"My asthma has been acting up. I feel terrible." We sit at her kitchen table as she wheezes and coughs.
"Which medicines have you been taking?" I ask, as I move the bottles and containers around the table, examining the original prescription dates and refills remaining on the various labels.
"Oh, I've been taking this one, this one, that one, and definitely this one," she replies, lifting up various bottles and shaking them in the air. They each have just a few pills left. "You see?" she says. "There's not much left in any of them."
"So," I continue, "you've been taking this one every day, without fail?" I hold up a bottle of Singulair, a pill to be taken every night to prevent asthma attacks.
"Oh yes," she says.
"Well, I just don't know," I reply. "This label says that you filled this bottle on March 17th, 2006. That's ten months ago. Are you sure?"
"Absolutely. I take it every day."
I take my cellphone out of my pocket and call the pharmacy. They inform me that she hasn't filled any prescriptions for six months, and the Singulair has not been filled since March of 2006.
"Do you use any other pharmacy?" I ask hopefully, knowing full well that she only uses the one at the clinic, which is within walking distance of her apartment.
"I only use the pharmacy at the clinic. Do you mean I haven't filled that prescription for ten months?" She looks perplexed.
"You know," I say, taking her hand across the table. "You don't need to lie to me. It doesn't hurt me when you don't take your medications. It only hurts you. I just want you to feel healthy."
"I'm sorry," she replies. "Please forgive me. I didn't want you to be mad at me."
We hug as I get up from the table.
"I'll refill all of your prescriptions when I get back to my office. Don't be afraid to tell me the truth. And don't be afraid of the pharmacists. If you don't have money for your copayments, they'll keep track of what you owe them."
"But I already owe them $44!" she replies.
"Well, now you'll owe them a little more. Just pay something each month when you get your check. Better to owe the pharmacy money than to be in ICU with a breathing tube, don't you think?"
I smile on my way down the stairs. Medication adherence is half the battle. Win that skirmish, and half your work is done. Well, sometimes, anyway. I remind myself to pay this patient a visit in about thirty days and see what meds she hasn't refilled yet.
Patience, persistence and a sense of humor. A nurse's best defense against burn-out.