The Pharmacy Chick

Flying the coup in retail

Trainwrecks

Filed under: Uncategorized — pharmacychick at 9:38 pm on Saturday, April 23, 2011

My last customer of the day on friday night was a trainwreck. I suspect everybody has a name for these people.  I personally call them “trainwrecks’.  Before I go on, I will define a “trainwreck”.

A trainwreck is a person who posesses the  following characteristics:  1) his/her  life is one crisis after another.  2) couldn’t be organized or make a plan if their life depended on it.  3)  when given the choice to make a good decision or a bad one, will chose the BAD option every single time.  4)  Will F-up everything they do.   5)  has no comprehension whatsoever that their lack of planning/poor choices, etc, creates hassles and inconveniences  everybody they come in contact with.  and 6) generally passes this trait onto their plentiful offspring.

Meet Kevin.  Kevin is a trainwreck and has all of these traits but No. 6.  I dont think he has procreated yet.

 I got a call from Big Box asking me if we took Crapola HMO state welfare plan.  My head was screaming NO!, but my mouth said Yes.  Glancing at the clock I noted to Big Box pharmacy ” WE close in 40 minutes, they need to get their butt down here”.   (Note: big box is a whopping 1 mile drive…they took 20 minutes).

Kevin and his (what appeared to be) his long suffering mother stood before me. He looked about 24ish.  Half of his teeth were missing ( meth head),  had scars on his arms ( more meth head traits),  smelled like he had smoked cigarrettes from birth, heavily tattooed and pierced. Mom looked like the lady next door.  I doubt she was impressed with his appearance.  He had a Vicodin and Keflex script. As is customary for all controlled rx I asked for his ID…We photocopy ID and staple it to the hardcopy on ALL controls for new patients.   ” All I have is this”…and he hands me a bus pass with his picture on it. Um Kevin, this isn’t positive ID in this state:  Driver’s license..State ID card, Military ID or Passport, that what is acceptable.  I asked him for his insurance card..since Big Box told me he had Crapola HMO.  ” I didn’t bring it”. He claimed he had memorized his ID number, but what he produced was 6 of 7 digits in the Crapola HMO ID number. I swear..he had this deer-in-the-headlight-light-clueless-wonderboy-look when I told him that if nothing else, he should always have is ID and insurance card on his person.

It was 20 minutes before closing.  In a normal situation I would have blown Kevin off and sent him packing..and had every right to do so.  No ID, no Insurance info.  But Mom was there and she was showing a lot of patience and grace for this boy who probably gave her nothing but a lot of anguish. I decided to show her the same grace and patience.

 I called Big Box and got the ID number they had on file for him.  I noted that he went to BigTeachingHosiptal ER and Crapola HMO only covers rx’s from Crapola contracted hospitals..and Big Teaching Hospital wasn’t one of them.  I had to break that news to Mom because Kevin didn’t have any money ( surprise?).   I told her that I could find a free drug discount card to keep their cost low. She told me that Big Box didn’t take Crapola HMO and said it would be $40 for the two.   I told her that we will get them for less than $40. I also told them we closed at 9pm and don’t wander too far away. These wouldn’t take very long.

I filled the two rx’s and they came to just under $20.  Tech extraordinare and I were waiting for them to come back..8:54….8:55…I sent a page over the intercom…8:56…..8:57.  (second page over the intercom).  8:58….8:59….Ive closed 2/3 of the pharmacy gates, and all of the computers but one. Ive scanned all the aisles for Trainwreck and about given up.  8:59:59 he comes trotting up with a big McDonald’s cup in his hand.  ” I was starvin man… needed some dinner”.  I told him jovially that his dinner about cost him  these two prescriptions…as I was closing up shop, and had paged him twice.

I counselled him, rang him out (mom paid..of course).. and sent them on his way.  Mom thanked me for waiting. 

I closed up shop and headed for the door.  Mom was waiting near the rest rooms.  “thanks again” she said.  I smiled and wished her a good night.

Cutting slack for Trainwrecks is not my normal MO. I’m not cutthroat, but I don’t make a habit of babysitting these people, as it simply enables them.  Mom, however was just part of the wreckage Kevin left behind.  I hope Kevin gets back on track someday…but I am not holding my breath..

13 Comments »

Comment by PharmacyJim

April 24, 2011 @ 1:59 pm

As long as good ole Mom is the enabler, Kevin is not going to change. However, PC, in the spirit of Easter, kudos on your patience and grace.

Comment by Lois McDonald

April 24, 2011 @ 4:01 pm

My heart goes out to his mother, who is not necessarily an enabler. Who is to say he would be able to clean up his act if she stopped helping him? Maybe he would just end up on the street, or dead. I’m glad you made an exception in this case, although I realize you cannot make a habit of it, or you’d never get to leave work.experience (and a lot of it) tells me that once a trainwreck, always a trainwreck because as I mentioned in the post, they have no comprehension of what a mess they are!

Comment by Stacey

April 24, 2011 @ 9:34 pm

As a person who has two trainwrecks in their family (cousin and brother) I have to thank you for how you treated that mother. Yes she is enabling him but in the long run, paying for a perscription isn’t really going to matter to his future and you probably saved that mother a whole lot of greif as that ‘boy’ wouldn’t have let it drop and would be getting his mother to drive all around town to get those medications. Sometimes when you know you can’t help the trainwreck, you still have to have compasion for the ones that deal with them 24/7. If trainwreck isn’t ready to get clean there is no point in trying, but you probably made that mom feel like at least that night he wouldnt be out using street drugs with all the medical issues attached to those.

Comment by Mickey Blue Eyes

April 25, 2011 @ 5:04 am

I don’t feel I know enough about the situtation to call the mother an enabler. Maybe she tried to raise him right but, for whatever reason, he was born to be a trainwreck and she decided that its too late to change him and to accept him for the trainwreck that he is.

However, if the mother was a trainwreck or a PITA, then I would say that she is an enabler. But her patience with the situation suggests that maybe she has given up on him but hasn’t the determination, possibly out of fear of a meth-head coming after her, to cut him off and let him find his own level.

Comment by Frantic Pharmacist

April 25, 2011 @ 7:00 am

Once in a while I watch an episode of “Intervention” or “Relapse” on the A&E channel, and it’s quite remarkable how often one or both parents are the enabler in some pretty horrible addictions. However, they point out that they’re not willing to put their child out on the street to fend for themselves. It’s got to be a horrible choice to make.

Comment by Unchained Pharmacist

April 25, 2011 @ 12:27 pm

Before I have my two “tax deductions,” I could never have understood the mother. Now I do. It is a gamble to cut your trainwreck of a kid loose. He/she will either clean up or get cleaned up (in the morgue). I don’t think any parent can live with him/her-self if it’s the latter.

Comment by Texas Pharmacy Chica

April 26, 2011 @ 2:41 pm

http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html

The 2nd National Prescription Drug Take Back Day
Saturday, April 30, 2011
10:00 am – 2:00 pm

I don’t want to spam you, but if you don’t know about this: Tell your patients they can drop off all their old meds at the approved sites for free this Saturday – INCLUDING controlled substances (police or other law enforcement present at all locations). Most take-back places or mail-in options do not take controlled substances.

Keep drugs out of the groundwater!

Comment by Tee

April 27, 2011 @ 11:20 pm

It was very kind of you to look after this man’s mother the way you did. It sounds like her son railroads her and that surely wears her down quite a bit. You were well within your rights to have sent this trainwreck packing but instead, you showed grace and patience to him and his mother. Thank you for doing that!

Comment by PharmacyJim

May 1, 2011 @ 9:50 am

After reading the criticisms of me calling the mom an enabler, I agree that I did not have all the facts to make that statement. Being a parent of 4 grown children, I agree that it is easier to make absolute statements in the abstract, rather than to stick to your guns when it is the real world. Having said that, mom could very well be an enabler….but I just don’t know enough of the facts to make that statement. I see plenty of enabler parents daily, but that does not make her one in this case. Seriously, thanks for calling me out on this. The bottom line here is PC showed patience and grace in this situation. I know I need more of that attitude every day, especially in the retail world.Jim, Fear not, I dont think you were too far off base, and while none of us (including me) has the inside scoop, its safe to say this: This kid hasn’t hit his “rock bottom”, that point at which his lifestyle finally becomes unacceptable even to himself. As long as he has somebody to keep him going in his current lifestyle, he will do so. And to some degree we are ALL like that. I have a lifestyle of my own that I prefer to maintain, I just hope that it doesn’t involve making everybody else run in circles for my incompetetence!

Comment by daph

May 6, 2011 @ 4:10 am

i want to be a pharmacist so badly..and time is ticking! lol not like this made me want to be ..a pharmacist anymore than i already want to be!! lol..i just would have love to be in a position like that! Story made me kind of laugh lol!

Comment by Ndemrose

May 13, 2011 @ 7:57 pm

daph,
I just got laid off from my job as a pharmaist. I’d think long and hard about this job… they are scarce where I am from, … starting up unemployment and seriously thinking of going back to school to retrain.sorry to hear about that! There are jobs, but admitedly, not as many as there used to be and often now you have to relocate to get them.

Comment by Tired of It

November 30, 2011 @ 5:07 am

So this kid comes in for a prescription for an antibiotic and pain killer and the only reason that you can think of that he is missing teeth is that he smokes crystal meth?

I’m glad that you deviated from your usual policy of denying medical treatment to those who do not meet your standards for personal appearance. I am not glad that this required you to empathize with the patients mother, rather than the patient.

As a physician, I empathize with you – working in a stressful job, where you patients / customers can really put a strain on you, is not easy. A certain amount of emotional distance is needed to simply get the job done.

That being said, the next time you feel like denying medical treatment to someone who is in pain because you feel they “look like a trainwreck”, consider how you would look after an all-night stay in the hospital, or if suffering from a painful illness. More than likely, you would “look like a trainwreck” as well. You might be rude, distracted, exhausted – those are symptoms of pain, arent they?

If staying open a few minutes past closing time to do so is too much of an inconvenience, then please do yourself (and the public at large) a favor – and simply leave healthcare. There *are* jobs available that do not require you to meet with the general public, or that would require the level of responsibility intrinsic to healthcare – many of those jobs pay very well. Operating a pharmacy, or a doctors office, is not like operating a retail outlet – the decisions you make will either prevent human suffering or add to it, sometimes significantly. How could you make that decision based on something as trivial as a tattoo, ear-ring, or clothing? Does human life hold that little value?

Being a physician does not mean you have to be a saint. It just means that your first priority is healing the sick. The physical appearance of your patients is completely irrelevant to your job – unless that appearance is a symptom of an illness. Patients filling a prescription are not attending a job interview, they are sick people looking for relief.

I’ve read this blog for sometime, and laughed right along with you at the absurdity of the demands of patients needing immediate fills of acne cream and the like, but that is not what we are talking about here.

Oh and as an aside – how is a mother showing up when her child goes to the hospital “enabling”? Is she somehow a better parent by not showing up when her child calls from the hospital?Geez, did you even READ the post? this isn’t about physical appearance. In my neighborhood, I am about split iwth 3 piece suits and meth-heads. This bit was about personal responsibility: about NO ID ( required on controls) how many patients does your office see without any physical ID? NO INSURANCE CARDS ( unless you are a non profit, I bet you dont see patients without any proof of insurance either). The rest was setting the stage for the story. I could have written about some guy in a suit with no ID and no insurance card too. He didnt appear to be suffering much as he was chowing on some french fries and a coke when he finally came back. He had posture attitude from the beginning, something I failed to put in the original post I re-read. I think its a stretch to compare this guy with your spinal cancer patients.

Comment by Tired of It

November 30, 2011 @ 5:30 am

Another quick aside – assuming the worst – assuming this kid was a drug addict. Why does that mean he should be treated with a lack of human dignity or not be provided with healthcare? Its irrelevant, whether you buy into the disease model of addiction, etc.

He had impacted teeth. He came in for what amounts to the most commonly prescribed pair of meds for impacted teeth – I’m not seeing where an addictions assessment plays into this. What caused the impacted teeth is not a reason to deny treatment for him.

Im rarely such a prolific commentor but I will continue a bit more. A patient I am close to suffering from late stage spinal cancer was turned away two weeks ago by every pharmacy in her town for exactly this type of on-the-spot morality play. With the size and placement of the tumor, we are expecting her to be able to live another 6 months. The opioids medications prescribed to her allow her to live outside of hospice with her family. The real absurdity of the situation is this – I am certain that the dismissal was based on the type of medication and her physical appearance. It never occurred to these pharmacists that the physical wasting of the patient that they interpreted as drug dependency were symptoms of her actual physical illness.

The patient was forced into excruciating pain while we scrambled to find her medications and finally had her placed in the ER, at great cost to her family. The fact that this woman is under the care of three separate board certified physicians at the moment, and that their opinion can be over-rode or neglected with a simple “she / he looks like a junkie to me” appalls me.

If there is some moral calculus that is being performed with these sorts of denials – I am baffled by it.

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