As soon as the consultation window was free, I stepped up to the counter and caught the eye of the pharmacist, Joe Brooks, who’d been helpful in the past. He was a man in his seventies with snowy white hair that eddied into a swirl in the middle of his forehead. He said, “Yes, ma’am. How’re you? I haven’t seen you in a while.”
“I’ve been around-staying out of trouble as much as possible,” I said. “Right now, I need some information and I thought you might help. I have a friend who’s taking a number of medications and I’m worried about him. I think he’s sleeping too much and when he’s awake, he’s confused. I’m wondering about side effects of the drugs he’s on. I made a list of what he’s taking, but the prescriptions weren’t filled here.”
“That wouldn’t make a difference. Most pharmacists handle patient consultations the same way we do. We make sure the patient understands what the medication does, the dosage, and how and when it should be taken. We also explain any possible food or drug interactions and advise them to call the doctor if they have reactions out of the ordinary.”
“That’s what I assumed, but I wanted to double-check. If I show you the list, can you tell me what these are for?”
“Shouldn’t be a problem. Who’s the doctor?”
“Medford. Do you know him?”
“I do and he’s a good egg.”
I took out my notebook and folded it open to the relevant page. He removed a pair of reading glasses from his jacket pocket and eased the stems over his ears. I watched him trace the lines of print with his eyes, commenting as he worked his way down the line. “These are all standard medications. The indapamide is a diuretic prescribed to lower blood pressure. Metoprolol’s a beta-blocker-again, prescribed to treat hypertension. Klorvess is a cherry-flavored potassium replacement that requires a prescription because potassium supplementation can affect heart rhythm and damage the GI tract. Butazolidin is an anti-inflammatory, probably for treatment of osteoarthritis. Did he ever mention that?”
“I know he complains about his aches and pains. Osteoporosis, for sure. He’s just about bent double from bone loss.” I was looking over his shoulder, reading the list. “What’s that one?”
“Clofibrate is used to reduce cholesterol, and this last one, Tagamet, is for acid reflux. The only thing I see worth scrutiny are his potassium levels. Low blood potassium could cause him to be confused, weak, or sleepy. How old is he?”
“Eighty-nine.”
He nodded, tilting his head as he considered the implications. “Age plays a part. No doubt about that. Geriatric individuals don’t excrete drugs as promptly as healthy younger people. Liver and kidney functions are also substantially reduced. Coronary output starts declining after age thirty, and by ninety it’s down to thirty to forty percent of maximum. What you’re describing might be an unrelated medical condition nobody’s picked up on. He’d probably benefit from an evaluation by a geriatric specialist if he hasn’t seen one.”
“He’s under doctor’s care. He dislocated his shoulder in a fall a month ago and just went in for a recheck. I expected a quicker recovery rate, but he doesn’t seem much improved.”
“That may well be. Striated muscle also declines with age, so it’s quite possible his shoulder repair has been impeded by torn musculature, the osteoporosis, undiagnosed diabetes, or an impaired immune system. Have you talked to his doctor?”
“No, and I doubt it would be productive, given current privacy laws. His office wouldn’t acknowledge his being a patient, let alone put his doctor on the phone to chat with some stranger about his care. I’m not even a family member; he’s just a neighbor of mine. I’m assuming his caregiver’s conveyed all the information to his doctor, but I have no way of knowing.”
Joe Brooks thought about that, weighing the possibilities. “If he was given pain pills for the shoulder, he might be abusing his meds. I don’t see reference to anything of the sort, but he might have a supply on hand. Alcohol consumption’s another consideration.”
“I hadn’t thought of that. I suppose either one is possible. I’ve never seen him take a drink, but what do I know?”
“Tell you what: I’d be happy to call his doctor and pass along your concerns. I know this guy socially and I think he’d listen to me.”
“Let’s hold off on that. His caregiver lives on the premises and she’s already hypersensitive. I don’t want to step on her toes unless it’s absolutely necessary.”
“Understood,” he said.
I left the office at noon that day, thinking to make myself a quick lunch at home. When I rounded the studio and reached the back patio, I saw Solana knocking frantically on Henry’s kitchen door. She’d thrown a coat over her shoulders like a shawl and she was clearly upset.
I paused on my doorstep. “Is something wrong?”
“Do you know when Mr. Pitts is getting home? I’ve knocked and knocked, but he must be out.”
“I don’t know where he is. Can I help you?”
I could see the conflict in her face. I was probably the last person on earth she’d be appealing to, but her problem must have been pressing because she clutched the edges of her coat with one hand and crossed the patio. “I need a hand with Mr. Vronsky. I put him in the shower and I can’t get him out. Yesterday he fell and hurt himself again so he’s afraid of slipping on the tile.”
“Can we manage him between us?”
“I hope so. Please.”
We walked double-time to Gus’s front door, which she’d left ajar. I followed her into the house, dropping my bag on the couch in the living room as we passed. She was talking over her shoulder, saying, “I didn’t know what else to do. I was getting him cleaned up before supper. He’s had trouble with his balance, but I thought I could handle him. He’s in here.”
She led me through Gus’s bedroom and into the bathroom, which smelled of soap and steam. The bathroom floor had a slippery cast to it and I could see how difficult it would be to maneuver. Gus was huddled on a plastic stool in one corner of the shower. The water had been turned off and it looked like Solana had done what she could to dry him off before she left. He was shivering despite the robe she’d thrown around him to keep him warm. His hair was wet and water was still dripping down his cheek. I’d never seen him without clothes and I was shocked at how thin he was. His shoulder sockets looked enormous while his arms were all bone. His left hip was badly bruised and he was weeping, making a whimpering sound that spoke of his helplessness.
Solana bent over him. “You’re fine. You’re okay now. I found someone to help. Don’t you worry.”
She dried him off and then she took his right arm while I took his left, offering support as we hoisted him to his feet. He was shaky and clearly off-kilter, only able to take baby steps. She moved to a position in front of him and held him by the hands, walking backward to stabilize him as he tottered after her. I kept one hand under his elbow as he shuffled into the bedroom. As frail as he was, it was a trick to keep him upright and on the move.
When we reached the bed, Solana stood him close by, leaning him against the mattress for support. He clung to me with both hands while she slipped first his one arm and then the other into his flannel pajama top. Below, the skin sagged from his thighs and his pelvic bones looked sharp. We sat him on the edge of the bed and she slipped his feet through his pajama bottoms. Together we lifted him briefly so she could pull the bottoms up over his flanks. Again, she eased him onto the edge of the bed. When she lifted his feet and rotated his legs to slide them under the covers, he cried out in pain. She had a stack of old quilts nearby and she laid three over him to offset his chill. His trembling seemed uncontrollable and I could hear his teeth chattering.
“Why don’t I make him a cup of tea?”