S – Straight Face

Theres a skill that should be taught in pharmacy school, but isn’t. Its learning how to hold a straight face.
All pharmacists, techs, clerks have been in this situation:
You are working along, typical day, when a well endowed (not in the good way) woman comes in obviously not wearing a bra. You think to yourself “oh please, not today” but fate drew your unlucky number. She quickly walks up to the counter, and asks if she could see you. You don’t even have a chance to mentally prepare yourself before she horks up her shirt to show you her two very red and very angry mommy-bags right there in the middle of the store for all to see. She asks “Is there any cream I can put on these to make the rash go away?” You think “Holy crap are they really laying on the counter?” as your clerks make a bee-line to the break room.
Now a seasoned retail pharmacist wouldn’t even bat an eye. Been there, done that, heres your miconazole, thanks for coming. Now we shall share our secrets.
There are some main types of straight-face holding. Lets review them.

• Laughing: You mostly get this when the patient says something really stupid and you don’t wish to make them feel bad. However there are times when it takes all your will not to laugh at the patient. A prime example of this is watching an old man bend down to pick up his dropped cane only to rip the loudest, wettest, juiciest fart you have ever heard. Now to some, farts aren’t funny, but to 99.999% of the people who are actually living, farts are a joke that never get old. Other examples include “oh god” moments like having someone shout from the isles if they can use a Fleets Enema up their vagina, or asking for the “large tampons” because they have an “especially large cooter”. This takes practice. If the other pharmacists in the store are jokers, then this is a skill you must learn as soon as possible.
  • Disgusting: The yeast infection under the breasts is a prime example of this. Now the goal of this face is to not visibly show that you have been mentally (or sexually) scarred from this experience. You will be shown stuff that you don’t want to see. You will have to talk to people who have the worse BO/Breath/Cat piss/etc stank known to man. Boobs really aren’t /that/ bad, however add on the smell of BO and you have some serious face-restraint going on. This face can also be used when looking at boils, draining wounds, the use of laxatives and pill hunting in poop.
    • Embarrassing: This one usually involves teenage girls and personal questions. Pretty easy to keep a straight face if you know what you are talking about (or are a female and speaking to a female). You’ll be asked how to properly put on a condom, how to take Plan-B, or how to insert a tampon. It can be embarrassing at first, but if you’re professional about the whole event, it’ll go smoothly. Like wild animals, they are more afraid of you than you are of them. Remember, its okay to think the “You’re pregnant at 12!?!?!” thoughts, just not the face.
      • Anger and Disgust at Humanity: You use this face when some welfare baby-factory brings in her 10 children (who are tearing apart your store) and yells at you because her Protonix has a $3 copay /and/ she cant get her vicodin/soma filled 2 weeks early. Similarly, when a 11 year old comes in for prenatal vitamins and her parents are so proud of their little girl even though her life is pretty much put on hold. Welfare recipients who drive $60k SUV’s (and frequent the ER to get more OTC Tylenol/Pediacare/Pedialyte for their crotch-fruit) also fall in this category. You must suppress the face of disgust and be neutral. Keep on telling yourself that living a lifestyle off of the working class’ dime is extremely hard and we should feel sorry for these people. …..Then think what a load of bullshit that last sentence was and why these bastards cant go out and get a goddamn job and quit talking on their goddamn cellphones while you’re telling them how to give medication to their goddamn bastard children. Am I bit bitter on this subject? Nah.
        • Pity: You use this face when you are explaining (for the 40th time) a simple concept to an elderly (or just an idiot) patient. Its suppressing the face of “How did you get through life being this stupid”. Mostly seen when people (mostly elderly) do things that you cant comprehend how they thought that could be a good idea. Such as dumping all of their medication into a candy dish. Or deciding that if 1 is good, then 5 is better. Fortunately most elderly are hard of hearing, so that long sigh of “kill me now” you let out wont be noticed the first time.
          So whats the secret? Experience, plain and simple. Having a stroke will help 1/2 of your face, but usually people don’t care for that solution. Ive given you a primer as to what to expect, its up to you to practice at home in front of a mirror.

Comments #

Comment by Kishore Murthy on 2007-02-26 14:18:35 -0800 #

Excellent post! Not only did I learn from it but I also enjoyed it thoroughly.

Comment by Kevin Traser on 2007-02-26 16:59:50 -0800 #

How is pharmacy? Because right now, I am a second year in the Saint Louis College of Pharmacy, and I pretty much hate this place.

Comment by A Bohemian Road Nurse… on 2007-02-26 18:03:32 -0800 #

This hilarious post totally cracked me up and calmed me down from your ranting about “Entitled Old People”. Geez, now I won’t be able to keep a straight face about anything for at least the next 6 weeks…

Comment by Crown on 2007-02-27 07:40:07 -0800 #

What is really hard, keeping a straight face, when your smarter-than-you pharmacist gives out the wrong medicine, then bitches that he can’t resell it when you bring it back for a refund and/or the right medicine. Try to be civil then.
But I did it.
I don’t agree w/you about stupid elderly or rich welfare bums. But I understand why you don’t understand, why I don’t understand.
Peace and Fiat Lux

Comment by Runner Woman on 2007-02-27 10:17:01 -0800 #

I only get intertrigo when I run 3 miles or more. I wear a very good bra and always have. I wear TWO sports bras when I run. I am a 34 DDD–not hugely overweight. My BMI is under 25. I admit the running is important to keep my weight down and that’s why I do it. I read on the Internet that losing weight is key to battling intertrigo. Funny how running helps me keep the weight down, but also causes the “disgusting” intertrigo. I am very clean. It’s the chafing of the sports bra, which only chafes at about 3 miles. I have learned to change bras the minute I get done running and NOT to use any creams or medications–I read that on the Internet too. Why do I get my information from the Internet, even if it’s wrong? So I won’t have to disgust anyone! I used to use “Body Glide” but I think it contributed to problems so now I just dry off as soon as possible after running and hope it doesn’t come back this summer. I obviously disagree that something which occurs to someone due to chafing when they run is “disgusting” or evidence of a bad lifestyle.

Comment by MLO on 2007-02-27 11:20:11 -0800 #

Makes me glad I went to library school. We actually had classes that went into great detail as to the variety of questions we might be asked – including the drunken bets. Reference Desk roleplaying was not unlike some of the things you describe.
It is not unheard of for someone to come into the library and ask for something that has pictures so they can self-diagnose. This, of course, is a bad idea in most of these cases.
Pax,
MLO

Comment by Emma on 2007-03-01 16:00:53 -0800 #

Your post brought to mind a recent event that occured in the Welsh Valleys. A rather dumb-ass, stinking family came into the pharmacy (shared premises with the local surgery) bitching because their Doctor will not allow their daughter to have IVF on the NHS or even refer her to a fertility clinic – the monther loudly wailed “she’s 15! she should be able to get pregnant! The doctors don’t care that she’s not conceiving!” – maybe they do care – maybe they’re ringing social services as you scream…

Comment by Jeff on 2007-03-02 20:31:39 -0800 #

Oh man … where the hell have you been?!?!?!? You know, I always felt bad as a recent grad that I shouldn’t have feelings where my fucking eyes twitch with homicidal rage everyday after work. I work for an independent pharmacy too in Maryland. The liberal douchebag state. Well, if it feels like I’m patronizing you, well fuck it, I am.

Comment by Matt on 2007-03-04 20:26:34 -0800 #

Long time reader (of this journal and others), first time question asker.
I’m a medic/teacher looking to implement a progressive emergency response program at my school. We have the AED, but would also like to have O2 in the health room to treat students and visitors experiencing difficulty in breathing.
Most people say it requires a prescription, but it is my understanding that emergency O2 labeled as such does not, and does not require medical oversight. No one, our medical director included, seems to know. Any ideas of where to ask next? I’ve spent far too much time on Google and local resources (small town).
Thanks!

Comment by Ticked off Tech on 2007-03-06 10:13:52 -0800 #

Having a straight face is really hard to do. Some say they can handle anything without a problem but they just haven’t met there match. Fortunately for us Technicians all we have to do is spot the “show and tell” patients waiting in line, as we turn around and walk toward that back while giving the pharmacist that “sucks to be you face” we kindly tap them on the shoulder and point them in the direction of the “exposer”. It’s quite humorous turning around and waiting patiently while we watch the pharmacist face turn from normal to slightly disturbed. However we must keep a straight face as well. I mean I don’t think it would be quite appropriate to laugh obnoxiously when a patient is asking the pharmacist about their problem. It’s not easy at all.

Comment by drugmanrx on 2007-03-06 20:35:59 -0800 #

Crown, have you ever made a mistake on the job? I guess you haven’t judging from your post. Besides that, pharmacists rarely fill the prescription themselves (techs do that, pharmacists check at a computer) Maybe if nagging customers would actually leave the pharmacist alone to do “the important part” and making sure you aren’t going to have a problem with the medication prescribed there would fewer mistakes! Judging from what you said that the pharmacist wouldn’t take the med back, it probably wasn’t the wrong one (every pharmacist i know would take it back in this case because its their mistake) Instead, you probably got a generic when you wanted brand or a med you didn’t need after all (this is where pharmacists don’t take them back after they leave the store) Boo-hoo, go cry somewhere else

Comment by RJS on 2007-03-07 05:53:04 -0800 #

The first week I was a pharmacy technician (and long before pharmacy school entered my thought processes), a 75 year old woman walked up to me and asked what to do about a yeast infection. I was 18.
I kept a straight face then, and I’m proud to say I’ve never cracked since. Not until after they leave anyway. I’ve had to go sit down somewhere else afterwards because I’m laughing so hard, but never in front of the patient!
Matt: “Most people say it requires a prescription, but it is my understanding that emergency O2 labeled as such does not, and does not require medical oversight. No one, our medical director included, seems to know. Any ideas of where to ask next? I’ve spent far too much time on Google and local resources (small town).”
Let your fingers do the walking through the yellow pages for DME (durable medical equipment) suppliers. Give one of them a call and ask. I think you’re looking for HOME (Home Oxygen and Medical Equipment).

Comment by Amanda on 2007-03-12 17:30:50 -0700 #

Keeping a straight face is hard indeed, especially when facing weird situations, like the ones you mentioned. Haha. We are human beings right? So trying to conceal our thoughts is quite difficult, unless with practice. The lecturers in my university are always telling us, and training us (in a way, I suppose) to not laugh or show any emotions to patients, in order not to offend them.

Comment by John Doe on 2007-03-15 09:20:52 -0700 #

Ha, I just wanted to tell you how much I love your blog and how it makes my day. It’s so funny, yet so unbelievably true.

Comment by john hawkins on 2007-03-16 13:49:58 -0700 #

how about a response to
http://www.freakonomics.com/blog/2007/03/15/if-crack-dealers-took-lessons-from-walgreens-they-really-would-be-rich/
Your riposte though sometime painful are always worth it.

Comment by Lisa on 2007-03-26 17:16:31 -0700 #

Your site is hilarious!! It is SO true, and reminds me everyday why I practice hospital pharmacy instead of retail… Keep up the good work!!!

Comment by Kristen on 2007-04-07 21:59:04 -0700 #

I’ve heard about this site many times and finally got a chance to read.I am not a pharmacist,but a certified pharmacy tech. I could not agree with you more on any of your postings.
Its a wonder we all aren’t nuts yet.

Comment by ANGIE RPh on 2007-04-09 16:26:06 -0700 #

I really enjoy your blog. I’ve worked in many pharmacies throughout CA and OR, first as a Tech and now an RPh. I’ve certainly experienced some CRAZY people in this profession. Anything from people picking their own headlice from their head while at the counter, to asking me to smell their underclothing. Sometimes I regret not becoming a mortician instead of a RPh. Dead people don’t talk back!

Comment by Amanda CPhT on 2007-04-23 16:29:33 -0700 #

So, while traveling the tangled abyss that is the world wide web, I came across this little oasis. I have been slowly going through and reading your older entries generally without incident. Today however, I made the mistake of reading this entry while drinking a glass of soda and nearly destroyed my laptop in the process.
Honestly, I love your site, keep being an angry pharmacist. Perhaps if ours vented like this they wouldnt be so rude to us 🙁

Comment by RxTech317 on 2007-05-09 21:02:23 -0700 #

C’mon drugmanrx- I’m pretty sick of the pharmacist cop out on blaming techs. This happens so much in my store (luckily i’m not the problem tech haha) but u gotta admit techs are vital to u getting ur job done and seriously underpaid and underappreciated. i’m not gonna stereotype pharm-d’s here, but i’ve seen more than my share of lazy ones who want to sit back and brag about their fucking huge paycheck while i wear a hole in the carpet running back and forth doing the work of 3 people! whoo anyways!
my fav try to keep a straight face moment is when great grandpa types but condoms, not your regular plain condom- no twister condoms with warming ky, and no seriously i couldn’t make this up, the man is like 75+ and has one arm. no joke. then another one who buys just regular lube and the warming condoms, yah what the fuck??? U can’t possibly be gettin’ some old bitch prego and if ur 80 and u gets std’s big fucking deal, right? ur gonna die any day now as it is! these thoughts all cross my mind as i ring up the 2 items and try to remain composed. i’m pretty good at it. but my fav is trying to get the ones who can’t stay composed going. like telling the cashier i think a customer looks like tweedle dum as he walks to the counter, she fuckin lost it.

Comment by UFpharmboy on 2007-08-10 15:27:29 -0700 #

Just found your site today…Best straight face I had to put on was a gentleman that spent some time in the condom section before coming to ask if we had anything smaller.
Luckily I was still an intern and was able to deflect the question to the pharmacist. Will never forget the moment of deciding if he was serious or if I was on a gameshow.

Comment by Josephine on 2007-09-07 12:08:50 -0700 #

I really love this post and it has thought me alot. I’m still a college student majoring in prepharmacy and with my interest in my major i have been looking up whatever i can see which can be of great help to me in this profession and also help me to get into my pharmacy school. Right here i’m sitting trying to think of myself placed in a similar situation and trying to see whether i can put on a straight face if this comes my way. Thanks a million for teaching me this today.

Comment by pill pusher on 2010-02-05 01:54:08 -0800 #

I don’t think it matters whether I work for an independent or a retail chain. I think the most important thing for me is to be able to practice pharmacy, for profit. Now, I am not asking for insane profits like the insurance companies take/steal from us and their members. I am just asking for a fair share of not from stolen money but fairly earned money. Every year like clockwork the insurance companies increase premiums and the drug companies put out more expensive drugs. They both benefit because they each get a bigger share of our money.

The industry is skewed to favor the 3rd party payers and drug companies. The drug companies make sure of that and quickly answer to the insurance companies so that they can get as much money out of Americans as possible via their partners, the insurance companies. Remember what happened when Zithromax 1st came out? Pfizer charged too much for Zithromax when they first released it 15 years ago. Greed caused them to price it too high. They eventually had to lower the price. Do you remember how much it cost when it 1st came out? Look at the cost of the brand name now compared to then after 15 years of inflation. Can you remember the last time you dispensed brand name Zithromax? Still the drug companies put out more drugs that may be marginally better or in some cases even worse than the last drug but manage to charge more. They cry that they need that money for research and development but I don’t’ see that. Ask a scientist for Merck how much he gets paid, ask them what their financial incentive is, they will tell you that they get a regular salary and work on that basis. They are not driven to create the new wonder drug for money or a piece of their the profit. They do it because it’s their job and they know how, much like Jonas Salk (remember him) because its’ the right thing to do.

How much more plain and simple can it be staring at us in the face? Americans pay at least twice as much for their medicine than anyone else on this planet. The only reason for that is because we are forced to by the powers that be. Who has more representation in determining how our government and laws are enacted? You? Me? or these incredibly deep pockets that have swindled us into giving them control of our dollar. We just can’t sit idly by and watch our livelihood disappear. What would that mean to the people of this country. People need the guidance from their pharmacist as much as they need the guidance of their physicians. The greediness from the corporations are constantly trying to take that away from us and our expertise. If we become cynical and demonstrate that same greed then it will eventually lead to our demise.

I am sure you can agree that CVS/Caremark and all similar entities should not be allowed to exist. Just on the premise that this type of business is not morally sound, moreover, businesses like these will destroy the economy even further. Allowing these companies to exist doesn’t give them a license to practice medicine or pharmacy, but it gives them a license to print money. How long before our dollar is worth as much as a Peso? Hey the Canadian dollar can buy a lot more American dollars now than it could a few years ago. Greed is killing this country. Don’t get me wrong the federal government is worse. They are experts at printing money, they last thing we need is them controlling healthcare because all the money will just be disseminated into different hands with different interests. The last thing we need is a federal plan controlling healthcare because the people in power don’t always do to the right thing. Many times they will be short sighted by the money waved in front of them to save their own ass. A good example is our pal Bernie Madoff. I am going to stop short of saying that I almost feel sorry for him, he was just a small fish. At least Madoff’s company never became part of the DOW JONES. Pfizer’s shares were made a component of the Dow Jones Industrial Average on April 8, 2004. Pfizer pleaded guilty in 2009 to the largest health care fraud in U.S. history and received the largest criminal penalty ever levied for illegal marketing of four of its drugs. Called a repeat offender, this was Pfizer’s fourth such settlement with the U.S. Department of Justice in the previous ten years. Is this the type of company that we want to represent? Is this what healthcare is supposed to be about?

Pharmacy is a very noble profession. We keep up with the latest developments to make sure that we dispense the proper care. One reason that pharmacy was separated from medicine was to ensure that the conflict of interest from dispensing was separated from prescribing. It is one of the fundamental reasons that our profession exists. If we allow CVS and Walgreens to form minute clinics then that confidence is broken and where will we be then? As for the drug companies what can we do? We can follow the lead of North Dakota and only allow pharmacist to own pharmacies reducing the leverage that insurance companies have on healthcare because if there is no one there to administer it then they can’t exist then. What will the drug companies do then? Close up shop? It took a long time to get into this mess and it’s going to take a long time to get out, I just hope that we are all not speaking Chinese before it’s all over.