Late Night Phone Medicine

During my present night shifts, I field calls from the answering service for our clinic. Last night I had a series of phone calls that make for a retelling that is, at least to other physicians, humorous. I recognized the name from a couple nights previously. It's a schizophrenic patient who (like many schizophrenics) smokes a lot and has some early emphysema as a result. Some of my favorite patients (not that I have favorites) are schizophrenics, and thus I have a special place in my heart for those who have to live with this mental illness. Anyways, last night 1:30 a.m:

"Hi, it's Dr. McLaughlin from the University of Michigan. What can I do for you?"

"Oh, Dr. McLaughlin, I know you from a couple days ago."

"That's right."

"Well, I ran out of my albuterol inhaler, and I need a refill. I usually use it once every 2 days or so. It's not really any worse, but I ran out."

(Thinking: Why does he need this at 1:30 in the morning? He doesn't seem short of breath) "Sure, I can call that in. To the Kroger pharmacy in Milan?"

-our phone call gets cut off. So I call in the prescription to his pharmacy and call him back.-

"I called in the Albuterol. Is that a 24-hour pharmacy?"

"No. Can they Fed-Ex it to me?"

"Uh... no. You'll have to wait until the morning."

"They can't Fed-Ex it to me?"

"No, no one is there at the pharmacy."

"Oh, could you find a 24-hour pharmacy for me and then call me back?"

(Thinking: This is getting ridiculous.) "Uh... sure. I'll do that." I hang up and search google for awhile until I find a 24-hr pharmacy about 20 minutes away and call in the prescription.

"Hi, sir, I found a 24-hour pharmacy and called in the prescription."

"Will they Fed-Ex it to me?"

"Um....no, you'll have to go and pick it up."

"Oh! I have transportation issues. I don't have a car."

"Oh! (Thinking: why did he think this plan was going to work, then?) Well then, I really can't think of any way to get this to you before the pharmacy opens."

"Oh. OK."

I hang up and shake my head and smile. Strange that people would try and deal so ineffectively with these issues at 2 in the morning. I lie back down only to get another page within 10 minutes from the same patient:

"Hi again. What can I do for you?"

"Hi Dr. McLaughlin. I've got 3 cigarettes left, and I'd like to quit smoking. Can you call in a prescription for me for a nicotine patch?"

"Um... no."

He called back again tonight, asking for prescriptions for his albuterol and nicotine patches. I'm not sure why he didn't call during the regular office hours. I called them in again, though the pharmacy closed 20 minutes before he called. The thing is, I'm quite confident nothing medically dangerous is going on. I suppose I can relate to someone with an atypical sleep-wake cycle, being on nights myself right now. And I suppose it's good that he feels he has someone that he can go to with his concerns, though I'm not sure how much I helped. My guess is that it's hard for him to establish those kind of connections. And then, there's the issue that, at some point, you have to stop and inform him of the boundaries for appropriate usage of this phone service. Or maybe it's just one of those quirky, humorous life stories.