It was a busy Monday morning. I was focused on the many tasks at hand and trying to stay "afloat" when I heard a meek voice at the pickup window. "I hate to bother you, I know you are so busy, but I have a question.” I hope it’s not another cost/insurance-related question, I thought. Thankfully, it wasn’t.
“How long does it take for this medication to start working?” Finally, a drug related-question. She held out the bottle. The label said amitriptyline 100 mg at bedtime.
“How long have you been taking it?” I asked. “About three months,” she said. Assuming that she was using it for sleeplessness, I asked her whether she was sleeping any better at all since she started the medication. No, came the answer. Not at all. I felt a pang. Our pharmacy had already failed her; it was obvious that we had never followed up with her.
“The pain keeps me up almost all night," she said. Pain? “I had titanium wrist implants about two years ago, and the pain never really went away.” A cursory review of her profile showed gabapentin, duloxetine, and diclofenac. She had been extraordinarily compliant with the regimen, but had no understanding of its intended purpose. Another failure on our part.
“I feel so tired and confused, but I can't sleep through the pain,” she said. I took it as a plea for help.