Consequences of sharing prescription drugs- A story.

Doctor Mark glanced at his watch. He was way behind schedule, no thanks to the rain that delayed him this morning. It was already 7:32 am and he still had four patients to see. Even though he originally hoped to finish the early morning rounds by 7:55 am, he admitted to himself that that was no longer feasible. He moved quickly to the next patient, five year old Ebenezer.

“Good morning ma. How are you two?” he said, greeting Ebenezer’s mother.

“Thank you my dear. We are fine.” she replied.

“Ebbyyyyyy! Bobo! Good morning! Won’t you greet me?”

Ebenezer was trying to keep a straight face, pretending like he hadn’t seen the doctor but after much psyching he eventually smiled. “Good morning doctor. You keep trying to make me laugh, but I’ve not forgotten that you said I’ll soon go home. Can I go home now?”

Everyone burst out laughing. Children and their bluntness!

Suddenly, Azi, the steward rushed in, panting like he just ran a marathon, “Doctor, Doctor…”

“Azi, calm down. What is the matter?”

“One woman is… causing problems.” he managed, while trying to catch his breath.

“Which woman? Why? Where…”

Excusing himself, he made to go after Azi but a ruckus stopped him in his tracks. It was like a movie scene. Two security guards were trying to stop a woman accompanied by some unidentified people from gaining access to the wards. This was amidst lots of shouting and yelling and made him wonder what the fuss was all about. Alas, he didn’t have much time to wonder because in a split second she practically flung the guards aside, and turned to face him, ready to unleash her fury.

“That’s him there!” she yelled, pointing at him with fiery red eyes. “He’s the one that wants to kill my children.” she said clapping her hands rapidly.

With all the calmness he could muster, he replied, “Good morning Madam. I don’t understand your accusation but I’m on a ward round. Could you please wait outside? I’ll attend to you once I’m done.

“No! No! I am not going anywhere.” she retorted in a thick Yoruba accent.

This must be a joke, he thought.

“Please let’s go outside madam. Or am I being pranked?”

“You think I’m here to joke abi? I will deal with you. Everybody must know that you’re a fake. Quack like you. Useless doctor!”

Doctor Mark was taken aback by the barrage of insults hurled at him. He remembered how hard he worked to get here, the sacrifices and pains; the tiresome days and sleepless nights… all to be called useless and quack? His temper was boiling!

“Madam, you must have me mistaken for someone else. I’m most definitely not a quack. Please let’s step outside.” he managed through gritted teeth.

“I say no! No, no, no! I’m not going anywhere. We must settle this matter here.”

The crowd was getting larger. He knew he had to act fast to defuse the situation. She was being stubborn, so he decided to deal with the issue there. After all, he had nothing to hide.

She seemed vaguely familiar but he couldn’t quite place his hands on it.

“Have we met Madam?” he asked her.

“Have we met ko, have we met ni. Were you not the one that treated my daughter in clinic three weeks ago?”

Oh yeah. He remembered her now. She brought her sick seven year old daughter to clinic that morning. She had a headache, fever and cough.

“Okay. So what is the issue with the treatment?”

“The issue? You did tests, you said she had pneumonia. You prescribed drugs for her, she used the drugs. Yet, she is in the teaching hospital, lying there – almost unconscious. The doctors there said she has severe sepsis and the pneumonia is still there. Also, my only son, her five year old brother is very sick, and on admission for the same thing. So it’s either you gave us the wrong drugs or you gave us fake drugs. Either way, you are going to pay!”

“Excuse me madam, I don’t seem to understand what you are saying. I didn’t treat your son, did I?”

“No but I gave the same drugs you gave me to her brother. So if you treated my daughter well, he wouldn’t be on admission now.”

“I beg your pardon madam! I want to believe I didn’t hear you right…”

“You heard me well doctor. You heard me very well. Do you know me? Do you know who I am? I will deal with you in this town!”

He sighed deeply. He was obviously not making any headway. “I’ve heard you madam. I see so many patients every day so I may not remember the exact drugs I wrote for her. Are you with her small hospital card so I can send for her case note?”

“You don’t need to send for her case note. I have the drugs here.”, she said, flinging it at him.

Oh the nerve! His anger hit the roof. He was ready to explode when suddenly, a thousand light bulbs flicked on in his head. The beautiful Aha moment! Everything became crystal clear. He was going to enjoy putting her in her place.

Stooping down to pick the drugs, he said, “I prescribed these drugs for your daughter three weeks ago, right?”

“Yes. It was you. You can see that you gave us wrong drugs? Nonsense! I will have you arrested and prosecuted….”

“Wait madam,” he interrupted, “before you arrest and prosecute me, if you used these drugs for your daughter as I prescribed, how come the drugs are still here?”

“Ehn? She used them o. Wait… I don’t get you?” she said stuttering, obviously flustered.

Glee! She didn’t see it coming.

“You heard me well madam. But in case you didn’t, I will repeat myself. If you used the drugs as I prescribed, how come they are still here? These drugs were supposed to be exhausted in five days but everyone can see the medications here, three weeks after. How come?”

You could hear a pin drop. This woman that was raging uncontrollably minutes ago was dumbstruck. Unbelievable!

“Answer me madam. You said we had to settle this here, so please speak.”

No word, no sound. Silence still.

“You said I’m fake or the drugs are fake yet you haven’t answered my question.”

“I… I started using the drugs for her… but after the second dose… she said she was fine and that the headache and cough had reduced… she didn’t want the drugs again and since the fever had gone… I… I… she stopped the drugs.” she replied fiddling with her thumbs.

“And you’re blaming him!” someone shouted from behind. “You just came to waste everybody’s time. Nonsense!” another person yelled. The crowd began murmuring.

Doctor Mark didn’t need to be a mind reader at that moment to know she wished the ground would open up and swallow her. It was either that, or she wished she never started this drama in the first place. Right then he was grateful for how it all played out. This was an opportunity to teach her as well as the other people around some important things.

So, raising his voice slightly, he continued, “Madam, first of all, I’m sorry that both of your children are sick, BUT it is not my fault or the fault of the drugs. When a drug is prescribed to treat an infectious disease, it is important that the full course is completed. All doses need to be taken because if it is stopped midway, the organism that caused the illness may not have been fully destroyed, and you may be wrongly assuming that the drug is not effective.

“I’m sorry doctor.” she mumbled.

The lion had been tamed but he was not letting her off that easily. She still had lessons to learn.

“Also, I prescribed the drugs for your daughter so why did you give them to your son?”

 “He was… he was having the same symptoms… so… I felt he could use it too.”

“Hmmmmmmmm.” the on-lookers chorused.

“You see, it is completely wrong to give the medications meant for one person to another person. There are many consequences of sharing prescription drugs and some of these are deadly. It is even illegal and can get you arrested in some places. Let me give you three reasons you should not share prescription drugs. First of all, the fact that the symptoms are the same doesn’t mean it’s the same problem. For example, two people with symptoms of fever, headache and vomiting may have completely unrelated issues. One could be malaria and the other could be meningitis. Another example; cough could be due to pneumonia in one person, due to lung cancer in another person, and due to heart failure in a third person. Misusing prescription drugs like that can delay the diagnosis of a serious emergency or make diagnosis difficult and confusing.”

“Secondly, even if it’s the same illness that produced the symptoms, the dose may be too high or too low for the person you share the prescription drug with. This can cause severe complications of drug overdose and toxicity, or under-treatment, where the dosage is not enough to completely treat the illness like in the case of your son. It can even lead to very serious side effects where the person reacts negatively to the drug, creating a new set of health problems for the person. Many people have died because of this.”

“Aye mi o.” she said putting her hands on her head.

He tried to hide a smile. The message was definitely getting in.

“Thirdly,” he continued, “another consequence of drug sharing is that it reduces the effectiveness of the drug for the person it was prescribed for. This is most likely what happened with your daughter. The total dosage she took was too low to eliminate the bacteria and so they had enough opportunity to multiply. This therefore led to her immune system being overwhelmed and if you haven’t figured it out yet, that contributed to the severe sepsis.

“And, even though I said three, I must also add that when using a drug you don’t need, especially an antibiotic, you put everyone in danger. How this happens is this: when bacteria are exposed to the antibiotics unnecessarily, they begin to beef up their defence system. Then, when there is an actual need to use the antibiotic, the bacteria would have developed so much resistance to the antibiotics such that the drug may no longer be effective for treatment. People infected by resistant bacteria get very very sick and may even die if no other effective antibiotic is available. Anyone can be affected including you!”

He paused to let it sink in. “I can give you a whole lecture on this but let me stop here. You need to go and attend to your sick children. Do you understand all this madam?”

“Yes sir. I do. I’m so sorry. I thought…”

“You thought wrong. But it’s alright. Go and sin no more.”

The crowd showed their appreciation and understanding with a thunderous applause.