This Bitter Pill

I have a lot of things wrong with me. It's quite an impressive list, but right now, let's just focus on two of them.

One: I have a bad heart. You know how people talk about someone and say, "Oh, he's got such a good heart"? I'm not that guy. My heart sucks. It's lame. Hence the pacemaker I've had since 2001, and hence the heart pills. I take two kinds - one, the beta blocker, I take two of, twice a day. 50mgs, four times, totaling 200mg. The other is the Coumadin, which I take one of a day, except Mondays and Fridays, wherein I take two - which helps maintain my Coumadin level just in the right range, something that's tested monthly when I take a long lunch, go to the lab, and get my blood sucked out.

Two: I have a problem swallowing. First, I have weak muscles, throat muscles included, I guess. Second, thanks the rods fused to my spine, my head is perpetually tilted back. This makes swallowing food more complicated than it is for most folks. And it makes swallowing pills a bit of a pain in the ass, too. As you can figure from the previous paragraph, I have pain in my ass, therefore, quite a bit.

I go to the Walgreens pharmacy to get my pills refilled monthly, as my insurance doesn't allow more than 30 days of meds at a time. It works out. They're open 'til 9:00pm (6:00pm on Sunday), which, sadly, means I still sometimes have to rush to make it there after work, but usually it's not a problem. After working all those hours at the office, the last thing I want to do is stop off on the way home and sit in a line, but it's only once a month, so no big deal.

A while back I'd called the automated refill phone line at Walgreens and punched in my presciption number, and the friendly computer told me that all was well and my pills would be waiting, as per normal. This was a particularly long day, and I really just wanted to get home, and I had some other things to pick up at the drug store, too. So when I got to the front of the line (finally) and put my stuff on the counter and ask for my refill, I didn't think twice when they bagged up my stuff, including my refill of the beta blocker that was already sealed in its own separate paper bag. I got home, set the bag down, tiredly made my dinner, and watched a few minutes of TV while I ate. Then it was pill time, so I opened the bag to pull out my trusty blockers del beta.

Wait a minute...

I immediately noticed the bottle was much larger than it should be. Had they run out of small bottles, I wondered, and had to use a big one? I opened the bottle. These were not my pills. These were, in fact, giant white horse pills, chalky torpedoes that I had no chance of swallowing. I was annoyed, because it appeared the pharmacy had given me the wrong prescription. Yeah, THAT's safe to do. Wondering what kind of stuff I could have been getting inadvertently high on had they been the same size as my pills and therefore kept me from noticing the mistake, I took a look at the bottle. No, same brand. And the same dosage. That didn't make any sense. Confused and perturbed, I knew the pharmacy was already closed, so there was no chance of dealing with it that night. And of course I had let myself run out of pills, so I had nothing to take that night. I figured one night wasn't going to cause anything dramatic. I'd just have to take the bottle back the next day.

Which I did, after work. I stopped there again, got back in line again, and tried to remain cool about the whole thing. Honest mistake, right? I mean, whatever the mistake actually was. I've always felt sorry for pharmacy techs, as, sitting there in line as often as I have, I've seen first-hand the ration of crap they have to deal with from customers day in and day out. Everybody's got a problem, everybody blames it on the pharmacy, everybody yells. I never wanted to be one of those people. I went out of my way, in fact, to be extra friendly to them just to make up for all the other jackasses they had to deal with before me. One of my favorite of that type was a guy who was yelling at them when I came in one time, for some reason or another unable to get his pills. He was getting more and more angry the more they clearly let him know there was nothing they could do. He finally got so flustered he stormed out, but not before barking these ominous, indignant words at them:

"Fine. You know what? When I die, I'm gonna SUE your company!"

He stomped off, leaving me there with my brow creased in thought, pondering his words. He'd been so off the reservation that he hadn't said that with any irony at all, and clearly hadn't realized what he'd said. That was one of my favorite empty threats ever. I started imagining a daytime TV law firm commercial. "Are you dead? Deceased? Have you shuffled off the mortal coil? Our firm can help!"

I finally got up to the counter and tried to explain my problem, calmly, to the girl there. She mostly scratched her head. And as they often do after a few minutes scratching their heads, she went and got the pharmacist, a balding Hispanic gent in a white coat (like pharmacists wear, you know. That's how you can spot 'em). After scratching his own head (and he had much better access to his than the girl, thanks to his recession), he checked some things, figured out the problem, and let me know what had happened.

My insurance company insists that you take generic brands of whatever the doctors prescribe. I have no problem with this, knowing that the generics are just the same thing, but cheaper. I have no belief in the mystical power of the brand name. But the generic I'd been taking recently switched manufacturers. And that new manufacturer, for some reason, had decided that even though the pill was at the same dosage, it would be cool to make it, like, literally five times bigger. No reason for it I can imagine. They just decided bigger was cooler, or something. Which was all fine and good, except that the pills (that I needed for that whole "bad heart" thing we talked about) were now too big for me to hope to swallow. This, then, was a problem.

I tried to explain this to him, and he seemed to understand. Thinking it over, he said they could special order the small one for me, but it would take an extra day. Well, okay. As long as they could get it. I tried to give him the big bottle back. He said he couldn't take it. It had left the store, and therefore they couldn't accept it back. Okay. I guess I could have laced the beta blockers with LSD just to get my kicks imagining the old guy who got them next freaking out and running around the nursing home screaming about the devil stealing the remote control. So I could see that. Annoying, but kind of logical, I guess. So I was stuck with the big horse pills, and with no other options that night, headed home.

At this point you're probably saying, "Why didn't you just cut the pills up?". Logical question. Let's talk about that. I do have a pill cutter at home. There are times when I end up with a non-standard prescription, as we all do from time to time, be it for antibiotics for an infection or pain pills for surviving after oral surgery. When this happens to me, and I find myself with a new pill that's obviously too big for me to deal with, I have to dig out the old cutter - this stumpy plastic blue cylinder that's shaped kind of like a pill bottle, and about the same size. The upper 1/3 of it is on a hinge and folds back. Under the lid is an embedded razor blade. On top of the 2/3 section below it is a flat base with a kind-of-adjustable "V" on it that's supposed to hold your big pill in place for the chopping. The idea, then, is to pretend your pill is French aristocracy and bring the blade down on and split it in half. Sometimes it actually even works that way. More often the pill shifts slightly and you just end up shaving a sliver off the side of it instead of halving it. I wonder if French aristocrats fought back like that? Wait, what am I saying? They're French.

So, yes, I CAN cut the pills, and even have a cutter. But here's why that option really sucks. To be able to take one of these big Seabisquit pills, I have to cut it into a minimum of four pieces. That's still pushing it, as those pieces are still pretty challenging, and often the cut doesn't go right, leaving one half bigger than the other, and requiring it be chopped in two as well. But let's assume all goes right with the cutting. That means, each evening, I'm taking at least nine pills (with the Coumadin thrown in), since I have to cut two pills into four pieces each. And that's ten pills on Mondays and Fridays. That's nine to ten pills at one sitting for a guy who has trouble taking pills in the first place. At worst, I could be taking thirteen or fourteen. And that's just in the evening. I'm supposed to be taking the beta blocker in the mornings, too, remember. Which means anywhere from eighteen to twenty-eight "pills" per day. So I get to live the panic moment of trying to swallow a pill over and over. And it's even MORE fun, because these now aren't smooth little pills after the cutting, but jagged, sharp pills, which are even cooler to get caught in your throat. And when I do get a pill caught, I know from experience that no amount of extra water is going to dislodge it. It has to be food that gets it down. So I have to A) get home and start dinner, B) start taking pill pieces, C) wait for one to get hung up (the anticipation is so delightful), D) wait with it hung there until dinner finishes up in the microwave (I know, I should wait until dinner's ready to start taking them, but I'm too much of a multi-tasker), E) eat a bit to get it down, F) start taking pills again until G) another one gets hung and H) lather, rinse, repeat. At some point they all go down and I get to actually enjoy my dinner.

So I had to do this that night, since I had no other pills to take, but I went back, with the bottle, to the pharmacy, after work (again) the next day to get my normal ones, which were supposed to be waiting. Well, they were. However...a wrinkle! The pharmacist let me know that he had them (in his hand, no less), but that he just checked and my insurance wasn't paying for them. Huh? He explained that the insurance saw that I'd just HAD a refill, so weren't going to let me get another one.

The conversation went like this:

"So, wait...I got the wrong refill, and now I'm coming back to replace it."

"Well, actually, you got the right refill, as far as they're concerned."

"But I can't take these."

"That doesn't really concern them."

"Look, I have the big ones right here. In my hand. You have the small ones, right there, in your hand. I can't just give you the big ones and you give me the small ones?"

"No."

"No?"

"No."

"So you're telling me that I have to spend the next month taking the big pills and use up that prescription before you'll give me the right ones?"

"Yes."

"How does that make sense?"

"You could always buy these yourself instead of using the insurance."

"Okay, what would that cost me?"

"Two hundred dollars."

"Two hundred dollars."

"Yes."

"For the pills I was supposed to get?"

"Yes."

(Pause)

"If I give you another two hundred dollars, will you take the big ones back?"

"Huh?"

(Note to self: deadpan sarcasm is lost on pharmacists. Do not attempt).

So not having an extra two hundred dollars to spare at that time (coming up on my birthday Vegas trip as I was), I took the only option, apparently, that was open to me, and I kept the big pills. And took them. For a month. A month of slicing and choking, of leaving a layer of white powder all over my kitchen counter, likely making my housekeeper think she was working for John Delorean. And as I'm not going sit at my desk at work going through this whole process in the morning, I ended up taking half my usual dose. And the month passed.

Finally, I went back in, and got my hands on my normal sized pills. Whew. Life was back to normal. The only problem was going to be that I'd have to call ahead each time, instead of just using the auto refill line, to let them know they needed to special order the small ones for me, so I'd have to allow for an extra day. Allow for that, and for the fiasco I knew would be coming. And it did.

Refill time. I called ahead and explained, over the phone, the situation, and what I needed, to a pharmacy tech whose vocabulary was populated mostly by the monosyllable, "Huh?" I did my best, but the best she could do was tell me I'd need to call back and talk to the morning pharmacist tomorrow. Okay, fine. I did. He (after his own chorus of "huh?"s), told me they'd TRY to order them for me. Try? That last guy me they could do it. What was up with the "try"? There IS no "try"! Am I the only one who listened to Yoda? So I had to wait another day, then call in. I was told my prescription was ready. Works ends, I drive over, I wait in line. They try to hand me the bag. I ask the girl to open it.

Sure enough. The big pills.

Rrrrrr.

Having learned my lesson, I refused to accept them, and explained myself AGAIN. No surprise, she got the pharmacist (yet other one), who got the idea, and said he'd make some calls, and that I'd have to come back the next day.

Sigh.

I came back. They had the small ones. A hollow victory, but I took it.

I had an appointment with my cardiologist a couple of days later. This is the same cardiologist who, not too many months before, apparently tried to kill me by giving me samples of a cholestoral medicine that interacts badly with Coumadin (and you'd THINK he'd be the one to know this...). I'd found this out when the samples were gone and I went to get the actual prescription filled, and the pharmacy refused to fill it, for the interaction reasons mentioned. I'd called the doctor's office and got on with the nurse, who gave attitude and just said the pharmacy was "just trying to play doctor" (a phrase which brought up a disturbing mental picture), and that my doctor knew what he was doing. The next day I'd gone in for my usual blood test, and the day after that, the same nurse called me in a panic after checking my Coumadin levels, and asked if I'd been having any nosebleeds or excessive bruising. ExCUSE me? Trying to put it on me (and apparently having forgotten all about our conversation a couple of days before), she asked if I'd made any major dietary changes. Uh, no, but there was the matter of the CHOLESTEROL MEDICINE THE DOCTOR GAVE ME. She didn't have much to say about that, except to suggest that maybe I stop taking it. Good call. Rrrrr.

So I tell my doctor (Kevorkian! Cough!) about the pill size problem, and he offers to write me a no-substitution prescription for the band name beta blocker. That was going to cost me more with my insurance on my co-pay, but at least I'd have the right size. I took it, just in case, because I already saw bad things on the horizon. And it turned out I was right. The next time I called ahead, after being put on hold for about twenty minutes (which is fine, because I have nothing better to do with my work day than tie up my phone and sit and listen to Dan Fogelberg standards in my headset), I was told the manufacturer had discontinued the small size and recalled them. Okay, that's just insult to injury... But they did tell me there was another manufacturer that had an alternative that might work, and they'd have to check on that. I should check back the next day.

Sigh.

Called back the next day. No one was there who had talked to me, and no one could figure out if anyone had found anything. I should just come in. But, you know...the next day.

I did. I was told they had my prescription. The girl brought a bag up. I had her open it.

You saw this coming, didn't you?

So I explained AGAIN...and one of the pharmacists who knew what was going on happened to be there. He explained that there was now no other generic option but the big boy. Sighing, I pulled out the no-substitution script from the doc, and asked for the brand name. And since it was right at closing time (I'd had to make a couple other stops on the way), they wouldn't be able to fill it that night. Fine.

The next day, I returned. Up to the front of the line again. I ask a new guy for my prescription. He seems confused and can't find it. He finally comes back and tells me they're out. Gritting my teeth, I told him the night before I was told they had it, but just couldn't get to it in time. He looked around some more. He found that they had SOME in stock, and, luckily, enough to fill my prescription. Okay...progress was a good thing. I'd take it. That was until he handed me the bottle and told me it was lucky they had thirty pills left. Thirty? My precription is for a hundred and twenty.

"Huh?"

In the end it was discovered that my genius doctor, who was SUPPOSED to be in the know and realize I was taking 200mg per day (as he's the one who put me on that much) had scribbled out a prescription for 50mg...but wrote "one per day" instead of "two pills, twice per day". The amount in that bottle he held was enough for a week.

Screw it.

I took it, figured I had a week to sort out the rest. I just wanted the damned tiny pills. The brand name's actually not as tiny as the (old) generic, but I can make due. So I tried to get someone on the phone at the doctor's office to get them to call the pharmacy and clear this up, and got put through to the nurse's (yes, that nurse) voice mail. I left a detailed message explaining the problem, and asked that she get me a proper dosage script called in. Later that day, I got a ring on my cell - it was an automated recording from the pharmacy telling me there was a problem with my prescription, and that it was not filled yet, and to please call back later. This was actually good news, I thought. This meant she actually called it in, and they were trying to sort it all out. I figured I'd check in the next day, as I still had a few of the week's worth left in my bottle. I made it home, started my dinner (which I could enjoy now instead of using as a tool to shove pills down my gullet), and decided to check the messages on my machine. There was one there, left early in the day, from the nurse.

"Hi, it's (nurse) from Dr. (doctor)'s office. I got your message. I called it in to the pharmacy, and they're going to get that filled. The doctor wants you to take two 100mg pills per day. Oh, size was a problem, wasn't it? Well, you can always cut them in half."

AAAAAAAHHHHHHHHHHHH!!!!

Cut to yesterday. I got to work, got on the phone, and called the pharmacy, just to check something out. Sure enough, the delay in my refill was them having to special order 100mg pills. I called the doctor's office and left an even more detailed (and much less pleasant) message for Nurse ASShead, explaining the whole point of ALL OF THIS was to get the 50mg pills. THE ONES I CAN SWALLOW. I asked that she call the pharmacy right away and have them order the 50mg ones. I got a call back. Nurse ASShead was off that day, but someone else (who I know from the clinic and actually like) had gotten the voice mail, and said she was getting it taken care of for me, and actually apologized. Wow. Finally, some kind of apology for all this. I didn't even bother dropping in last night, as 1) I'm really REALLY sick of going into that place, and 2) I knew that it would certainly take them an extra day to figure it out, and 3) I had exactly enough pills left to make it through today, and 4) I was too depressed at the thought that I had actually BECOME one of those complaining people at the pharmacy that held up the line and got exasperated with the people behind the counter and whined. Almost worse than this whole ordeal was that fact that it had turned me into that person. All I needed now were three screaming children orbiting me and a common-law spouse sitting in the background lounging on the "Try Me!" massaging recliner.

Got off work today, feeling good. Worked a good long shift and got a lot done, knowing that while I SHOULD still sign on from home and work tomorrow, I don't HAVE to. I stopped off for gas, happy that 1) it's now cheaper and 2) that I finally got the station whipped into shape so it wasn't a major act of God to get someone to come out and pump my gas for me (that's a whole other blog...). I headed into the OH-so familiar Walgreens, and it was a madhouse. Particularly at the pharmacy counter. There was one girl working the counter, who was also trying to handle the drive-up (there was a line of cars around the building) and answer the phone. I was in a peaceful enough place to where I became my usual sympathetic self. I wasn't going to add to her problems, I decided. It was Friday night, I didn't have to get up early for a change on Saturday, my evening was free and I was in no rush, so I was fine waiting in line, even preparing for the thought of them telling me the prescription wasn't ready yet. While I really didn't want to have to go back the next day, I really didn't care as long as I eventually got my pills.

I got up to the counter and had to sit there for about five minutes while she ran around in a panic. I used no impatient body language. I was serene. Eventually, she got to me, and I asked if she had anything for O'Connell. And she did. She grabbed the bag out of the bin. Note that this is someone I've dealt with a couple of times on this, so she remembered my problem.

She opened the big, looked in, and pulled the bottle out.

The very big bottle.

This time it was not only the generic again, and the horse pills again, but it was the special-ordered 100mg generic size.

So they were even BIGGER.

There's comes a point (and I've reached it several times in my life) where things become so absolutely ridiculous that they can't NOT be funny.

She caught on quick (God bless her) and she went to talk to the pharmacist. One of the ones who knew what was going on! Score! She apologized and said that they'd get the name brand prescription filled, but it was going to be a few minutes. ZERO problem for me. I was more than willing to wait. Mostly because there wasn't another brick wall thrown up on the other side of the error, one that added further complications and inevitably ended with me being told to come back the next day.

She was busy doing things (and the place was getting even more chaotic and full), so it was the pharmacist himself who called my name. And there it was, in his hand. One hundred and twenty of the RIGHT pill. The brand name. The small size. He explained that what the doctor's office had called in was just the size, not a "no-substitutes" prescription, so the order had automatically switched over to the generic, as my insurance wants. Well, now the problem was fixed, so I didn't care. I did have to ask him, though, because I already knew the answer - does this mean, I asked, that every time I call in for a refill from now on I'm going to show up and find the generic waiting? His pause, and the look on his face (a rather helpless one), told me all I needed to know. A bridge, I figure, I'll cross when I come to it. And I will.

Ah, but there was the final twist in this tale. He was able to get the brand name for me, but since it hadn't been requested by the doctor (even though it had), he had to put the order through as a "patient requests" on the brand name. This means, to the insurance company, that I really want that brand name on my pills, for style reasons, like I need REAL Dockers instead of some Ross-brand knock-off so I can feel good about myself. And when you request that? That shoots your co-pay up to a nice $75.00. So to get my pills, to be able to actually take them home with me, I had to pay the $75.00 on top of the co-pay I'd already put down last weekend for the short-term refill.

Whatever.

It's Friday, I'm home, I've got a warm meal in me, I've got a weekend of relaxing and catching up on projects ahead of me, and I have a month's worth of small, stylish brand-name pills sitting on my counter that'll only hang up about every fifth or sixth time I swallow them. I'm trying not to think about starting the whole fiasco over again in December (just in time for Christmas!), or about the fact that I have to brave the pharmacy again in a few days for my Coumadin refill, and the chances that some manufacturer at that company may have decided, too, that bigger is better when it comes to the pill game. More pill for your co-pay is our motto! I'm just trying to appreciate that I don't have go all "Saw III" on the big generics again, and have to deal with choking on a chunk of beta blocker because of the whims of a marketing guy who had no idea what his random decision was going to do to my life and to my otherwise patient good nature.

Because, seriously, if I'd ended up choking, and if I'd have died?

I'd have sued their ASSES off.