Message in a Bottle
A nurse handed me a list. “Mr. Bowen just moved to town and ran out of medicine. You don’t have to see him. I scheduled an appointment in two weeks,” she said. I had already seen several patients that day and had more waiting, along with secure messages, the medical advice line, and phone appointments to finish. Filling out a list of medications was not a priority. But I faked a smile and said, “Yes, of course.”
At a glance, the list included usual medications patients take for blood pressure, depression, allergies, eczema, and pain. I tossed the paper on top of a pile of folders and followed up on a phone appointment with another patient, Ms. Cordell, who was upset that I was late in calling. Chronically ill and lonely, she loved to talk. While listening to her, I looked up Mr. Bowen’s remote records and reviewed his medications. They were accurate—he had visited his Veterans Affairs primary care physician less than a month ago and his labs were fine. As I was placing the orders for his refills, I heard a knock on my door. My next patient was ready. I wrapped up my phone call with Ms. Cordell and walked out into the waiting room.
With his list of medications in my hand, I called Mr. Bowen’s name. No response. I asked the clerk if he was still there. She shook her head and shrugged her shoulder. I thought about having the clinic pharmacist enter the refills to save time, but he wasn’t available either so I went back to my office and quickly entered his medications.
My next patient was Mr. Robinson, an elderly man accompanied by his daughter. They had visited oncology to follow up on his lung cancer. He was told that chemotherapy was not an option given his frailty. “Life is precious,” he said. We agreed to work towards realistic goals in promoting his function, dignity, and comfort and supporting his caregivers. When Mr. Robinson and his daughter left, I began responding to urgent messages in my alert box. I saw that Mr. Bowen’s medications were ready for window pickup.
It was nearly noon by then. While passing by the waiting room to get lunch, the clerk alerted me that Mr. Bowen was back. I contemplated asking her to let him know that his medications were ready and that he should come back to see me in a couple weeks. With a few minutes to spare before my next task, though, I found myself walking toward him.
A man in his early thirties, he stood up. I extended my hand and greeted him. “Thank you for waiting. Let’s verify your medicine and we’ll get you out quickly.” He followed me quietly; he walked straight, his face held forward in a steady gaze. It was a bit awkward, but I assumed this was the way he always looked.
We sat in my office. I turned to my computer and started reviewing his medications. His responses were muted, but he had a decent understanding of his illness and treatment. Then silence ensued. “How did you end up running out of medicine?” I casually asked without looking at him.
“I swallowed all my pills last week. I was in pain and did not want to live.”
His voice penetrated my psyche. My heart sank, cold sweat swept over my body, and my hands shook. I reached out to him and touched his hand. Perturbed, I kept hearing myself repeating the few words I could. “I am so sorry.”
A combat Marine, Mr.