Diphenhydramine, Spironolactone. Celebrex, Xtandi, Robaxin. I would sort my father’s pills by linguistic patterns: syllable count, consonance, alliteration. I liked Omeprazole because it sounded like a yoga chant. Dad liked it because it settled his acid reflux. The end of my father’s life was dominated by the medications he took. They would rule his schedule, his body and, increasingly, his mind. I had little say in the matter, especially at first, when he was still sharp and very much his own doctor. Even after he stopped practicing medicine, he kept up his license to prescribe so that he and Mom would be able to avoid needless treks to the doctor’s office for “little things” like antibiotics and muscle relaxants. I was accustomed to this all-access pharmaceutical household, having grown-up with prescription cough medicine and allergy relief throughout my childhood. If you had the sniffles, you got the purple medicine (a prescription version of Dimetapp); if you had a cough, it was the red medicine (Phenergan VC with codeine). I preferred the purple medicine because it tasted better, not because I had any inkling that the red medicine was a narcotic. Somehow my sisters and I avoided addiction despite liberal usage, but my father was unabashedly hooked on pills, not so much for their medicinal effects, but as part of a lifestyle devoted to mid-century medical science.
Renowned for his bedside manner and genuine affection for his patients, Dad was also the kind of doctor, educated in the late 1950s, who relied on the miracle of modern medicine to address any symptom. This was long before the word holistic entered the mainstream. In fact, I remember a conversation I had with him in the 1980s when I began to see my own doctor about a holistic approach to medicine that included an examination of diet, activity and wellness. I believe he dismissed it as “voodoo” and had a hard time believing this “lady doctor” of mine was a certified M.D. (He didn’t have a problem with women becoming physicians, he would explain, but he always called them “lady doctors” to distinguish them from “regular doctors.”) In his world, any discussion of diet was reserved for obese patients. Exercise was a fad, and “wellness” — please. If something was wrong, there was sure to be a pill to cure the ill. As a kid, I remember visiting his office and sitting behind his big desk while he was in the exam room with patients. I was impressed by the swag he displayed from various pharmaceutical companies. This was the 1970s. A pen with the company logo was nifty back then, but he showcased an entire desk set: paperweights, notepads, paper clip holders, blotters, all embossed with names of various drugs in gold lettering. I hung onto one of these items, a powerful pocket magnifier with a leather case advertising a drug named Thiosulfil, an antibiotic used for urinary tract infections (I know that because it’s actually printed on the case). I can only hope it was not intended to double as a diagnostic tool.
Dad would acquire these items at conferences run by pharmaceutical companies, an industry practice that persists to this day, although I like to imagine that a new generation of marketing-resistant doctors has evolved alongside the drug-resistant pathogens bred from all the overprescribing committed in my father’s era. Of course, my father was also witness to cures unthinkable in the generation that preceded him, when people died of simple infections and a host of viruses, from polio to measles, for which these same companies now produced miracle vaccines. It was, no doubt, exciting for him to hear about new medication that would promise relief to his patients who suffered from ailments great and small. Why live with a muscle ache or acid reflux if you can erase these discomforts with a pill? Why ever cough or sneeze or itch again? I have vague memories of his brief absences to Boston or New York and his jolly returns that would include the dog running circles around us as my sisters and I wrapped our arms around my father’s legs. I would later learn that he’d use these occasions not only to learn about the latest drugs, but also to eat prime rib, stock up on office supplies, and cheat on my mother.
Our home pharmacy, a.k.a. the linen closet, was stocked with the usual prescriptions along with free samples that Dad didn’t need at work. Medication was packed in hard plastic bins the size of shoe boxes. I deduced that they were organized roughly by ailment since certain boxes came out at certain times. When we were little, they were careful about storing medication out of reach. That did not prevent me as a toddler from getting my hands on the baby aspirin one day, apparently ingesting the contents of an entire bottle. In my defense, they did refer to this medicine as “baby candy.” When my own kids were little, I had a bottle of Ipecac syrup designed to induce vomiting in such emergencies. These days, I’m told, Ipecac is no longer deemed safe. Still, my mother frantically rushed me to my father’s hospital where they administered something similar. The nurse asked me how many pills I swallowed, and I dutifully held up my hand with five fingers splayed and announced, “Fwee!” When I was instructed to “throw up in the pan,” however, I looked shocked and told the nurse that she should throw up in the pan instead. After refusing to vomit, I was pronounced well enough (or at least stubborn enough) to go home. It wasn’t until I got in the car that the hospital-grade Ipecac kicked in, much to the horror of my mother who would complain that everything bad happened the minute my father left the scene. I was far too young to remember this episode myself, but it became a legend, told again and again (usually to a boy I brought home to meet my parents), so I presume something like it probably happened.
The scare of an accidental overdose, however, did nothing to change their storage habits; if anything, they seemed to relax as we got older. Maybe they assumed we had all been schooled by this cautionary tale (and the one where I got into the bleach, but that’s another story). At some point before he retired, my father got possession of an old urologist’s cabinet, designed to store equipment and perhaps even specimens. It features a glass front cabinet with glass shelves that light up when you open it and several narrow drawers beneath. This became the official pill repository once we were old enough to know better and it traveled with them into old age. These days, it sits in my dining room, displaying china I inherited from my grandmother. We don’t usually tell our dinner guests about its past.
Having a central location to store medication did not prevent pills from spilling out all over my parents’ house, especially as Mom and Dad aged. When I brought my own toddlers to visit them, I would have to perform a thorough check for DWRs (“drugs within reach”) before letting the kids loose in their house. Over the years, their breakfast table became crowded with bottles of pills meant to be taken with food. Pills to be taken at night littered their bedside tables. Dosages would be lost regularly to the vacuum cleaner as pills lay buried in the carpet. In the bathroom, they would balance pill bottles on the window sill or the skinny ledge behind the sink — anywhere but the medicine cabinet. The kitchen sill, on the other hand, was reserved mostly for dog pills because their dogs received medication in direct proportion to their own medical needs. Sometimes a prescription for humans would end up beside the blue-labeled veterinary pill bottles. If I tried to move it, I would be stopped. “That’s for the dog,” they’d correct me. “The vet said it was ok.”
In addition to prescriptions, they stocked an impressive quantity of over-the-counter medications (antacids, eye drops, ear drops, nose drops, cortisone cream, bacitracin tubes, laxatives, fibers, Tylenol, Advil, Motrin, along with their generic equivalents) and equipment (boxes of tongue depressors, hospital-grade Q-tips, ace bandages, boxes and boxes of Band-Aids, medical tape, gauze, steri-pads, etc.) Add in all of my Dad’s vintage stethoscopes, otoscope, blood pressure cuffs and a variety of clinical equipment related to his Foley catheter and their house could have served as a field hospital for the neighborhood in the event of a wide-scale geriatric attack. To top it off, Dad consumed several glasses of quinine water each night, “for leg cramps,” so he kept full liters in the garage and amassed the empty bottles by his bed until trash day.
As he started to decline, Dad would end up in the ER for this, that or the other, and would proudly rattle off a long list of daily medications to the nurses. Then one day, he couldn’t. The list was too long; it had changed; he had changed; what was that pill he took for ear aches? So, we committed his pills to paper, a two-page, single-spaced list of medications that he could keep in his wallet. I was astonished to see it all laid out, pill after pill. This couldn’t be right, but my father insisted that everything on the list was essential. I wish now that I had kept that original document representing the high-water mark of my father’s pill intake, but I learned to dispose of each list thoroughly after every change to avoid a mix-up at the hospital, which had an even harder time keeping track of Dad’s medications since he was prone to tweak his dosages and modify his pill regimen on a daily basis.
Did his doctors know? Because he had practiced Internal Medicine, Dad rarely saw his own primary care physician; he relied on specialists for each part of his body right down to his little toe, which was constantly getting infected because he would saw away at it compulsively with the nail clipper. My mom would refer to this specialist as “Dr. Foot” because she could never remember his name. As I would eventually drive my father from one appointment to the next, I would add his doctors and their locations to my phone. These included: an oncologist (for metastatic prostate cancer); an infectious disease specialist (for his drug-resistant MRSA); an ear, nose & throat specialist (for persistent ear infection and chronic nose bleeds); a podiatrist (Dr. Foot); a foot surgeon (for malformations of his feet due to radiation for the cancer); an ophthalmologist (general eye care); a urologist (cancer radiation also affected his urinary tract leading to catheterization); two different orthopedists (for two different back problems) and a cardiologist (who, fun fact, was also a stand-up comedian). Every visit ended with a trip to the pharmacy.
I began to wonder about the cost of all these drugs. Between Medicare and his AARP Supplemental plan, he actually spent relatively little per prescription, but together they amounted to hundreds of dollars a month. This included a wildly expensive experimental cancer drug provided at a massive discount. Dad wasn’t into buying anything else: clothes, fancy food, or electronics. He liked to make small donations to charities like the Salvation Army and Doctors without Borders, and he liked to buy medication. This was the extent of his retail therapy. My main fear, then, was drug interaction, but Dad assured me the pharmacist would always cross-check. He presented this counter-argument with a calm, measured tone — like a doctor. He had spent his career sounding authoritative. Still, this quantity of pills could lead to no good. Mom agreed, although she, too, was habituated to a “treat the symptom” lifestyle and relied on Dad to dispense medications, starting with a high fiber concoction in the morning and ending with Imodium to stop the flow at night. In the end, she had little influence in this department.
As the pills were ramping up, my father’s driving was taking a nosedive. He had steadily weakened as a driver over the years and was annoyed that since the mid-2000s I wouldn’t let him drive with my children in the car. He’d only had “the one accident,” he argued in his calm doctor voice, and no one got hurt. Indeed, everyone survived, although both his car and the car he hit while merging onto the highway were demolished. I was terrified that he would kill someone, and I wasn’t afraid to tell him so. I worried about him and my mother, since she was always the passenger, even though she remained the better driver. As devastating as losing them to a car accident would have been, having to deal with my father hurting someone else seemed worse. I learned that the only way I could separate him from his license was to report him to the DMV, and then his doctor would have to declare him incompetent. Were we there? I hesitated. Then, one day, my father smashed into the refrigerator they kept in the garage. Apparently, he fell asleep at the wheel just as he was getting back from the dump one day with a friend. The friend shouted as Dad plowed ahead. He was able to stop, but not before leaving a sizable dent in the fridge door.
Maybe now Dad would be convinced, we hoped, but not before checking in with his doctor. Dad took to writing in his retirement, honing fictionalized stories of his medical practice through senior writing groups. I would later find his account of this incident in his papers, written as non-fiction — I knew because he used real names in place of his usual pseudonyms. His short stories featured the antics of “Walter” and “Louise”; this piece referred to himself and Lois, my mom, along with Bob, his friend in the car at the time, and Dr. Walker, his primary care physician. “Doctor, please help me get back behind the wheel,” he writes, “and I promise to be a very cautious driver. Lois hates being a chauffeur. She doesn’t feel safe on highways, and her vision is too poor for night driving. I really have to drive!” The doctor responded by asking him to refrain from driving until he had completed a sleep study at the local hospital. My father had a history of sleep apnea and believed this was related to his daytime drowsiness. When the hospital failed to confirm this theory, my father shrugged and was back on the road.
I shared my fears with all who would listen, and everyone shook their heads. Some responded with similar stories. Everyone concluded that the issue was less about driving and more about independence and control, which I had already deduced. I did not dispute my father’s desire to drive and why driving was important for his independence. These facts had nothing to do with the imminent danger he posed every time he drove. Uber had not yet arrived in their “Quiet Corner” of Connecticut, and taxis were rare and expensive. Their town did provide a service for seniors who needed to get to medical appointments, but the process was so convoluted, my father couldn’t manage it. He kept driving, and I became the one tossing and turning at night.
Finally, I couldn’t bear the stress of knowing he could harm someone, and I brought the matter to his doctor myself during his next appointment. My father was annoyed that I had come with him, and I mustered all the courage I had to state my concern about his driving, not to mention my alarm over the number of medications he was consuming. His doctor looked at me askance, having already established that Dad was part of the fraternal order of physicians, but told my father that when family members express a concern, it’s worth listening. He suggested that my father get tested again, this time at a facility that assessed driving ability for people with disabilities. He also told us to bring all his medications, in their original bottles, to his next visit and we would go over them. Ultimately, we figured out that Dad’s driving was greatly impaired because he was overmedicated, and his doctor managed to cut his prescriptions in half, using the same calm doctor voice that Dad would use with me. He also urged my father to lay off the quinine, which Dad didn’t consider to be actual medicine (despite his using it for medicinal purposes).
Incidentally, Dad did manage to pass his specialized driving test. He confessed several times to me, however, that he did so by convincing the administrators that the tests themselves were not accurate, that he would miss something for legitimate reasons (the seat was set wrong or the road conditions were unrealistic, etc.) It’s hard to know, not having been there, what really went on. I believe he passed on his own merits (rather than his rhetorical skills). When he was able, he could drive just fine. It was the times when he wasn’t able that I worried about. Significantly during this same period, I convinced Dad’s doctor to administer a MoCA (Montreal Cognitive Assessment Test) to serve as a baseline for his cognitive abilities. Even my Dad knew his memory was failing, but no one could gauge his competency. At least we could have a comparison in the future if we needed it, as indeed we would. Years later, President Trump would brag about his MoCA score as evidence that he was a genius. Not only does the test not measure intelligence, it doesn’t offer any indication of mental decline until you take it more than once. In short, it’s an excellent measure to have in your back pocket if you are worried about someone’s future mental fitness, whether or not they have access to the nuclear codes.
Once we established that pills were the root cause of Dad’s drowsiness, he tamed his medicinal ways, particularly the round-the-clock muscle relaxants he’d been taking, enough to keep driving for at least another six months. Then one day, out of the blue, he decided he was done and told my mother he wanted to relinquish his license. And that was that. We scurried to accommodate his frequent trips to his various doctors, the pharmacy, the hardware store and Highland Park Market, which he kept calling “Highland Fling” for some reason. Mostly, I carried the load, but we also hired help and used Mom, who remained a perfectly good driver almost to her own end three years later — except at night and on the highway, of course. Whoever drove was subjected to my father’s excruciating directions. Not only would he tell you when to turn (even though you were familiar with the route), he’d point out landmarks and describe bends in the road like they were rare phenomena. This drove me nuts at first, as I battled to assure him that I knew where we were going. I quickly realized, however, that he wasn’t narrating the route for my benefit, but for his own, to assure himself that he knew where he was going. I drove silently after that, allowing him to narrate our journey like David Attenborough out for a stroll on the Serengeti. I began to see the region differently, populated haphazardly but functioning with a synchronicity that included us somehow, weaving through it all, atomically pulsing past the dry cleaners, the crumbling barn, the gas station that kept changing its name.
Eventually, my father would be diagnosed with vascular dementia, which is caused by a series of small strokes. A follow-up MoCA and MRI would confirm his condition. During this time my sister was fostering a little boy named Avery who stayed with her family for two full years before he was able to return to his parents. He became a regular visitor with my sister, but Dad just couldn’t hold onto his name. Instead, he would call him Aleve, like the painkiller. Avery was only three at the time, and oblivious to the slip, but my teen and tween sons thought it was hilarious that their foster-cousin was repeatedly mistaken for a bottle of pills. They still refer to him as Aleve. Given Dad’s reverence for pharmaceuticals, they considered it a badge of honor.
After my father’s death and my mother’s decision to move to a retirement community, we would spend weeks cleaning out their house. I took several trips with overflowing boxes of pills to the police station where they collect unused and expired medications. We kept for our own use what I believe to be a lifetime supply of ibuprofen, band-aids and toe pads, which proved invaluable to my youngest son who was always battling his soccer cleats. Otherwise, I am wary of pills. This is not to say I am entirely sans medication; I do fear, however, becoming like my father in this regard. My husband Tom doesn’t take any medicine at all. He’s not fanatical; he just doesn’t need any right now. Recently, he went in for a routine colonoscopy and the nurse asked him what he was taking. When he replied, “nothing,” she looked skeptical and asked again. Is it that unusual? I wanted to assure her that we regularly self-medicate with caffeine, alcohol, and Netflix comedy specials, but I didn’t want to add to her confusion.
Having suffered from postpartum depression, then dysthymia (a low-grade depression), I’ve been on and off antidepressants. I would taper off regularly, when I thought I was fine, just fine, but then the everyday struggles would turn into an ill-defined morass. My problem was hormone-related. They had fluctuated dangerously during my pregnancies and then surged and retreated sporadically, never quite finding equilibrium. My resistance to staying on medication had nothing to do with the popular debate over the existence of “happy pills.” I am substantively in favor of medication that enables people to function. I am well aware that depression is a medical condition that is not just “in your head.” As one therapist would ask every time I thought of stopping my own medication, “If you were diabetic, would you feel compelled to ‘taper off’ insulin?” My brain was not ready or willing to sustain basic serotonin levels on its own, and wasn’t I lucky to live during a time when we could treat our physical limitations in order to live more productive lives? Indeed. My father’s lifelong dependency on pills haunts me to this day, but I’m less and less compelled to base my medical decisions on principle alone.
Just a day after we buried Dad’s ashes, I suffered a heart attack at the age of forty-nine. Luckily, I did not have heart disease; “luckily” it was just stress — a “fluke.” Needless to say, I was showered with heart medication: beta blockers, blood thinners, statins, a daily aspirin regimen. Almost immediately, my blood pressure plummeted. Unlike my brain, which needed chemical assistance, my heart was telling me to knock it off, it could heal just fine on its own, and if I wasn’t going to listen, well then, I would just have to pass out on the floor. Even my cardiologist conceded that I probably didn’t need the beta blocker and the statins. Because I’d had stents placed in my artery, he insisted that I stay on the blood thinner for a year. The daily baby aspirin was practically nostalgic. So much of my healing would have nothing to do with pills; it was (and continues to be) a process on a different time scale, governed by a different set of actions and reactions. Pills, as my father and his generation understood them, imply immediate relief. You take them and your symptoms melt away; if they don’t, then you must be taking the wrong dose or the wrong pill. This was what my eighty-five-year-old mother-in-law assumed when, having had a bout of insomnia before a family trip to Italy, she decided to take an Ambien (surreptitiously acquired, I’m told). When she still felt anxious, she decided it wasn’t working, so she popped another and thought it would be a good idea to mow the lawn before leaving for Europe. Her daughter, after discovering her incoherent, lying next to the lawn mower, assumed she’d had a stroke. As the rest of the family began to assemble in Spoleto, she was in the ER undergoing tests until the Ambien fog cleared enough for the truth to emerge and she was cleared to fly (this time by airplane). This is the same woman who, upon hearing that I had suffered from postpartum depression, remarked, “We didn’t have postpartum depression in my day. We just took Valium and drank.”
Hanging in my front hallway is a three-by-four-foot painstakingly detailed hand-lettered chart created in the early 1970s by homeopathic pioneer Les Kaslof. It lists every conceivable ailment across the top and every conceivable herbal remedy down its side. Sore throat? Try angelica, avens, bayberry or bistort. Insomnia? There’s black cohosh, catnip, chamomile or clivers. Just to name a few. Although it would have definitely qualified as “voodoo” in my father’s eyes, this chart belonged to my mother who has always had a fondness for herbs. She used them mainly for cooking, but was clearly aware of their medicinal properties. She and Dad always planted herbs in the garden and included fresh dill, rosemary, oregano and basil in their diets. Mom regularly sent away for sorrel plants to make soup. They never consulted the chart, however, when their bodies needed healing. I sometimes imagine that Mom meant to take a different path or supplement their pharmaceutical lives with something more organic. The chart first hung in a commuter apartment that she kept in New York City, when she was working as a teacher during the week, returning to Connecticut on weekends. When she left her job, I asked if I could have the chart to fill some wall space. Like my parents, I treat it more like art rather than as a reference guide, mostly because I’m overwhelmed by the sheer scale of it. The handwritten print is so small, I need the Thiosulfil magnifier to read it.
Lately, however, I’ve been studying its meticulously annotated rows, deciphering its coded symbols, and sounding out the Latin names of herbs in alphabetical order. The more I do this, the more I can imagine my octogenarian self in a house that smells like lemon balm, sifting through roots and leaves, concocting remedies for my bursitis. Maybe I should order some seeds — carum petroselinum, mentha piperita, valerian, vervain, verbena… I imagine my kids coming to visit me, ducking beneath sprays of lavender and motherwort drying from the rafters, and begging me to lay off the nettles. They will probably tell my doctor. I think about this as the world is lining up for a Covid-19 vaccine, which like the Salk vaccine for polio will be a game changer, and I redraw the line between medicine as a remedy and medicine as a lifestyle. Already, public health officials worry that anti-vaxxers and conspiracy theories will keep the population at risk. Our relationship with medicine, as old as time, is complicated, and not always good for us. Too much, too little.
My father’s story is a cautionary tale that was built on a foundation of knowledge and optimism. The power of medicine can overwhelm, dazzle and frighten us; it can change the course of history. It can also cause us to fall asleep at the wheel.
Image: by Nastya Dulhiier on Unsplash, licensed under CC 2.0.
- Pillapalooza - April 29, 2022