To read this serialized blog of A Relationship Beckons from the beginning, click Crisis Averted #1 on the sidebar.
The Emergency Room
The paramedics wheeled Peter who was resting on the collapsible gurney straight past the crowded waiting area into the emergency room proper. He was lying against the angled backrest trying to absorb the myriad of colors, sounds and activity surrounding him. His nose and mouth were covered by a clear, green face mask connected to tubing that snaked to an oxygen tank lying beside him. The boy had been talking incessantly since being placed inside the back of the large rig and seemingly had reveled at the special attention and the siren-screeching ride. “I can’t wait to tell Stephen that I got to ride in an amboo-lance,” he’d bragged to Caroline as she caught up to the stretcher as they off-loaded Peter from the ambulance.
Caroline had followed the medical transport in her Escalade to Tidewater Regional Medical Center in Newport News. Now, she walked just behind the pair of first responders keeping pace with her hand resting on the angled backrest. A young woman in green scrubs standing behind the counter at the circular nurse’s station saw the quartet approaching and pointed to an open, glass-walled room.
“Put him in room three,” she instructed.
The pretty nurse followed everyone into the treatment room and greeted her young patient. “And who do we have here?”
The reply was muffled and hollow through the oxygen mask. “I’m Peter. Peter Clivio.”
“Are you Mom?”
Caroline nodded, a relieved smile creeping over her face. She adjusted her large purse against her shoulder and pushed out a weak, “Yes.
The nurse turned her attention back to the boy. “My name is Gretchen. I’m one of the nurses who will be taking care of you today.”
The paramedics had lowered one side rail of the gurney and pushed it against the hospital bed. Gretchen asked Peter to scoot onto his new bed. She disconnected his oxygen tube from the O2 tank and reattached it to the hook-up in the wall. The paramedics recited a quick report of the boy’s vital signs and Gretchen wished them a good day. Caroline thanked the two young, athletic looking men as they gathered up their gear.
Gretchen rolled a tall, medical monitor on a wheeled pole to the bedside and proceeded to place a pulse oximeter on the middle finger of Peter’s right hand and a small blood pressure cuff over his bicep. She calmly explained what she was doing in a soothing, unhurried voice. Peter still breathed somewhat heavily. Each breath briefly fogged his mask.
Gretchen noticed Peter’s hands trembling.
The nurse asked Caroline what had happened. Caroline relayed the episode of Peter’s asthma attack in the car and her frantic rush to the only place she could think to go quickly, the pharmacy in the northern stretches of Newport News and the heroic pharmacist who’d administered the albuterol puffs into her son’s lungs.
When she turned her attention back to Peter, Caroline took measure of this twenty-something angel who now captivated her son. She was about five-six with sparkly, ocean blue eyes that were striking beneath the silken, blonde hair pulled into a ponytail.
Her ex-husband Luca had taken Caroline to Italy three years before their divorce to Nerano, a small town on the western coast about three hours south of Rome on the Sorrentine Peninsula, a stone’s throw from Sorrento and a short drive to the Amalfi Coast and Positano. From their villa, they enjoyed a spectacular view of the Isle of Capri and the three Faraglioni in the Tyrrhenian Sea. She remembered the boat trip over to the island for a romantic lunch with Luca. Of course, that had been during better times–much better times.
She recalled marveling at the rich cerulean water as they circled the island in a charted boat. It was the bluest water she’d ever seen. Gretchen’s eyes held that same hue now over the pleated surgical mask as they darted between the instruments she was manipulating and her son who seemed taken by her natural beauty.
“–need this, Mrs. Clivio,” Gretchen said, holding out an unused blue mask to Caroline.
Caroline took the mask and replied, “It’s Miss Clivio.” She had divorced Luca a year ago. Though she was no longer married to the man, she’d kept his name for Peter’s sake. However, the moniker of “Mrs.” was one she refused to wear.
Gretchen nodded, acknowledging the correction. “Peter’s doing fine. His vital signs all look good. His breathing is a little labored but I think he will be okay. He’s trembling a little, probably due to the albuterol. The doctor will be in to see him in just a few minutes.” Gretchen slipped out of the room.
It was then that an older, portly woman about Caroline’s height hastily entered the room. “Mon dieu! Is he okay?”
Caroline stood, leaving her purse on the chair. “Hi, Mom.” The women hugged. When they separated, Caroline looked her mother in the eye. “He’s fine. He had an attack. The pharmacist at the store gave him some albuterol. We brought him here just to be cautious.”
Though, she carried her years well, the ravages of time and raising four children had begun to take their toll. Her jowly face and liver-spotted skin added years to Nora Martel’s appearance. The hazel eyes still bespoke a sharp mind and the ability of critical analysis that came with sixty-five years of life’s trials and tribulations.
Nora’s eyes shifted to Peter in the bed. His eyes were closed. The fatigue and energy he’d exerted this morning trying to breath had caught up with him. Caroline followed her mother’s gaze to her son. “He’s exhausted. But he enjoyed the ride in the ambulance. He’ll have lots to tell his friends.”
“I won’t wake him. “And his father,” Nora added. She hesitated a moment. Then in a very soft voice muttered in French, “Est-ce-que le connard sait?” Nora Martel always reverted to her native language when she was worried.
Caroline sucked in a heavy breath and closed her eyes trying to summon patience. The last thing she wanted to endure this morning was the one quality her mother had perfected, and one in which she was a virtuoso: pushing Caroline’s buttons and finding fault with just about everything she did. Caroline performed a silent five count, re-opened her eyes and expelled the air and her response. “No, mother, the asshole doesn’t know.”
“Am I going to have to see him today?”
“Mom, this is not the time…or the place,” Caroline chided.
“You know how he’ll react when he finds out,” Nora continued.
Caroline cast her gaze to the ceiling. “Not now, please,” she insisted, bringing her eyes back to Nora’s. A single tear traced its way down Caroline’s cheek. Her mother was also always the first one to confirm what Caroline was thinking…and fearing. She could read her daughter blindfolded .
In addition to being concerned about Peter, Caroline’s mind struggled with the fear of what Luca might say–or–do when he found out about this latest episode. She had pushed the worry about Luca’s reaction into a corner of her mind temporarily as she phoned her mother to tell her to meet her at the hospital. Caroline had been on her way to her mother’s when Peter took ill. The plan had been for Nora to sit with Peter while Caroline ran errands. After she had hung up and as she trailed the ambulance, Caroline had become consumed with the possibility of Luca finding out. As a result, she experimented with different reasons and rationales for why she hadn’t remembered to bring Peter’s inhaler with her. Her hands had trembled as she gripped the wheel with a white-knuckled strange hold.
Despite the fact that they were no longer married, Caroline would never be rid of Luca. They shared a son. A son Luca doted on. Luca’s Italian heritage made him quick to temper. His occupation and his affliction made him suspicious and unpredictable. He was a powder keg. The tiniest spark could set off the volcanic rage, sending him into explosive–sometimes violent–tirades.
And for a few moments, Caroline recalled the relief and gratitude she’d felt when the pharmacist had administered the breath-saving medication. She made a mental note to go back to the pharmacy sometime soon and thank the man.
Nora dug into her daughter’s eyes with her own. Caroline surmised that her mother realized that she had pushed too hard. Nora patted her arm and relented. “We’ll deal with that later.” But, Caroline knew the issue was not dead. Her mother would pursue it relentlessly.
The Doctor Departs
Their conversation was interrupted when a short but authoritative-looking man dressed in khakis, a blue shirt and red tie and cloaked in a knee length white coat entered. His stethoscope was draped horizontally around his neck. “Good morning,” he said. “I’m Dr. Hobson. Are you,” he referred to clipboard he’d retrieved from the holder outside the door. “Mrs. Clivio?”
Caroline frowned your, but chose not to correct him. “Yes,” she replied with a single nod.
“Peter experienced a breathing episode today?”
“Yes. I forgot his inhaler at home.” Caroline shot a glance at her mother whose brow crinkled deeply. “A pharmacist at the Alliance Pharmacy helped me and gave him two puffs of albuterol. He called the paramedics who brought him here.”
“Let’s take a look,” the doctor said, rounding the bed. He placed a hand on Peter’s shoulder and said the boy’s name. Peter roused and blinked several times, looking up at the newest stranger. He asked Peter to lean forward and take deep breaths as he placed the stethoscope along various spots around Peter’s back. Then he listened to his heart. After several minutes, his preliminary exam complete, the doctor replaced the stethoscope laterally around his neck. “He’s breathing well. Still a little wheezy. He’ll be fine. We’re just going to watch him for an hour or so.” The doctor nodded and departed.
Caroline lowered her head, relieved. She saw the doctor’s comfortable shoes hesitate as he exited the treatment room. A shadow spilled from the hallway into her field of vision. She heard her mother’s whispered word of contempt in her ear. “Merde!” Caroline spun her head toward Nora. Nora’s eyes did not move in her daughter’s direction. Instead they were riveted on something in the doorway.
Caroline hesitated a moment, realizing Nora was staring beyond her. Caroline turned her head in the opposite direction. It was not something. It was someone. Backlight by the harsh emergency room light of the nurse’s station, Luca Clivio towered over the departing physician. The tension in his frame, the hard eyes and the repeated flexing, relaxation and re-flexing of his right hand into a fist sent a dagger of dread through Caroline.
To Be Continued
If you have a pharmacy story or a story (heroic or challenging) of everyday life in your healthcare world, send it to me by clicking the link below…
(This is a fictionalized scene based on a real incident that happened years ago.)
“Honey, are you okay?”
Caroline caught sight Peter of the corner of her eye in the rearview mirror as they say at the red light. She was concerned. Her six-year-old was strapped into his car seat behind the passenger side. He seemed quiet and more subdued than normal this Monday morning. He protested saying he was tired. Dark circles hung beneath his young eyes. A niggling cough rattled in his chest.
Every other morning, he woke bounding from under the covers a chatty ninja, racing downstairs to watch cartoons or play with his toy cars heedless of her commands. She had taken his temperature and found it normal. Something just did not seem right.
Turning her head to look at him, she repeated her question. Again, there was no response. That was when she noticed the rapid heaving of his chest. His lips displayed a bluish haze. His rapid, shallow inhalations sounded like angry hisses.
She pulled over, stopped the SUV on the shoulder and quickly rifled through her purse looking for the albuterol inhaler. She could not find it. Panic welled in her. Dumping out the contents of the purse onto the passenger seat, her hands moved through the items desperately touching each one in the hope she’d overlooked it.
Shit! It wasn’t there.
Then the realization struck her: it was sitting on the kitchen counter where she had left it last night as she cleaned out her bag.
She swore out loud again.
Glancing into the backseat again, Peter’s head had slumped forward. His chin rested against his small, heaving chest.
Panic morphed into full-fledged terror.
Ramming the gearshift into drive, she slammed the accelerator to the floorboard. The Cadillac Escalade lurched forward, fishtailing sideways in the soft grass until the tires found purchase on the asphalt. A car horn blared followed by the sound of screeching rubber. The passing vehicle swerved dramatically barely avoiding colliding with her Cadillac.
She ignored the near miss and continued pressing the gas. Her mind ping ponged wildly, assessing her options as her heart was in her throat, bounding rapidly. Should she turn around and head back to the house to retrieve the inhaler? Or she should head to the nearest emergency room? By her estimates, both options meant thirty minutes.
Was Peter breathing?
Oh my God! She should have leaned into the backseat and checked on her son.
Her momentum pulled her alongside the car that had nearly struck her. The still-irate female driver glared over at her mouthing unheard epithets while at the same time moving one hand in rapid, ill-willed gesticulations. Ignoring her, the Cadillac crept passed the other vehicle as they both raced along. Her mind still trying to recall a place where she could take him that was nearby then through the windshield, she spotted a beacon of hope.
When she reached the turn off, Caroline jerked the wheel hard, barely braking. The Cadillac listed severely as the tires wined in protest. She skidded to a halt in one of parking spots at an obscure angle. The other driver, apparently unsatisfied with her earlier demonstration of dissatisfaction followed the Cadillac into the parking area.
Caroline pushed open the door so violently, it bounced back onto her. Pushing it open one more time, she rounded the hood in a full run and yanked open Peter’s door. She could she his chest moving erratically in short, inadequate bursts.
She unbuckled him from the car seat, pulled him onto her chest, darting around the other car which had stopped right behind her. The driver was exiting the car and shouting, “What the hell do you—”
Caroline screamed back, “He’s in trouble!”
She bolted across the parking lot in front of another car causing it to brake hard. Five seconds later, she disappeared inside the pharmacy.
Jake swore under his breath at the growing workload before him for at least the tenth time today. The tightness in his chest expanded, threatening to consume him. As the pharmacist on duty on this first Monday of the month, the number of prescriptions thrown at him today was non-stop. He’d already had two patients scream at him because he’d had to tell them that their orders for pain medications wouldn’t be ready with the speed of a McDonald’s restaurant. It was always the patients on narcotics that gave him the hardest time. Another patient’s insurance wasn’t paying for her medication because it was too soon to fill. The patient refused to leave and was demanding that someone from the pharmacy call the insurance company to get an override because she was heading out of town.
If he had a dollar for every time he heard that one!
The woman stood at the drop-off window, arms crossed angrily across her middle, silently shooting impatient darts with her eyes at Jake.
He had COVID shots scheduled every fifteen minutes. And finally, to make matters worse, one of his technicians had called out sick.
Jake put his hand on his forehead and dragged it over his face, taking with it the patina of perspiration that had formed on his skin. As his palm passed below his nose, he opened his eyes and saw her. It was a thirtyish woman clutching a child to her chest running full speed down the center aisle straight toward the pharmacy department.
I don’t need to hear it from anyone else today, he thought.
The queue at the inside pharmacy register was four deep and—because of the callout—his lone technician had been camped out at the drive-thru for the last forty-five minutes. They had managed to fill very few prescriptions to this point. His best guess was that he had about eighty prescriptions to fill at the moment. And surely there would be more to follow.
Ignoring the work and the frustrated stares of the patients in line, Jake watched the mother frantically trying to get his attention. She jumped the line at the cash register and elbowed the elderly gentleman there out of the way.
“Help me please! Help me! It’s my son!”
She shouldered her son around to face the pharmacist. Jake’s held his breath and braced himself for some kind of tirade. His angst instantly turned to alarm when he saw the boy. His lips were blue and a gray cast painted his skin.
“Oh shit!” Jake exclaimed. “Is he breathing?”
“Yes…but barely. I left his albuterol at home.” The mother’s voice was husky with fear.
Jake turned his head and hollered to his technician at the drive-thru window. His throat immediately went to his throat. “Helen, get over here now and call 911!
The technician named Helen stopped and turned her head. “What?!”
“I said, ‘Call 911’! Now!”
Racing from his workstation, Jake ducked into one of the pharmacy bays. Finding what he needed, he moved out front without delay. He instructed Mom to move him to one of the chairs in the waiting area. They slipped through the line of waiters as Jake removed the albuterol inhaler from its box. He shook it hard for five seconds. He asked the boy’s name and mom told him. While propped up on mom’s lap, Jake held the inhaler to the boy’s face and placed the mouthpiece between his lips.
“Peter,” he instructed loudly, “when I count to three, I want you to take a deep breath. One…two…three…”
He’d depressed the canister. The boy did not respond. The pharmacist was certain the powder had not make it into Adam’s lungs. Jake could hear the panicked, rapid breaths of the mother coming faster followed by a weak declaration filled with terror, ” Oh my God!” Jake shook Peter’s shoulder hard, rousing him slightly. Behind him, he could hear Helen in the pharmacy shouting into the phone at the 911 operator.
Jake repeated the procedure and counting to three again. On three, the boy sucked in as deep a breath as he could muster while Jake simultaneously depressed the cannister on the device. Again, a short puff of powder hissed into the boy’s mouth. The pharmacist encouraged the child to take several deep breaths to drive the medicine deeper into his lungs. Jake shook the inhaler again and administered another puff a minute later. He checked the boy’s pulse and respirations as patients gathered and gawked.
Helen called from the pharmacy over the repeated dings of the drive-thru bell. The impatient driver outside–unaware of the crisis inside–was mashing the button. “An ambulance is on the way,” she shouted.
A few minutes later, the color began to return to the boy’s face and the cyanotic tint of his lips began to fade. His chest began to move with deeper, regular inspirations and the wheeze from his throat eased.
“There it’s working,” Jake said.
Mom loudly exhaled relieved sigh. It was apparent, she had been holding her breath. “On my God!” Thank you…thank you so much!”
Mom hugged her son tight to her chest and caressed his hair with a thumb. A patina of sweat glistened on the child’s skin. Jake placed his fingers on the boy’s wrist and checked his pulse once more. He counted the boy’s respirations.
Satisfied a crisis had been averted, he stood and said, “EMT’s are on the way.” He glanced around at the patients who had witnessed his intervention. A few had left. Those remaining peered at him with a newfound awe. One, an older man, said, “Great work, young man!”
The paramedics arrived and Jake relinquished care of the mother and child to the first responders.
Jake simply nodded and strode slowly back into the pharmacy and was greeted by three ringing phone lines, the incessant buzzing of the drive-thru and a stunned Helen. The tall stacks of prescription baskets listed precariously to one side like a dying plant.
“What do we do now?” Helen asked minutes later barely above a whisper.
The paramedics had loaded the youngster onto the collapsible stretcher accompanied by the relieved mother who made eye contact with Jake. She folded her hands in front of her in a prayer-like manner and mouther the words, “Thank you so much! I will be back.”
Jake moved his gaze to his technician and rolled his shoulders into a shrug and replied, “I guess we get back to work.”
To Be Continued…
If you have a pharmacy story or a story (heroic or challenging) of everyday life in your pharmacy, send it to me by clicking the link below…
Pharmacy Access Saves
One observation all pharmacists understand is the nearly unlimited accessibility of pharmacists to the general public. For patients, this is a convenient and sometimes vital service. For pharmacists and their technicians, it is can be an extremely satisfying aspect of our jobs. At times, this ease of access can cause workflow problems for the very busy professionals behind the counter. In short, pharmacy access saves.
In this blog, I endeavor to highlight the great things we pharmacists do in improving the lives of our patients and to show how pharmacy access saves; and to educate the public and the industry about the obstacles and dangers inherent in a complex, overburdened retail pharmacy system.
I Need A Shot
Here’s an example of a wonderful service I was able to provide recently: An elderly woman called the pharmacy asking if she could receive a tetanus shot. She stated that she had cut her leg when the woman and her husband were spreading a manure over a garden. The woman was a regular patient with us. I was able to review her medication profile and run a report from Virginia’s Immunization Information System. She had not received a tetanus immunization in twelve years.
We were quite busy at the time (as usual). But I instructed her to come in right away. With the help of my competent technical staff, we moved around some workload to accommodate this patient. When she arrived, I inspected her wound. Luckily, it was not a deep laceration and did not appear to require sutures or an ER visit. And she said she didn’t want to go to the doctor. I administered her the tetanus shot and instructed her on how to care for the wound. Keep it clean. Apply triple antibiotic ointment. Watch for any signs of infection. The patient was extremely grateful for our speedy attention to her need.
We’re Not a Fast Food Restaurant
This situation is a perfect example of the benefit pharmacists and their technicians serve. She was able to come in without an appointment and receive her shot. This was a patient in true need of an immediate action from the pharmacist (unlike many of the overly demanding patients we sometimes encounter who think we are nothing more a pharmaceutical fast-food restaurant…this public image is one that our industry has cultivated over the last forty years and must fix! New York Times Article). And we averted the need for a visit to the doctor’s office, urgent care center or emergency room.
eMail Me Your Story
Pharmacists and pharmacy techs or patients: Please email me with your stories of how you really served your patients well. I would love to highlight them in this blog. Tell me how Pharmacy Access Saves.
David Perry is a best-selling author and pharmacist. His medical suspense thrillers about pharmacy, medicine and healthcare are available in print, digital and audio formats are available where ever books are sold.