Thursday, January 7, 2010

Just What the Doctor Ordered

One goes to the emergency room for succor in adversity: a nascent kidney stone, perhaps; pain in one’s extremities or bowels. One is treated kindly, examined, tested, reassured, and dispatched to a pharmacy with appropriate prescriptions for the alleviation of anguish and infection.

Like the people one sees on those signs in the post office, medicines go about under many names, and one wonders if pharmaceutical companies are staffed by people who write Heroic Fantasy in their spare time. (“When the tyrant Ketorolac sent his armies, under his ferocious vizier Meloxicam, to plunder the peaceful kingdom of Ativan, only the hero Celebrex, wielding the enchanted sword Lorazepam, stood between his people and subjection to the evil Flurbiprofen Empire…”)

Pharmacists now need printers as well as pestles, for, along with the cute little orange storage jars in which pills and powders are customarily dispensed, one receives also a page--two pages--several pages--of information on each medicament.

If one takes time to read these screeds--not always an easy matter, as some are printed in 6- or 8-point type--one may well decide to live with one’s pain and misery rather than risk the utter destruction that may follow if you dare to swallow one of those pills.

Here is a capsule to “relieve pain and swelling… treat headaches, backaches, tendonitis…, gout.” A worthy goal. But… but… “NSAID medicines may increase the chance of a heart attack or stroke that can lead to death”. “Serious side effects include: heart failure from body swelling; life-threatening skin reactions; liver problems including liver failure;” and six other things. Some are less serious: “Possible Side Effects… include upset stomach, nausea, vomiting, heartburn, gas, headache, diarrhea, constipation, drowsiness, or dizziness.” “Contact Your Doctor Immediately,” it says, “if they continue or are bothersome.” (If!? Evidently it is thought that nausea, vomiting, etc. are not “bothersome” to some people (Spartans, Stoics, masochists?))

You read these pages, nervously moisten your lips, and inspect the medicine jar. No, it doesn’t say Dr. Lucrezia Borgia. But look here… “Possible Side Effects” for another medication you were given to take along with the first one: “blue or purple skin color, yellowing of the skin or eyes…” “Check with your doctor as soon as possible” it adds helpfully: valuable advice indeed, as many might otherwise not think to do that for a trifle like turning purple.

Perhaps there is something to be said for illiteracy, or for just not reading these information sheets. After all, the basic instructions are on the label, e.g. Aqua Tofana: take one every four hours. Ignorance is bliss. Che sarà, sarà. Trust the doctor, be a man, take the pills and go about your business. Yes. Indeed. But… if you take Phenozopyrid (alias Pyridum, a.k.a. Phenazopyridine) without reading about it, and then go to the privy, you will suddenly discover that the water in the bowl becomes orange: vivid, almost neon, orange. Then you will wish, after you recover from your faint, that you had read “This medicine may cause the urine to turn orange or red. This is harmless but it may stain fabric.” And you will have similar feelings if your soft contact lenses turn orange because you wore them while taking Pyridium.

There is much other helpful advice. “Check with your doctor as soon as possible if you experience memory loss.” Hmmm, yes… now what was it I was going to do after I took that pill?

“If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include confusion, slow reflexes, clumsiness, deep sleep, and loss of consciousness.” Perhaps your unconscious self can make the call.

“Check with your doctor”--this mantra is incessant. Pharmaceutical companies seem to use it as a safety valve to excuse their inability to abolish potentially catastrophic side effects. Do they expect doctors to set aside a couple of hours a day to deal with patients who are swelling up, turning purple, or dissolving?

People who live alone, at least, might well decide to take their nostrums only where help is at hand: at parties or the theater, in church, or… why not right in the lobby of the emergency room? Just pop in two or three times a day with a glass of water, gulp down your pills, and sit there shuddering quietly, waiting to see if the Sword of Damocles will descend this time.

And now one can see why, along with Phenazopyridine and Naproxen, one was given Lorazepam (“a benzodiazepine used to relieve anxiety...”): If you had no anxiety before you went to the e.r., you will most certainly have it once you have read about your medicine.

“DO NOT EXCEED THE RECOMMENDED DOSE” it says emphatically on all the sheets. No fear. The challenge is nerving oneself to take the minimum dose.

Now, if you’ll excuse me, I have to go fill prescriptions for Mortufax and Thanatophilin. I hope they have no bothersome side effects.


  1. I chuckled as I read of the side effects of Pyridium. I was a co-op student who worked at the only facility in the world that made that compound. (Fortunately, the factory made many products, and I worked elsewhere.)
    There was a single building reserved for Pyridium manufacture - we called it The Yellow House. Only a single employee worked there, the guy who started up the process when it was invented. No one else wanted to visit. Why? The product dust was ubiquitous, and when you walked out of the building and perhaps got rained on, you had orange splotches everywhere (including your skin). That employee always had an orange face.
    The most popular practical joke was to sneak some pyridium powder onto someone's pizza. (In finished form, it is brick red and hides well on pepperonis.) The next day, the victim's urine turned bright orange.
    Near the end of my fourth work session at that company, they had to prepare for the impending retirement of The Yellow House employee. The engineer who had to go inside and learn the process always wore full Tyvek suits with hoods, and rubber boots and gloves, plus barrier cream on his face. I daresay he made some recommendations for taming the dust!
    I should add this was all in pre-history, before the government started regulating nuisance exposures. I thoroughly expect operations at The Yellow House are more reputable now!

    1. Wow--that's a fascinating, and somewhat scary, story. Thanks for sending it!