16 , 2005
Way out in the Mojave Desert there still live some old homesteaders, squatters and other such rugged individuals who live a simple life in bashed together shacks with few or none of the modern amenities. As a home health nurse I've been sent out to see many of them, but this gentleman stands out in my memory.
He was quite shy at first, having difficulty sharing much with a total stranger - this "nurse" come to meddle in his business, but I persisted in gentle questioning, all the while reassuring him that my only purpose was to help him prevent another wild trip to the hospital.
He had recently seen a doctor in the ER, not going to a doctor regularly because he did not drive and did not like to impose on anyone. They had tried many different medications, and combinations, but seemed unable to manage his heart condition without frequent ER visits and hospitalizations. This time his assigned primary doctor had decided to see if there was something they were missing by sending a home health nurse to evaluate him in his home. The fact that he quickly stabilized while IN the hospital should have told them plenty, but they didn't get it until after they saw my evaluation. (Too bad they didn't think of that a lot sooner...)
Part of that evaluation is a request to see the bottles and packages for all medications, both prescription and over the counter, that the patient is currently taking. This is often the most revealing part of the interview, but I was not prepared for the shock of this one.
He shuffled into his little waterless kitchen and removed a large fish bowl from the top of a cabinet. It was covered in dust and fly specks, so I didn't see what it was until he handed it to me. It was full of loose pills, and dead flies, and dirt...
Now wouldn't that put our super spoiled "infection control" people in a tight knot of untidy underwear? I'm not squeamish about such things, but I'm glad he'd turned away and didn't see my face for those first few seconds.
I asked him how he knew what medicine to take, and he hesitantly explained that he knew he took a red one and a green one in the morning... blithely unaware that colors and shapes of medications can change with the manufacturer or that medications exposed to heat, air and dust, etc. are not safe or effective, even if he had a clue which was which or how old they were.
He didn't have any of the bottles, he told me, because he threw them out as soon as he got home. The young man that drove him to the store and pharmacy would take the "damned caps" off the things, and he would then pour the pills into the "jar". He didn't know he could request non- child proof caps.
I wrote out for him the latest doctor's medication orders in plain English and large print. Very gently, I asked him to remove those specific medications for one dose from "the jar" and he was, of course, unable to do so. He was intelligent and alert, so the look of consternation that came over his face was sad. He just hadn't realized that his solution to the problem had almost killed him many times - but he was forcefully aware of it then.
Again, very gently, I instructed him on the importance of taking the medication as ordered, keeping it clean and cool as possible and in the closed containers that came from the pharmacy with the name and directions on them. I gave him a large divided pill box to use when the new medications came. (They are ok for a week at a time)
After a great deal of argument with both the insurance company and the pharmacy, I ordered all new medications and even arranged for the pharmacy to make sure that NON "child proof" caps would be provided so the friend who brought the old man home could remove the mandated caps and replace them with something he could use. They would NOT dispense the pills with plain caps, no matter what I said. (This is no longer the case, thank goodness. They will put the other caps on if you request it, but they don't offer it.)
On my visit the next day, we examined the new pills and I showed the patient how to prepare the divided boxes each week. Since the patient was able to read and follow the directions and understand how to use the boxes, I was confident that he would not return to the hospital again soon... and he didn't.
thing that had been standing between him and good health for a very long
time was "child proof caps", and the bureaucracy that thinks
they are so necessary - no matter how many people it kills.
The High Cost of Medicine part 2