I keep my head down and don’t say anything as they walk away shaking their heads.
Then I sit back down and study old college textbooks, read medical journals, and scroll through package inserts attached to each prescription bottle, memorizing every mechanism of action, bioavailability, contraindication, drug interaction, and adverse effect.
I study all night long, waiting for the next customer to walk up with a prescription, a question, or a disease. Then I do one thing. I follow the routine.
Until four o’clock.
At 10:45 a brunette with bloodshot eyes and a pink-studded tongue ring slides over a prescription for clarithromycin, opens a bottle of Diet Coke before paying for it, and tells me she got strep throat from kissing her boyfriend, Jake.
“And he got it from kissing that slut Joanna Jenkins.” She jams her bar-stamped hand into her purse, pulling out a flask and pouring some kind of brown liquor into her soda bottle. Then she rips open a bag of potato chips off the shelf and stuffs a handful into her mouth.
No physician signed the prescription, so I call the City College Med Center to verify which doctor wrote it.
Red splotches wrap around her collarbone. It could be hickeys from her boyfriend, but my medical opinion says they’re spider bites. They run down her chest, disappearing into a mountain of braless cleavage and a see-through white tank top.
She scratches above her collarbone. “It’s like I have Joanna’s DNA inside of me now.”
When different doctors keep putting me on hold, no one remembering writing the prescription, she says, “I didn’t even see a doctor. I just sat in the waiting room for an hour, and a nurse brought me a prescription.”
Strep accounts for only 10 percent of all sore throats in adults. Viruses cause the other 90 percent and produce coughing, sneezing, and nasal congestion—all symptoms of the common cold.
When I ask if the doctor stuck a long Q-tip down the back of her throat, she says, “I don’t let anyone stick anything down my throat. Unless, that is, he’s really cute.”
Doctors swab a sample of cells from the back of the throat, add the sample to sodium nitrate and acetic acid, and within minutes they can locate a specific protein found in Streptococcus pyogenes bacterium.
Finally, after a resident tells me to fill the prescription and stop tying up his phone line, I walk to the register, put my head down, and ask if she has any questions.
“Can you get strep throat from oral sex?” She stuffs another handful of chips into her mouth, washing them down with the last of her Diet Coke. “Giving oral, not receiving it. Does that make a difference?”
I scan the empty pop bottle and empty bag of chips into the register, pushing them into a pile of mixed amoxicillin suspensions, cigarette butts, ripped magazines, and every other piece of trash my customers dump on my counter each night.
“Because then maybe I got strep from Ryan,” she says. “Or Bruce.”
I want to look this girl in the eyes and say the 10 percent who have strep throat wouldn’t be able to eat potato chips, drink soda, and talk without pain, how they’d be sipping hot tea, sucking lozenges, and wondering why it felt like they were swallowing razor blades.
Instead I keep my head down and say she probably doesn’t need the medicine, that maybe an anti-inflammatory would work better.
She swipes her credit card and leans over the counter, looking around the pharmacy. “Where’s the other pharmacist? The cute one with the hot swimmer’s body. I wanted to ask him out tonight.” Then she scratches her collarbone again.
Hickeys go away on their own within a week, while severe cases of spider bites can lead to a staph infection in the bloodstream, causing headaches, stomach cramps, and loss
of consciousness.
But since she starts stumbling down the first aid aisle—now chugging directly from her flask—there is a good chance she will experience each of these effects before morning.
She drops the empty flask into her purse and pulls out a cell phone.
I wonder which lucky guy it will be tonight.
Jake. Ryan. Bruce.
“Hey, Steve, it’s me. I’m heading back to the bar. Want to hook up later?” She pops two pills into her mouth and staggers down the aisle. “No, don’t go out with Joanna Jenkins. She’s such a slut.”
Drunken, horny college girls are always entertaining.
I’m a pharmacist, but on ladies’ night, I’m also a temporary babysitter.
I walk over to the sink and wash my hands, rubbing the antibacterial soap over still-bleeding cracks in my knuckles. Then I sit down, open up my Microbiology 100 textbook, and resume studying.
Side effects of clarithromycin overdose are vomiting,
vertigo, and pancreatitis.
Only six more hours until four o’clock.
Third shift in a pharmacy means fewer customers. It brings fewer prescriptions and even fewer questions. And it provides more emergency room prescriptions for sore throats, ear infections, and runny noses.
It means more antibiotics.
Doctors cannot run tests on every patient with an infection. Government regulations force cutbacks on throat cultures and blood work, tests that require longer patient stays and cost hospitals more money.
So doctors overprescribe antibiotics for colds and viral infections. Or they prescribe broad-spectrum antibiotics that treat a large array of different bacteria.
If doctors don’t know what’s causing the infection, then they have to guess how to treat it.
Over 130 million prescriptions for antibiotics are given out each year. And half of them are for the common cold.
People demand amoxicillin for ear infections. They think every sore throat is strep. They don’t believe they will get better by drinking fluids, getting plenty of rest, and letting the virus die on its own after seven days.
Prescription medications go through years of clinical trials. During these trials, some patients unknowingly take sugar pills as opposed to the actual medication. Up to 50 percent of these patients drop out of each study because they claim the sugar pills cause unbearable side effects.
If you believe you are taking medicine, then your body reacts like it is getting medicine.
This is the placebo effect.
We can make ourselves believe anything.
As a pharmacist, I see all the potential diseases floating around. Every red splotch above a collarbone could be a minor case of hickeys, or it might be spider bites that eventually spread to a deadly blood infection.
But if no one directly asks me a question about it, I keep my head down and let them believe whatever they want.
It’s better to be a ghost than to try and be a savior.
It’s all part of the nightly routine. Until four o’clock.
Until right now.
At four in the morning the world stops. For one hour.
The phone forgets to ring. The front door stays closed. The soft buzzing from the fluorescent lights fades away.
For one hour between four and five, no one is sick. No one needs a prescription filled. No one has any questions.
Three o’clock is late. Bars close by two thirty, leaving stragglers swinging in for cigarettes and condoms and Doritos.
Five o’clock is early, people turning off their alarms and getting up for work.
But at four o’clock, for one free hour every night, I am completely alone. And that’s when I scan the 9,516 drugs surrounding me on the shelves.
I could walk over to the shelf and make a meal out of a heaping handful of Vicodin, and within twenty minutes those tablets would plummet my heart rate, make my muscles go limp, and turn my skin cold, clammy, and blue, all while chewing a hole in my liver and pushing me into a full-blown coma.
I could take thirty of those chalky white potassium chloride tablets used to treat hypokalemia, and the potassium would paralyze my muscles and scramble my heart rhythm, not stopping until finally giving me a heart attack.
Then there’s
zolpidem—the quick-acting imidazopyridine —and a bottleful of those would let me drift off to sleep, escorting me into a pillowy coma as my heart slowly
stops beating.
Any drug can be a poison, depending on the dose.
Especially the drug erythromycin, an antibiotic used to treat bronchitis and pneumonia. I should have learned that it doubles your chances of sudden cardiac death due to ventricular arrhythmias. And if it’s taken with a blood pressure drug like diltiazem, which inhibits the CYP3A enzyme used to metabolize erythromycin, this increases erythromycin’s concentration in the bloodstream, trapping salt inside heart muscle cells, prolonging the time in between heartbeats, and triggering fatal, abnormal heart rhythms, which eventually cause the heart to stop beating altogether.
I was supposed to remember learning this in school.
But I will never forget it now.
Side effects of dispensing erythromycin are insomnia, endless bouts of guilt, and the nightly urge at four o’clock to swallow an entire pharmacy and drop dead on the floor between the birth control and asthma inhalers.
I look down at yesterday’s newspaper. The obituary says Edith Reddy passed away at home alongside her loving husband. It doesn’t mention my name. Or the word murder. But I know the cold truth.
Pharmacists can kill anyone at any time, just by handing them a bottle of pills.
The only admirable thing to do now is take one final dose of my own medicine.
Survived
Gus Moreno
Four summers ago I stopped waking up to watch X-Men and slept the extra two hours until Saved by the Bell: The New Class. And during that summer—when Jordan came out of retirement for the first time and six hundred people died from the city’s heat wave—a man collapsed in my grandmother’s building. When she woke up that morning I was sitting in the living room, inches from the TV with a bowl of cereal resting in my lap, my legs wrapped Indian style. Instead of telling me to move back, she asked why I never wore the pajamas she bought for my birthday.
“The one with the footsies?”
She didn’t answer and walked towards the kitchen. Then the phone rang a full Zack Morris monologue before she finally picked up. Grandma walked back into the living room, the phone nestled between her left ear and shoulder. “Take the bowl and go outside.”
“Why?”
Her eyeglasses slid down the bridge of her nose. “Go outside and wait for your tio.”
My shorts snagged on the front steps. The paleta man wheeled his mobile freezer to the curb, but I told him no thanks. He pedaled on past me and jingled the bells along his handlebars.
Tio Raúl double-parked in front of the house and rushed to the door. “Are you okay?”
“I’m fine. Can I go back in?”
“No.” He traded glances between the second floor windows and me. “The light guy collapsed upstairs.”
“No way.”
“Yes way. Where’s Grandma?”
From what she had said, Doña Rosa paid a visit to the electrician working in the empty apartment next to her. She knocked twice with no answer. When she leaned against the door it creaked open, and there the man lay, facedown with his body collapsed on his arms. Doña Rosa dropped her pitcher of rice water and called my grandmother.
Outside, two men dressed in oil-stained jumpers walked past the stoop. They talked in Spanish and way too fast for me to understand. One guy pointed to his crotch, and the other one laughed. When the two were almost down the block, I could still hear them calling each other guey, which sounds exactly like way.
Way. Way. Way. Way. Way.
From inside the house, my uncle yelled into the phone, “Damn it, just go back in and check his pulse.”
The electrician’s pulse.
Across the street, a woman stepped out of her car to make sure she didn’t hit the curb.
Upstairs, the rice water pooled around the electrician’s body, soaking into the carpet, seeping between the cheap clip-together floorboards. Already dripping onto the drywall below, my grandmother’s ceiling. Moisture and time would turn the rice water into a moldy outline of the electrician’s body. It would be months before it showed through the ceiling, another few weeks before my grandmother noticed it. Something like a man’s shadow hovering above us in the living room until my uncle replaced the drywall.
Paulina lived on the third floor. Every tenant had to walk down my grandmother’s stoop to exit the building, and as I turned around, Paulina was walking down the steps that led to the rest of the apartment floors. She stopped next to me and said, “Don’t go upstairs.” Her purple lips turned yellow when they pushed against each other to make words.
Even with only bums and churchgoers roaming the streets this early, an ambulance would take some time.
The running joke was that out of the six hundred deaths that summer, Latinos only accounted for 2 percent of the heat-related fatalities. The people stereotyped as overloading cars and living in cramped spaces like ants in the wall, they were outliving the rest of the city. Everybody laugh.
Grandpa died that April, which ruled him out as a casualty to the heat. A cousin who wasn’t really related to me recorded the entire wake and funeral to send to relatives in Mexico, but after he passed around a bottle of mescal with my uncles, the tape went missing.
Grandpa’s funeral came and went, and summer vacation meant a whole season flipping through cable channels with a blank tape inside the VCR, the TV set up to record anything with sexual content or brief nudity. Anything with Demi Moore would do. I sat alone at home while my mom waited tables. Never answer the door, she would tell me, but answer the phone because the answering machine had stopped working. One day the phone rang, and the caller ID read my grandfather’s name.
My dead grandfather’s name.
He couldn’t hold a job so my grandmother paid the bills. She put everything in her name. Every ring created a new explanation for how this could be happening. He was calling to me as I raised the phone to my ear. His cold voice freezing the side of my face, his throat coarse and dry from the soil buried over him, he called me mijo. He asked his mijo how he was doing.
“Qué pasa?”
It’s hazy whether the phone dropped from my hand or if I hung up on my grandfather. The one thing that sticks out, I wish I forgot: running out the front door and crying to no one but myself. The moment you hear the voice of someone who should be lying in a satin-lined time capsule, your mind starts to gather all the rules you’ve learned from zombie flicks. Only old enough to think masturbation is something you invented, you ponder whether you could take a crowbar to the back of your grandfather’s head if he really is part of the undead. But mostly you’re just plain confused.
Five minutes later my cousins called back laughing. The phone in my grandfather’s room was a separate line.
Under his name.
And still in service.
My uncle peeked out from behind the doorway. “Paramedics show up?”
“Nope.” I handed him my empty bowl to take into the house. He set the bowl on the floor and headed upstairs.
I could see the park from our stoop, it being only a block away. Three Asian women practiced karate moves in slow motion. A stray dog limped past me. Tio Raúl checked the electrician’s pulse while two boys from across the street clapped to get the dog’s attention. They were wrestling in the baseball field, and beige dust created a cloud around their heads as they clapped and howled. Doña Rosa was somewhere sprawled in her apartment, sobbing.
Nothing went unnoticed, especially in a neighborhood clustered with buildings so close together. A family in one building could smell dinner from a family in another building. It’s the reason the heat stayed concentrated. So many buildings and pavement to absorb the rising temperatures. You stayed trapped inside your neighborhood, your own private frying pan, and things remained hot and only got hotter. The county coroner had to call in refrigerated trucks to store all the bodies that came in during those months. S
o it was nice to have the morning air slip through my shirtsleeves, though I told myself the goose bumps came from spotting Maria across the street. Maria’s mom called out to her as she walked along the sidewalk with laundry bags slung over her shoulder, and I broke eye contact.
The elote man deflated the silence of parked cars with the static from his stereo hanging off his cart of corn. Butter, lime juice, and hot pepper clogged my nose.
I turned my head towards the door and asked my grandmother, anyone, if I could get a corn on the cob.
And a voice echoed back to me. “Sit outside and wait for the goddamn ambulance.”
Grandma never swore. She sneered and squinted four-letter words. The curse came from Lucia who lived three floors up. Her apartment came with no bathroom. She had to use the toilet in the hallway. She always got a pass for the attitude.
The ambulance pulled up without the siren on, only the lights above the truck flashing, barely making a difference through the sunlight. An entire block of curtains opened like fans doing the wave in a baseball stadium. I saw people sliding away hanging fabric to push their faces against the window screen. Comadre Vicky lived in the white building that turned rust at the edges. She pointed out her open window, and Don Juan poked his head out. The paramedics brought out a gurney, and my uncle met them at the door. People opened their front doors and pretended they had left something outside. I couldn’t hear anything Tio Raúl said to the paramedics. His shaking body and clenched fists told the whole story. I caught the words badge number and supervisor before they followed him upstairs. The four señoras who went to church every day slowly trailed off their usual path and gravitated towards our building.
Letí and Isabel both lived two houses to our right. When an ambulance parked outside, it seemed like the best time to sweep their share of the sidewalk. The church señoras were the first to start loitering around our building. Their palms were interlocked with rosaries. Wrinkles hugged whatever life was left in their faces.