Help From An Unexpected Source

Monday, the day of the week that makes us want to run away in terror screaming more loudly that Jamie Lee Curtis in Halloween and with much the same feeling of doom. My Monday was worse than a usual. I had the morning shift which is usually nice cuz you get work out of the way and have some time to relax. This time however, it wasn't so nice. Why? Because later on that day a "situation" developed. A situation that actually dragged on for 2 days. As you must have guessed by now it wasn't a pleasant 2 days. So what happened? Well let me tell you.

Its about 10 am. I'm working up a storm, posting orders, waiting on patients, answering phones and questions from a new tech who is really catching on but still needs help occasionally. Its quite busy. I am in the middle of a call with a patient requesting refills when one of our pain clinic patients arrives. Not just any pain clinic patient either, but one whom I have had to deal with at 2 different chains over my years. 2 chains and a total of 3 stores. He is well known to me. One of those who you must double and triple count because hes always "shorted". He is also one who always wants brand name. We'll call him Mr. Salvo. I finish my phone call and ask him if I can help him. He hands me his scripts from the pain clinic. We have 3 in my area. One is very good, very thorough. One is slightly off but at least keeps her patients somewhat reigned in and does treat them with more than JUST pain meds. Then there is Mr. Salvo's doctor....Dr. Shell. Dr Shell is in a league all his own. He writes more than just oxys and morphine, hydros, but his patients only fill what they want. Which means nothing but the narcs. If you call him he will OK this, and he will always say its OK for an early fill no matter how early. To give you an idea of the way he prescribes....Duragesic 100 mcg patches #15 apply 1 patch q 48 hours and 50 mcg #15 1 patch q 48 hours, for the same patient. 'Nuff said.

Mr. Salvo hands me 2 scripts, one is for Oxycontin 80 #90 and the other is for Valium 10, Remeron 15 and hydrocodone 10. He tells me he wants the Oxy in brand name. Now, I ALWAYS check that we have enough of a C2 to fill it before I allow the patient to leave. I don't like being yelled at by people who come back 2 hours later expecting their scripts to be done only to find out we didn't fill it at all. So the first thing out of my mouth on seeing that number one it was for a C2 and number 2 that he wanted brand name was "I'm not sure we have this in brand Mr. Salvo let me check." So I walk around the corner and speak with the POD (pharmacist on duty). He was on hold at the moment but told me he didn't think we had it. That he had looked for another strength earlier and saw only one bottle in the safe. That bottle was a partial. He then handed me his keys and told me to check. I walked to the back of the pharmacy and locating the correct cabinet proceeded to look for the brand name drug. Like the POD I only saw the one bottle with the X on it. I picked it up and shook it and could tell by the weight and sound that there were not 90 in there. I walked back to the front and told him that I was sorry but we didn't have brand name. Then he said in a very very hateful tone " You've lied to me about that before you need to have someone else look." I'm used to stupid statements like that so I really didn't take offense at this point, I just smiled and said "Mr. Salvo there is only 1 partial bottle but I'll be happy to go and count it to be sure." I walked back to the POD and asked told him I needed him to check again. He was still on hold with a Dr so he gave me the keys again and told me to go get it. I walked back to the safe...looked again...saw nothing different. I got the bottle and took it back to the filling station and began to count the pills, all the while answering questions from the tech we were training as well as the POD. I double counted the med and found only 64 in the bottle. I walked around the corner, bottle in hand and said "Mr. Salvo, I'm sorry, I counted them and there are only 64, we don't have enough to fill it." We then have to go through the explanation of not being able to "owe" him any and that if he took what we had he lost the rest. At that point I offered to call around and find the medication for him if he would tell me where he wanted me to try. He said, "No, do you have it in generic?" I hadn't even checked that so I told him I didn't know but I would look. So I go BACK to the POD, he is still on hold same office. He gives me the keys again. I go back to the safe. There is one bottle of generic in there. I opened it and it was sealed so we would have enough with 10 to spare. I walked back up front and told Mr. Salvo that yes we did have enough generic. I then again offered to call another store. I knew he didn't want generic. "Mr. Salvo I'll be happy to call around for you. We can fill your others if you'd like and I'll find you the brand name somewhere else." At this point he stated "No, just give me the generic" I asked him "Are you sure?" He said yes. I said OK. I finished entering and filling his scripts and then went to ring him up. Before I could scan the first one he took the bag from my hand ripped it open and popped a hydro and an oxy right then. His wife had to make him hand me the bag back to scan out. He asked if he could use the discount card he had that took $50 off of brand name. I told him no because it wasn't a brand name drug and that the coupon would reject when transmitted. He seemed fine with it and left.


Fast forward about 4 hours. I get a call from the night tech giving me a heads up. She told me Mr. Salvo had been back in and the he said I lied to him and he was going to have me fired. It seems that he still didn't believe me so calls back about 9pm. Pharmacy was dead and the fill in on duty went through the cabinet and found 1 bottle that had gotten put behind the wrong strength. I didn't look through all of the strengths, just in the place it should have been so I didn't see it, nor did the pharmacist who had been with me that morning. The tech told me that he was screaming that it was the 2nd time that I had lied to him about it and he would have my job. Now, I didn't remember any such thing so I checked his profile when I got to work the next morning. Every time my initials came up as waiting on him he had brand name, except for this one time. He asked for the corporate office phone number to complain and was given the number. He had called 2 times before I got in the next day.

Long story short he called the pharmacy and started yelling at me over the phone. Dr. Cookie was the POD Tuesday morning and he took it from me and asked him what his problem was. He went into this long diatribe about what a rotten tech I was and how unprofessional and that I was trying to kill him. Dr. Cookie explained it was a simple mistake and that 2 people had overlooked it and that the guy who had found it only found it by accident. Salvo then starts screaming that I didn't look hard enough and Dr. Cookie gave him a lecture on how many drugs were in that cabinet and that we didn't have time to go on a hunt. It got pretty nasty. He swore when he called our toll free number that it was a woman talking dirty to him and wouldn't believe that was the only phone number we had. Dr. Cookie asked him what we could do to make him happy and he said he wanted me fired and to be given brand name. Dr. Cookie at this point said, "So you only want the tech fired and not the pharmacist? You want her fired for making a mistake?" Salvo told him yes that I was unprofessional. He then demanded the corporate number again, and Cookie told him the toll free again. Salvo screamed, "That's a SEX line!" Dr. Cookie told him, "No, its not and see there even you make mistakes." I could have kissed him at this point.

All day long Salvo is calling us, he talked to the store manager who told him that he would let him have brand but only if the Pharmacy DM OK'd it. By the time She finally called back and got the whole situation laid out for her(She laughed at his demand that I be fired, stating that I had offered repeatedly to find it so we weren't at fault) She said we could give him brand but only if his doc wrote him a new script and he would have to pay the difference. Well the store manager, Dr. Cookie and myself all thought this would be very simple because after all it was Dr. Shell. So Cookie calls his office and tells the ENTIRE story to his nurse. She became incensed and told him that Dr. Shell would handle it, for us to make him keep the generic and she would call us back. When she did call back she said, "Mr. Salvo will not be bothering you again. Dr. Shell will NOT be writing him a new prescription. We told him to take the generic, there was nothing wrong with it and if he didn't like the service at your pharmacy to find a new one. We also told him that if he bothered you again we would dismiss him from our clinic." She ended with a plea to my store manager not to fire me because of him. He laughed and said that was never a question..

Dr. Shell and his staff are now on my Christmas card list. Lord knows how Mr. Salvo had been treating the office staff for them to stick up for a pharmacy. Its the first time I can EVER remember a physician standing up for the pharmacy instead of blaming them. I still don't like his prescribing habits but I'll cut him a little slack for a while. Forrest was right. Life IS like a box of chocolates.