last refills

Our store has a vampire.  Before it opens, he works there in the dark, drifting up and down aisle number six, taking phantom counts of the kotex.  He is known as the count because he is constantly counting things; the kotex, the money drawers, the number of bathroom breaks the cashiers take.  He glides past me as I unhinge the metal pharmacy gates that rattle like chains. When the store lights come up, the count disappears, and boards himself in his coffin office. He is my store manager and he has a gothic personality.

My pharmacy technician comes flying in next. Everyone who works here has two names:  a trade name provided by me and a generic name provided by their parents. My technician’s trade name is Craft.  She can deflect customer’s curses, fill the bottles with potions, and transform the insurance claims. She types all the labels and her spells hold the pharmacy together. Craft is already on the phone with the first call of the day, but she isn’t able to make it vanish. She puts the caller on hold and says:

-”The thyroid customer wants to talk to you. He said that you told him that his diarrhea might be caused by too high of a thyroid dose. Now he doesn’t want to bother the doctor.”

-”So tell him that his diarrhea is just some random shit.”, I said to Craft.

Craft gave me her warning look, so I picked up the phone.

-”Yeah, hi”, I spoke into the phone. ”Well, I noticed that the doctor had increased you to 137″, I explained, “Its probably nothing but better to let the doc rule out the dose increase”.

The thyroid customer was still talking in my ear. I reached my hand into the left pocket of my lab jacket and found a little gold pin that I had stashed in there. I pressed it with my fingers.  It was a little metal charm to ward off  the stress.  Craft pushed a stack of finished meds toward me that I needed to check. During verification I reviewed the computer prompted warnings for each patient:

“WARNING: SSRI may inhibit platelet aggregation, recent fill with clopidogrel”

“WARNING: Tramadol may decrease seizure threshold, inferred seizure disorder from use of gabapentin”

“WARNING: Use caution giving potassium, inferred gastric motility disorder from use of Omeprazole”

The pharmacy computer had diarrhea of the warnings. The thyroid customer had diarrhea of the mouth. Still talking to me.  I opened the bottle of each prescription I checked, to peak at the pills. Metoprolol came in blue and pink. Prometriums could either be bubble gums or lemons.  Digoxin came in white and yellow. Yellow Digoxin. I remembered we had to call Ella Yellow, one of our delivery customers for today. Our driver called out sick, and I had no one to take her pills to her house. I covered the reciever with my hand.

-”Craft, call Ella Yellow, we can’t deliver her Metformin.”

A bundled up man in sunglasses and scarf was waiting to speak to me at the pick up counter. Kind of extreme for December 1st.  My thyroid call was turning sluggish, he decided he would call his doctor. Bye now. I walked over to the counter.

The customer spoke to me-“I sat next to someone reading the NY TIMES on the train. I should never have done that. I love the times, but I am deathly allergic to the ink.”

-”Ink allergy, huh?”, I asked the sunglasses. My eye rose above his head to look out one of our front windows. The morning sun had just spread across the bagel shop.

-”Oh yes. I don’t even have to touch it. I just have to be near it.”

-”Well, let me ask you a question”, I started seriously, “Do you think there were a lot of headlines today?”.

-”I suppose”, the sunglasses hesitated.

-”Just be thankful it wasn’t the Sunday edition. Benadryl is in aisle two.”

Craft was waiting for me when I returned to my computer. She had something to say but the phone rang and Craft took the call.

-”Yes Mr. Mainchent. OK, we’ll put it back into stock and cancel the refills. Good bye.”

Craft turned to me and said-”You are going to have to start being nicer to those customers.  You don’t have one positive comment listed on the customer feedback report. Your boss commented on it”.

-”Look Crafty, did you call Ella yet?”.

Craft stopped talking and searched the computer for Ella’s phone number.  I thought about the “customer feed-back report”.  Customers were encouraged to call an 800-number listed on their receipts so they could comment on our job performances.  Once, our district manager actually suggested that we should point out the number whenever we were nice to a customer. Stack the document. I do go out of my way for certain types of customers, but mine didn’t take surveys. A customer had been waiting near the vitamins.

-“Excuse me, I’m looking for empty capsules. I want to fill some capsules with  my own herbs now.  I’m growing them”, his voice called.

I looked up.  It was a man wearing a straw hat. In December.

-”Yeah, we don’t sell the empty capsules anymore, since we started carrying rat poison.  Try adding your herbs to brownie mix. Aisle one”, I suggested to the straw hat.

I clasped the metal pin with my pocketed hand. Surely it would charm away the rest of the possessed questions.  Craft rescued me from the hat by turning my attention into a different problem. She was on the phone with Ella

-”She sounds pissed. She needs her Metformin.  She says if you don’t bring it to her by tonight, it will be the second time this year that you tried to kill her.”

Ella was referring to the yellow digoxins she thought I gave her.  Every time we talked, I had to relive this horror story.  It was why I traded her name to Ella Yellow.

Ella had been taking digoxin forever.  One night, just before closing, Ella called me at the pharmacy.  She said I gave her yellow pills and hers were always white.  I apologized and said I would drive straight to her house when we closed. I took a bottle of the white tablets to correct my error. And some money to give her a refund.

-”You make a mistake doctor”, she laughed as I entered her house.

I looked at Ella. I was alarmed.  Ella’s skin was yellow. Then I looked at my hand. My hand was yellow. I looked under a lampshade. Everything in the house was being lit by yellow light bulbs.

-”Ella, let me see the pills we gave you”.

They were the correct strength of the digoxin. They would have looked white if Ella’s house had normal lighting.

-”Ella, these are the correct pills”.

-”No they’re not. You gave me yellow pills”.

-”Your whole house is yellow! We’re breathing yellow air! Get me a sack of rice, I bet its yellow.”

-”You are trying to kill Ella”, she whined.

So me, Ella, and the prescription bottles formed a  mission, to journey from room to room in search of white light.  It took longer than the stations of the cross. There were twelve rooms, each with its own sickly glow. My biggest fear was finding the body of one of her dead husbands propped in one of them. I finally convinced her by opening the refrigerator so we could inspect her medication in its light.

With its door still open, Ella said, -”Oh yes. Those are my white pills. You want I should make you something to eat?’.

-”What’s in that tupperware on the second shelf?”, I asked without shame.

I stayed to watch a jaundiced Jay Leno monologue and we ate some potato salad. Now I would have to stop there again, to deliver the metformin.

-”I’ll go back to that freaky mustard house, Craft, but tell her it will have to wait until after closing”.

-”Thats OK. Ella said she’ll come in tonight. And when she’s here she wants you to give her a flu shot’.

I took the pin out of my lab jacket. I had been squeezing the magic out this charm all day.  The thing had arrived at my house a few days ago and the mystery of it stuck to me. The pin read: “I’ve been Voted Most Popular Pharmacist”. Me. My company’s logo was printed above this metal irony. I was curious about which customer may have nominated me. I was guessing it was the lady who came in with the blood pressure monitor. I think I may have saved her life by having the sense to ask her the second question.

Second questions.  Once, one of the doctors in the area explained the concept to me.  The doc said you can’t always trust the first facts that a patient discloses to you. A good clinician will know when to ask a second question that may be completely unrelated to the first.  Or maybe ask the second question to someone other than the patient. Sometimes it will take you to the patient’s most truthful problem.

-”Craft, when Mr. Mainchent called before,  what medicine was he cancelling?”

-”He said his doctor told him to stop the Plavix. And by the way Mrs Nervache is still waiting for the tegretol, it has to be counted”, warned Craft.

-”I’ll get it.  Call Mainchent’s doctor and have them check the chart about the Plavix”.

I poured tablets of Tegretol XR onto the counting tray. These round little pills always made me pause. Each pink tablet had a tiny little porthole on its surface. It was this secret of the tablet that made it an extended release.  After it was swallowed, gastric fluid entered the hole in the Tegretol. This fluid slowly pushed out the active ingredient at a steady pace, throughout the tablet’s journey through the digestive tract. In the end, all that remained was a spent shell, which was flushed away with all the other crap.

-”My boy says his throat hurts”.

I looked up at a concerned mom and asked -”How old is he?”

-”He’s 20 and away at college. I want to mail him some Sudafed. Will that knock out his flu?”

-”Uh, I’d check to make sure he won’t be doing lines of coke or using meth while he takes the Sudafed.”

I thought of saying this, but I was nice and helpful instead. The mom confirmed that her little bundle had gotten his flu shot this year.  I explained that he was trapped in a dorm room, with hundreds of sleepless college freshman and all their rhinoviruses. They were spending the semester passing colds and failing tests.  He needed sleep, not medicine. Although I tried my best to sound convincing, the mom wound up buying the Sudafed and not my recommendation.

I overheard Craft talking to Mainchent’s doctor’s office about the Plavix.  I was not surprised that the 91 year old patient  had gotten confused about his platelet medication. The doctor never told him to stop taking it. The nurse thanked Craft and said she would call Mr. Mainchent.  When she hung up the phone I explained to Craft that a doctor had taught me that we shouldn’t always trust the first information that the patient provides us.

-”Hold that thought. Its 5 o’clock, I’m going home”.

She flew out of the pharmacy.  The second tech had arrived but would barely keep up with the line at the cash register. The dinner rush was always hell, and I would have to type all the prescriptions, fill the bottles, and verify my own work. Before long, I would start to take on water and my shell would be half spent.  Would I find the time to verify that the blood pressure lady had gotten me popularity-pinned because  I had “second questioned” her?

And sometime tonight, I still had a rematch with Ella the Yella. We were scheduled to battle among the bottles. I would arm myself with a  23 gauge needle and dead flu virus. From the building’s second story, I heard a bump or two. It was the count, emerging from behind his pine box desk.  I looked at the front window from my mound of prescriptions. The bronzed sunset pitched its best light at the Home Towne Pawn Shop, striking a sign that said: “We Buy Gold”.

***INTERMISSION***

*What is the source of the pin’s power?*

*Does The Count ever speak?*

*Will we meet the Bipolar Secret Shopper?*

Continued in Part 2.