A Conversation Between a Pharmacist and Someone Who Needs Her Psych Meds

Once in a while, I forget to tell my psychiatrist I’m low on my medication. My shrink is cautious and protective of his patients, so he rarely issues refills. I have to be mindful of this, since many of my former therapists in the past had the less responsible practice of leaving one, two, even 10 refills on the script.  While this was tons easier for me (I could go for months without seeing the shrink), it didn’t help make the psychiatrist or me accountable to our relationship and work together.

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Anyway, when I do forget with my current shrink, it’s embarrassing. This last time I had to call him on a Sunday. I left a message. Then I called or stopped by the pharmacies to see if they carried the Trifluoperazine I needed. After talking in person to the pharmacist at the Target and CVS in my neighborhood, I proceeded to call the 24-hour CVS in another town for convenience’s sake. None of them had it in stock. It didn’t surprise me since the pill is quite an old medication most patrons of CVS do not use. But it did frighten me. Left me feeling uneasy. Vulnerable. It is…an anti- psychotic. Hospitals are more likely to carry it, my psychiatrist told me later, because they experience more turnover of psychotic patients than your friendly CVS.

And that’s precisely the problem. I have a block asking for Trifluoperazine in “normal,” civilian surroundings. The conversation with the pharmacist goes something like this (I’ll give you what we said and what we were really saying):

Me: Hi. I wonder if you have a certain medication in stock.

Code for: I have a mental illness and I’m still sort of ashamed of it but I need my medication.

Pharmacist: What medication? 

Code for: Just how sick are you?

Me: It’s called Trifluoperazine. 

Code for: I know, I know, it’s an anti-psychotic but I promise you if I stay on my meds I will not get psychotic or dangerous or weird.

Pharmacist: Can you spell that?

Code for: We haven’t had a request for that in years!

Me:  T-R-I-F-L-U-O-P-E-R-A-Z-I-N-E. 

Code for: See, I know what I’m talking about. I’m a healthy, normal, sane woman.

Pharmacist: Uh huh.

Code for: Ah, so you are prone to psychosis. I hope you’re OK now. I don’t want you hanging around the store.

Pharmacist: How many milligrams? 

Code for: How psychotic are you?

Me:  Oh, only one milligram. 

Code for: I promise, I hardly need the stuff.  It’s just for maintenance.  Honestly. I really don’t need it that much at all.

Pharmacist: When do you need this? 

Code for: Now we’ll find out just how psychotic you are.

Me:  I need it right away. I don’t have any more pills left. 

Code for: OK, OK you called my bluff: I am prone to psychosis. If I go several days without the drug I get shaky and unstable. And, yes, besides that, I’m irresponsible. I didn’t tell my doctor ahead of time. I’m a mess.

Pharmacist: We’ll have to order that. It will take a few days. 

Code for: You must be really bad off.  We never get requests for this drug. It’s only in the psych wards that they have a full supply.

Me: Oh. Well, do you think you could advance me a few pills until it comes in? 

Code for: I’m begging you. Yes, I have a problem. If I don’t get the meds soon, I might have another breakdown.

Pharmacist: I told you, we have to order it.  We don’t have any currently. 

Code for: Just go to a hospital.

Me: OK, thanks.

Code for: Sure, push me into a mental funk because you are too stingy to carry my medication. I know I’m not the only one! Surely other psych patients need it!  You are depriving a whole population! Tyrant.

I throw my bag over my shoulder and leave the drug store sort of empowered, with my head high, vowing to give my psychiatrist plenty of advance notice the next time my pills dwindle low in their vial.