In Aliens, the human colonists have been eradicated by the ruthless queen. As Sigourney Weaver is escaping, she loses the little girl she has promised never to leave. She returns to the hive and, as she straps on her guns, the camera lingers. Her face is grim, and you realise that she is more dangerous than any monster. Hunters have a saying: “Never get between a she-bear and her cubs.”
We general practitioners also have a saying: “Never get between an elderly woman and her tablets.” Not quite the same: elderly women don't actually love their tablets; “Love is not love, Which alters when it alteration finds,” but the effect is similar.
I remember, as a junior doctor, admitting an elderly woman who was on about 40 different medications, and we were scathing about indolent GPs prescribing willy-nilly. With youthful innocence we stopped all her medications, and to our satisfaction she began to perk up. Unfortunately, as she perked up, she also realised that she was drug free, and over the next few weeks she remorselessly wore us down, day by day, tablet by tablet; firstly (of course), the hypnotic, then an anxiolytic, then an antidepressant, her vitamins, her aspirin, her antihypertensive, etc etc. By discharge we had capitulated and thrown in a few more, just for show.
Nothing changes; polypharmacy thrives. Why? I write prescriptions, so why can't I just say no? I won't be offended if patients change doctors, and the financial loss will be minimal.
I was trying to rationalise Maggie's particular cocktail, unchanged for millenniums. “You won't need these,” I said, reaching for the levodopa on her overloaded shelf.
My wrist was caught in a vice-like grip. Terry Pratchett observed that whole economies have been built on the ability of elderly women to carry massive loads on their backs; they look frail, but they're wiry.
“Dr Sloan said these would help,” she said. Dr Sloan, I guessed, was some harassed junior doctor from the mists of time, trying to escape his coffee break by pretending he was actually doing something, but no edict from Pope Pius could have carried greater weight or echoed so grandly down the years.
“He was a very good doctor,” I agreed, as she was between me and the door. A prescription has many fathers, and physical intimidation is yet another.