Prescription for Tragedy

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Not long ago my father, who is 84, had a great fall. Great meaning bad.

He doesn’t remember tripping on anything, just that suddenly he was on the floor of his bathroom. He’d hit his head on the corner of the sink. There was a lot of blood. A long hospital stay followed after surgery to drain the blood that had pooled on his brain. He recovered, with a hole in his head as a constant and ugly reminder of his unexplained collapse.

The surgeon came to see us in the recovery room. He said “Martin, no more falling. If you hit your head again it will probably kill you.”

My father fell again a few months later. In the hallway of his apartment. There were no shoes or piles of mail or anything else on the floor to trip over. Again, he didn’t understand what happened. The hall is too narrow for furniture, thank goodness, so this time his head hit carpet. Still, he ended up bloody and back in the ER. He was extremely fortunate that the surgeon’s prediction didn’t come to pass.

Other than the falls, my father complained a lot about feeling horrible in the morning. He was sleeping just fine, but on waking he felt nauseated or dizzy, and always just blah. It was hard for him to describe, but it took him hours to feel human. He has type II diabetes, but he is truly obsessive about managing his sugar. The man has been writing down his glucose readings and everything he eats—literally everything—for years. His little notebook is packed full, with his shaky, black scrawl like dead spiders flattened on the pages.

Whatever was wrong, it plagued him for many months, dominating his days. At one point he visited the ER four times in the course of week, terrified each morning that he was dying. The staff would keep him for a few hours before sending him home, telling him to follow up with his regular doctor.

Of course, he’d already visited his regular doctor numerous times. Dr. C was in his 70s. He’d been my dad’s primary care physician for more than 30 years. Dr. C said there was nothing (new) wrong. Told him dizziness must be from an inner ear issue. Told him weakness came with old age and nausea, well, who knows. He didn’t offer a solution and wasn’t concerned. They talked about the old days. They talked about the Cubs’ winning streak.

I was never a fan of Dr. C. He seemed out of touch, long past due to retire, and after so many years as my dad’s main guy, he was no longer truly engaged with his health. He went through the motions and was lucky nothing went awry. I’d been pushing for years to switch to someone new. My father didn’t want to. He was afraid of insulting the doctor and thought Dr. C was “terrific.” After all, they were close in age and had a lot to talk about.

I went to Chicago to stay a while. I sat with my father at the kitchen table, a virtual pharmacy, as he carefully completed his monthly task of separating out his daily meds into a box with 30 tiny plastic compartments. He takes a dozen or so pills a day. At one point I asked him if anything had changed with his medications, and he said not in a very long while. A dim light went on in my head. It flickered.

I called around until I found a private doctor who actually called me back and who sounded intelligent and caring, and I made my father an appointment for the next day.

During the meeting, this whip-smart and kind woman, I’ll call her Dr. P, asked my dad what medicines he was taking. As he listed them proudly from memory, including exact doses, she took notes and looked concerned. She then accessed both her office’s online system and the entirely separate one for the Veterans Administration—where my father was seen occasionally—to compare notes.

She had him go through his meds again, one by one. And within 15 minutes, this doctor figured out the source of the problem that had made my father a regular at the ER and had knocked him flat twice, almost killing him.

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My dad was on two blood-pressure-lowering medications. Between them, based on recent readings, he was taking twice as much as he needed, she said. No one had reviewed the doses in years. In fact, he was getting one of these drugs through the VA—it came automatically every month with a doctor’s name on the label who it turned out wasn’t even on staff there anymore. And the VA and Dr. C had no communication about the prescription.

And then there was this: He was also on a post-prostate-cancer medication, prescribed by Dr. C. It helps to relax the muscles in the prostate and head of the bladder to make peeing easier. In some patients, it also lowers blood pressure.

So he was taking three drugs that lowered his blood pressure. It’s amazing his heart was pumping at all.

It would be easy just to blame the VA. Everyone else does. In recent years the agency has seen false-record scandals, a messy reorganization, and a tall stack of complaints from patients—over long waits for care (sometimes leading to patient deaths), the use of contaminated equipment or exposure to infectious diseases (hepatitis, HIV, Legionnaire’s disease), and so on. In 2014, the VA served more than 6.5 million patients.

So, it’s no secret that this government agency has a timeline dotted with slip-ups and scandal.

But, to be fair, I’d bet the bulk of healthcare providers, if put under the microscope, would disappoint. My dad’s own private doctor would be a great test case; he’d surely get a failing grade for thoroughness, and who knows what else.

But my real worry here is dot connecting. There are disastrous implications if you don’t do it. My father’s situation can’t be uncommon. It revealed the same mistakes by a government and a private healthcare entity. His private physician failed to look at his medications as a whole, to communicate with his other caregivers, and to correct dosages and eliminate overlap. He also simply failed to diagnose a fairly simple problem, which is another issue entirely.

The VA, meanwhile, failed to ensure my father had a doctor who was actually employed there—to oversee and update any VA-provided meds. It failed in the internal-communication department, ignoring the left hand while the right hand was busy mailing out pills from outdated prescriptions. And it, too, was remiss in staying on top of my father’s overall care, including what he received from non-government physicians.

And so my father had continued to fill his month-of-drugs container with too many colorful pills, some picked up at the Walgreens and some shipped by the VA, and continued to feel weak, nauseated, and dizzy, day after day.

Add to this that my dear old dad had been obsessing over his blood sugar and every bite of food for ages because a VA doc, years before, had suggested he keep a log for a limited time, just for her information. Once he started keeping track, he never stopped. He fixated on it. He was fanatical. And if his numbers weren’t absolutely perfect, he fretted about what he’d eaten, recounting the carbs, reconsidering his food choices. It sucked up time, annoyed the hell out of whomever was around him regularly, kept him from enjoying some foods he loved, and added to his daily worries.

Dr. P told him to stop. He was 84; perfection wasn’t necessary. No more logging numbers and keeping lists of food, no more fretting over peaks and dips in his sugar unless they were severe. She moved a mountain of stress out of his way that another physician had built up and left there. In that case, the lack of communication was between doctor and patient. If that other doc had told him to stop obsessing years before, he would have. And for a worrier like my dad, that would have been great for his health. The stress was doing more harm than blips in his blood sugar would ever do.

With adjustments to his meds and less worry over his diabetes, my father improved dramatically. He loves his new doctor—says she saved his life—and hasn’t thought twice about ditching the old guy. He now also has a real, living doc at the VA and because of Dr. P’s efforts the two physicians are in touch.

That last part is the key to everything. With his doctors communicating, the chances of my father being overmedicated again are minimal. Dr. P even communicates with me, calling me after each appointment to tell me how my dad is doing. I know I can’t expect all docs to do a rotation in the heavens, but it’s nice to know a few of them have wings.

It comes down to this: After good care, shouldn’t coordination be a top priority? Why was it up to us, to me, to demand this very basic thing? You would think the doctors themselves would want to collate all the data on a patient to make sure he or she isn’t headed for trouble. Many VA patients see private physicians for all kinds of problems. This is nothing new.

I don’t claim to have a fix for this mess of a system. But right now the lines of communication lead into a void or at best are severely bent out of shape. And that’s a trip hazard that can kill an old man in an empty hallway.

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CORRECTIONS: My father has informed me that the doctor who asked him to keep track of his diet was not from the VA but was from the private office. Also, he’d like to say that Dr. C took excellent care of him for years and was responsible for helping resolve some serious medical problems in the past. Finally, he did review my dad’s medicines with him periodically; however, he did not communicate with the VA nor did he notice the dosage problem.

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3 thoughts on “Prescription for Tragedy

  1. What a revelation, what a recipe for death or living hell ! You, my brilliant niece, have saved my brother’s life….again and yet again. I don’t really know how one message can go viral, and I don’t really understand what THAT means…I too, am old and those words are simply recent to my knowledge. But, this message should reach anyone who has ever taken many pills for long stretches of time. If anyone can figure out how to do this…it is you. Jennie, that you for being you, loving, interested and interested and smart enough to be able to do something to help out millions who have the same problem of over dosing. Maybe, along with all your other awards, you can win the Medical Alert Award. I love you and thank you. I am sending you an extra hug and kiss. Aunty Judy

  2. I watched my grandmother go through very much the same thing you outline, back in 1972 – her beloved Dr. E. was a personal friend, an avuncular model of the “doctor knows best” family doctor of song and story … and a pill pusher par excellence. My aunt, who was one of Stanford’s heart transplant OR nurses for 20+ years, was the watcher on the wall who, after Nana had had a series of downward spirals as she approached her 80th birthday, yanked open her “pill drawer” to find more than FIFTY pill bottles therein contained, at least 95% of which were both unnecessary and badly interactive. The family fired Dr. E., Nana’s meds were reduced to (IIRC) three daily dosages of [whatever], and she lived a vibrant, active life for another decade … and spawned e-patients (my ‘rents and myself).

  3. It is not only prescription drugs to watch for; there are interactions between so-called “herbal” medications as well, and many doctors don’t know anything about these as they get their information from the pharmaceutical sales reps. And if you don’t tell your doctor about the non-prescriptions, how is he or she going to be able to help you? Just because it’s not a prescription, doesn’t mean it’s not dangerous. Good article, thanks for posting.

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