerks habitually tell the customers it will take 20 minutes for their scripts to be ready. Realizing that you're so far behind that there's no way you can fill new scripts in 20 minutes, you tell everyone that the wait time is now AT LEAST half an hour. The next technician/customer exchange goes something like this:

"The wait time is 30 minutes, but it might not actually be that long. We're just really busy, so we're just telling people 30 minutes, but it will probably be done before that, so stop back and check in a little bit."

Therefore, despite the at least 30 minute wait time, customers routinely return to the pharmacy counter in 15 to 20 minutes. Upon return, the technicians apologize to the customer that it's not ready yet, and then both the customers and technicians look at you expecting you to drop everything you're presently doing to finish their prescriptions. You don't want to, but you can't help but start rushing in this situation.

One customer wants his Suboxone prescription that he dropped off 15 minutes ago. It's for a box of the film strips, so you think it's a quick one. You find the label, grab a box off the shelf, label it, and send the customer on his merry way relieved that you no longer have to look at him.

Eventually, the other pharmacist returns to work, and you steadily grind down the mountain of prescriptions. At the end of the day, you actually filled only slightly more than normal for a Thursday, but it felt like 10 times that. Exhausted, you go home and pass out without even eating dinner. The only thought in your head is that you have to rest up, so you can be at the pharmacy at 8:00 the next morning to do it all over again.

Over a month later, a doctor calls you up inquiring about one of his Suboxone patients. The guy was complaining about having withdrawal symptoms and needing to increase his dose. The doctor couldn't understand why after being stable for so long the man was suddenly going through withdrawal, so he wanted to check with the pharmacy to see if you could perhaps shine some light on the mystery.

This month, the patient received the 2 mg Suboxone, just like the doctor ordered. However, the previous month, he got the 8 mg dosage. In fact, that was the only time he ever got the 8 mg dosage. Upon checking the prescription, you find that your initials are on the hard copy of a prescription that was filled in error. The man got 4 times his usual dose because instead of dispensing the 2 mg to him like he always got, you dispensed the 8 mg film strips.

Your error, while thankfully not harming the patient, caused the doctor to have to alter his treatment plan and increase his dose to accommodate for his withdrawal symptoms. The doctor reported the error to the state board of pharmacy, and 3 weeks later a drug control agent wants to speak to you about the mistake.

In the end, you don't suffer any serious penalties as no one got hurt, and it was your first offense. However, it's still embarrassing because you know how hard you work and how serious you are about being accurate. You're professional about the whole situation. Your initials are on the prescription. You missed the check. It's ultimately your fault, so you take the blame. However, you know that there were a lot of factors that contributed to that error. It wasn't just carelessness on your part. The error was part of the retail pharmacy culture that promotes speed, volume, and business-related paperwork over accuracy and patient care.

You were lucky this time. No one got hurt. Maybe the next error won't come with such good fortune. All you know is that you don't want to be around to find out.

Thursday, November 18, 2010

My Last Post

My first blog entry was June 24, 2007. In the 3 and 1/2 years since that first post, I've experienced a whole lot of life. While my original intentions for writing this blog were to entertain, it quickly evolved into a form of self-therapy. I looked deep inside myself to figure out what I really wanted in life. I explored the darkest emotions and analyzed past events repeatedly until I covered every conceivable angle. In the process I learned about not only myself but also the world in which I live.

In 2007, I was a 25 year old kid. I had no idea what I wanted. I was less than a year out of school. I still wasn't certain if I could cut it in the pharmacy world. I still viewed the world through the immature eyes of a child. There wasn't a single area of my life with which I was at peace, and I couldn't find a direction in life that would provide me with peace. Lost is easily the best way to describe my situation.

Over the following 2 years, I attempted to build up a life which could bring me some satisfaction. I took more responsibility at work. I attempted to make more friends and go out whenever the opportunity presented. I was determined to not let the breakup with my ex-girlfriend stand in the way of my future love life, so I even ventured as far as to try an online dating service... twice I might add.

I took the suggestions of friends and readers who commented on my posts. I made what many self-help gurus would say were healthy attempts at picking up the pieces of my life and moving on. However, no matter how hard I tried, my life always came crashing right back to square one.

The reason for the repeated crashes didn't occur to me until much later. My foundation wasn't solid. I was trying to build a life upon a flawed and shaky foundation. Therefore, no matter how many times or how many techniques I would try to build up to a higher and happier place, that faulty foundation would always cause my efforts to collapse back to ground level. I realized that the only way I could get to a better place was to start all over again and build my entire being from scratch.

In order to do this, I had to really analyze who I was and what brought me the small slivers of happiness that occasionally pierced the ever-present darkness in my life. I had to decide what, if anything, I wanted to believe in, and what were my core values. Anything that didn't fit in with those beliefs and values had to be removed from my life.

Everything was eligible for the chopping block. Family, friends, work, basketball... absolutely everything. I had to figure out the key components of that solid foundation I desperately needed. The first thing that went were most of my friends. People, who upon deep reflection, didn't value me as a person and whose lifestyles didn't mesh with my own interests and values were removed from my life. I knew that I wasn't a guy who was interested in going out partying and getting drunk, so any of my friends who thought the best use of their free time was to hit up a club and get wasted weren't going to fit into the life I wanted.

The next important step was deciding the best use of my free time was to get in shape. Having been an athlete for most of my life, it always upset me that I had put on 20+ pounds of mostly fat since the end of high school. No, I wasn't fat by any stretch of the imagination. However, I knew that I was out of shape. I knew that my diet of pizza, pretzels, beer, and cookies wasn't healthy for me. Objectively I knew that exercise and eating properly are far superior to any anti-depressant medication for lifting one's mood, but I was always too lazy to maintain a workout plan.

I educated myself on how to eat properly. I participated in online health and fitness forums in which knowledgeable posters showed me the evidence that proved that most of what I had known about nutrition and fitness was incorrect. I learned how to exercise efficiently. I learned how to eat a balanced diet, and more importantly, I learned the differences in the way our bodies metabolize different nutrients. Understanding the difference between high and low glycemic index carbohydrates and learning the fallacy of low fat diets enabled me to make great progress towards cutting weight and getting into good shape.

In less than 6 months, I shed 17 pounds (mostly of fat) and greatly increased the strength and efficiency of my muscles. I went from barely being able to do 3 pull-ups to being able to do sets up 8 reps with 35 pounds of weight strapped to me. Through high intensity interval training, I increased my cardiovascular endurance to the point where I could play basketball for 3 straight hours and barely feel winded. I brought my mile-run time down under 6 minutes for the first time since I was in middle school.

Besides the physical benefits of being in-shape. The absolute best part was that I felt happier. I didn't stress out as much. I found it easier to remain calm. I had more energy to do more things in my free time, and that led me to be in better spirits most of the time. It was wonderful.

Being in an almost perpetual good mood allowed me to finally come to terms with my, what many people would call depressing, beliefs. I knew I didn't believe in any organized religion. I knew I was a strict science and logic guy. There's no heaven. There's no hell. Human beings aren't a part of some big plan, but rather an evolutionary accident that will some day vanish from the earth just like virtually every species throughout all of the planet's lifespan has done and will do. Life will continue to thrive on this planet long after humans are extinct. We will ultimately be forgotten by the universe and nothing we ever did or will do will ultimately matter.

With that in mind, I don't believe in angels. I don't believe in demons or ghosts. I don't believe things are "meant to be," and there is no divine plan. I believe praying does absolutely nothing besides provide a placebo effect (and even that is being shown to be untrue by newer studies on the subject). Moreover, as I've noted before in this blog, prayer is kind of a stupid notion because when you break it down logically, it makes no sense at all. I don't believe everyone is special. I don't really believe anyone is special. We're all just kind of here entirely by accident, and we're all going to die sooner or later.

Depressing, right? I know. I struggled with it for a long time. It's hard to come up with a reason to go on when you don't believe there's any real point to all of this. It all just seems so unimportant, and objectively speaking, it isn't important at all.

However, in my fitness induced good-mood I had a moment of clarity. Why does there have to be a purpose? Who cares if we live a few decades and die without leaving any real lasting impression on the universe? The funny thing about human intelligence is that we're the only species in the entire history of the planet who could even care about a meaning to life. For a billion years, life has been rolling along. Each individual life form lives out it's comparatively short life-span, and the cycle just keeps going.

Maybe the point of life is simply to live. In that way, no living thing is any more special than any other living thing. However, the simple fact that we're alive makes us all special. In case, you haven't noticed, life is pretty rare in the universe. The chances of the right compounds being present in the right environment for the chemical reactions of life to start are very very slim. However, right here on Earth, it happened, and in that sense, we've hit the universal lottery. Our mere existence is incredible. In my eyes, that's all the reason I need to live.

That was the last piece of my foundation. I knew it was a solid one because it came entirely from myself. No part of it was unconsidered or handed down from a parent or other authoritative figures in my life. It was my own.

From there, I could slowly start building up the life I wanted without excessive worries or expectations. I was finally content, and that happy feeling allowed me to finally pull my heart away from my ex-girlfriend and open it up to someone new. As I've said before, I'm not happy because I have a girlfriend. I have a girlfriend now because I'm happy. She didn't save me, and if this relationship doesn't work out, it won't ruin me either. I saved myself, and my happiness is completely derived from myself.

That brings me to the end of this blog. The previous 325 posts have helped me accomplish everything I wanted to when I wrote that first post in June, 2007. It was important to me in ways, despite all my analysis, I'll never fully understand. I thank everyone who has ever read my blog, and I especially want to thank those who took the time to comment on my posts (regardless of whether the comment was positive or negative, whether it agreed or disagreed with what I was saying). Whether you realize it or not, your shared in my strange, enlightening, and often times frustrating journey. I was a kid when I started this blog. Now I'm nearly 29 years old, and now I'm a nearly 29 year old man with a renewed sense of self. I'm sure if you go back and read my earlier posts, the change in tone is very noticeable. Looking back, it's actually quite fascinating to see how my mind was working at each stage of my metamorphosis.

The blog will remain up for a little while I try to back up my posts. I've written nearly 1,000 pages here. I'm not just going to throw them away. However, once I get everything archived, I'm taking the blog down. I'm sure this won't be the end of my writing. I like to write, so I'll continue in one form or another, but it won't be here. Maybe I'll start up a new blog. I'm keeping my options open.

(Typical of my writing style, this last post was incredibly long-winded. I'll apologize one final time for writing too much.)