Tuesday 8/03

Last night I intended to call the Egyptian guys for dinner and some shopping but it ended up the number they gave me didn't work. Then I thought about continuing the blog but Starbucks was full so I decided to get some food, the same fish by Eminonu, baluk ekmek, because it was that good.

As I was sitting down to eat in the middle of it all, a moment later an old man came to sit next to me. He said something in Turkish I did not quite understand, as if to attempt a greeting. I simply replied "ingilizce", after which he nodded as if that was all Ok.

We proceeded to eat our fish, for the next 10 minutes or so in complete silence. Around us are a swarm of people bustling around, as always this is a very popular place, with locals and tourists.

I don't know enough Turkish to carry a conversation, and he doesn't speak a word of English, but somehow none of that matters. Without saying so, we've both agreed for now there is no need for words.

For a few brief moments I feel a sense of perfection. We listen to the sights and sounds around us, the sun is on it's way out but still shining that last hour of brightness to end the day. Somehow I like to think we enjoyed every last bite of our food more than anyone in the surrounding mass.

At the end, he said something very simple and resolute, then nodded as if in respect and just like that went his way.

There is a metaphor here somewhere but I'm not exactly sure what it is.

Mustafa is back with us during the day. He's in his late 20's like me and looks like Thom Yorke, the lead singer of Radiohead. He doesn't have a degree but he's been working in pharmacy since he was 14 and is somewhat like an ex-officio in charge when Erdem slips away.

During that morning, Erdem indulges me for some time one of his life goals, if you will.

He wishes to get a boat in the summer. After the pharmacy closes at 7:30 he says he would depart Istanbul, collect beers and whatever friends available, and set out to one of the neighboring islands, have food and spend the night, awake at 7:30am and return to Istanbul to re-open the pharmacy for next day business. He tells me this in most seriousness.

He could have told me he wanted to sail to Mexico. The point I found interesting is he has specific life goals.

I reflect for a brief second we're both in a career where life goals like this are possible, even in Turkey.

I start to think today about my experiences so far and if I ever had the choice would I want to stay here. The more I think about it the more I find in the end it's just not for me.

The advantages are enticing... The relationships you can have with patients are close when they walk in the pharmacy. There's an ease of give and take that reminds me of some of our best patients back home. Most of the time, they are not in any hurry and they know the pharmacist is not in any hurry.

It just makes for, I don't know how to say, a more relaxed dynamic between the 2 parties. Not to mention the smaller physical space, the waist-level counters, the sitting chairs facing the front.

It's certainly true the volume of prescriptions in a day is dramatically less, so you learn to become accustomed to down-time and creative ways to stay busy.

And it's true I like that down-time. I like talking with Erdem or Semih, or any one of his friends that pops in, sipping our tea and watching crowds pass by. It has it's own peacefulness, the ebb and flow of these types of days...

But just the same there's something that tells me there is another side to this picture. I don't know if you would call it the "American lifestyle" or wanting to get ahead or whatever. What I know best is what I'm accustomed to.

I also feel in many ways the profession is doing more back in the States to help patients clinically. Here the students spend more time in labs, not to mention experiments with plants and other substances - more on the producing end - an nudge toward industrial pharmacy.

The herbal/supplement/alternative people push their products aggressively here. They occupy about a third of the physical space in the pharmacy. Almost all do nothing for the patient but sell the illusion of feeling healthy and you begin to see the pharmacist is stuck in a somewhat conflicted position. These products are serious revenue to the business. Without them, financially, the pharmacy would not survive.

One of these products, prominently displayed almost wherever you look in the pharmacy is "BIOXCIN", which promises a special formulation to regrow hair etc. One look at the box and you know it's a hoax. Erdem knows it. Nonetheless he sells about 12 boxes of this stuff a month... somewhere around 300 TL of profit.

There is also the strange relationship the government has with pharmacies and how they change the rules, making it difficult for compensation and other incentives.

For example I might have mentioned the situation with bar codes and having to physically cut each out of the box, tape it to a sheet a paper like a kindergarten project and send it to the agency for compensation. These are for the older boxes (becoming phased out) without the new 2D codes.

There is also some list he needs to write out, by hand, of medicines sold to the patients in order to get reimbursed.

In short, they make things difficult.

I think all of these things tell me it's still difficult to find the ideal system. We are still searching, whether it be Turkey or the United States. You might say at the end of the day are the citizens better managed on their med's? healthier? Taking the right med's? etc... My answer is this is not clear.

What I've found is citizens of Turkey, especially the working class, are just as uneducated about medicine as citizens of the U.S.

Another thing I have discovered, which has opened my mind even more, is that socio-political climates play a big in role in how the profession works.

You can have the most clinically adept, empathetic and knowledgeable pharmacist in the world but without the right socio-political environment to work in that all becomes meaningless.

There are cultural expectations, government attitudes and policy that not only shape the way medicine is delivered but the public perception of pharmacies. For example, the idea of chain pharmacies is resisted because it is a threat to the way things have been done here for years. A lot of pharmacists would go out of business.

It turns out Erdem also saw "Inception" last weekend. We both agreed it was an excellent movie, even though for me at least I wasn't exactly sure what was going on (I have in my head what I think happened and that's good enough for me).

This prompted a discussion about lucid dreams. Erdem assures me, as if relieved to share the news with someone who understands, they do in fact happen.

He is right, of course, because I have had them myself.

I dream a lot when I sleep here. All of them seem to have an epic-type scope often with a dilemma. I remember one was a race with hurdles. Even though I was fast enough to win, I never would because I was not skilled enough to leap the hurdles.