On an early summer afternoon in 2009, the clinical pharmacy team paged, informing me that they were sending a patient with an INR of 6.2 for evaluation. Wondering how many notes I would need to put off writing in order to see an additional patient and get to the wards for turnover on time, I found myself listening poorly to the person in front of me. Sadly, this had become a trend. As faculty at a military residency where frequent deployments caused chronic staffing shortfalls, I often felt pulled from one moment to the next, and being present was becoming progressively more difficult.
Thirty minutes later, I met Mr R., an 85-year-old gentleman accompanied by his son-in-law who had driven him the 2 hours to our hospital. The two broke off their conversation as we greeted one another, and I asked how I could help.
“I’m not sure, doc,” Mr R. offered. “I must have done something wrong because I’ve never had this problem before, but the pharmacist tells me that my blood is too thin and that’s why I’ve been bruising . . . just can’t figure out why.”
We discussed the previous few weeks of his life, reviewing his medications, diet, and activity, but were unable to find the culprit.
“Do you happen to have your meds with you?” I asked.
“Yup! He’s got them alright,” his son-in-law commented good-naturedly. “Brings them to every visit. I’ve told him a thousand times that you all have records of his medications, but he always says that with the number of medicines he takes, it’s better to bring them in. They’re in the tote.”
Opening the bag, I saw 10 pill bottles with a single letter atop each of the caps. I saw an M, a C, a G, and an L, among others, forming an alphabet soup in a bag.
“I see a bunch of letters on the caps. Is that a system for taking your meds?” I asked.
“Yeah. I’ve got macular degeneration, and those pill bottles have everything written so darn small, I can’t read them. So, I put a letter for each medicine on the top—sometimes based on the color, sometimes the name. Between that and knowing I take 10 pills per day, that’s what I go by.”
Taking a second look at each bottle, I noticed that the G (his shorthand for green) was blurred and appeared more like a C (his shorthand for Coumadin). A quick pill count confirmed my suspicion: He had confused the two medications. Because he had two bottles, he assumed he needed to take two C pills per day and was using just one bottle, doubling his Coumadin dose without realizing it. As I explained the next steps in his care, including my recommendation that he use a weekly pill organizer, I returned the bottles to the tote and noticed something glinting at the bottom of the bag. Taking a closer look, I saw that it was a weather-beaten harmonica.
“Mr R., is that your harmonica?” I asked.
A grin spread across his face as his son-in-law jumped in exuberantly. “Oh, it’s his alright. You should hear him play—been doing it since the ’40s!”
“What’s the story?” I inquired.
“You want the whole story?” Mr R. asked.
My face clearly showing that the answer was yes, he went on. “Well, I was a belly gunner in World War II. That was some rough duty—in a metal chair underneath an aircraft encased in a small plastic bubble, seeing the explosions all around us as the enemy tried to knock us out of the sky. And a number of those anti-aircraft rounds did just that; I saw a bunch of my close friends’ planes go down.” He paused wistfully before picking up the thread again. “Anyway, after that first mission, when we landed, my hands wouldn’t stop shaking. I tried shaking them out, exercising—nothing seemed to help. A guy I knew in another unit saw me and asked what was going on. I think he knew it was stress or anxiety or whatever you doctors call it, but there was a code—we didn’t talk about those things; we had a job to do. The next day he finds me at chow and hands me a harmonica. Said he’d brought two in case he lost one and wanted me to have it. I started learning to play that night and wouldn’t you know, as horrible as that war was and despite what I saw, my hands stopped shaking and never started again. That harmonica you see in the bag—it’s the same one. I’ve been playing it every day since 1943.”
For a moment, Mr R. paused, traversing a course through the memories of his extraordinary life as tears welled up in his eyes. When he looked up 20 seconds later, there was a glint in his eye as he asked, “Want to hear?”
For the next 10 minutes, Mr R. didn’t play that harmonica; he wailed. I was transported back to my experiences in the French Quarter during medical school, hearing the likes of Keb Mo, Clarence “Gatemouth” Brown, and Taj Mahal as he belted out three blues songs in quick succession. I was floored and, for the first time in months, I rediscovered what it was to be fully in the moment.
After his third number, he said, “Well doc, I know I was added onto your schedule, so I’m guessing you need to get to the rest of your patients.”
I reluctantly left the room and entered the next, apologizing.
“Were you next door?” she asked.
“Mm-hmm,” I muttered, my mind trailing my body into her room.
“Well, I’ve got some issues to address. At 79, who doesn’t? But I have to say, I kinda wished you’d stayed in there a little longer. Listening to whoever that was made me feel better than I’ve felt in a long, long time.”
I nodded my head, understanding exactly what she meant.
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