I noticed the announcement on the door of the Doctor’s lounge. It was another list of drug shortages similar to the one that appeared last July. I assumed the first one was an aberration. Apparently it was not. I read over the current list which mostly reflected drugs administered in the hospital. You might ask how this is relevant. Well, I think a shortage of nitroglycerine is a significant issue.
I asked two pharmacist friends, both doctors of pharmacy, about the current shortage announcements. They told me shortages have become an increasingly common problem in the last four to five years. I recalled with them my memory of only the occasional shortage over my forty years in medicine. I was somewhat reassured to see that July’s shortages of magnesium sulfate for eclampsia (severe hypertension of pregnancy), dopamine for shock, and morphine supplies had been restored by year’s end, though nitroglycerine was still scarce.
There are multiple factors that contribute to shortages in a country of historical plenty. Regulations place huge burdens on all industries. I read recently that a new regulation appears every four minutes in America. I understand that there may be good reason behind some regulations even those of the EPA. However, I just can’t get out of my mind the EPA agent who insisted on turning off the confinement grid in the movie Ghostbusters. I wrote recently about the high cost and risk of new drug development. Additionally, the low profit margin of generic drugs often results in fierce competition with sometimes just one company producing a generic agent. What happens if there is a production problem at that company’s plant because of contamination which forces a voluntary shut down or through government regulation?
Recently, we noticed a leaky faucet which might have been damaged in the Polar Vortex of Al-Gore’s global warming. As I prepared to crawl under the house to inspect our pipes I searched for an electrical extension cord. Have you ever wondered why string or ear buds in a drawer tie themselves in a knot just like my extension cord? What goes on in that drawer at night to cause contortions sufficient to produce the proverbial Gordian knot? One tongue in cheek explanation is gremlins. Do you remember the infamous creature in the Twilight Zone episode with William Shatner of Star Trek fame? No one could see the monster wreaking havoc on the airplane’s wing except Shatner who finally saved the plane by shooting the little devil. I guess Rod Serling was unaware of TSA regulations when he wrote that episode. I suspect these mischievous sprites are also responsible for twisting our land line telephone cord making it as tangled as Chevy Chase’s Christmas tree lights in National Lampoon’s Christmas Vacation.
Becky suggested I write about driving issues and older adults. You notice that I did not use the word elderly which is descriptive, but is often pejorative. I recently read that there’s been a rash of car accidents in Colorado and Washington State where marijuana has been legalized for recreational use. This is a classic example of stupid legislation and its consequences. These days we are bombarded with public service ads warning us to not drive “buzzed,” the new term for being high on alcohol, but not falling down drunk like Otis on the Andy Griffith show. An interesting scientific study appeared in the prestigious NEJM this January. It clearly showed that texting while driving causes impairment comparable to using intoxicants like alcohol. Now the PC (politically correct) liberal legislators have enabled a new class of inebriates to roam the roads in an impaired state. Police don’t even have breathalyzers for pot, and no one is talking about the cancer risk of deeply inhaled carcinogens in marijuana joints.
I take a pragmatic approach with older drivers whose reaction time is certainly slowed, but who are more cautious and generally drive slower than teen agers who consider themselves immortal. Frequent fender benders, poor vision, and general frailty are indicators that the family, the older citizen, and the doctor need to talk. There are also programs for driver evaluation at the Patricia Neal Center and the Highway Patrol.
The Hindu philosophy of ahimsa means to cause no harm to another, and this perspective seems operative when considering impaired drivers. No one has the right to harm someone else, and we hope to protect our older folks from harming themselves. I once had a couple who traveled across town through heavy traffic to see me. He had serious Parkinson’s disease where all his movements were slowed and delayed. She was demented and could not remember that a red light meant stop and a green one meant go. Like so many older couples they supported each other’s weaknesses. Driving became a serious issue when approaching a red light: He would say.… “Stop!”, eventually. A family/doctor conference rescinded their driving privileges.
I’ve said many times that I’m trinitarian at heart, so a patient’s observation of life’s three stages intrigued me. “There are three stages of life, Doc. First, you’re good looking. Then you’re ‘looking good.’ Finally, they’ll say, ‘He looks so natural!”’ As we age the trick is to stay at the second level as long as possible. General Douglas McArthur once said “Old soldiers never die, they just fade away.” In a somewhat similar vein, sports figures struggle with the end of their careers. The trick is to finish at the top of one’s game before the inevitable decline in abilities. I believe that Chipper Jones of the Atlanta Braves baseball team handled his sport retirement better than anyone I can remember.
The Welsh poet Dylan Thomas eloquently challenged all of us who recognize our aging. He penned, “Do not go gentle into that good night, Old age should burn and rave at close of day; Rage, rage against the dying of the light.”