Pills

Due to the war in the Middle East, my family and I had to cancel a much-anticipated visit to Israel this holiday season. Instead, we decided to fly to Bogota. My late father grew up in Colombia, but I’ve never been there; we hope to visit my great-grandmother’s grave and my father’s old neighborhood.

Given constantly evolving infectious risks, we made an appointment before our departure for my older daughter to visit an infectious diseases specialist. The physician sent prescriptions for acetazolamide (for altitude sickness) and azithromycin (for traveler’s diarrhea) to a local pharmacy—part of the country’s largest chain.

When I was deciding what pediatric subspecialty to pursue, one mentor gave me this advice—think what common condition you wouldn’t mind seeing on a daily basis. As I considered various diagnoses, one stood out—iron-deficiency anemia, the backbone of pediatric primary hematology complaints. Indeed, during my fellowship in pediatric hematology-oncology, I’ve seen a plethora of patients with iron-deficiency anemia. The majority are adolescent females, iron deficient due to myriad causes, most often diet or abnormally heavy menstruation.

As a new nurse, I practiced the “Five Rs” of medication administration with religious devotion:  right patient, right medication, right route, right dose and right time.  Over the next thirty years, I gave thousands of pills to patients.

Early one morning, my fellow RN called out from within a patient’s hospital room, “Getting ready for medical transport, need some help!”

Peeking into the room, “What can I do?”

Tanya replied, “Get Mrs. Smith’s meds.”

My husband knew his body.

When he was diagnosed with atrial fibrillation in his 40s, despite the fact that he was a dedicated runner, every physician he ever saw recommended that he take some blood-thinner or other. Each of them gave as their rationale the fact that he had a five-percent chance of experiencing a stroke without such medication.

Two dreaded words for medical providers and patients: Prior Authorization (PA). For the fortunate few who have not needed to engage in this process, here’s a definition from the American Medical Association website: Prior authorization is a health plan cost-control process by which health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

I’ll be the first to admit that I only know a fraction of all there is to know about the wide variety of tablets, capsules, caplets, and other pills out there.

He said he wanted to talk to me. He asked for me by name. He was seated in the waiting room, a lone pale face in a room full of brown faces. I asked my medical assistant to query him as to why he was there, while I continued to see patients; he told her he had something to give me—something he could give only to me.

Dr. Neil called me. She needed stat labs for an elderly patient, June.

“Esther,” Dr. Neil explained to me, “a few days ago, June took three Lisinoprils, three Metoprolols, and three aspirins, all on the same day!”

Shocked, I asked, “She didn’t bottom out or have a heart block?”

“That isn’t Tylenol.”

It had taken more than half an hour for the nurse to arrive at my bedside with the pills I’d asked for, following my grueling four-and-a-half-hour surgery. I had finally been wheeled into a hospital room at midnight, had pushed my call button, had asked for Tylenol, and then had waited.

“What is this?” I asked, as I handed the pills back to the nurse. The color drained from her face. “It’s pain medication,” she said. “I brought you pain medication.”

My body resists most medications. I had my first allergic reaction at age 20, breaking out in hives from head to toe as I stood in a post-game locker room. I don’t recall the infection I had, but the pill I’d been prescribed to treat it was penicillin. Since then, my allergy list has expanded to include almost all antibiotics except Bactrim, Flagyl, and Macrobid. I also get heartburn from baby aspirin, itching from Vicodin, and dizziness from steroids.

The current daily medication regimen for a lot of people with HIV involves one pill. Granted, there are several drugs in that one pill; they’re all lumped in there together to make it easier for people to comply with the requirement that they take all their meds, every single day. Still, there’s a part of me that can hardly believe it. One pill. One pill! And it actually keeps people healthy!

I take two medications. One is Armour Thyroid, as I can’t tolerate the usual thyroid medication. The other addresses symptoms of a neuroimmune disease I’ve had for years—allowing me to endure sound and light and stopping the minor seizures I had when I was subjected to those two things. Those meds help me, and I am grateful for them. But the problem is that I can tolerate almost no other medication that doctors have suggested.