Happy Hour

Between 4 and 5 pm is a time when many people start to wind down, even at work. In our clinic it is usually a mad dash for the finish. We often begin the last hour of the day with all bases loaded – a patient in every exam room.

This is also a time when some of the strangest phone calls come in. Today we heard from Beulah Betts.

Beulah Betts is a remarkable 94-year-old woman. She is almost blind, and lives by herself on Yellow Brick Road, which is a trailer park from the late sixties or early seventies. Her home is neat as a pin, even though she doesn’t see well enough to watch television, read the paper or even see where she put the vacuum cleaner. Her refrigerator door is full of pictures of relatives’ children, even though she cannot see them.

I did a house call there a week or two ago. Her two younger sisters were there, obviously a bit concerned about Beulah’s failing memory. Soon after I arrived, Beulah told me something important about her medications:

“I didn’t know what all these pills were for, so I stopped them.

I was humbled. Other than her macular degeneration and her memory, she seemed to be in great shape. The trailer was as neat as ever, and she looked good, with normal vital signs despite her noncompliance.

I quickly proposed a compromise. Her cholesterol pill and her eye vitamins seemed more important than the rest of them:

“Why don’t you take these two kinds of pills and we’ll put the rest of them away.

She was O.K. with that, and we finished the home visit.

Today, shortly after 4 pm, Autumn got the call from Beulah as she suddenly missed all her other pills. I paused for a moment. Was this her usual, mild confusion, or had she had a little too much of that orange soda-looking concoction she once admitted to keeping in her refrigerator? Should I call her sisters, or maybe Adult Protective Services? I decided against it; she was probably safe. Autumn was able to confirm with Beulah that she still had the cholesterol pills and the eye vitamins.

At 4:45 Beulah called again. I was still up to my ears in messages and had two more patient visits to wrap up. This time, she talked to my appointment secretary, Gwen.

Gwen was clearly concerned. Beulah claimed she had been at our clinic this afternoon and we wouldn’t give her any medication.

My heart sank. Was Beulah really that confused? Was she drinking? What was going on?

I called Beulah’s sister, Beverly. That’s how the story finally came together:

Beulah had an appointment with the eye doctor today, long overdue. I had actually asked Autumn to call the eye doctor to facilitate this. Beulah has now developed glaucoma, and had been given a prescription for eye drops. When Beulah and Beverly found out how much the drug store was going to charge for the eye drops, they had come to our clinic. Someone at the front desk had taken the prescription and forwarded it to the staff member who helps patients apply to the pharmaceutical companies for free medications. Because of how wild things tend to be here between 4 and 5 pm, nobody had told me yet or had had an opportunity to document their conversations.

So, during our Bewitching Hour, I had myself worrying that poor Beulah was hallucinating about coming to the doctor’s office while sipping too much of her yellow concoction during her Happy Hour.

As it turned out, she was no more confused than our clinic or I was!

1 Response to “Happy Hour”

  1. 1 Joe Carr October 10, 2008 at 2:52 pm

    I thought I was the only one who experienced this type of thing! Makes me feel good to know that other practitioners feel as harried as I do at times.

    Love your writings (and your heart for your patients)… keep it up!

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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