We're called for a woman unconscious. I recognize the address. We have been there many times before. Two sisters. Extremely co-dependent on each other. The younger sister has chronic pain and is a known drug seeker. The older sister is just plain crazy.
On the way we are updated. The woman is conscious and breathing. It seems she passed out while doing the laundry, and has a cut on her elbow.
We find the younger sister sitting in a chair. The cut isn't much more than a scrape. She is alert, but slightly confused with slow speech. Drowsy is perhaps the best description. On the counter is an empty vial of Fiorinal. It is dated the previous day. There are supposed to be 120 tablets inside. Fiorinal is a barbituate/analgesic. It is also a Schedule III controlled substance.
"Are these yours?" I ask holding up the empty vial.
She squints to look at the vial. "No, they are my sisters," she says.
The older sister wanders into the room now. "Yeah, those are mine. I got those from the internet. They help us sleep."
"Us?"
"Yeah, I give her half of them. We both have trouble sleeping."
"You gave them to her?"
"Yeah, we both have trouble sleeping. We also have low potassium."
"Why didn't she get her own pills?"
"She needs to find a new doctor."
"And which doctor gave these to you?"
"I got them from the internet. I can't sleep at night."
I read the vial. The doctor lists his address as Chicago, Illinois.
"He just prescribed them for you without seeing you?"
"I had to fill out a questionaire."
She doesn't seem to think there is anything odd about this or anything wrong with giving them to her sister.
"She's my sister," she says. "We have headaches."
There are some patients you just can't have a conversation with.
We can't find the pills. The older sister says she divided them up and put them away. The younger sister says she took some but can't remember how many. First, its two, then its four. I ask her how many darvocets she has had. Normally when we are there -- the issue is her darvocets. She ran out, she had some this morning. She can't remember. Like the other times, we can never find any of the pills.
"All right, let's get you on the stretcher," I say.
"I don't want to go to the hospital. I just want the cut on my elbow cleaned. The doctors won't help me there. They never do."
"You can't stay here. You're confused. You probably took a few too many of these pills."
"I'm just a little confused."
"Just a little counts enough that we can't leave you here."
"I don't want to go."
We go back and forth, but aren't getting anywhere.
Finally, I take a stab. "Your sister said your potassium was low."
"Both our potassiums are low."
"Well, you can get your potassium checked while you're down there."
They both nod. I've found the magic words.
I can't resist. "Maybe they'll prescribe you some bananas."
"They don't ever give me anything," the younger sister says.
"Well, if not, maybe they'll give your sister a web site where she can order them for you."
