Medicinal Muddles

My mother’s memory troubles and general confusion have increased to the point where the possibility of her overdosing on her daily medicines is a constant worry.

Months ago, I wrote out a list of all her meds: brand name, generic name, dose, and purpose. She has handled this handwritten list so much that it is wearing thin. There are check marks penciled all over it. But this list was intended as a reference, not for checking off when pills were taken; a check mark on it is meaningless because it isn’t linked to any particular day.

I began to notice that she was needing refills of prescriptions about a week sooner than she should have run out. Then CVS said that insurance wouldn’t pay for a certain refill because it was too soon to fill, yet I couldn’t have her go without, so we paid full price for the anti-hallucination medicine.

Part of the problem is that she’s in such relentless back pain that she has a constant urge to take medicine to make the pain stop. There is no convincing her that hallucination medicine will not help her back pain.

Clearly Mom needed a way to remember whether she’s taken her pills. I tried to sell her on a pill organizer. She declined, saying the idea depressed her. I told her that I use one myself because the motions of taking medicine are so much the same, and the routine so mindless, that soon after I’ve done it, I can’t reliably say if I did it that day or if I’m remembering the day before. You don’t have to have dementia to forget this kind of thing! But no, she insisted, she wanted to stick with the pill bottles and a checklist.

So I devised several candidates for checklists, some from templates and some from scratch based on observations and guesses about what might work. She rejected all of them. Unchecked boxes were intimidating, and I think sharp black-on-white printouts made her nervous. I know that doesn’t make sense. But I started to notice that my computer-printed efforts stressed her out just to look at, no matter how simple and full of white space I made them, whereas she loves the handwritten page.

This makes me wonder if, in our later years, as our minds fail us, people all try to revert to the forms of communication we liked most during our lives. Handwriting on paper would definitely be the thing, in Mom’s case. It’s an unanswered question, because it’s only in the last few decades that these forms have changed as fast as they do now. But the rate of change increases all the time, so I wonder how it will play out, and if anyone is studying it in a gerontology program somewhere. I hope I’ll be able to keep up, but I picture myself pining for Excel spreadsheets long after there’s no longer any such thing, and I’m so fond of texting that I wonder if I’ll be able to adjust to whatever replaces it. I don’t know. If my giant paper calendar (color coded for each family member, natch) is any indication, I might have some trouble. (People used to see it and say “I like paper better, too.” Now they just say “oh, wow.”)

But I digress.

I now have Mom using a pill organizer with big compartments labeled S M T W TH F S. Every visit, I refill the compartments for the days ahead. At first, I’d look at the pill compartments and half of them would be empty and the other half filled with Advil. She would insist that she hadn’t taken any more pills than were in the box, and I would say but Mom, they’re gone, so where else did they go? I wanted to hire an aide, but she asked for “one more chance to get it right.”

We’ve compromised. I now call her every day to say it’s time to take the pills in that day’s compartment. She puts the phone down to get some water, and says OK, now what? and I tell her what compartment to open, and she counts the pills and describes them and asks is that right? and I say yes (with no small relief), and she takes them. Every day she asks me why she has no pills in the empty compartments, and I tell her it’s because she already took those. Every day she asks what happens when she runs out, and I tell her I will be back to refill the compartments.

This is working, at least temporarily. Someday she will have to have an aide come in every day to be sure she has taken her meds.

You may be wondering how Dad does. Turns out for managing medications, it’s more important to be able to think than to see, so he’s actually OK on this front. He keeps his meds in a kitchen drawer. One bottle has tape around the top, and one has a rubber band around the middle, and one is unaltered. He knows which is which and how much to take from each bottle, and I refill the bottles when he’s running low.

There are workarounds for blindness, as awful as it is. This slow, relentless failing of the mind, though? All we have are temporary patches to a system that is doomed to fall apart completely.

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