More Than Just Refills
by Shannon Rotolo, PharmD, BCPS
I work as a specialty pharmacist at a large hospital. My team and I run a program to help patients fill prescriptions for complex or high-cost medications at our on-site specialty pharmacy every month. We schedule a delivery of their refills, review side effects or other medication changes, and assess for barriers to medication adherence. Our workflow has not changed much since the COVID-19 pandemic began; only now more of us work remotely. One thing has changed: I’ve realized how attached I feel to my patients.
During the pandemic, I started receiving more messages from the pharmacy technicians with whom I work, like this one: “Call Attempt 5 - unable to reach” tied to a patient’s name.
In mid-March and April, I’d think to myself, “Well, that’s weird; Mr. So-and-So always answers.” Then I’d call that patient every day for a week with no answer. “Well, that’s weird; he usually picks up on the second or third ring.”
I’d see nothing out of the ordinary in the chart. I’d notice appointments scheduled with a primary care physician or a pulmonologist in 6 months to one year. But patients need prescription refills every month, so often a patient’s chart would lack any new notes between refills. That’s not unusual. But, Mr. So-and-So always answers. Sure, maybe it’d been on the fourth or fifth ring the last few months, maybe his lung disease was progressing, and it was taking him just a little longer to get to the phone, but in the past he had always answered my calls.
Eventually I’d reach out to emergency contacts. These might be out-of-date or simply not a reliable source of information – invalid phone numbers or a sibling that lived out-of-state and only spoke with the patient infrequently. So I’d search the internet.
Sometimes I’d find obituaries. Same city or town. Same date of birth. A date of death between the last prescription refill and that day. And then I, the pharmacist, would have this information, this heartbreaking news, that I needed to share with the rest of the team.
I felt under-equipped to do it. How do you break the news to someone that a patient they’ve been treating for decades is gone? What are the right words to use? This wasn’t something we’d covered in pharmacy school. And considering who I needed to contact, it felt even more impossible. I work with physicians in our pulmonary clinic, physicians who were often also working in the COVID-19 units, floors our hospital had converted to intensive care units (ICUs) to handle the sudden influx of patients when the pandemic first hit Chicago. They are critical care experts and deal with life and death situations every day. They’re more comfortable than I am at talking about it, at sharing this type of news. They have training. They have years of experience. And here I was fumbling through that conversation, at the end of their long day under stifling layers of personal protective equipment (PPE), there I’d be on the phone or in their inbox with a poorly worded message full of awkward condolences.
I love being a pharmacist. It is a privilege to be one of the most accessible members of the healthcare team, to have the opportunity to speak with patients every month, to hear their stories, to laugh at their jokes, to get to know their little quirks, and build a unique rapport by talking so frequently. But it’s also heartbreaking to lose those relationships.
I feel anxious now calling someone whom the pharmacy technicians haven’t been able to reach. What was once an ordinary, uneventful part of my day-to-day work has become one of my more stressful tasks: listening to a phone ring, hearing a recording that a voicemail box is full and unable to accept more messages. Months have gone by, and while the frequency of those calls has leveled off, it’s certainly not over. Our state is reporting its highest numbers of cases per day. I know I’ll have more difficult conversations in the coming months. I’m getting better at it, but this isn’t a skill set that I’d wanted or planned to grow this year.
For now, I’m trying to take a few moments to appreciate the time I have with each of my patients. After that initial wave of relief when someone answers the phone, we go through our usual questions about medications, but then we’ll talk about what’s giving them hope or getting them through this challenging time – video chats with grandkids they aren’t able to see right now, sitting in a small garden just to get out of the house, a good book – and I end the call confirming they have a mask that they’re comfortable wearing, they had a flu shot or a plan to get one, and I ask them to stay safe. These little connections are a bright spot in my day, and hearing patients share what they’re doing to care for themselves and their communities makes me feel hopeful, and like we are together in some way even if we aren’t together in person right now.
