Diary of a Neighborhood Pharmacist, Entry #9

The local hospital doesn't have 24-hour pharmacy coverage. That's a shame, because they really need it.

Around midnight, just before Pat*, the pharmacy tech, is supposed to go home, we get an influx of patients from the ER. Some of the patients look around, see how many people got there ahead of them, drop off their prescriptions and head for the magazine rack, or go home. Others, though, want to declare an emergency. They had just come from the emergency room, hadn't they?

I got one of those last night: A slim, well-dressed woman with a take-charge attitude, who announced that she and her mother had just spent five hours in the ER. It wasn't clear if the five-hour figure was intended to show how severe the case was, or how she had left all her patience at the last place and had none left for me. There's always the temptation to ask why, if the ER can have that much of her time, I'm not worth 30 minutes (or how she thinks that we're somehow connected to the hospital).

As I took her prescription, it suddenly occurred to me that her long wait probably meant that the triage nurse hadn't been overly impressed with her complaint, and others had a better claim to attention.

Sure enough, her prescription wasn't quite for a placebo, but it came close.

One of the problems with pharmacy is that we're the most accessible healthcare professionals, and the most limited in scope. Nobody has ever asked me to draw the chemical structure of penicillin, although I could to that, or list the adverse effects of a flouroquinolone, although I could do that too. Instead, I get questions that that I'm totally unqualified for. Of course I know which OTC to recommend for your wife's gas pains – as soon as I have a differential diagnosis. No, if it's really fecal impaction then you don't want to use laxatives – well, you used the term "fecal impaction," and I have to work from that. I can tell you what to do for an allergy, but I really can't say whether what you're dealing with is an allergy.

Decades ago, I took a course in pathology, but because there were so few pharmacy students taking the course, we were enrolled with the dental students. If somebody came to me with symptoms of a tooth abscess, I might know what to do. The only trouble is, there are no over-the-counter products for tooth abscesses, so I'm back to square one.

Are you sure you wouldn't like to know the chemical structure of penicillin?

*   *   *   *   *

When I took this job, I thought the proper working attire was the standard academic uniform, khaki pants and blue Oxford shirt, so I stocked up. Turns out that I was wrong. When I leave in the morning, and when I go back at night, I see the same person, so I want it to be perfectly clear that I've used the time not only to sleep, but to shower and change clothing. That means whatever I wear when I check in at night has to be visibly different from what I was wearing in the morning. Fortunately, I haven't gained that much weight over the years, and can even fit into the pink shirts that I wore in the 1980s. Equally fortunately, I had thrown out the polyester floral prints from the 1970s.

Maybe people who work nights all the time can adapt their schedules: Sleep during the day and work at night. But working nights only half the time seems to have confused my biorhythms. Apparently I'm not the only one. The other night, a physician stopped off on his way home from a stint in the emergency room. We talked for a while; it was the quiet period. Then I rang up his purchases: a supply of sleeping pills, two bags of popcorn, and two bags of cheese curls. "That's dinner," he said. "When I get home, I'm too tired to cook."

Next week, when I'm off, I've planned sesame-crusted tuna for one night and curried tofu for another. But on working nights, roast beef on a roll and a side order of Diet Coke will have to do.

*not his real name

See the previous installment, Diary of a Neighborhood Pharmacist, Entry #8, or the next installment, Diary of a Neighborhood Pharmacist, Entry #10.

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