To Snort Or Not To Snort (the H1N1 Mist)

Last Sunday, I went ahead to get the H1N1 (novel influenza A) flu mist. Our local hospital was giving it to people who have ‘direct patient care’. Meaning healthcare workers like me who are 3-6 ft away of patients suspected with influenza-like illness. To be honest, I was having a dilemma about this. I wasn’t sure if this is ’safe’ or not. To snort a live virus was not my favorite thing in the world, but if it could protect me from getting the H1N1 (also known as the swine flu or flu babi, as Indonesians say it), I’d do it.

I’d personally prefer the shot version, but only people in this group could have it:

• Over 50 years of age
• Pregnant women
• People who have a severe allergy to chicken eggs
• People who have had an allergic reaction to a flu vaccination
• People who have developed Guillain-Barre syndrome within 6 weeks of receiving an influenza vaccination.
• People who have a moderate to severe illness.

Others asked me, “Why would you do that? Aren’t you scared? I wouldn’t do that if I were you. This is new and still experimental. My body is my temple, I will never get anything weird into it.”

First of all, I have faith in nowadays’ medical breakthrough. I may not be religious, but I do believe in science. I understand it’s a clinical trial, but if I could partake in a scientifically controlled study to ensure the safety and effectiveness of the H1N1 vaccine, I would. Second of all, I would not be selfish -not wanting to try on a possible precaution-  for the sake of my two kids who are the age of 7 and 8.

Back then when measles and smallpox were epidemic, could you imagine if nobody want to try to be vaccinated? Not saying that this H1N1 would be as scary as those two, but the number of deaths is rising.  I bet a lot of people was also pessimistic when Emile Roux and Louis Pasteur were working on the first vaccine for rabies by growing the virus in rabbits. And not too many were very enthusiastic to be administered by the vaccination.

Hopefully the inoculation of novel influenza A (H1N1) will be as successful as Edward Jenner’s smallpox. If a milkmaid from the 17th century could do it, so could we.

My body is my temple, and I’d like it good and strong to last a long time.

**Here is more info from CDC about 2009 H1N1 and Seasonal Flu**

Dante Survived Myringoplasty

Dante’s myringoplasty last Tuesday (1/27) was uneventful. It was the fastest recovery I’ve ever witnessed from my children. My son and I left the house around 6:15 am and it was still dark. We got to Mary Greeley hospital at 6:30 am, have them valet park my little Scion for free, then walked in to register.

Right after we walked in to the building, we informed the greeter that we’re there for a procedure. She took Dante’s information and gave us a beeper/pager (the kind that Old Chicago restaurant has); we’re supposed to go to the business office area once it beeps (and vibrates). Ten minutes later, our pager/beeper vibrated. We went to the business area and was helped by a nice representative, Jody. She took our information such as address, phone number, emergency contacts, insurance carrier, member number, etc. Fifteen minutes after that, we were given a folder to go to the next area, which is the waiting room for the Short Stay unit.

There, another nice middle age lady greeted us and said to Dante, “Hi, you have something for me?”
Dante handed her the folder and was asked his name.
Meekly, he answered, “Dante.”
The lady then asked, “What’s your last name, Dante?”
Dante gave his, and the lady gave her a different pager and said, “When this buzzed, a nurse will come out to get you and Mom, OK?”
Dante nodded quitely.
He’s getting nervous, I could tell.

About fifteen minutes later, while Dante was coloring the activity book that the hospital had given, the pager buzzed. He looked up at me and gave this ‘Uh-oh’ look. The door behind the receptionist area swung open, and a nurse called out, “Dante?”
I gathered our stuff and winter coats, and gently told my son, “Time to go, buddy.”
“Well hi there. What’s your name?” she asked my son.
“Dante.”
“Hi, Dante. My name is Pam and I will take you to your room, OK?”
As we walked along the sterile hallway, the nurse kept chatting with Dante about his age, which school he goes to, if he has a brother or sister, and what he likes to do.

still in good spirit

We got to our room and Dante was asked to change into a hospital gown. Then she asked us to follow her to get Dante’s height and weight. As we were walking, Dante tried so hard to keep the gown (which tied at the back) to cover his ‘behind’. I whispered to him, “Don’t worry hun, Mom’s right behind you, I’ll cover it.” Then he gave me a wink and a thumbs up.

After that, another nurse stopped by one more time to go through some medical questions and to get my signature for this procedure. Dante was given a monkey stuffed animal, and a ‘bracelet’. After that, it was the waiting game. The clock was showing 8:15 am, and we’re still in the room. Good thing they have cable, so Dante was content watching Spongebob. Around 8:20 am, a nurse came in to our room and told Dante that it was his turn and I could go with him until the Preop room. Now it’s my turn to be nervous. Preop room is basically an area where patients wait before being taken to the Operating Room (OR), and put under anesthesia. On our way from the Short Stay unit to the Preop room, Dante’s holding my hand all the time. He refused to lie down on the bed, he wanted to sit up straight. As we’re turning left and right on what seems to be an endless hallway, Dante kept on whimpered.

more anxious

The preop room was a bit ‘intimidating’, even for me as an adult. It’s so… sterile.  Gray wall paper. Cold. More medical gadgets and monitors. More nurses and physicians, wearing scrubs, surgical mask, and surgical hat. A nurse took a blanket from a warming drawer and wrap it around Dante’s shoulder.  She then put a surgical hat on Dante’s head. “Oh you look so cool.” She was trying to be funny, I know. But it made Dante’s nervous even more. His mouth mere shaped like an upside down ‘U’ and his eyes were starting to water.

Not too long after that, the anesthesiologist stopped by. The way he explained to Dante about the anesthesia process (using gas mask instead of needles) was amusing. He also let me know that Dante will be in the Recovery Room after the surgery for as long as he would need to. Apparently the anesthesia will go away faster if the patient would be able to ’sleep in’. He put the pulse ox on Dante’s finger to check his oxygen saturation in his blood. Dante cringed at first, but he told Dante to look on the monitor, take a deep breath, and watch the number jumped up. “If you wiggle your finger, you’d make the line go up and down like.” So Dante did, and exclaimed, “Hey, I just made a mountain!”

Shortly after, the surgeon, stopped by. We chatted a little and he said it shouldn’t take him longer than 20 minutes to do it. “Any other question for me? No? Alrighty then, let’s get this party started,” he said. His nurse then started to move Dante’s bed out to the OR and said, “OK, let’s go, Dante.” I think that’s a sign for me to go. I walked with them out of the Preop room, kissed Dante on the forehead and whispered, “Don’t worry, you’d be fine. I will see you soon.” We gave each other thumbs up. I watched them walking away, another door swung open automatically and closed behind them. Through the circular glass, I could see them getting farther and farther, then they turned left and disappeared from my view. I choked.

after surgery

I sat in the Short Stay unit room trying to concentrate on the book I was reading. Every now and then I saw some children were brought in after surgeries and the younger ones were heard crying. I put on my iPhone and listened to Pandora. Twenty minutes later, Dr Ford came in and told me that the surgery’s done and he was happy to see Dante’s ears were both dry and healthy. Infections had gone away right in time for the surgery. He reminded me to make a two weeks follow up with him. Fifteen minutes later, Dante came back. He was lying on his tummy and was snoring. As soon as he heard my voice (thanking the nurse), he woke up and complained, “Mommy, I feel dizzy. I don’t like it.” Tried to comfort Dante that he’s OK and the ‘dizziness’ will go away faster if he could go back to sleep.

Hubby walked in and his deep voice awaken Dante which started crying for no reason. He told Dad the same complain, and hubby said, “Honey, your head is feeling the same thing like mine when I drank too much beer. It will go away soon.” He felt especially better after the nurse gave him a popsicle since he hadn’t eat or drink after midnight the night before. “Now I feel so much better. This popsicle really helped, Mom!” Even though the nurse warned us about the possibility of nausea, Dante said he was very hungry and wanted McDonald’s breakfast. “Well then McDonald it is! The boy just had a surgery, he could do whatever he’d like, eat whatever he’d want,” declared hubby.

Dante and I left the hospital around 10:30 am, with a big “Get Well Soon” balloon from the hospital; straight to McDonald’s drive through. Got home, ate on my bed while watching a movie, then we both fell asleep for about an hour and a half. When we woke up in the afternoon, he’s back to his normal self. How did I know that? The first thing he said was, “Mom, wake up. I’m hungry. Super hungry.” His sense of humor came back and he didn’t feel sicky anymore, wants to get going and going just like the Energizer bunny.

He’s back to school by the next day.

Dante’s Myringoplasty Tomorrow

My son Dante is going to have a myringoplasty tomorrow. No, it’s not a fun dance lesson to learn merengue. Quite the contrary. It’s a surgical procedure (minor surgery), to repair a hole in a child’s eardrum (tymphanic membrane). In my son’s case, after removing the ear tubes. In this surgery, the hole is going to be covered with a small piece of a special paper or gel foam that temporarily seals the hole, encouraging the body’s normal healing processes.

The ENT physician thought this was needed because my son’s been having a lot of ear drainage and to a point, a staph infection. I thought this was ironic because they wanted to put the tubes in (my daughter had a pair too, but hers fell out by themselves since a year or two ago) because the kids were prone to ear infection.

My concern was, this type of surgical procedure requires anesthesia. I’m guessing through a mask that carries air mixed with medication and I heard that the child may choose a favorite scent to flavor the air flowing through the mask. There are no shots or needles used while the child is still awake. With anesthesia, there’s always a tiny possibility that you might not be able to see them waking up. Kids or adults. There are also debates that surgery drugs will kill kids’ brain cells.

The ENT physician himself admitted that he could do the procedure as an office call and my son wouldn’t have to be under anesthesia. But he wasn’t sure if my son would be able to endure the pain. Imagine somebody poking a microscope to look at your eardrum perforation through your ear canal, then pull the tube out, finished by inserting some kind of paper ‘patch’ to close up the hole. This sounded painful to me, let alone to a six years old boy. I don’t even like it when a nurse check my temperature on the ears.

We were told to check in at the hospital at 6:30 am tomorrow morning, and then wait for about an hour to an hour and a half before the surgery starts. My son was not supposed to have anything to eat or drink after midnight tonight. This is going to be hard, since the first salutation in the morning I’d hear from him has been always, “Mom, I’m hungry.”

Oh For the Love of Breasts!

October is ‘Breast Cancer Awareness Month’. Coincidentally, Rimster tagged me to write a post about boobs. Now, just how do I achieve that without making it sound like porn or sounding like a narcissist? They are just a lump of meat, but men are surely can’t get enough of those mammary glands. For some reason, [although it's considered rude] it’s fine for men to stare at them when they’re talking to the other sex; but when a woman stares at a guy’s crotch when having a conversation, it’s uncalled for. Go figure.

Anywho, I’m happy with my kaboobies. They are not gigantors, nor they’re bare. They are there, and just the right size. Normal size breasts women should be grateful because:

• They don’t give us back pain. I know a nurse who went under breast reduction surgery because they’ve been giving her back pain for a decade. And many more patients with the same health concern.
• Comfortably wearing the right size for tops. The nurse I mentioned above told me, before the reduction, she had to buy one size bigger for tops. Just to get that ‘extra room’ on the chest area but it ended up with other problems like the sleeves are too long or the tummy area is too big. Now she can wear her size M just right and not needing the bigger size just the get ‘everybody’ fit in the chest section. Additionally, I never worried when wearing a shirt/blouse with front buttons, that ’something’ is showing between the buttons.
• We could run, hop scotch, jump up and down without that ‘boink boink’ sound effect like a slow-mo movie clip.
• We’ll always certain that the person we’re talking to is having eye contact instead of boobies contact with us; and is really listening to what we say without the dirty thoughts running through their mind.
• We won’t have trouble doing the breast self-examination to screen for breast lump. We should feel the slightest lump right away. One of the physicians I work for did say that it’s harder to look for the lump for big breasted women, due to the excess fat/tissue of the breast.
• Thus, when it comes to do a mammogram, it’ll be less painful.

Tag… you’re it! to Katadia, Santi, Yoyen, Eva & Lalita.

Weird Injuries

It’s Monday. The only day weird things are supposed to happen. Plus, it’s [almost] full moon, folks said. We tend to blame out-of-whack craziness on full moon anyway. So when a patient called this morning stating that he needs to be seen because he threw his back the night before, I asked if this was a work-related injury or not. Because if it was, then his company needs to pay for it and he should be seen at a different department (Occupational Medicine). When the answer was ‘no’, he further explained that it happened at home. He sneezed so hard, he threw his back! Seriously. What a weird injury.

Couple of hour later, a young lady called stating that she just had a ‘high heel accident’. She apparently got a job interview and was wearing her high heels. At this time, I was going to guess that she had missed a step, therefor sprained her ankle. But she said it wasn’t it. “I actually was practicing at home, going up and down the stairs with these high heels. Who would know that the steps or stairs were not solid and have holes on it?” She was probably referring to the artsy, industrial-looking steps/stairs made out of black steel which do have lots of holes. Her heels were actually stuck in those holes, and she fell forward and hurt her knees. Good thing that it happened after her interview. Another weird injuries.

A friend of mine who is also a physical therapist was bitten by her own dog on the throat. This was actually last week. Though this would fall under this ‘weird injuries’ category for sure. When she called to ask if she needs to go to the ER or not, I was in disbelief. I jokingly asked, “Do you want me to bite your dog back?” Then when she started crying, I thought, “Oh snap! She’s serious. I better have her talk to her nurse.” Surely enough, after a short triage, the nurse adviced her to go to the ER. Later on that week, when I saw her in the building, she explained. She’s going to give her pet dog a hug, just like usual, before going to work. Normally, she’d get a loving lick from the dog. Instead, it was a bite on the throat, punctured her trachea a little bit. Was it a Rottweiler? German Sheperd? Pit bull? No, no, and no. It was a Beagle. A cute, small, lovey dovey Beagle. Size does not matter in this case.

The only weird injury that I can think of was when I watched one of Will Ferrell’s movies (pretty sure it was the Blades of Glory, the scene where Will Ferrell and Jon Heder do their final routine). I was watching it at home, on my bed. I was laughing so hard, my abdomen cramped. I think I must’ve pulled a muscle. It was so painful, I couldn’t sit myself upright, nor lay down flat. I had to take a couple of Advils to relax it and was finally better a couple of hours later. I watched the rest of the movie laying down sideways, almost in a fetal position. Oh, I couldn’t imagine if I was in a movie theatre.

Have you had any weird injury before?

Free Drug Samples, Anybody?

To the best of my knowledge, drug samples are meant to be given to patients for trials. To see which medication works best for you. Samples were given regardless if you’re insured or uninsured, rich or poor. Let’s say I’m coming in for allergy. Instead of prescribing something right away -for example Allegra- which may not work, given samples -let’s say Zyrtec- to try is really helpful.     

But some people like to take advantage of free samples. Patients and also sadly, clinic’s employee, love to ask for samples even though they’re not being seen by a physician. When I first started working here, I voiced my concern about this, and the reply from a co-worker was, “Don’t worry about it. Everybody’s doing it.” I don’t mean to be all hollier than thou but it really bugs me. I understand medicines are costly, that’s why we have medical/health insurance, but taking drug samples on monthly basis? C’mon…

I noticed there are three different types of drug sample requestors. The first one is what I call ‘In Betweens’. Patients who are out of meds refills but couldn’t get in to see physicians soon enough. They’ll be out of meds until appointment date, but don’t want to pay for short-period refills. Typically, they’d call and say, “I couldn’t get in to see Dr. X until 3 weeks from yesterday but I’m going to be out of meds. Do you guys have any samples to get me through my appointment date?”

The second type is the ‘Flip Floppers’. Those who think a medicine should be able to cure the sickness in 24 hour. ”The sample given yesterday by Dr. A isn’t working; I still feel bad. Can I get a different sample?” Or patients who don’t like the way some medicines ‘work’. “The sample given by Dr. B a week ago is working for my depression, but it’s making me gained a few pounds. Could I get a different sample?” For one, medicines do need some time to ‘kick in’, even antibiotics. A lot of things need to be considered when you’re trying on samples; like if you’re diabetic or have blood pressure problems. And especially if you’re on so many different meds. There’s no such thing as ‘the magic pill’.

The worst one is the ‘Freeloaders’. I understand why the uninsured ones are doing this, but the ones with insurance? Unbelievable. Some scenarios:  

• “Hey, can I speak to Jane (Dr. X’s nurse)? This is John. I need my monthly samples for Lipitor 20 mg. I’ll swing by tomorrow around noon to pick it up.”
• “Hello, this is Mrs. so and so. Mary (Dr. Y’s nurse) told me that anytime I need more Nexium, I could call you guys and she’ll give me a bag of it.”
• “Is Dr Z’s nurse available? I need my monthly samples.”

And a hundred more different ways of them requesting free samples. The very frustrating part is, some of them have insurances. And how do I know this? It’s there in the patient’s database. So when I couldn’t resist the frustration, I just asked, “Oh? You need samples again? Do you not have health insurance? What’s that? Oh, you do. Any problem with the insurance or something?”

Sad thing is, our clinic’s employee are doing it too; for themselves and/or family members. Almost everybody. They are as bad as those naughty patients. 

When I had my pap smear appointment, I was offered by the midwife to take home some samples of birth control pills. I was ‘in between’. I told her I feel bad taking free samples from people who need it more than me. She said it’s OK and that I as an employee have ‘the right’. Still doesn’t feel right; so I said ‘no’. I don’t feel it’s right for me that just because I work for the clinic, I’m entitled to gorged myself with samples. I do take Advil or Tylenol samples from time to time when I have a tension headache at work from time to time. But not on a regular basis and for more ’serious’ medicine. 

This source shows that patients with the highest incomes were the most likely to get free samples, according to a survey of nearly 33,000 Americans in the February issue of the American Journal of Public Health. Only 28% of those who got samples were poor, whether insured or not, with incomes less than twice the federal poverty level — $18,400 for a family of four in 2003, when the survey was taken. The study doesn’t suggest doctors deliberately discriminate against the poor. Study author Sarah Cutrona, a hospital doctor with Cambridge Health Alliance in the Boston area and an instructor at Harvard Medical School Cutrona says many poor and uninsured people never get to see a doctor and more often visit public health clinics or emergency rooms, where samples may not be available, or go without care.

And here I am, just got done talking to a patient who requested her monthly free samples of Cymbalta. Tsk… tsk…

If Two-Faces Baby Were Your Child

Why do parents put their kids on braces? Why do they want to spend a lot of money and time to make sure their kids’ smiles are perfect? When their teenagers are starting to have acnes, why don’t parents mind spending cash on dermatology products and consultation? Why are parents okaying their youngsters’ wish to switch the glasses to contact lenses? Giving the health-related answers would be very common, but let’s be frank: it’s to make them look good.

I’ll be honest. I had my mole on my face removed 7 years ago because not only it was noticeable, but it started to itch and growing in size. Again, health reason and look-awareness. Why did I agree to suffer multiple tooth extraction and braces tightening for 28 for months? Sure my dentist was concerned about my mouth being over crowded (I used to have 32!) and it was hard to keep them clean and decay-free. He also mentioned something about crossbite. But to be honest, I hated my crooked teeth. I tried to switch from eyeglasses to contact lenses, especially to go out socializing, but I hate poking my cornea. So then, back to eyeglasses to complete my dorky look.

When my 5 year old son was diagnosed with chronic hyperopia or farsightedness (difficulty seeing up close), I felt so bad. My boy has to wear glasses in such a young age?  I groaned. What if his friends make fun of him? I worried. Spending extra on ’hip’ glasses was our choice. Yes, I still want him to look good besides to able to see.

We all very cautious about how we look. Consciously or not. To ourselves, to our children, to people we care about. Sometimes we care about it too much, we judge people by it. When the Indian baby girl was born with two faces in mid March (read here), I deeply symphatized with the parents. Like the rest of the world, my first reaction was ‘Omg!’. Then as I followed the news, I learned that the father of Lali -the baby’s name, meaning ‘red’ because of her cheeks- had refused the doctors suggestion to have a CT scan to determine whether her internal organs were normal. He felt that his daughter is acting normally, therefor no need for the test.

Lali has an extremely rare condition known as craniofacial duplication, where a single head has two faces. Except for her ears, all of Lali’s facial features are duplicated -two noses, two pairs of lips, and two pairs of eyes. Regardless, her parents who are poor farm workers, think she is fine just like any other child. Even though Lali’s rare condition often linked to serious health complications, the doctors of Saifi Hospital in New Delhi saw no need for surgery. Reason being, she has no breathing difficulties. ‘Nuf said.

As I did more online research on Lali, I found out that some people’s reaction toward the treatment refusal is somewhat concerning. “Why would you as a parent do that [refusing]?!” a coworker exclaimed.

Others worried about the child’s psychological development when she’s growing up. If peers should giving her a hard time. If she’d be making fun of. But since they live on a rural India which is very superstitious and the fact that Lali is already hailed as a return of the Hindu goddess, maybe she’ll be okay. Some says she’s the reincarnation of Durga or Shakti. Living among people who think you have a god-like status is not so bad after all. The village chief wanting to built a temple on your behalf. Hundreds of people want to see you, touch your feet out of respect, and even offer money to receive blessings. Not a bad life, huh?  

I don’t know what would happen should this take place in United States, to an American. Would the parents undergo a surgery to ‘fix’ the baby? Look at Abigail and Brittany Hensel. Born 18 years ago, the conjoined twins are still inseparable and live happily with their mom who is a registered nurse and a carpenter/landscaper dad. The twins have made many media appearances and have a younger brother and sister. I think they have an amazing parents who don’t judge a book by its cover and love them unconditionally.

Stomach of Steel

Being born and raised in Indonesia, I have the stomach of steel. Meaning I’m used to eat any food that’s been left out (and cooked, of course) for more than a couple of hours without getting sick. Before you say ‘eeewww‘ and crinkle your nose, hear this out. Since we were kids, we’ve been fed food that’s been on the table or cupboard for a while, after it’s being cooked. At home, school’s cafetaria (kantin), and small local restaurants or the street vendors. We were ‘introduced’ to bacteria at such a young age.

Having lived in the US only for 8 years, my intestines were being pampered with the better hygiene that they have here. When I flew back home to Indonesia in 2006, I had a mild diarrhea at the end of my trip. I was hesitant to go to my favourite food street vendor in Jakarta (Sate Ayam Pondok Indah), but I was longing for it and even had a dream about it. But my stomach of steel had helped me going through eating in other countries’ road side food.

The only ‘bad’ thing about it is; I tend to forget that some people don’t have the stomach of steel and they tend to be very cautious to go anywhere in the world that is less ’safe’ and ’clean’ as the US. Working in a medical clinic who also provides travel medicine service, I came across a lot of travellers who are hesitant to go to a ‘poor’ country. Our travel clinic provides pre-travel counselling, immunization advice and delivery, and also immunization certificates (yellow fever). Before I work here, I didn’t know that there is such thing as travel clinic. I didn’t know that yellow fever vaccination is required for countries like Brazil, Paraguay, Angola, and some others.

Personally, I have nothing to worry about to go to places like Mexico or the Caribbeans. I’ll be fine eating their food and won’t fuss about vaccination. But this is not the case for others. Even the most touristy places are questioned by them,”Is there any vaccination needed for Playa del Carmen, Mexico?” 

My smart-ass state of mind would blurt out, “Duh… no. It’s a touristy destination, just like going to Miami, Florida.”

But fortunately I was able to bite my tongue and keep my manner (otherwise I’d be fired by now). The ones that I couldn’t comprehend are, “We’re leaving to Tokyo then Singapore next month. Do we need any vaccinations?” and “Do you guys know if I need to worry about the water condition in Dublin, Ireland? Should we get a typhoid injection or prescription before we go?“

As an avid traveller myself, I’d go places in a heartbeat if money and time aren’t the issue. That’s why I sometime tend to advise patients not to hesitate to travel and not to be so worked up about vaccinations. Just last week, a 60-something old lady called because she’s  travelling to Peru with her husband but was too freaked out when she find out 2 or 3 different vaccinations are needed (plus a malaria prescription). I spent 20 minutes on the phone consoling her. 

“Oh my goodness gracious. Hepatitis A, typhoid, yellow fever, and malaria prescription? Oh this is too much. And I need to have this 3 weeks before leaving? Oh my word… we’re leaving in a week. The travel agent said I won’t need anything,” she said all this in one breath!

Then I explained to her, depending on which area she’s visiting in Peru, she might not need the yellow fever or malaria. She then asked me to hold on while she’s looking for her printed itinerary from the travel agent. I usually am the one who put callers on hold, not the other way around, he he. After a while, she’s finally back on the phone and read me her itinerary from Day 1 to Day 4! Double checking with the CDC website, I was sure that she’s not going to need malaria and yellow fever. Then she questioned what’s the use for Hepatitis A vaccine for. I explained that it’s for precaution for virus which is most commonly transmitted by the fecal-oral route via contaminated food or drinking water.

That’s when she panicked, “Oh no… this is not good. I don’t want to go to a poor country and get sick. Oh my, I better tell my husband I’m not going.”

I felt really bad for her. I told her not to worry because she’s staying in an Americanized hotel; not in a local home. Just don’t drink tap water. Then she went on and on about the quality of the lettuce of the salad which probably would be provided by the hotel. I told her not to worry so much, just enjoy Peru and go to to the Macchu Picchu. This is where I was thinking for myself. I was wanting to scream, “C’mon already, just go. Don’t fret so much. I’ll go if you don’t want to.” But I didn’t. I understand that for some people, ‘differences’ could be very scary. Just like James Michener, an American author, said: “If you reject the food, ignore the customs, fear the religion and avoid the people, you might better stay home.”

… and she did. 

Drug Reps: Friend or Foe?

Working in a medical clinic, I’ve seen a lot of pharmaceutical sales representative or commonly called drug reps. On a ‘normal day’ (meaning nice weather on Mondays or Tuesdays), we could easily see 12 drug reps in one day. Meaning 8 am to 5 pm with an exception of noon to 1 pm lunch break. Since our policy only allows one rep at a time to go back and talk to the docs, seeing reps sitting in the waiting room in their cute outfit, between sick people in their pajamas, is quite ironic.

Other than the nice suit, drug reps also known for being nice and friendly. Too friendly, sometimes. You can always tell which one is genuinely nice and which one’s not. There’s a lady rep which I’m going to call Ms Fufu, for confidential purpose. Little Miss Fufu was probably a Miss-something in her younger years, won some pageants or hailed as the State Fair Queen or similar to that; judging from the way she carries herself. Body always straight, walk elegantly, and smile just enough not to show the whole teeth. She likes to dress to impress, appears like she comes out fron an Ann Taylor catalog. Miss Fufu also likes to carry a little basket filled with goodies, be it a pen, a note pad, or chocolates. When she’s done talking to the docs, she’d stop by at the front desk to do her “Hey… how are you? Oooh I like your sweater” routine. She then would hand the little basket and whispered, “Take a pick, don’t be shy…” I just want to roll on the floor laughing out loud. It’s not like she’s handing us gold coins or something, but the way she said it makes the whole situation so awkward.

And there’s Mr Man. If he wasn’t a model, he should consider to be one. He’s only nice and would smile for the nurses and/or doctors. He would smirk to us receptionists only when he needs something, like a doctor’s state license number or to schedule a lunch. Mister Cool is all chatty when he’s back there talking to the docs or nurses, but all quite and short with the front desk. I personally don’t mind it at all, less BS is better. I do find it interesting how drug reps should appear as nice and friendly, and how most of them are good looking.

PLoS Medicine, a peer-reviewed open-access journal published by the Public Library of Science, did a study on how drug reps make friends and influence doctors and it was published on April 2007. A former drug reps for Eli Lilly who is now with School of Pharmacy, University of California, testified that reps may be genuinely friendly, but they are not genuine friends. Drug reps are selected for their presentability and outgoing natures, and are trained to be observant, personable, and helpful. This amazes me. I mean, I would think the real personality of the rep is actually the one they show to us the receptionist. Be it the meany, boring, bitchy, or the lame one. When they go back to talk to the doctor, then they put this ‘genuinely friendly’, outgoing, etc.

Drug reps are like profiler. The journal above mentioned that reps are supposed to be observant. A couple of years ago, our doctor who heads the department allowed a 10-minute talk with a rep once a week, in his little office. Reps liked that very much, instead of trying to catch doctors in the hallway in between patients. But due to the increasing number of patients need to be seen, the doctor decided to no longer doing the 10-minute meeting with the reps. As the journal continues “…  They are also trained to assess physicians’ personalities, practice styles, and preferences, and to relay this information back to the company. Personal information may be more important than prescribing preferences. Reps ask for and remember details about a physician’s family life, professional interests, and recreational pursuits.”  Hm… no wonder they knew every little thing about our doctors. They’d follow up with questions like “How was your golf trip to Colorado?”, or “Did the knee surgery for your son go well?”, etc.

Sounds like a butt kisser? You bet! Do they deserve to be hated? Wait a second. There is always somebody who has to do the notorious job like telemarketer, debt collector, or drug reps. If it pays their bill, so what? Just because their job is annoying to us, doesn’t mean we have to bash them. Which brings me to Mr Naive. He and his wife work as drug reps and although I don’t know them personally, I can tell that they’re genuinely nice people. One day, I had a bad day after dealing with a nasty and demanding patient. When Mister Naive came in and greeted us, I didn’t answer. When he tried to make a small talk, I didn’t budge. I was still steaming. Ten minutes later, he walked out from the back and as he was signing himself out, I told him I was sorry for being short. He said it was all fine. I explained to him briefly what happened and he laughed. “Come with the territory, right? Don’t worry, you’re not mean at all. I’ve seen mean and I’ve experienced degradation,” he said. He also mentioned that most of the clinics he visit in his teritory really look down on drug reps. How he was treated poorly by the front desk, nurses and doctors. “I was just doing my job and really didn’t mean to offend anybody.”

We are all entitled to pick a side. Some doctors and department managers disagree with the whole pharmaceutical business. One of our doctors who retired a couple of month ago was one of them. He’s still nice to the reps and talk a little (he’d also use the reps’ drug samples from time to time) but he refused to give them his signature. He refused to go to drug reps lunches and would throw away any brochures, studies, or phamplets from the reps. There are so many reasons to dislike the business, but that doesn’t mean one should kill the messenger.

Speaking of No Voice

Hubby’s leaving tonight for Kansas City for a week and I have no voice. I’ve never had laryngitis before. Working as a receptionist, I’d always wish I’ll never have one.

I sound horrible, I scared my dog. But I don’t have any fever or sore throat. Just… no… voice… I don’t know if I’m able to work at all tomorrow, I can’t even hiss.

[... ...!] –> read: This sucks!