I'll be good for you...

...if you're nice to us, that is.

On this lovely Saturday, as I sit in Franchise Cafe finishing up the shitload of assignments I've let pile up for this rotation, I viewed a customer become upset with a cashier because their stupid sandwich wasn't made correctly.  That made me sit back and think about the real similarities between food service and pharmacy, which I'm sure we're all aware of.  I think I've made some mentions to this effect before, but I couldn't help but think of my favorite mantra:

This is not Burger King - you cannot have it your way.

So yeah, at Franchise Cafe you can technically have it your way, but to all you patients out there...be careful about you you piss off...you could end up with a Spit Special, as my fiance likes to call it.  In a pharmacy, you really can't have it your way 99% of the time.  You're out of your #120 Vicodin after 7 days?  Nope, sorry, no early refill...you can't have it your way, and I'm not falling for the 'but my pills fell in my toilet' excuse.  You're completely out of your Xanax and it's a Friday night, can you have some to get you through the weekend?  Hell no, you can't have it your way.

Here is a prime example of a pharmacy-type Spit Special:  You're dropping of a prescription with a write date of three months ago and you get pissed because we tell you that you have to wait 20 minutes and you need it right this second.  'It's just some pills in a bottle, 20 minutes is ridiculous!'  No, sir, you can't have it your way, and I will make sure it takes at least 20 minutes to fill it.  Oops!  Typed the sig wrong, need to redo it.  Your insurance is expired, do you have another card?  Give me about 5 minutes to rebill that, sir.  By the time you're out of there, it's at least 30 minutes by design.  I may be cynical, but if you'd dropped off that prescription and had us hold it until you needed it, it would have been done as soon as you called us to fill it.

Recently, I was reading the Pharmacy Chick's blog, and she makes a very valid point:  "How long will this take?" and "when should I come back for this?" will elicit two totally different responses.  The person accepting the prescription or refill will respond more favorably to the latter.  Asking how long it will take to fill the prescription makes patients come off as impatient and ungrateful.  Most of the time, patients asking this question seem perturbed an in a hurry, like our time is not as valuable as theirs is.  And when we tell them it will be about 20 minutes, they usually roll their eyes or sigh.  Sorry, you should have called ahead for your 8 refills or dropped off your new prescription with the intention of waiting a little bit.  For those who bring in a buttload of refills and give me shit for having to wait a little longer than normal due to the amount, I put stickers that say "For refills, call 24 hours ahead!" on every single bag receipt.  My hope is that the patient will get the subtle hint, but usually they don't.  If I wait on them at the cash register and they complain about the wait time, I very politely say, "Well, next time you need your refills, you can always call the night before!  And if you don't want to use our automated system, dial the phone number and press zero...that way, you'll be connected directly with someone at the pharmacy!"

Part of Pharmacy Chick's message in her last post is that "you get in what you put out."  I totally agree with her.  If you form a great relationship with your pharmacy staff, they will be totally receptive to you.  Trust me - we can tell when you're genuinely in a pinch versus just being a d-bag.  And it's important to form a great relationship with everyone that works behind the counter, not just the pharmacist.  The technicians make the pharmacy world go round.  Without them, if pharmacists were solely relied on to input, fill, call insurance companies, and deal with customers in addition to what their real duties are (ie visual verification, taking verbal prescriptions, catching drug interactions/duplicate therapies, anomalies between what a patient was just prescribed versus what they'd had before [this is in no way an exhaustive list]), every pharmacy would be in chaos.

Be nice to your pharmacy staff...or else you might end up with the pharmacy's version of a Spit Special.

PS:  Worked with Floater Pharmy this week!  To my dismay, I've left my Little Notebook o' Quotes at home.  I will be posting some gems when I get the chance!

so tell me what do do now, 'cause...

...I am a weirdo magnet.

For realz, yo.  It's been what, a week since I've blogged?  That's because nothing really interesting happened last week.  But this week, oh, this week has been very different.

I'm at a busier store this week, so I get lots of patients.  And lots of patients means lots of counseling.  And lots of counseling means you're bound to get the weirdos from time to time.  How do I even begin??

Let's start with the 70-ish-year-old old guy with yellow teeth, most likely from smoking, a shirt that used to be white with holes in it, and jean-short cutoffs.  He was picking up a prescription for Vicodin (obviously), so I counseled him on it.  At the end of our conversation, I said, "Do you have any other questions for me?"  His response:  "Can I have your number?"

Now before you all say, "Oh, he was just joking," you didn't see his face.  He was completely serious.  Then when I said, "I don't think so," he shrugged and said, "Well, I hope you have fun tonight.  I know I will," then he winked and left.  Creeper.

Today, however, took the cake.  This middle-aged guy, probably in his 40s, came to our drop-off window.  He presented me with a prescription and told me that his address was incorrect because he "used to be in prison" and was "probably going back next week because [he] got a DWI" and that I'd probably read about him in the newspaper.  If this wasn't enough, he also informed me that he was poisoned with antifreeze, was hospitalized in the ICU for 4 days, and that his serum creatinine is currently about 2.8 mg/dL and wanted to know if the kidneys regenerate.  He kept smiling at me and as I counseled him, our conversation went something like this:

Ex-con guy:  Oh, hi.  I see you're wearing a ring.
Me:  Yes, yes I am.
Ex-con guy:  Well, rings can come off.  **wink**
Me:  Uhm, mine doesn't.

I mean come on...what is it with people?  He creeped me out from the get-go because he was too friendly.  The pharmacist on duty who is about 8 months prego (bless her heart...and she's working up until her due date) said if she would have known, she would have taken the counsel because she's got such a big baby belly.  But how would she have known?  And...some guys like that kind of stuff.  Eek..whatever.

On Monday, I also had a googly-eyed lady freaking out because the doctor didn't call her prescription in correctly.  She screamed at me that she needed to use our phone so she could call her "godddamned doctor" and "get my pills because I'm out of my damn pills."  So after she yells at me and simultaneously spits on me while doing so, I lend her the phone next to the drop off window.  She gets ahold of the office and screams into the phone at the secretary, who puts her on hold so she can look into the problem.  The lady turns around and yells to her equally attractive husband, "THE GODDAMNED BITCH PUT ME ON HOLD!"  Mind you, there are lots of other people milling around as well as small children (oh, those poor kids).

The NP from the practice finally gets on the phone and tells the patient that she will talk to someone right then to straighten out the mishap.  The beauty shoves the phone in my face, so I took the prescription and talked with the NP, who apologized for her patient.  Why should she apologize?  Googly-eyed Lady owes everyone an apology!  She told the NP at her appointment that she takes Effexor XR 75 mg, which comes as a capsule.  The NP called in a script for that, but the catch is that it's not generic.  There are, however, venlafaxine XR 75 mg TABLETS, which is what the lady wanted because they're cheaper than the capsule.  I understand the lady was frustrated, but I will NEVER, EVER understand why patients think yelling and screaming will make things happen faster.  It will most likely cause me to move even slower just to piss you off.  UGH...people.

I was really, really frustrated in general today, though.  I worked with a pharmacist whom I've never met, and she made me stay at the drop off window for my entire 10 hours because I'd "learn sooooo much standing there."  That might be good and all IF I WAS A TECH TRAINING ON THE COMPUTER.  I'm not saying I shouldn't learn to do all I can so I can help while I'm there, but how is taking prescriptions preparing me to be a pharmacist?  I should be counseling, making MD calls, taking prescriptions, and making OTC recommendations.  I don't mind helping out at drop off for a little bit, but 10 hours?!  Honestly...no one else stood there their whole shift.  I'm just free labor so they can do whatever they want, I guess.  Whatever...here's to hoping tomorrow is better.  At least I'm off Friday.

I'm going home this weekend...yay for four-day weekends!  I work four-10 hour days so I get Fridays off, plus Monday is a holiday and I don't have to go in...YAY!  Working Saturday at home...will update if I have stories!!

I'm going crazy

Today was first official day of APPE 1.  Woopee.  It's my first of two retail rotations, which is my bread and butter.  This particular pharmacy I'm at right now has only been open since late March, so they don't have too much business.  When I talked to my preceptor on the phone, he told me that they're kind of slow, but that it would give me an opportunity to counsel a lot (which is something I am looking forward to since I don't get to do much of that at home).  BUT...when he said "kind of slow," he wasn't telling me the whole truth.  When he said "kind of slow," he meant "so slow you could watch paint dry and it would be more exciting."  In my 8 hours there, I did a grand total of 3 transfers, took 6 drop-offs, and answered the phone twice.  And they got not one phone call from a doctor's office, either directly or left on the voicemail.  Luckily, I have a good classmate on rotation with me to pass the time with. 

Oh, and my actual preceptor wasn't even there...he's on vacay for the next week.  We were fortunate enough to work with this eccentric 60s-ish floater from Taiwan.  I've decided that he's a conspiracy theorist.  He thinks everything is evil and out to get people - ie the higher management in the company he works for, drug companies, the government.  Don't get me wrong, I really liked him...he was just strange, lol.  And I may not have gotten any interesting patient stories, but Floater Pharmy had plenty of one-liners:

(overhearing employees cheering somewhere in the store**) "Drug Store loves me, Drug Store hates me...no, Drug Store is just using you."
**apparently there was some type of manager's meeting this morning...I have no clue what they were so happy about.

Tech:  "It's hot in here."
RPh:  "Because I'm hot."

(referring to inserting rectal suppositories)  "You just spank it and it automatically shoots in - it's a nursing skill."

This last one needs a little explanation:  Floater Pharmy had a big blue jug of water that was crystal clear early in the morning.  Throughout the morning, the water began to turn a greenish hue, and I noticed that there were 3 teabags floating in the top.  An employee stocking the OTC section noticed as well and asked what was floating in the top of his jug.  His response:

"Goldfish."

And 10 minutes later, when the tech noticed the teabags and asked about them, she was awarded with an totally different answer:

"Dead rats.  Mmm...rats."

I work with this guy tomorrow, too...should be interesting!!!

I just wanna tell you how I feel.

Today I spent most of the day doing our narc audit with another intern.  So fun!  NOT.  We found at least 5 discrepancies...and that's 5 too many.  We were lucky enough (again, please infer sarcasm) to have to figure out why there were discrepancies.

But, never fear!  I wasn't that busy with narcs that I couldn't wait on a customer or two to get this gem: 

I ring out this patient who gets a script for Vicodin ES and something else (I can't remember what it was...an antibiotic maybe?).  I ask him if he has any questions for the pharmacist, and he responds laughingly, "Well, can I drink alcohol with these?  Haha..."  I smiled, thinking he was joking, and replied that it is never advisable to drink alcohol with any medication, especially Vicodin ES.  The following is the subsequent conversation we had:

Patient:  But seriously, can I drink while I take these?
Me:  It's really not recommended, sir, especially with the Vicodin.
Patient:  Well, can you ask the pharmacist how long I should wait between drinking and taking one of these then?
Me:  Uhm, okay. (I consult the pharmacist, who rolls her eyes and shakes her head as I relay the conversation.  She tells me what to tell him, and I return to the customer.)  Sir, she says she can't even recommend  that.  You really shouldn't drink while taking that medication.
Patient:  Oh, I was just wondering...I have horseshoes on Thursday nights.

Really, I mean really?!  I should have said, "Would you rather be pain-free or almost dead?"  And come to think of it, he probably shouldn't even be playing horseshoes while taking Vicodin, anyway.  You're not supposed to "operate heavy machinery", ie cars, steam rollers, farm equipment.  How are you supposed to chuck a heavy horseshoe toward a pin sticking out of the ground?  Too bad he didn't get metronidazole...we probably would have still had the same conversation, then I would have told him to make sure he drinks a fifth of vodka and call me in the morning to tell me how he feels.

Oh, how I love my patients.

You're making moves, you're going to lose.

Well, the first day back at work (Monday) was pretty uneventful.  We had the regular, what I like to call, "oh shit rush" as in "oh shit, they close in 5 minutes so I better get my lazy ass to the pharmacy to get my 4723048 refills!"  But yesterday...yesterday was much more interesting and chalk full of amazing customers!  We were really steady all day, with the typical rushes mid morning and around lunch time.  But I've got some great stories.

Scenario:
Drive thru bell rings (I f-ing hate, hate, hate that stupid thing.  And let me just tell you - our DT isn't face-to-face like most normal pharmacies.  Nope.  Ours requires the use of cameras and television screens to see one another because the actual drive thru is nowhere near the building.)  Intern (me) sighs dejectedly as she prepares to answer the malifluous device.

Intern:  Hi, picking up or dropping off?

Ms. Pinocchio:  Dropping off a new prescription.

Intern:  Is your name written clearly on the prescription?

Ms. P:  Yes.

Intern: How about your date of birth?

Ms. P:  Yup.

Intern:  Any allergies to medications?

Ms. P:  Nope.

Intern:  When would you like to pick it up?

Ms. P:  As soon as possible.

Intern:  Okay, that will be at least 45 minutes.

Ms. Pinocchio drives away.

So, I get the carrier back through the vacuum tube and pull out the prescriptions - wait, did I just say prescriptions??  This chick told me she had A new prescription.  Now, it wouldn't be a big deal if there were 2 or even 3 prescriptions, except there were 10 prescription blanks...each with about 3 drugs on them...for 5 different people.  As soon as possible, my ass.  She gets to wait for not telling me the whole truth.  That means every person from now on who drops a new prescription off through the DT gets to send it in and wait until I get it so this doesn't happen again.  This may not seem like a big deal, but in a busy pharmacy, I'm not rushing to fill 30 prescriptions because she wanted them ASAP.  Sorry, lady.

And since this entry is getting way too long, here are some amazing one-liners:

Tech: (on the phone)  Okay, give us about an hour.
Patient:  UGH!  I hate that.  click.

Mrs. Pee Pee:  They took me off my Detrol but I'm still peeing.  I pee a lot.  My husband bought me diapers for Mother's Day.

Workie workie today!  Can't wait for more pharmacy follies!

Bye bye bye.

So, I'm dunzo.  No more tests (until the NAPLEX and MPJE at least), no more stupid homework, no more dumb group projects were I get stuck doing all the work, no more teachers who think they're God.  My last final was yesterday in a class I believe to be pointless with a teacher who bores me to no end and asks true/false questions that are opinions (and his is the only right one), and it was comprised of 105 questions - which I finished in 26 minutes. 

Now, one thing you need to understand about me is that, in ANY exam in pharmacy school, I was consistently one of the first 5 people done.  For this last final, I looked at the clock and realized how fast I got finished, so I started to check over my exam.  I got through the first 5 questions when one of my classmates stood up to leave, so I decided to, too.  I was immediately followed by 2 other classmates.  We were all waiting on someone else to stand up and leave, haha.

Anyway, about 2/3 of my class went out right after the test to this awesome, hole-in-the-wall bar in the city.  We were all so excited to be done with school, but as I was saying my goodbyes before I left, I got a little sad, and so did some of my friends.  For three years, we've seen each other every single day.  Suddenly, we're all spread out.  The next time we'll be together as a class is this time next year for board review and graduation.  There are definitely people from my class I won't miss, but I've made some of my best friends in school.  At least I'll be in town for half of my rotations; I'll be able to see them while I'm here.

Tomorrow is moving day!  I'm moving out of my apartment...and I can't say I'm upset.  My roommate is, well, annoying, and that it putting it nicely.  I have another place to stay while I'm here on rotations, so I don't need to put money into an apartment, especially when they wouldn't allow a short-term lease.

I'm going home for the week we have off between finals and rotations.  Home means work, and work means fun/frustrating/inexplicable/dumb stories!  Should be interesting!

A little more time.

Welp, one final down, two to go.  My first final wasn't too much of a bruiser, nothing I couldn't handle.  I keep looking at the stack of notes for my next couple finals, and I just don't care.  It's too nice outside right now to sit in here all cooped up studying.  I think it's pretty ironic that our very last lecture ever in my therapeutics class was ADHD.  Maybe they did that on purpose.  All I know is my attention span is about 2.320981 seconds.

I am not looking forward to my next two finals.  I can't concentrate for shit, and all I keep thinking about his how much I have to do before this weekend.  My lease ends May 31st, and I'm moving this weekend to a place that is way more cost-efficient, since only my first 4 rotations in the town where my school is.  The other 3 are at home, so I'll obviously live with my parents (eek!).  I'm celebrating the end of my classroom career with my classmates Thursday right after our final, but I really need to pack.  I need to go get boxes, throw shit away.  It's amazing how much stuff I've accrued over three years.

Bleh...oh, well.  APPE 1 starts in less than two weeks.  At my school, we're required to contact our preceptors 30 days in advance of beginning a rotation so we can find out if there are any site-specific requirements, what time we should show up, etc.  I e-mailed this dude 3 weeks ago but never got a response.  I finally called yesterday to see what the hold up was.  He said he needs to catch up on e-mails, whatever that means.  It doesn't matter anyway.  It sounds like my schedule will be flexible, so I'm happy about that.  I'm hoping that means as long as I get my assignments done and complete the hour requirements, I can make a 3-day weekend here and there.  That would be good, especially since my manager back home wants me to try to work once a month just to stay on payroll.  I really hope that counts for something when they're deciding which interns to hire in the fall.  I drop everything to go in when they're in a lurch, I've worked split shifts between two stores resulting in 13-hour days, I stay late, etc.  I hope they realize that.

Anywho, I should probably get back to 'studying.'  Thursday can't come soon enough.