May 5, 2006 - Cinco de Mayo at the Oncologist's

On this Friday morning, my mission is to pick up my Neulasta prescription from our local pharmacy – but it turns out to be not so easy as I’d thought. On Wednesday afternoon, Dr. Lerner’s office had immediately phoned in my prescription, but when Claire called on Thursday to check on it, she learned that the medicine had to be special-ordered and would take a day or so to come in. The pharmacy staff advised us to call back this morning, which I do – only to learn that the delivery has been further delayed, and will not be in until 1:00 p.m.

Neulasta is supposed to be administered 24 hours after chemotherapy, in order to begin its important work of boosting the white blood-cell count that the chemo drugs tend to suppress. I’m scheduled for a 9:40 a.m. appointment for my shot – a good bit longer than 24 hours already – but now I have to call the office and ask them to push it back a few hours longer. They tell me to drive right over with my Neulasta, as soon as I get it. (I’m aware, of course, that there’s plenty of the stuff sitting in the refrigerator in the doctor’s office, but they can’t give it to me, due to the insurance company’s changed reimbursement policies.)

When I get to the pharmacy, things seem to go smoothly enough. I pick up the prescription bag, sign for it, and hand over my $100 co-pay via debit card. As I walk away from the pharmacy counter, though, I glance into the bag and do a double-take. What I have in my hands is not Neulasta at all, but Neupogen – the older, less-expensive medicine that Dr. Lerner’s office could still have given me directly under Blue Cross/Blue Shield’s coverage guidelines (but which requires a weeklong series of daily shots).

I go right back to the counter, and point out the error. One of the pharmacy staff shows me their order slip (written down by whomever took the call from the doctor’s office) that clearly says “Neupogen” – though who can say whose error it was, the person making the call or the person receiving it? Another clerk gets on the phone to Dr. Lerner’s office, and confirms that it’s indeed Neulasta I’m supposed to have. They invite me to be seated, while I ponder the implications of all this. What if it takes another day or so for the Neulasta to be delivered? Are there health implications to delaying the injection even longer than I already have? Maybe I’ll have to submit to the daily Neupogen shots after all.

Fifteen minutes or so later, the pharmacy clerk calls me to the counter again and gives me my Neulasta. They had it in stock all along – it was the Neupogen (the medicine I didn’t need) that had to be special-ordered.

I drive over to Dr. Lerner’s office, and find that the staff is celebrating Cinco de Mayo, the Mexican patriotic holiday. “Happy Cinco de Mayo!” proclaims a string of cardboard letters, hung on the waiting-room wall. The nurses are wearing colorful ponchos and sombreros, and – for some inscrutable reason – distributing plastic leis (the Hawaiian flower garland). A sombreroed nurse, a set of maracas stuck into the waistband of her scrubs and a twirly mustache painted onto her upper lip with mascara, loops a couple of leis around my neck. The nurse, who knows my name is Carlos, seems to think this will mean something special to me. She probably has no idea I have no Hispanic ancestry (I’m mostly Scottish and Swedish – my first name is a fluke, that I’ve had to spend a lifetime explaining to people).

The staff here do their best to cultivate a cheery atmosphere. Most patients I’ve seen in the waiting room on past visits are elderly. Some of them, weak and infirm, ride in wheelchairs or lean on canes. There are often trays of cookies and brownies to pass around (provided by pharmaceutical salespeople, I’d guess) – chemotherapy recipients aren’t supposed to be counting calories or fat grams. Cinco de Mayo may be a bit of a stretch for this crowd – nobody on the staff or in the waiting room looks to be remotely Hispanic – but hey, it’s a holiday, so why not celebrate?

Back in the nurses’ room, where I go to receive my injection, there are more sombreros. A pinãta is hanging from one of the IV-bag hooks on the ceiling. Even Dr. Lerner is wearing a sombrero. It’s all very cheery, but a bit surreal all the same.

Surreal is the word for it – not only the sombreros in the doctor’s office, but my roundabout journey to receiving my Neulasta shot. Olé!