By Karen Dempsey
My breasts ached with the need to nurse Liddy as I stood at the pharmacy counter, gripping the prescription bottle of omeprazole the pharmacist had neglected to flavor. I knew that if I gave Liddy the vile-tasting acid suppressor unsweetened she would screw up her tiny face and cry, and when the liquid hit her tender stomach it would come straight back up. I had already delayed her ten a.m. feeding to pick up the prescription; she needed to take it on an empty stomach, before she nursed. I had left her at home with my mother and my eighteen-month-old son, Brennan. She was waiting for me, crying, I imagined, from hunger, and refluxing because of the crying.
The pharmacist’s voice and expression were passive as he stared at a computer screen and clicked the keyboard. “There’s no note here about flavoring.”
I leaned onto the counter, fighting the urge to scream or throw something. This pharmacy—a huge urban pharmacy in a national chain—had already failed to refill the prescription the first time I’d called. This was my third trip here in a week, and I still didn’t have what I needed. “She has to have the flavoring,” I said. “She can’t keep it down like this. I called last night, and they said it would be ready by ten.”
“I can mix it again, but it needs to sit for twelve hours. We can have it for you tomorrow.”
The week before, Liddy had stopped breathing after a feeding. She had just been diagnosed with gastroesophageal reflux disease. At the time, I didn’t fully understand the mechanisms of reflux, and I’d thought she was choking, gagging on spit-up. I had been sitting on the couch, her warm little newborn body curled on my shoulder, when she spit up and then spit up again. Milk surged up out of her mouth and nose, and she suddenly tensed and arched away from me, her face puckered and red. “Okay okay okay,” I said, and turned her over my forearm and vigorously rubbed her back as I’d seen a nurse do at the hospital, when she’d stopped breathing after birth.
Liddy’s face was scrunched closed, and she’d turned a deep purple. John was downstairs, out of earshot. My heart raced as I searched the bassinet for a bulb syringe to suction her mouth. Suddenly she gasped, and breathed, and relaxed into my arms. The incident was over in a moment, so quickly that I had a hard time believing it had happened at all. The next morning, I learned from her doctor that these episodes occur in reflux babies when the esophagus closes off to protect itself against the burning of stomach acid. The closed esophagus prevents the child from breathing. “That scares the heck out of me,” the doctor said. “Next time, don’t hesitate to call 911.”
I thought about saying all of this to the pharmacist as he stood before me, so dispassionate, in his crisp white coat. I could feel other customers watching me, and I knew that I must look like a mad woman—my tearful, red-rimmed eyes framed by the dark hollows of sleep deprivation. Like Liddy, I’d been sleeping for only forty-five minutes or an hour at a time. When I finally spoke, my voice was low and even, though I forced the words through what felt like a knot in my own throat, a swallowed scream or sob. “She is three weeks old.”
He took the bottle from my hand and walked away.
For a moment, I thought the conversation was over, but then I saw that he was mixing something. He came back out with another bottle and said that though my insurance would only pay for the generic version of the medication he had refilled it with the brand-name, Prilosec, because it mixes faster, and had added the cherry flavoring. He said to shake the bottle, then remove the cap and let it sit for ten minutes before giving it to her, to help the medication break down.
The gastroenterologist had warned me not to expect Liddy’s condition to improve until the medication had been in her system for a couple of weeks. Omeprazole does not actually prevent reflux from occurring. It simply reduces the acid content in the spit-up, allowing the damaged esophagus to heal over time. Still, I carried the bottle home flooded with relief that we could at least begin Liddy’s treatment.
The first few days, Liddy swallowed the medication easily, but something looked off. I held the dark brown prescription bottle up to the light in the kitchen, swirling the contents and studying the bottom of the bottle, where I could see little beads floating in the liquid. John called the pharmacy again to ask about it, and he received the same advice I’d been given: Shake the bottle, remove the cap, and let it sit for ten minutes before filling the tiny oral syringe. I kept looking at the bottle, though, and at the liquid in the syringe each time I filled it. A few nights later, I called the pharmacy again.
“Oh,” said the woman who finally picked up the phone, when I described what I was seeing. “Oh, no … that doesn’t sound right.” I heard distress in her voice. She told me she needed to hang up and check something, and then she would call me back.
My phone rang again within minutes. The flavoring they had used, she said, was incompatible with the medication. The omeprazole had failed to break down. It had stayed in the bottle, in tiny, silvery beads, as I fed Liddy cherry syrup twice a day for a week. “I am so, so sorry,” she said, assuring me that she would have the prescription refilled again, this time with a compatible flavoring.
The next morning, I took the kids on a major outing by myself for the first time. We went to the Museum of Science, Brennan’s favorite place on earth, and I managed to time Liddy’s feedings right and keep her straight and still for the requisite thirty minutes afterwards while Brennan rearranged the pieces of an enormous Lite-Brite and built a fragile wall with spongy, yellow blocks. The outing exhausted but also energized me because I had made it through the morning alone, in public, with two very young children.
When Brennan fell asleep in his car seat on the drive home, I took advantage of the relative quiet to call the pharmacy again. Yet another pharmacist answered the phone. At first, he could find no record of another refill. Stunned that anyone in the store could be unaware of the terrible mistake they had made, I retold the story, no longer feeling the need to hide my fury. He put me on hold and came back on to say that the medication had been prepared overnight, and the store had identified the correct flavoring, but they didn’t carry it, and they had not yet been able to arrange for a delivery.
“This is the eighth phone call I have made to your store about this prescription,” I told him. “I have been in to talk to a pharmacist three times. Someone has to take responsibility here. My daughter needs this medication, and you need to get it for me. Someone has to figure this out, right now, and that someone cannot be me.”
He promised to call me back.
I drove home, slipped Liddy out of her car seat and into the special sling-like seat that held her body straight and upright, then carried a sleeping Brennan to his crib. I sat at the kitchen table and dialed John at work; the moment I heard his voice I knew that my reserves of strength had dissolved. I wept as I described my latest, fruitless phone call. I had remembered another pharmacy, one that specialized in compounds, and I wanted to know if they could take the omeprazole already prepared by CVS and flavor it into a form Liddy could tolerate. I just couldn’t pull myself together to make that final phone call. I spelled “Skendarian” out for John, and he hung up to look for the listing.
Skenderian Apothecary is an independent, family-run store about a fifteen-minute drive from our house. I had been there only once, after Brennan’s birth, when, in the process of sterilizing the tubes for my breast pump, I had somehow melted them into a rubbery lump. I’d spent that desperate afternoon calling around for replacement tubes and posting a message to my local new mom support group listserv. Another mom had e-mailed to recommend Skenderian. I called the pharmacy, and the woman who answered told me to come right over. She kept the store open for me past closing time and showed me how to cut the ends of the tubes so they would fit my machine.
John called me back just minutes after we talked to say that Skenderian, which specialized in compounds, could take the omeprazole we already had and flavor it on a form Liddy could tolerate.
I called the big-chain pharmacy for the last time, and the young guy I’d spoken with on the drive home from the museum told me they had located the flavoring and he would spend his own time, after his shift ended, driving to the other store to pick it up so that they could have it ready for me that evening. He also suggested that, after this refill, I transfer my prescription elsewhere. His pharmacy—with one of the highest volumes of prescriptions in the area—was not equipped to do it.
I let him finish and then told him I would be in to pick up the prescription, unflavored, and that I would be transferring everything over to Skenderian. And then I hung up, and waited for my new babysitter to come and care for Brennan so that he could run his toy trucks through the back yard instead of accompanying me on the frantic drive to two separate pharmacies.
After fetching the bottle from the original pharmacy (along with the address for the complaint department of its national headquarters), I drove over to Skenderian and carried Liddy inside. A man who I would come to know as Robert, the pharmacy manager, met my glance from behind the counter.
“My husband called—”
Robert nodded and reached out to take the brown plastic prescription bottle I held in my hand. “I talked to him,” he said. “Let’s see what we’ve got.” He examined the label, then held the bottle up to the light just as I had a few minutes before. “Bubblegum or grape?” he asked.
I paced Skenderian’s immaculate waiting area. We deliver for any reason, read a sign posted over the registers. I looked around and saw, tucked into the corner, a basket of brightly colored toys and books. Several therapeutic chairs rested nearby, including one that bore a sign beckoning, Try this seat.
Robert came out with the uncapped bottle of omeprazole, and held it out for me to taste. “Sweet enough?” he asked.
Skenderian became a regular outing for the three of us, as Liddy’s dosages changed frequently and her medication regimen soon expanded to three separate prescriptions. On my second or third trip there, I parked outside and entered into a long negotiation with Brennan over how many matchbox cars he could bring in with him. When I finally got both kids into the store, Robert’s younger brother Joe was waiting behind the counter, holding a pen out to me. He had already located Liddy’s prescription, set it on the counter and flipped to the page in his notebook where I needed to sign for it. My face must have given away my astonishment. He laughed and said, “I saw you getting out of the car. I know from experience that it takes a while with two.”
Most of the staff, in fact, knew me by sight once I had been in a couple of times. “How is Liddy today?” they would ask, reaching up to the shelf or into the refrigerator for whatever prescription I had called in.
We visited the store once or twice a week, and it soon began to rival the Museum of Science for Brennan’s favorite place on earth. He ran straight to the toy basket each time we walked in, digging for the red plastic van and the tiny dinosaur that had quickly become his favorites
I began to think of Joe as my personal pharmacist. He conducted a great deal of research after the shelf-life of omeprazole compounds came into question, and helped me determine when the time was right to switch Liddy from the liquid compound to solutabs, little tablets that break down instantly in water, which were easier to store and dispense. Joe would compliment me on a new haircut, and say things like, “You’re a good mother,” unsolicited, with utter sincerity. He told me anecdotes about his own two children, and said Saturdays were his favorite day to work because it is a slower day and he can chat with people.
The sense of ease and familiarity I felt with the staff took on new meaning as summer approached, when I finally admitted—to John, to my doctor, and to myself—that I was sliding into the depths of post-partum depression. When I spoke to my doctor about anti-depressants, I had a fleeting but intense desire to have her call the prescription in to some other pharmacy where I could remain anonymous. My cheeks burned when I went into Skenderian, alone this time, to pick up the medication. But Robert saw me walk in and sailed right over, asking gently, “We haven’t done these for you, before, have we?” And then he spent ten minutes advising me on easing into the medication. My eyes welled as he spoke, but he never looked away as he talked about beginning with half-doses the first few days and trying different times of day if the drowsiness was too intense. He cautioned me against taking cold medications, which would keep me awake when we both knew that I couldn’t afford a sleepless night. And he smiled when he said that a glass of wine, once in a while, would be okay.
Liddy suffered through eight or nine ear infections in her first eighteen months. The pain increased her refluxing and fussiness and marked the periods of our most sleepless nights. With each new round of antibiotics, her pediatrician prescribed numbing ear drops to soothe the pain while we waited for the infection to subside. On New Year’s Eve, I checked our supply to see that we were nearly out, and desperately dialed Skenderian, hoping they had some on the shelf so that I could get it before the holiday.
The answering machine picked up and a prerecorded message told me the store was not only closed for the holiday but would close early for New Year’s Eve, at two p.m. I stared at my bedroom clock, which told me it was after three, as I listened to the message and the beep that followed.
“Oh, we’re fucked,” I said—into the pharmacy answering machine.
When I had confessed to John my reluctance, months before, to fill the antidepressant prescription with Skenderian, he had made me laugh by assuring me they already thought I was crazy.
So when I told him now about the message I had inadvertently left, he burst out laughing, then quickly composed himself. “I’m sure it happens all the time,” he said. Though I was sure I’d feel sheepish the next time I went into the store, I knew that they knew me and that they’d be laughing, too.
Author’s Note: The bad bottle of omeprazole sat on a shelf in my refrigerator for months. I kept it as a reminder of what we had gone through, Liddy and I, a reminder that I had held the pieces of the puzzle and that I had to fit them together, even when it was hard and I was tired. John took the bottle out one day when he was cleaning the fridge. “Why are we keeping this?” he asked. The stubborn silvery beads that had not broken down after all those months. I knew what it held and represented, and I didn’t need it anymore. I told him he could toss it, and I heard it disappear into the trash.
Brain, Child (Fall 2008)
About the Author: Karen Dempsey’s writing has appeared in The New York Times, Babble and other publications. She lives in Massachusetts with her family. Follow her on Twitter @KarenEDempsey or read more of her work at kdempseycreative.com.
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