It’s Just One Pill

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.

After making a diagnosis, I prescribe iron supplementation. “Just one pill—or two—a day,” I say. They come back a month later, often with the same iron and ferritin levels. “Are you taking your pills?” I ask. They shrug and look down. “They hurt my stomach,” they say, ashamed. Their parent berates them: “Why can’t you take one pill!”

In these moments, I have a flashback. I think back to my teenage self, the first time I felt failure. I was 16, the fifth-fastest runner on my varsity cross-country team. I never thought I’d be good at sports, but here I was performing better than I’d thought I could. Gearing up for the season, I had high expectations for myself. But I gradually started feeling more fatigued than normal. My legs felt heavy. They didn’t move when I told them to. I remember running one race that should have been easy, but 10 minutes in I had to drop out. Tears streaming down my face, I told my coach I didn’t know what was wrong but I couldn’t run anymore.

I saw my pediatrician the following week. My hemoglobin was 8, indicating iron-deficiency anemia. As I’ve done for many of my patients, she prescribed ferrous sulfate. “Just one pill twice a day,” she said. I couldn’t do it. I tried, but it hurt my stomach, made me nauseous. My mom yelled at me, “Just take it!” She called my pediatrician, who also berated me: “It’s just one pill!” I couldn’t do it. I went from fifth-fastest to fifth-slowest and finally dropped cross-country. It was demoralizing.

But many years later, facing my teenage patients, I know what it’s like to be in their shoes. Instead of yelling at them, I look into their eyes and ask if they’re taking their pills. I explain that I’m not asking to get them in trouble but to know how I can best help them. Sometimes I tell them my story, to show I have their best interests at heart. I never want them to feel they’ve failed, like I did. Taking one pill can be harder than it looks.

Sunita Sridhar
San Diego, California