***Read “The Second Question (part 1) first.” ***
***Ready, Set, GO.***
It’s six o’clock in the pharmacy and Crash and I cannot keep up with the night of the livid prescription pickups. Cold zombie customers pull at stuffed up noses and runny eyes. I pump my counting tray twice and end them with Levaquin. Another high pressure corpse rises from the floor. As quick as you can say co-pay, I take that one down by shooting a volley of Diovans into its mouth hole. The rx department is surrounded by the walking dead, each one clawing a debit card. I glance over near the cash register. There is a flu-shot zombie waiting in the vaccination chair, its head lolling to one side. My opportunity. I grab half a cc of flu virus and draw up my escape plan. Just as I’m ready to shoot him, I drop the damn syringe. The sound of it attracts the mindless hoard. The patients encircle me, then I’m eaten, limb by limb.
This is the scene that is played out every night during the flu season. We get overrun, the manager gives us an extra body to work in the pharmacy. This frees up someone to help me fill prescriptions. So I had a guy named Crash typing the labels, and another guy named Burn ringing up the customers. Burn wasn’t the greatest mathematician. He was known to enflame many a customer after they counted their change. And Crash wasn’t my first choice to work with me in the pharmacy. Especially around the glass bottles.
When it finally started to slow down, we inched our way to the bottom of the prescription baskets. I had to correct every other label that Crash presented me. One label had been typed “take 1-2 tablets”. Someone’s grandma might read it as “take 12 tablets” and sleep from here to eternity. I change the label to “take 1 or 2 tablets”.
After a few more, he types “Apply to right arms”.
-”Hey Crash”, I ask, “exactly how many right arms does the rash guy have”?
Work does stop. I let the manager take Crash and Burn to help him in the basement. They had to prepare for the arrival of the bipolar shopper. She was one of our famous customers. She would come into the store during a manic phase, and buy dozens of whatever random item that was in her brain’s focus. Tonight it had something to do with torch lights.
My thoughts return to the metal charm in my lab jacket. It was a popular pharmacist pin that my employer sent me. I won it because a patient wrote a glowing letter about me. My tribute was delivered to me at home, without explanation. I was pretty sure that the lady with the blood pressure monitor had written the letter.
I remembered when she showed up at my cash register. She had dumped random warranties, manuals, and packaging in front of her at the counter. Among that pile sat a digital blood pressure monitor. She was breathing heavy and had a look of fury in her eyes.
-”I bought this here and it isn’t working right. I am not an idiot. I know what I am doing. I have never used it since I bought it, and now I tried it for the first time this morning and its crap”, she shook her head back and forth, picked up her receipt, and threw it back down.
She seemed a charmer. Craft looked at us out of the corner of her eye. The quickest way out of this would be to ask some questions about her technique then confirm it was operating properly. I looked at the receipt. She had purchased it six months ago. I looked at my patient, and decided to ask a different question.
-”Where have you been storing the monitor?”
-”In my hall closet. But it was safe. It was up on a shelf and it hadn’t been touched.”
And then I asked a second question. Second questions are usually “why” questions.
-”So why today, of all days, did you go into your closet and get out a blood pressure monitor that has been sitting there untouched for six months?”
I looked at her more carefully this time. She looked to be at about five years away from having hypertension. But she also looked about five minutes from having a mental breakdown. I quietly wrapped the cuff around her upper arm and she told me her second story.
-”Look, I ain’t sleeping. My husband is out of work, and we just have my paycheck, which isn’t much”.
I confirmed that the cuff was placed over where her brachial artery should be. I hit the start button.
-”Now they say there’s gonna be lay-offs at my job. Our kid needs my coverage. My heart races in the middle of the night. I don’t sleep. This morning I think I might have blacked out. I am 34, I can’t go through this.”
The machine finished. Blood pressure normal. Pulse high.
-”Your blood pressure reading is normal.”
When I told her this, her eyes watered.
-”But I didn’t say you are OK. Your pulse is high. Do you know what a panic attack is?”
-”What do you think I should do?”, she nodded.
-”OK, this is what I would do. If I had your symptoms, and my job was really threatened, I would take immediate action. I would get my ass into a doctor’s office today. I would answer all the questions about stress and depression and panic as honestly as possible. You’ll get a prescription for an anti-depressant, fill it right away, and stay compliant with it. I would be careful about the alprazolam, if they say you can have some. That drug has a dark side that can be a monster. Then I would go to my employer and have everything documented with human resources”.
-”Tell my work?”, she asked, shocked.
“Thats what I would do. Starting right now.”
She had thanked me. I had a strong hunch she would follow my every word. I had to remind her to take her blood pressure monitor when she left. Now I looked up at the front window. It was windy and dark out there. The black night was broken by lit messages sent by the across the street store signs.
-”Are you so proud of your little pin?”, the store manager said, bringing me back to the present.
The count had snuck up behind me and startled me. I jumped out of my body. I turned and we faced each other.
-”The customer still has her job and her insurance because of me”, I told him.
-”So you’re nice to approximately one out of five-hundred patients.”
-”You’re keeping count?”, I asked.
-”Of course”, he said, “it’s what we do. Actually, I wanted to tell you that Ella is waiting for her vaccine. It’s already paid for.”
Ella Yella sat in the vaccination chair. It was thirty minutes before closing time. She looked like an older Ella since I last saw her. She wore a white housecoat, and the rollers in her hair looked like electrodes. I took a vial of Fluvirin from the refrigerator, recorded the lot number, and drew up half a cc into a syringe. I reviewed her consent for Flu Vaccine. I went to the computer to look at her meds. Furosemide for her water. Metformin for her sugar. Potassium for what the furosemide took. Digoxin for her ticker. My docs hardly ever wrote for digoxin anymore. Very few woman on it.
Digoxin is supposed to help Ella’s ghost-like heart beats. But it can be poison if its blood concentration creeps too high. The classic target concentration is between 0.5 to 2 ng per ml. Thats smaller than an angel dancing on the head of a hypodermic. And elderly patients don’t cooperate when it comes to drug concentrations. Thats pharmacokinetics.
Over the years, study this and study that failed to demonstrate superior outcomes with the use of digoxin. Some said the mortality of those taking it was actually higher. But not all doctors bought the data, and I still saw an occasional patient on the drug.
Before I walked over to Ella, I noticed that the items being pulled up for the bipolar shopper had been scattered about the waiting area. I stepped over them as I made my way towards Ella. The assistant manager was hunched over, carrying boxes of tiki torches, the type that the neighbors used for lighting up their patios during a barbecue. Crash and Burn were hustling to move the inventory thirty minutes before closing. Our manic shopper. She had once purchased 126 wind catchers that were on sale and created a tempest in our store.
After her flu vaccine I sat with Ella and we waited for closing time.
-”You give good shot. Ella did not feel a thing”, she said.
-”That because I missed you and injected the arm of the chair.”
I looked down at the floor. Ella’s feet looked funny. The swollen ankles were as big as road kill. The Count drifted by, emerging from the basement.
-”So I hear the bi-polar shopper is in the store tonight, buying up all these tiki torches”, I laughed.
He presented a blank stare that was a reflection of my own. He was going to make one of his gothic speeches.
-”This is what I’m always telling you. If there is a vampire in this store, its you. Your sharp comments about the customers are like bites to the neck. You don’t even know this woman’s name. It’s Marcie. And you throw around terms like bipolar. She’s not bipolar. She buys all this crap for her students. She teaches writing at the college. And tonight she organized a scavenger hunt for her class. With her own money. You’re so busy counting their pills you don’t even learn any of your patient’s other stories”.
He crossed his fingers and left me with a stake in my heart. My night had just taken a bad turn. I wanted everyone out of the store. I locked arms with Ella to carefully walk her down the aisle. I could hear the writing instructor. She congratulated each of her students on surviving tonight’s scavenger hunt. The hunt’s last items, the tiki torches, had been found at my pharmacy. All night long, they had been driving around like bats. She was lucky none of them got killed. Road kill. I thought of Ella’s swollen ankles.
There was a question I should have asked her that night that I was in her mustard house, so we stopped.
-”Ella, why do you light your house with yellow light bulbs?”
-”It helps the rings go away. The regular light makes gold rings. It bothers my eyes”
That was a classic symptom of digoxin toxicity. It can cause the patient to see yellow halos around bright lights. Her swollen ankles were a sign that her body wasn’t clearing the drug fast enough.
-”Ella, I think your blood level of digoxin is too high. It can be dangerous, we should take you to an emergency room.”
-”Not tonight. Tomorrow. I go to doctor tomorrow. I will be OK tonight.”
The extra night would not make a difference at this point. I reached into my pocket and pulled out my gold charm. I pinned it to her white house coat.
-”Any drug can be an angel or a monster. You must learn the signs and always look out for them. Do you promise to wear this charm to protect you from the monsters?”, I asked.
-”I do promise. And do you promise to stop counting pills in the dark so much. Come into the light and get to know your people more?”
I would also send the delivery driver to her house, tomorrow, to make damn sure she saw her doctor. As she left, she looked as though she might kiss me goodnight. I was wrong. She gave my ass a pinch instead. I shook my head and laughed quietly in the dark.
It was windy outside. Tall, elderly Ella walked to her ancient car. The front door stuck, and when she struggled to open it, the charm fell from her white house coat. It struck her slippered foot, and shot out into the street toward the gold gobbling pawn shop. Some moments later her car pulled out of the parking lot. Then, the front door of the pharmacy yawned open, and released a string of tiki lights, dancing into the night.
(ROLL CREDITS, PLAY CLOSING THEME*
*Closing theme: A song called Perfect Symmetry by Keane:“I shake through the wreckage for signs of life/Scrolling through the paragraphs/Clicking through the photographs/I wish I could make sense of what we do/Burning down the capitals/The wisest of the animals/Who are you? What are you living for?/Tooth for tooth, maybe we’ll go one more/Read page after page of analysis/Looking for the final score/We’re no closer than we were before/Who are you? What are you fighting for?/Holy truth? Brother, I choose this mortal life/This life is lived in perfect symmetryWhat I do, that will be done to me/Lived in perfect symmetry/What I do, that will be done to me/As the needle slips into the run out groove/Love, maybe you’ll feel it too/And maybe you’ll find life is unkind and over so soon/There is no golden gate, there’s no heaven waiting for you/Spineless dreamers hide in churches/Pieces of pieces of rush hour buses/I dream in emails, worn out phrasesMile after mile of just empty pages”
***This has been a B-Blog Production***