Wednesday, September 10, 2008

Five hours, three Duane Reades, two prescriptions -- Just to get a painkiller!

We just received this contribution, which is thoughtful and brilliantly written. What an outrageous experience. Thanks, J.C.!

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Couple of years ago got one of those pesky early thirties cancer diagnoses. No problem – six months of moderate chemo should take care of it. Problem was, it didn’t, so it was on to the major leagues: full body radiation, heaviest chemo Sloan’s got, bone marrow transplant.

Nice thing is that it worked. Only reason I bring it up is that fingernails and toenails are destroyed by the HDC, and sometimes they don’t grow back correctly, which was the case with a couple of mine, which is why I had a toenail extracted this afternoon at two. Not a nice feeling, but the local anesthetic worked just fine (and really, it’s a lot more fun than a bone marrow aspiration).

Of course, when that local anesthetic wears off, you’re replaying George Clooney’s memorable interrogation scene in Syriana. Which is why the surgeon prescribes a painkiller. Just fine. And here’s where our favorite central character enters.

Duane Reade number one: I walk in, still entirely numb in the area affected, and hand the script over to a dainty, very courteous pharmacist, wearing a delightful periwinkle hijab. A half hour, she says. No problem. I walk gingerly to the nearest café, sit outside, and enjoy the autumnal sun.

I return to pick it up. But there’s a problem. The surgeon’s staff had failed to inscribe the dosage on the script. Well, that’s certainly their fault, not the fault of our esteemed pharmacy chain, certainly not the fault of the pharmacist (who truly seemed a nice person). Even at this point, somewhere in the darkest corners of my hypothalamus, I was already guessing the scenario.

I’ll just call my surgeon, I said. No, you can’t. Okay, I say, perhaps you can call the surgeon. No. We need a new script.

All right. I called my surgeon’s office. A young woman picks up. “That’s a little strange, but just come back and we’ll give you another one.” I did.

Back to Duane Reade, new script in hand. Thirty minutes, I’m told. Fine. Back to the café for another coffee. Back to Duane Reade. The local anesthetic is beginning to show signs of fatigue – merely the early stages, but still. And alas, another problem: they’re out of stock.

With all due respect to the lovely hijab-wearing young woman, wouldn’t she have been able to tell me that an hour ago? But I don’t want to make a fuss. Where, I ask, might I find the item in stock?

“We can’t tell you that, sir. This is a controlled substance.”

Well I know it is, I say. It’s a painkiller. I just had surgery. But you’re unable to call another branch and see if it’s in stock?

“We can’t do that, sir. It’s a controlled substance. But there’s another location just down the block.”

Of course there is: vermin spread like Starbucks. Off to Duane Reade number two.

This one, a block farther South, heading away from Tribeca towards the courthouse district, is a little messier. I mean that literally – the place was pretty filthy – and more crowded. But my spirits remain high. I wait in line patiently, then hand the script to this new pharmacist, who was not wearing a hijab, and was neither dainty nor particularly courteous. (Note: okay, I admit to a pro-Arab bias, but this has been borne out over and over, both here and abroad.)

Problem here eerily echoes the first: the staff had failed to specify the dosage.

“Well that’s odd,” I said. “This is a new script. I just picked it up a half hour ago. The problem with the old one was that the dosage wasn’t specified. That’s why I picked up this new one.”

No, this one isn’t any good either. I call my surgeon’s office. By now it’s around four thirty, and they’re not going to be open forever. My hypothalamus is starting to rear its pituitary hormones. (It’s the part of the brain that regulates hunger, thirst, fatigue, and anger – usually in that order, like passing exits on a freeway.) The young woman I’d spoken to previously picks up.

“You’re not at Duane Reade, are you?”

Of course I was, I told her. “They’re awful. Find another pharmacy. There’s no problem with the script.”

Maybe not. But one problem is that the local anesthetic is now starting to get really tired. (One can’t blame it, really.) The first flashes of pain, starting at the incision point deep beneath the toenail and sparkling up the leg like lightning: no thunder yet, but there’s a storm on the horizon. I try to talk to the pharmacist again. “I just spoke with my surgeon’s office. She says that there’s no problem with the script. She just wrote a new one. She said there wasn’t a problem with the first one, either, for that matter.”

The pharmacist, looking at the ceiling, mutters something to the effect that, yes, the milligram dosage is marked, but the something-or-other isn’t, and clearly the surgeon doesn’t know what she’s doing, did the surgeon fill it out, or did she get somebody else to do it, they don’t know how to fill a prescription, what kind of surgery is this anyway?

My composure intact: “I just a toenail extracted. I’ve got a local anesthetic, but it’s wearing off. I’m really going to need this prescription.”

“Well don’t get angry at me, it’s not my fault.”

I gently tell the woman I’m not angry at her, but pretty soon my body will be angry with me if I don’t fill the prescription. I call my surgeon’s office again. By now it’s almost five.

“Okay, just come over and we’ll write you a simpler script, a Vicodin.” I make it back to the surgeon’s office, limping now. Not a Keyser Söze limp, but a limp nonetheless. I run in, grab the new script, and run out without a word. Back to the second Duane Reade. The script’s great! It’ll be ready in twenty minutes. I sit down and pick up an issue of Star Magazine. I learned many things. Lydia Hearst – socialite, model, daughter of Patty (of Symbionese Liberation Army fame), granddaughter of William (of Citizen Kane fame), great-granddaughter of George (of Deadwood fame) – has collapsed. I wonder if I’ll join her.

After doing quite a bit of catching up on Anne Hathaway’s corrupt ex and Jen and Brad’s calamitous dinner date and Michelle Williams breaking her silence I suddenly asked myself -- who the hell is Michelle Williams? And why am I reading this? Because I’ve just been sitting here for a half hour and I’ll bet we’ve got a problem, Houston.

I go to the counter and have to ask the pharmacist – are we okay here?

“Oh. Sorry. We’re out of stock. Have been for four months.”

I’m starting to hurt. There’s a CVS about a mile away. It’s rush hour. I don’t want to be walking around. No chance of a cab. Once again, Duane Reade can’t call another Duane Reade to see who the hell has one of the most common painkillers on the market. And the interesting thing is that I sense an aura of suspicion on the part of the Duane Reade staff – the way they pronounce “controlled substance” with slightly narrowed eyes and a peremptorily lowered voice. I’m well-dressed, and I’ve just had surgery; yet I feel I’m being treated as a drug dealer.

I call my surgeon’s office again, asking if they could recommend a pharmacy in the neighborhood. “There’s a CVS about a mile away, but there are about fourteen Duane Reades.” Now we’ve got stabbing, stinging nerve action from the foot to the hip. No throbbing yet, but that’s next. I hang up the phone, and find myself at the Duane Reade number three. I should have resisted, but the centrifugal force is too great. Or maybe I am, on some level, a masochist? Not enough time to dwell on this.

The third Duane Reade is, frankly, nightmarish. About twelve poor souls waiting in one of Dante’s circles but they’re not guilty of simony or anything, they’re just trying to get their damned prescriptions filled. I’m impressing myself with my patience; I wait in line, then hand over the script.

Bingo! A half hour, the frowning woman tells me. I’m ready to propose to her. (And she’s really not my type.) But before I leave, I ask her something. “Are you sure there’s no problem with this script?” No problem at all, she says. “Is the dosage correct, and specified?” Yes, she says. “Do you have it in stock?” Yes, we do. “So there’s no issue at all with this prescription. I ask because I’ve just had surgery, and I’m either going to need to fill this prescription within a half hour or go to an ER and I’d rather not do that.”

She regards me directly for the first time. Junkie, she’s thinking. “We have a lot of people waiting in line here.” I say, of course, I realize that, but I just want to make sure there’s not a problem with this script. The surgeon’s office is closing soon, and I’m going to have to make other arrangements if there’s a problem. This is the third location I’ve tried, I explain, and the third script I’ve had written.

She scowls at me. “You gotta talk to her.”


Looking down: “Her.”

I glean from this helpful advice that she’s referring to a beleaguered, curly-haired woman in the back, who’s on the phone. “Well, can I speak with this woman?” I ask.

“She’s on the phone.”

I sit there for about, I’d say, fifteen minutes. All eye contact between staff and customers, needless to say, is rejected here. Finally I’m able, somehow, to get her attention. She meets my eyes, and I feel a flicker of sympathy for the woman: this can’t be a great place to work. But what was once a kernel of pain is now shrieking. So I’m projecting, vocally, like I’m on stage. “Excuse me, I’m very sorry, but I just need to know if you’re going to be able to fill this prescription. I’ve just had surgery. I’ve been trying to fill this script for three hours.” She regards the script.

“This is a controlled substance. I’m going to need telephone authorization from the surgeon.”

Okay, now I’m getting a little frustrated, and so are my neurons, for not being kind, supportive, nurturing – as if I have no respect for them, as if I take them for granted, don’t listen to them, always put myself first, say I’ll call and then I don’t, always late in giving them what they need (like a painkiller). (I just broke up with my girlfriend.) “Telephone authorization? I haven’t heard that before. I’ve been to two other pharmacies and have gotten three different scripts, for the past four hours, but no one, all afternoon, has mentioned anything about telephone authorization.”

“It’s a controlled substance, sir. You’re in line. We’ve got a lot of people waiting here.”

Okay. I call my surgeon’s office. “How long are you guys gonna be there? They say they need telephone authorization, don’t ask me why.” They’ll be in the office for twenty minutes.

I ask the woman at the counter – not the curly-haired one, who’s on the phone, but not speaking – if it’ll be possible to call my surgeon within twenty minutes. “A half hour,” she says.

Right, I say. But the reason I mentioned twenty minutes is because they’re closing in twenty minutes.

“Half hour,” she says. “There are a lot of people here, sir. You’re not the only one.”

Okay, I say, warmly. Thanks. I walk a few feet away, call my surgeon’s office again. The pain is radiating now, gleaming. I ask the office if they can just call the pharmacy. Maybe the pharmacist will have to pick up if they call. Figure, give it a shot.

I go back to the counter. The phone’s ringing, and I notice nobody’s picking up. Fifteen minutes go by, at the end of which I ask the first woman how things seem to be going and – in spite of the fact that I’m about four feet away from her – receive absolutely no recognition at all. “They’re closing in five minutes,” I announce, stridently, to a void.

I call my surgeon’s office again and get my surgeon’s cellphone number. This is what I’ll need, I’m thinking.

I’m kind of hopping around at this point – it seems to help a little. The problem with pain in the extremities, of course, is that they’re the victims of the gravity’s action upon blood flow. I find that if I stand on one leg and hold the ankle of the foot in question with the opposite arm behind me I’m not only mollifying the encroaching agony but maybe also performing an asana.

I look at my fellow sufferers. There’s a blonde woman next to me, perhaps in her late twenties, who clearly is in an analogous situation. I’m not sure what the ailment is, but it’s been one thing after another, and she cannot get what she needs. Now they’re saying that the insurance won’t cover her at this location. Why is that, she asks. It was fine at the other branch but they were out of stock. We don’t know, is the response. It’s not our fault. “Well can you call them?” she asks. I’ve tried, but I can’t get through, it’s not our fault. “Well what should I do, then?” I don’t know, Miss. You’re not the only person here. We’ve got a lot of people waiting here.

Including a middle-aged African-American woman who had patiently sitting on the single chair at the pharmacy area for – get this – five hours. That’s right. Five hours.

I look up “pain” on Wikipedia, on my Blackberry. “A definition that is widely used in nursing was first given as early as 1968 by Margo McCaffery: 'Pain is whatever the experiencing person says it is, existing whenever he says it does.’”

Thirty minutes or so later, I’m informed that my surgeon’s office is closed. “Is that right?” I said. “That can’t be.”

“No, really,” the woman says; “they’re not answering.”

I see an opening here. “That just doesn’t make any sense at all, because I had mentioned to you an hour ago that they were closing in thirty minutes. Granted, that would mean that they closed about a half hour ago. But you’re telling me they’re closed now? That doesn’t make any sense. Anyway, it’s not that important, I had a toenail pulled out of my flesh four hours ago and the local anesthetic has almost completely worn off.”

There’s a slight shift in the atmosphere – I have the attention of my brothers, my sisters, this small community of the oppressed: I am speaking for all of us, now, and in spite of the fact that at this point I probably do resemble a junkie – perspiring and hopping around – I am slightly vindicated.

The woman looks at me. “I don’t know what to tell you, sir.”

“I know what to tell you. My surgeon’s cellphone number. Please call her. She’s waiting for your call.”

She writes it down, but I can’t see if she’s making the call or not. There are collective groans. It’s getting hot – or maybe it’s just me. The pharmacy’s going to close in a half hour. And this is where I do it. A couple I know, two of my dearest friends, a brilliant engineer and sound designer and an inspired art curator, have, shall we say, an occasional foot in the world of – well, “controlled substances.” I text them. It could be my only way out – other than going up to the ER, which I really don’t want to do. But the pain is becoming pretty much unmanageable, and I’ve got a pretty good tolerance after a year in a hospital bed with my insides turned out.

They text me back immediately. Of course. No problem. And then it occurs to me: I’ve just had surgery, I live in the United States of America, and I’m seeking analgesia on the black market. What is this? When I was in Greece a few months ago and my companion developed a terrible bladder infection we walked into a pharmacy and were given an antibiotic – without a prescription, without a referral, and we’re not even Greek. Same thing happened to me one time in Istanbul.

And I’m sitting here with twelve other Americans enduring my same scenario, if for different reasons. They’re mainly mumbling about insurance.

The pharmacy’s about to close; I’m going to head over to my friends’ loft – what about these other people? One more time, I ask the curly-haired woman what’s going on. She claims she’s been calling my surgeon’s cellphone, but she’s not getting a response. “What should I do?” I ask her.

“I can give you the script back,” she offers. How generous. I wonder what would happen if I were to roll up the script itself and smoke it.

I call my surgeon on her cell. Of course, she picks up. I ask her to give the pharmacy a call. She says sure; she was expecting their call. She does. A minute later they hand me a little orange bottle. Five dollar co-pay. I’m one of the lucky ones that has insurance. I’m shaking in pain. I limp home, pop a Vicodin; my foot thanks me. I google “Duane Reade sucks” and a blog comes up with that exact title; I contribute without hesitation, painlessly.

I wonder about those other twelve people trying to get their insurance companies on the line this afternoon. I have much in common with Senator McCain: I’m white and have a terrible temper. (I’m proud of myself for controlling it today.) I have less in common with Senator Obama: I’m white and have a terrible temper, I grew up with a supportive, upper-middle-class nuclear family, and I didn’t go to Harvard Law School, never became the editor of the law review, and I’ve spent no time at all engaging in community service on the South Side of Chicago, the city where I’m from. Senator McCain calls for tax credits of up to $5000 for families that purchase health insurance, and he was quoted thusly in the Washington Post: "We do not believe in coercion and the use of state power to mandate care, coverage or costs." The non-partisan Tax Policy Center estimates that with his health care plan, we’ll have a million more insured citizens by 2009, five million more by 2013, and the national debt will increase by $1.3 trillion over the next ten years.

Senator Obama’s plan would raise the debt at about the same amount over about the same time, but we’d have 18 million newly insured citizens by 2009 and 34 million by 2018, covering almost every single child in the country.

But my goodness – is that Mrs. Palin cute, or what?

(NYC 9/10/08)


At 9/11/2008 10:14 AM, Blogger Everything Changes said...

Diagnosed with cancer at 27 in San Francisco, I soon became accustomed to the Walgreen's pharmacy run around. I've interviewed young adult cancer patients for my book on 20 and 30-something cancer and have found across the country, we are all dealing with this kind of BS. (Though I must say, you should be thankful that you are not counting on Indian Health Services for your care on a reservation!)

Here are some guerilla pharmacy tactics that worked for me:

1. Removing my bandages and placing them on the counter next to the cash register to reveal my flesh wounds. Then I start motioning as though trying to touch everything with my hands. Freaking them out so that they want you out of there is a good thing.

2. Telling them that you have the phone number to the corporate offices and that you are going to call them right now to complain that they are unlawfully withholding your medication. I don't know much about the legalities of medication dispensing and restrictions, but neither do the people working there and "corporate headquarters" and "unlawful" usually lights a fire under most asses.

3. As rude and uncool as this is to others waiting in line, I will not be placated by that as an excuse. I will not move from the counter, I will not stop asking questions, I will not sit down. Often they will just ask another employee to step up to the register to help the next customer, and if they don't, sure I feel badly for the next customer, but hell, saying loudly "I'm a cancer patient who just had surgery and is in need of my medication" usually garners enough support from the waiting masses that you can get away with it.

Anybody else have good guerilla tactics that have worked?

At 1/05/2010 6:02 PM, Anonymous Anonymous said...

Your blog keeps getting better and better! Your older articles are not as good as newer ones you have a lot more creativity and originality now keep it up!


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