The Best Thing in the World

A. Peevie takes Verapamil, a medicine that slows his speedy-quick heart-rate down. We try to give it to him in the morning, because he's already got a fairly slow heart-rate at night--but sometimes we forget.

One day last week we forgot, so I had him take it after school. Unfortunately, a few hours later when he took his other meds at bedtime, he took an extra dose of the Verapamil. This caused my own heart-rate to increase significantly.

By the time I learned about the double-dose, it was after 10 p.m. I called the cardiology service, and soon got the cardiologist on the phone. Unfortunately, what we needed was not a mere sub-sub-specialist like him (pediatrics and cardiology), but a sub-sub-sub-specialist, a pediatric electrophysiologist--a physician who specializes in caring for children with heart rhythm disorders. I believe there are eight of these docs in Illinois.

So the docs conferred, and they came up with a plan: They wanted me to check A. Peevie's heart-rate every two hours. If it stayed above 40 beats-per-minute (bpm), I would keep checking every two hours. If it dropped to between 30-40 bpm, I'd check it every hour. If it dropped below 30, I'd need to bring him to the hospital to be monitored for the rest of the night.

By the time we'd worked out the care plan, A. Peevie was already asleep and curled up under his blue camouflage comforter, snoring gently. I checked his heart-rate while he slept, and its strong, regular rhythm (about 50 bpm) soothed my mild anxiety. I crawled under the covers next to him, set my Treo to beep me awake every two hours, and went to sleep.

I am normally a sound sleeper. I can sleep through earthquakes, thunder-storms, most snoring, and early morning radio talk shows which are loud enough to wake Mr. Peevie but never enter my consciousness. But on this night I woke promptly to my Treo singing its descending arpeggio, "Din-ne-ne-ne, Din-ne-ne-ne, Din-ne-ne-ne, Neh" every two hours. Each time, I rummaged under the covers for A. Peevie's skinny wrist, found his pulse, and counted the beats for a full minute. If he shifted, I'd briefly lose the pulse, and I'd start all over again. It usually took me two or three tries--because I felt it would be prudent to be sure I'd gotten it right.

At one point, between Treo alarms, A. Peevie woke up and looked at me. "What are you doing here?" he wondered.

"I'm checking your heart-rate every two hours," I said.

"How come?"

"Because I want to make sure that your heart doesn't slow down too much."

"But you don't usually have to do that," he observed.

"Right," I said. "But you don't usually take a double dose of Verapamil, either."

"Oh," he said; and then he smiled at me, cuddled closer, and went back to sleep.

"Great," I thought. "Now he's going to double-dose himself on purpose just so I have to sleep with him." He's a cuddly ten-year-old who would sleep in my bed every night if I let him. Which I do not. He's far too pointy for comfort.

At every check-point, the tell-tale heart-rate was safely in the mid-40s, so we dodged yet another trip to the ER for this high-maintenance boy.

In the morning as we were getting ready for school, I was kind of a zombie. "What's the matter, mom?" A. P. asked me cheerfully.

"I'm just tired, honey," I told him.

"That's my fault, isn't it?" he asked.

"No, baby, it's not your fault," I reassured him.

"But you had to wake up at night to check my heart because I took an extra dose," he said. "That's why you're tired."

"A. Peevie, it wasn't your fault that you took it," I said. "It was an accident." I looked him straight in the eyes. "And besides," I said, "That's my job--to take care of you, and make sure you're OK. It's the best job in the world."

He smiled at me, the kind of smile that makes my eyes fill up with tears and makes my chest tight with gratitude and love. There is nothing better in the world.

In Which I Save A. Peevie's Life. Sort Of.

I saved A. Peevie's life tonight. Kind of.

It was nothing, really.

I went to Walgreen's to pick up one of his prescriptions, and before I left the store, I checked the 'scrip as I almost always do, to make sure I was getting the drug that I needed--Verapamil--and not one of his many other prescriptions. You remember Verapamil, right? The one that he accidentally overdosed himself on a few months back? Yes, that one.

The label on the pill bottle said "Verapamil," and that was good enough for me. Apparently, I should have looked a little closer, because when I got home and started to give A. Peevie his medicinal cocktail, I realized that they had given me 120 mg tablets instead of 120 mg time release capsules.

I briefly considered giving him the tablet, and then I realized that with the tablet, he'd be getting his 24-hour dose all at once. "Hmmm," I thought. "That might actually stop his heart. Bad idea."

As I climbed back into the Minivan of Salvation and drove back to Walgreens to make the exchange, I worked on my Indignant and Horrified Expression and my Speech of Potential Death Averted, No Thanks To You, Walgreens. What if I had been just tired and distracted enough to not think twice about giving him that pill? What if I hadn't been home, and Mr. Peevie was in charge of meds, and he didn't know the difference? Or if a babysitter had been in charge, and wouldn't know by looking at the pills that they were wrong?

At the pharmacy counter, I mentioned the itty-bitty problem of the Right Medicine, Wrong Dose/Delivery to the concerned but powerless pharm-tech.

"This dose might have killed him," I said gently but firmly. "The pharmacist needs to know that someone made a serious mistake."

"Oh, did the doctor write it wrong?" she said innocently.

"Um, no," I said. "This was a refill of a long-standing prescription that my son has been taking for years. Someone here made a mistake."

"I'm very sorry," she said sincerely, "I'll speak to the pharmacist about it." A few minutes later she reassured me that they were getting right on it, and would have the correct pills ready quickly.

Tick-tock, tick-tock. Customers came and went. I played Sudoku and finished solving a medium-difficulty game. Finally, after 15 minutes had gone by with nary a word, I stood at the counter again.

"Can I help you?" asked a boy pharm-tech (BPT) with a bored expression on his face.

"Yes," I said firmly and with a skosh less gentleness than the last time. "I'm waiting for a replacement on a prescription that was filled incorrectly the first time. The tech told me it would be ready in a few minutes. It's been 15." There was talking, scurrying, and PA announcing for an "exchange in pharmacy." Finally, BPT handed the new bag of pills over to a store manager, who began punching buttons on his register.

"That will be $4.78," he said.

"Noooo," I said, "I already paid for the prescription once. I don't believe I owe any additional money."

"Ah," he said, and punched a bunch more buttons on his register. The whole Accidental Death Averted Situation seemed to be a non-starter, and I was nonplussed. I prayed a quick prayer asking for wisdom, and then I started kicking ass. Nicely.

"I don't want to be difficult, here," I said, "but this was a pretty serious mistake that was made, and everyone seems to be pretty casual about it. This dose could potentially have killed my son."

Well, didn't that get his attention! Store Manager stopped punching buttons and looked back and forth at the two prescription bags in his hands. I waited.

"They're both the same medication," he said, confused.

"Yes," I said, "But one is time-release capsules, and the other is a full 120 mg dose tablet." He looked back and forth at the labels again. "He would be getting the full dose all at once," I explained. "My son weighs 75 pounds. It would be a serious overdose."

One beat. Another beat. Then: "Ahhh. Time-release capsules," he said.

"As I said, I'm not trying to be difficult, here," I reiterated. "I just want to make sure that everyone understands the potential seriousness of the mistake so that it doesn't happen again."

"I will definitely talk to the pharmacist," Store Manager said. "And I'm very, VERY sorry for the mistake and for your trouble. Very, VERY sorry."

That was more like it--and that's all I wanted, really--someone in charge, someone with actual responsibility to acknowledge that a very big and potentially very dangerous mistake had been made. Store Manager started punching more buttons on his register; he popped open his drawer and took out some money.

"I don't think I get any money back," I said stupidly--why am I turning down cash? "I didn't pay too much for the prescription."

"No," said Store Manager, handing me $5 and change, "It's because of our mistake and your trouble. We're covering the cost of the prescription."

Oh. Well, then. I accept.

But I'm still going to call the cardiologist tomorrow and find out what would have been the expected outcome if we had accidentally given A. Peevie the tablet instead of the prescribed capsule.

And then I might be writing a letter to Mr. Walgreen himself.