Don’t forget your tablets!

‘Yes’, said Mma Ramotswe. ‘We all know that it is women who take the decisions but we have to let men think that the decisions are theirs. It is an act of kindness on the part of women.’

Alexander McCall Smith, The Full Cupboard of Life What are friends for? 

Michael has been my friend since we were at school together. One of the good thing about our friendship is that our wives are also good friends. The only problem is that Michael also hap.pens to be my patient, and just as friendship can compromise a doctor–patient relationship, being a good doctor to a friend who has coronary heart disease can sometimes strain the friendship.

Recently the four of us decided to travel to Thailand together, to have the exotic holiday we had talked about for years but never got around to taking. We borrowed copies of the Lonely Planet guide from the library, read all about the places we were going to see, selected the best hotels and drew up a program that allowed us ample time to see what we wanted to see at our own pace.

Being the medical advisor to the group, I checked the internet, made sure all our immunisations were up to date and prepared a first aid kit. I wrote out new scripts for all Michael’s medications and gave him a duly certified letter listing his medications and a copy of his updated EPC Care Plan, including his medical history and latest ECG.

We spent our first day in Bangkok visiting the Grand Palace and several beautiful Buddhist temples, then made our way back to our hotel to enjoy the Happy Hour and a pleasant meal. Having planned to hire a car and drive north to our next desti.n a t ion, we turned in early for the night.

The next morning at breakfast Michael discretely waylaid me between the cereal and the fruit. ‘Mate, I’ve got a problem.’ Sheepishly, he told me that although he’d got all his medicines from the pharmacy, he’d left them all at home. ‘Do you think you could get me a supply here? I’ve been getting grief from Mary since she found out.’

I knew from Thai colleagues that most common medications were available in Thailand, and could usually be purchased with.out a script. So I went to the nearby pharmacy, introduced myself, and wrote out the generic names of the medications Michael needed. The pharmacist had no problems providing me with aspirin, atenolol, atorvastatin, ramipril and glyceryl trinitrate spray, but when it came to nicorandil, the potassium-channel blocker with which we had stabilised Michael’s angina, she drew a blank. It was not listed in the Thai edition of MIMS nor in her American formulary, and an internet search confirmed that nicorandil was not available in Thailand. I paid for the other medications, and to provide some form of substitute antianginal protection bought a supply of amlodipine. 

‘Michael’, I said when I gave him the tablets, ‘I’ve got all your medications but the nicorandil, which is not available here. Here’s an alternative that should give you adequate protection – but just to be safe you’ll have to avoid any excessive physical exertion that might precipitate an attack of angina. No jogging, no carrying heavy suitcases, no climbing stairs – and no sex’.

‘Thanks, mate’, he said with obvious relief. 

‘That’s a small price to pay. I’ll start these tablets right away.’

Over and above the call of duty 

Next morning at breakfast, again between the cereal and fruit, I met Michael. ‘Mate, I was wondering whether you could try and get me that nicorandil tablet’, he began. ‘You and the cardiologist are always telling me I must take all my tablets without missing a dose. I would really feel much safer if I could take that too.’

‘And how’, I asked with an exaggerated show of patience, ‘do you think I can conjure up this drug when it is not available here?’

Meanwhile, Mary had approached us, and appearing reluc.tant to offer advice on a matter that did not concern her, she ventured: ‘Perhaps you could call Justin on Michael’s mobile and ask him to send a pack of tablets by courier? You could easily fax him a letter for Customs’. 

Justin is our local pharmacist, but I felt that this request was over and above the call of duty, even if Justin happened to be a signatory to Michael’s EPC Care Plan. However, our wives discussed the matter and over-ruled me, so I dutifully called Justin, handwrote a letter for Customs and arranged for the hotel to fax it to Melbourne. 

We left a short while later for a trip to Phitsanuloke and then Sukothai, Thailand’s 14th century capital city. On our third day in Sukothai, there arrived probably the most expensive packet of medication Michael had ever received: $25.50 for the PBS subsidised nicorandil and $123.60 for the courier charges. 

Michael started taking his tablets that day, and soon appeared to have regained the spring in his step and sparkle in his eye.

The next morning at breakfast, he was waiting for me, as usual between the cereal and the fruit. ‘You’re a legend’, he began with the widest of grins on his face, ‘After you forbade me to exert myself physically, Mary wouldn’t even let me sleep with her. If you hadn’t managed to get me the nicorandil, I would have spent the rest of this holiday in an enforced state of celibacy.’ MT