T is for Trespass (Kinsey Millhone 20)

21

On the way to work the next morning, I took Santa Teresa Street as far as Aurelia, turned left, and made a detour into a drugstore parking lot. Jones Apothecary was an old-fashioned pharmacy, where the shelves were stocked with vitamins; first-aid remedies; nutritional supplements; ostomy supplies; nostrums; skin, hair, and nail products; and other items meant to alleviate minor human miseries. You could have your prescriptions filled, but you couldn’t buy lawn furniture. You could rent crutches and buy arch supports, but you couldn’t have film developed. They did offer a free blood-pressure check, and while I waited for service I sat down and affixed the cuff to my arm. After much huffing, squeezing, and releasing, the readout was 118/68 so I knew I wasn’t dead.

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.”