Six months after amma’s recovery from her April 2011 aortic dissection, the surgeon who had operated on her told me during a hospital visit that amma had so completely recovered that should she have any health challenges from then onwards, it would have to be absolutely new, and unconnected to the aortic dissection.
This made me absolutely relaxed.
What I don’t remember taking away from the discussion was the utmost seriousness with which amma should take her blood pressure medications, as her hypertension still remained within her.
Doctors could say it was obvious that the patient should take their life-saving medications seriously, but if my experience were to be any lesson, it might be a good idea for doctors to put the fear of death and catastrophe in the patient’s (and the caretaker’s) mind in this regard, especially for life-saving medications. 45
For many people, their commitment and adherence to medicine intake decreases significantly with time elapsed from an adverse event. 46 It is intuitive that the perceived gravity or impact of an event decreases with the amount of time elapsed after the event. Let’s say someone recently died from an electric shock in your apartment. This traumatic event will affect you significantly the first few weeks after the event, during which time you will be extremely careful with any electric equipment. But as weeks go by and nothing untoward happens, and as the traumatic event’s memory starts fading, many of us may revert to our old habits when dealing with electrical equipment – until something adverse happens to someone again.
Amma coming back home from her aortic surgery was considered a remarkable event by our family – we were unanimous that she had gotten a new lease of life. This made us absolutely sensitive about everything she did the first few weeks at home after her discharge. But I am not sure how things panned out after a few months. Specifically, I doubt if there was an effective system to ensure amma took all her medications without any mistake over a long period of time – I think we were somewhat casual about this.
This lapse would prove costly.
I’m not aware how well-educated Indian mothers approach medications, but I know how exactly those with minimal education do – with little clue. They just take what their caretakers recommend. Amma was highly disciplined, but in the case of her medications she just followed rules set by someone else as she did not understand anything about the medicines.
Post the surgeon’s assurance that all was well with amma, she was indeed back to her healthy, normal, active life. But I certainly became a bit casual with her health and medications.
While I remember purchasing her medicines regularly, I do not recall having a system to ensure that she took the right medicines at the right times. I recall that in 2014 she had complained of minor chest pains, and that I had taken her to a local doctor who provided her with an additional list of medicines. 47 It is possible that either amma or appa, or possibly even I, had mixed up the two prescriptions. Unfortunately, I had so disengaged myself with amma’s day to day health management that it is doubtful I would have been able to identify any serious lapses.
The above scenario is likely playing out in millions of homes worldwide with old parents. Prescriptions get lost or get mixed up, sudden suggestions spring up from new doctors, or they simply forget to take important medicines after a while. 48
If at all I thought seriously about amma’s medicines, it really did not translate into detailed investigation or corrective measures.
Until the next crisis day in April 2015, after almost exactly four years after her aortic dissection in April 2011.
47. It might be a good idea to stick with one reliable hospital and doctor alone as long as long possible for critical ailments.
48. Medication non-adherence is a big deal worldwide, and perhaps not limited to poorly educated people. Conservative estimates suggest at least 125,000 people die every year owing to this in the United States alone, and such non-adherence results in over $100 billion per year in preventable medical and hospitalization costs.
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