On the morning she died, Ashleigh Anderson researched her signs.
Nausea.
Jaw ache.
Chest ache.
Cold sweats.
“I think I am having a heart attack,” the 41-year-old texted her longtime boyfriend from the CVS retailer in Seymour, Indiana, the place she had simply begun her shift as the only pharmacist on obligation.
It was Sept. 10, 2021. Retail pharmacy was reeling from the pressures of the pandemic, and frontline employees like Anderson have been dangerously burned out. For months, they’d been filling prescriptions and vaccinating sufferers with out lavatory breaks or a chunk to eat.
Anderson’s cellphone buzzed.
“I hope not!” replied her boyfriend, Joe Bowman, who advised the signs might simply as simply be indigestion, stress or one thing together with her lungs.
Anderson was a smoker, and her job induced loads of stress. But she had simply been to the physician two weeks earlier and, in line with her household, obtained a clear invoice of well being.
“Can you take a long lunch and decompress?” Bowman requested.
“I can’t,” she texted again.
The CVS in Seymour was a 24-hour retailer whose pharmacy counter by no means closed, not even for lunch. Patients got here in any respect hours to choose up drugs, ask questions and get pictures. It was a relentless grind made worse by the recent departure of two employees pharmacists and the pharmacy supervisor. In their absence, the remaining crew struggled to fill the a whole bunch of prescriptions coming in every day and had quickly fallen behind by greater than 1,000.
Tensions have been particularly excessive that week after Anderson discovered her boss had assigned her the position of pharmacy supervisor regardless of her repeated refusals to take the promotion.
“I am livid,” she messaged a coworker 4 days earlier when she found the change within the firm’s HR system.
State legislation on the time required each pharmacy to designate a pharmacist in cost, somebody to carry accountable for complying with rules and to self-discipline for violations.
But Anderson didn’t need the additional duties. After 17 years with CVS, together with earlier stints as a supervisor, she was content material being an everyday employees pharmacist. She might clock in, clock out, and go home to Bowman and her beloved basset hounds with out the job following her there.
If anybody might deal with the gig, although, it was Anderson.
Whip-smart, selfless and reliable, she had managed one of many busiest CVS pharmacies in Indiana just some years out of faculty. When a historic flood inundated her retailer in 2008, she saved working till the National Guard arrived in boats to rescue everybody. The following yr, she gained the corporate’s highest honor, the coveted Paragon Award.
Anderson was calm amid chaos. But that morning when she texted Bowman, she was nervous.
If she was having a coronary heart attack, she wanted instant medical consideration. But if she left with out one other pharmacist to take her place, she must shut the counter. Prescriptions would get much more backed up. Patients can be upset. And the shop’s efficiency, carefully tracked by a sequence of company metrics, would undergo greater than it already had.
Anderson couldn’t attain her boss, so she texted his assistant at 10:11 a.m.
“I know this sounds crazy but I am having symptoms of a heart attack. Can you get someone here long enough for me to go to the ER and get checked out?”
Three minutes later, the assistant referred to as. The two spoke briefly, then hung up.
“I talked to Jessica,” Anderson texted Bowman, referring to the assistant. “She told me to close and go, but I told her to find someone if she could.”
Bowman replied: “Are you coming home or going to the closest ER? Do I need to pick you up?”
Home was 35 minutes to the south, in Henryville, Indiana. The closest emergency room was simply down the road, at Schneck Medical Center. Anderson might drive there in three minutes.
The assistant referred to as once more, and the 2 spoke for 46 seconds.
Then Anderson despatched Bowman what can be her remaining textual content: “Bob is coming now. I will go to Schneck here. Hopefully it’s nothing and I will come back to work.”
Fifteen minutes later, Anderson collapsed on the pharmacy ground.
A buyer who occurred to be a nurse raced behind the counter and began CPR whereas a pharmacy tech referred to as 911, a coworker advised USA TODAY.
First responders arrived inside minutes. They ventilated her. They gave her chest compressions. They jolted her with a defibrillator. Nothing made a distinction. They loaded her onto an ambulance and drove her to the emergency room at Schneck. Her pupils have been mounted and he or she had no pulse.
Staff at Schneck administered three rounds of epinephrine to stimulate Anderson’s coronary heart, nevertheless it had lengthy since stopped pumping blood. Her pores and skin turned mottled.
She was gone.
An post-mortem later revealed extreme atherosclerotic heart problems with 99% blockage of her left descending coronary artery, resulting in what’s known as a “widowmaker” coronary heart attack.
“If she had gone in quickly when she realized she was having a heart attack,” mentioned Dr. Eric Topol, a longtime heart specialist and the chief vice chairman of Scripps Research, “the artery would have been opened up, and she most likely would have survived.”
By ready, Anderson had made the ultimate sacrifice to an business that notoriously calls for an excessive amount of of its employees.
Corporate tradition’s position blamed in Anderson’s dying
Over the previous decade, companies like CVS, Rite Aid, Walgreens and Walmart have steadily slashed pharmacy staffing ranges whereas saddling remaining staff with a burgeoning checklist of further duties.
Stores that after had two pharmacists and 6 pharmacy technicians filling a mean of 500 prescriptions a day now could have half the employees and an excellent greater prescription quantity – plus an infinite crush of vaccine appointments, fast COVID checks and affected person session calls.
Every activity is timed and measured towards company targets that reward pace and income. Staff who don’t fill prescriptions quick sufficient, reply the telephones rapidly sufficient or drum up sufficient vaccination business can face self-discipline, reassignment or termination.
Read USA TODAY’s investigation: Prescription for catastrophe: America’s damaged pharmacy system in revolt over burnout and errors
No chain exemplifies this ethos greater than CVS, dozens of present and former pharmacists advised USA TODAY. Many recalled how they’ve been pressured to work by way of illness, bodily accidents and psychological breakdowns.
One pharmacist mentioned her boss refused to present her a day without work though she was struggling a full-blown panic attack. Another mentioned he was requested to remain behind the counter as an alternative of taking his injured son to the emergency room. Two pharmacists mentioned they labored whereas actively miscarrying as a result of their bosses couldn’t discover anybody else to cowl their shifts.
“You’re just programmed that if you’re sick or you need to go home, you can’t. You have to wait until someone comes,” mentioned Wendy Lear, a former CVS pharmacist who labored whereas miscarrying.
Although she had by no means met Anderson, Lear knew her identify.
They all did.
Word of Anderson’s dying unfold like wildfire amongst retail pharmacists. It turned a cautionary story of company martyrdom. It spawned a hashtag, #SheWaited, and a social media marketing campaign that urged pharmacists to hearken to their our bodies, stand as much as their bosses and care for themselves.
Not lengthy after she died, a vivid orange billboard went up on Interstate 65 in Indiana, between Seymour and Henryville. It featured a photograph of Anderson together with the hashtag and a easy message: “Your job can wait, your heart can’t.”
Anderson’s household had paid for the signal.
“We were trying to get exposure to this, because we thought it would gain media attention, and CVS would have to deal with this on some level,” mentioned Larry Anderson, Ashleigh’s father. “But unfortunately that didn’t pan out.”
USA TODAY interviewed Anderson’s father and stepmother, her long-term boyfriend and 10 former colleagues who labored with Anderson at varied occasions throughout her profession with CVS. Many of them described Anderson’s dedication to a job that, a few of them imagine, in the end killed her. Some of these colleagues nonetheless work for the corporate and spoke on the situation of anonymity to guard their jobs.
The media organization additionally examined textual content messages and calls to and from Anderson’s cellphone the morning she died, in addition to reviewed a abstract of her remaining moments detailed in a coroner’s report obtained by way of a public data request. A reporter moreover spoke to dozens of retail pharmacists from CVS and different chains throughout the nation concerning the circumstances and calls for of the job.
Taken collectively, the interviews and data paint a portrait of an business that circumstances staff to work past their limits and put their very own wants behind these of the job. So sturdy is the tradition that these near Anderson say that even when she bought permission to shut the pharmacy, she should have determined it was in her greatest curiosity to attend for backup earlier than searching for assist.
“She was, in our opinion, afraid to go to the emergency room and be told, ‘No it’s not a heart attack at all, it’s just anxiety,’” mentioned her father, Larry Anderson. “Because then she would have to come back and face her bosses.”
Michael DeAngelis, CVS’ government director of company communications, referred to as Anderson’s dying a “tragedy that never should have happened.” He pushed again, although, on the notion that CVS bears duty for her dying, noting that she was advised to go away and highlighting the corporate’s “culture of safety.”
Under no circumstances, he mentioned, does CVS count on or need its staff to work when they’re unwell, and it encourages them to hunt medical remedy when vital.
“It’s impossible for me to comment on why Ashleigh made the decision she made,” DeAngelis mentioned. “I think, by and large, pharmacists are highly dedicated health care professionals, and I would not be surprised if there are pharmacists who have the mindset of, ‘I need to keep taking care of my patients,’ versus ‘I’m afraid of being punished by my employer.’”
Although they acknowledge Anderson alone made the decision to attend, Larry Anderson and his spouse, Donna, nonetheless blame CVS for her dying. If the corporate cared about its staff, Anderson mentioned, it might have correctly staffed its places in order that nobody pharmacist was caught behind the counter, reluctant to go away.
“There is an intimidation factor,” Larry Anderson mentioned. “You don’t feel like you can take your lunch. If you have a doctor’s appointment, you’re extremely reluctant to do it. You just can’t be away from work.”
Pharmacist was a rising star at CVS
Anderson grew up in and round Lafayette, Indiana, the eldest baby and solely daughter of Larry and his first spouse, Nancy.
As a lady, Anderson was adventurous, spirited and naturally gifted. She excelled at all the pieces, particularly teachers, and he or she had a gentle spot for animals. Friends and household typically referred to as her “the smartest person in any room.” She didn’t even need to strive.
She graduated highschool as class valedictorian, and attended the distinguished Purdue University, situated in her hometown. Anderson might have chosen any main, however she gravitated towards medication and particularly favored the concept of changing into a veterinarian. The solely downside: She hated the sight of blood.
“She was maybe a year or two into college when she decided to go into pharmacy,” her father mentioned. “Pharmacy was an option that allowed her to be in the medical field without seeing a lot of blood.”
Anderson threw herself into her research, discovered all the pieces she might and earned a doctorate of pharmacy in 2004. She was 24 years old. Bursting with optimism and desperate to show her price.
No one was stunned when she rapidly landed a job. CVS was fortunate to get her, they thought. Anderson felt like she was the fortunate one. She cherished all the pieces about her work as a retail pharmacist – the quick tempo, the stimulating setting, the affected person interactions. It was endlessly difficult, and Anderson relished a problem.
Her coworkers quickly took be aware.
“I knew right from the start that she was going to be our next boss,” mentioned Trish England, who labored as a pharmacy technician on the CVS in Columbus, Indiana, the place Anderson began her profession. “She was a rising star. She was the best pharmacist we had. They praised her for everything she did.”
CVS quickly promoted Anderson to pharmacist in cost at one its busiest places within the state. Employees working in Columbus on the time recall dealing with between 3,000 and 6,000 prescriptions per week.
Anderson thrived in her managerial position. She was a grasp of the pharmacy who might rattle off the reply to any query, effectively clear a queue of backlogged prescriptions and make sufferers really feel like she actually cared.
She ran a decent ship, her coworkers mentioned, and was an absolute stickler for high quality management.
“CVS has a thing where technicians count prescriptions out and put them in a box that takes a picture and sends it to the pharmacist to verify and look at it,” mentioned one pharmacy technician. “She made us take the pills and bundle them in groups of five so she could count them herself. We all grunted, like, ‘Why do we have to do this?’ But it was all for patient safety.”
Anderson’s competency initially intimidated a few of her coworkers, who mentioned they thought she was “scary” or “cold” till they bought to know her. Then they turned fiercely loyal, describing her as a real pal whose heat was surpassed solely by her wit.
Managers at different shops despatched their pharmacists to Columbus to coach with Anderson. Around the time she gained the corporate’s Paragon Award, she was invited into its rising leaders program, a stepping stone to higher administration.
Anderson set her sights on a district chief position, a job overseeing a dozen or so pharmacies and making certain they hit their company targets. She appeared a shoo-in for it.
“She was one of the best pharmacists in the area,” recalled a CVS pharmacist who was despatched to coach beneath Anderson. “She was the kind of pharmacist people wanted other pharmacists to be.”
Then, in the future, Anderson shocked her coworkers by leaving all of it behind.
In August 2013, she abruptly transferred from the Columbus location to a lower-volume CVS in Greensburg, Indiana, the place she labored an in a single day shift as a employees pharmacist. She dropped out of the rising leaders program. She stopped speaking about profession development.
It made no sense, her colleagues mentioned. Some figured she simply wanted a change. Others assumed company compelled her out for falling in need of its rising targets.
“It was always numbers, numbers, numbers – you have to hit your numbers,” mentioned a pharmacist who labored with Anderson in Columbus. “The district manager would come in and be like, ‘How come you can’t hit this number? How come you can’t hit that number?’”
At the identical time, he mentioned, the shop’s prescription quantity was exploding as employees dimension steadily dwindled. CVS determined to not exchange a pharmacist who had lately left, and there have been fewer technicians at any given time.
“Working conditions just got worse and worse and worse,” England recalled. “The more we did, the more they expected us to do.”
When the numbers fell too far behind, “they took her out.”
But one former colleague mentioned Anderson’s efficiency on the retailer wasn’t the problem. It was an ethics hotline criticism that led to her elimination.
A pharmacy technician took offense on the method Anderson had dealt with a state of affairs, mentioned the previous colleague, a longtime CVS administrator who labored carefully with Anderson over the course of her profession.
“She was snappy,” the colleague mentioned of Anderson. “You have to be snappy in that job, but one day she said something in the heat of the moment that she probably should not have said.”
Human sources investigated the criticism, the colleague mentioned, and decided Anderson ought to step down. The choice gutted Anderson, who felt she didn’t get a good listening to.
“They knocked her down a peg,” Donna Anderson mentioned. After that, she stopped making an attempt to be something greater than a employees pharmacist.
Anderson spent the subsequent a number of years commuting from Columbus to the CVS in Greensburg after which the one in Shelbyville after which the one in Nashville, Indiana. All have been inside 30 miles of her home.
When she and Bowman purchased a newly constructed home in Henryville, 50 miles to the south, Anderson sought a shorter commute.
She discovered it in Seymour.
Anderson feared dying alone
The remaining CVS in Anderson’s profession sat on the intersection of a busy business strip, flanked by a big car parking zone, which on that late summer time morning was teeming with emergency automobiles.
Khandie Tharp would have seen them had she pulled in simply minutes earlier. But the pharmacy tech was late for her shift, and, by the point she arrived, the lot was eerily empty besides for 2 crying coworkers.
One of them approached Tharp as she bought out of her Mustang to inform her what had occurred. Distraught, Tharp bought again in her automobile and drove to the hospital.
During her 18 months working on the Seymour CVS, Tharp had bonded with Anderson. The skilled pharmacist had taken the brand new tech beneath her wing and given her the assist she wanted to excel in an setting rife with seemingly infinite duties.
In uncommon lulls, the 2 shared particulars about their lives and discovered they’d so much in frequent. As neither of them had any kids, they confided in one another about their fears of dying alone.
Tharp was decided that morning to not let that occur.
She launched herself to the emergency room receptionist and requested that somebody inform Anderson of her presence. Since she was not household, employees might say nothing about her pal’s situation however promised to let somebody know Tharp was there.
And then she waited.
“I wanted her to know that somebody was there for her,” Tharp mentioned. “I was there for her.”
Bowman was at home when his cellphone rang. The name got here from the CVS retailer in Seymour, and when he answered, he heard the rattled voice of one other pharmacy tech saying Anderson had collapsed and that paramedics have been on their method.
Bowman jumped in his automobile and saved a lookout for state troopers as he sped north on I-65 to Schneck Medical Center, not figuring out what he would discover when he bought there.
Tharp greeted him when he arrived. The two had by no means met, however she acknowledged him from photographs Anderson had shared. Bowman was grateful she was there.
A health care provider appeared and requested Bowman to comply with him right into a room. Bowman knew proper then that Anderson was gone. He remembers feeling his ft carry him into the room and his ears hearken to the physician clarify that her coronary heart had stopped.
The rationalization ended, and Bowman was led into one other room. This one held Anderson’s physique. Bowman was given time to say goodbye.
Time handed – 5 minutes, an hour, an eternity – earlier than Bowman reappeared within the ready room. He checked out Tharp and shook his head. She knew then, too. Tharp felt her knees buckle. Bowman caught her earlier than she fell. Then the 2 strangers cried collectively within the hospital over a girl they each cherished.
It was Bowman who broke the information to Anderson’s dad and mom.
When they noticed his quantity pop up on their cellphone, Larry Anderson mentioned, he and Donna figured Bowman was calling to thank them for the big patio umbrella they’d had delivered that morning to his home.
Instead, Larry Anderson mentioned merely, “What a shock.”
Family seeks solutions amid misunderstanding
When the shock wore off, the household needed solutions as to how a seemingly wholesome, lively girl within the prime of her life might collapse and die at work.
They knew CVS had anticipated Anderson to work by way of lunch breaks and toilet breaks, that she felt pressured to come back in even when she was sick. They knew her job harassed her. Now they needed to know if it killed her.
Larry Anderson mentioned he discovered the numbers for his daughter’s boss and his assistant and referred to as them, however neither one would discuss.
“After two or three attempts, her boss finally did talk to me, but he was very careful of what he would say to me,” Larry Anderson mentioned. “He said he had been instructed not to answer (questions) and said ‘I shouldn’t even be talking to you.’ But he was trying to be nice.”
Even the corporate’s gesture of creating a scholarship in his daughter’s identify at Purdue fell flat, he mentioned, when CVS made a one-time donation of $10,000 that December as an alternative of sustaining it yearly because the household thought it might.
DeAngelis denied that CVS averted conversations with the household or that it ever dedicated to funding a scholarship past the one-time donation.
“We regret if there was any misunderstanding,” he mentioned.
Misunderstanding was taking root on-line, too. Messages about Anderson’s dying began showing on Facebook, Reddit and Twitter. They claimed her bosses had forbidden her from searching for instant medical consideration and made her wait till a backup pharmacist arrived.
Among those that noticed the posts was Bled Tanoe, a former Walgreens pharmacist who amassed a big on-line following advocating for higher retail pharmacy working circumstances beneath the hashtag #PizzaIsNotWorking – a nod to corporations’ hole choices of free pizza to appease harassed staff.
Anderson’s dying struck Tanoe as additional proof of an business that mistreats its staff, she advised USA TODAY. She needed to amplify the story and create a brand new hashtag round it. So she reached out to CVS pharmacists in Indiana to confirm the story. They confirmed that Anderson couldn’t go away, in line with messages Tanoe shared with USA TODAY.
In October, Tanoe launched the #SheWaited hashtag, and the story exploded amongst retail pharmacists on-line. By the time Tanoe heard the small print may not be right, she mentioned, her sources had both stopped speaking or have been not certain, and the story had already taken on a lifetime of its personal.
Regardless, Tanoe mentioned, the message behind the motion she began stays the identical.
“It is established in our profession, there is a culture where you cannot put yourself first,” mentioned Tanoe, who is also the vice chairman of the net pharmacist advocacy neighborhood, RPhAlly. “It might not be written in a handbook and they would never say it to your face, but the message, through their actions, is that the company comes first.”
In the 2 years since her dying, Anderson’s identify has transcended social media.
It now echoes by way of the faculty classroom of Haley Howard, an assistant professor of pharmacy observe at Manchester University in Fort Wayne, Indiana, the place she teaches first-year college students about skilled self-advocacy.
Howard makes use of Anderson’s story to remind her college students that they’ve a proper to cheap working circumstances and to voice their considerations. Most importantly, she tells them, they’ll’t fulfill their obligation to care for his or her sufferers in the event that they don’t care for themselves first.
It’s one in every of a number of examples Howard consists of in an accompanying slide present that shares recommendation with future pharmacists about how you can advance their profession at a time when many are leaving the occupation and enrollment to pharmacy faculties is in decline.
Howard, who additionally works as an acute care pharmacist at Cameron Memorial Community Hospital in Angola, Indiana, by no means met Anderson. But she mentioned she heard about her dying from a fellow pharmacist who had heard about it from anyone else. It felt, she mentioned, like a wake-up name that extra folks wanted to listen to.
“Pharmacists need to be in safe working environments,” Howard mentioned. “I wanted to share with my students and say, ‘This stuff happens in pharmacy, and it shouldn’t be happening.’”
Emily Le Coz is a reporter on the USA TODAY investigations crew. Contact her at [email protected] or on X @emily_lecoz.
