“Well, let me tackle the most important thing first. Dr. Family really wants me to figure out what medications you’re on, Ms. Smith, since we weren’t so sure during your last visit,” I explain, settling into a Lazy-Boy recliner situated near the 89 year old woman’s end of the couch. My preceptor had asked me to focus my mandatory geriatric home visit on reconciling the medication regimen of this patient.
Overhearing me, Ms. Smith’s 63 year old daughter emerges from the kitchen to drop two gallon-sized Ziplocs and a weekly pill organizer into my lap before immersing herself back into baking what smells to be apple pie.
I glance down at the bags and struggle to hold in my reaction. One bag is simply a collection of appropriately labeled prescription bottles. The other, however, looks similar to this:“Ms. Smith, do you know what these pills are?” I ask, holding up the bag. Please tell me you don’t take anything out of this mess, I think to myself. My mind wanders to a story my preceptor told me of a woman who would toss all of her medications into one bag and take a handful each morning.
Her blue eyes, blurred by a recent stroke, squint to make out what I’m holding. “Oh, no, dear. That’s why they’re all in there. I don’t think I take any of those.”
“You don’t think you take them?” I prompt.
“No. But my daughter puts my meds out for me. I can’t see all those tiny little pills.” There’s a touch of frustration in her voice. Eighty-nine years of life and several mini strokes had robbed the frail woman of her strength and independence.
I make a mental note to ask the daughter about the hodgepodge of pills and shift my attention to the prescription bottles. I pull them out one-by-one, each time looking to Ms. Smith for confirmation that she takes this medication as prescribed, and she responds each time with a nod.
“How about aspirin? It’s the one to help keep your blood from clotting up and giving you another stroke.” I hold up the bottle.
“Oh, no, I don’t take that stuff. I don’t need thin blood!” Her arms fold across her tiny chest; an act of defiance that exerts some control over her life.
“I see. But what if it’s just thin enough to help you avoid strokes?”
She gazes back at me unconvinced. “I think I’d rather have a stroke.”
“Can we compromise? These are big aspirins, but maybe you can try just a baby aspirin?” I’m tossing out a lifeline. Changing medication doses isn’t exactly within my job description, but I figure my preceptor will agree that any aspirin is better than none in this patient.
She allows me a slight smile. “Okay. I guess that would be all right.”
I smile back, satisfied with my small victory. “What about your sleeping pill? Are you using that each night?”
Ms. Smith shakes her head. “Oh, no. I never take my sleeping pills these days. I’m always sleepy enough.”
I decide to open the bottle to take a look at the pills inside and compare them to the pills sorted into her weekly medication box. I immediately discover a matching white tab in one of the PM slots, but subsequently locate it in almost every AM box as well.
“Ms. Smith, you’re taking these twice a day every day! No wonder you’re sleepy!”
She shrugs her shoulders and laughs. “Oh. How silly. I guess that explains things.”
I start opening the other bottles and comparing the placement of the pills into the pill box with the prescribed dosing. In each bottle, I notice a few rogue pills hiding among the uniformed tabs that I assume are meant to be in that bottle. Where do these other pills come from? I debate.
And then I open her hydralazine bottle. Though I know this to be a blood pressure medication, I find a bottle stuffed with the exact same white pills I’d found in the sleeping pill bottle.
Crap. This cannot be good.
Thankfully, I’m learning to practice in the age of Google, and what would once have required scouring a thick text full of pages and pages of pill images now required simply locating a website on which I could type in “white” “circular” and choose the pill code stamped on top to discover the true identity of the pills.
They are, in fact, hydralazine. Ms. Smith is consuming twice the dose prescribed for her on this medication. Suddenly, her recent history of dizziness makes so much more sense.
“Ms. Smith, I think I know one way to make you better,” I declare, beginning the arduous task of returning the medications to the appropriate bottles.
“Good,” Ms. Smith replies. “Next, I’d really like to be able to see my TV again, okay?”