Ms. F was a ninety-something-year-old woman who scheduled to see me in clinic, then showed up ready to rumble. She was mad. I had recently refilled her medications. She took five prescription medications. Three of the five she took once daily, one she took twice daily, and one she took one-half of a tablet three times a week. She liked to pick up three months of tablets at a time to save trips to the pharmacy.
She was mad about the prescription for the half tablet three times a week.
“Why did you rip me off?” Ms. F demanded. “Did you think I wasn’t paying attention? Only thirty tablets.” She shook the bottle at me. “All the rest have ninety, or more.” She shook one of those at me for comparison. It was louder. I nodded, preparing to speak.
“Fix it,” she stated. “Fix it. Now. NOW.” Her level of anger seemed out of proportion to the issue but I tried to stay calm while ninety-plus years of anger glared at me from behind thick, smudged bifocals. She shook the pill bottle at me again with thirty tablets.
I tried to explain the math of one-and-one-half tablets and how many tablets that adds up to over three months. “If anything, I’ve overprescribed. You have more tablets then you need.”
She was not moved. At all. She got angrier. “I’m paying attention,” she told me. “To everything. Fix it.” Shake shake shake.
I tried to explain safe practices in prescribing and why ninety tablets would not be safe. I attempted to talk about risk of overdose if she were to mix up pills. This tactic did not help. She stood up and towered over me (I was seated) all 4’11” of her. She let me have it again.
“Fix it now,” Ms. F reprimanded me, like a teacher scolding a misbehaving student. “Fix. It. Now.” Glowering through the bifocals ensued. Shake shake shake. My calm was starting to slip.
After ten minutes of trying to explain and out of complete exasperation (and a little bit of desperation) I finally said, “it sounds like you’re really upset about this prescription.” I paused. I did not try to argue or explain.
She nodded and sat down. The fight went from a boil to a simmer. The air in the room calmed.
“It sounds like you feel you were ripped off when you only got thirty tablets and not ninety or more like the others?” I waited.
Ms. F nodded again, slightly calmer. “Yes,” she said. She did not yell at me. She sighed.
I waited again.
Then she started talking. “My family thinks I can’t take care of myself. They’re looking for any reason to put me in… a… one of those places.” She told me she watched everything closely to make sure it was orderly. No mistakes. She wanted to stay in her home. She did not want to move.
She had funds to hire a caregiver if she needed one. She did not need one yet. She did not want her family to think she was missing medications or was not on top of things. They would move her. She thought the thirty tablets could be a reason. She desperately wanted to stay in her home. Her. Home.
I listened. And I was humbled. She did not come into clinic needing me to explain the math of one-and-one-half tablets weekly. She needed me to listen. I spent ten minutes explaining and teaching. Wasting her time and mine. Thinking I was giving her what she needed. But I had not bothered to see beyond her anger or her shaking pill bottle. It was a good reminder, an important reminder.