I’m sitting across from my friend Sheila at a booth at Liguria, a favorite bar/restaurant in Providencia, and I can’t help but stare at the bags under her eyes. It’s the first time I’ve seen her in months, and she’s clearly on edge. Distracted, jumpy. She fidgets with the menu. Can’t make up her mind. Doesn’t know what she wants. And frankly, she looks like hell.
“What is wrong with you?” I blurt out. I’ve known her forever and have never seen her like this. Now that I think about it, she’s been out of whack for most of the past year.
“I feel like crap.”
“I can see that… What’s going on?”
“Jonesin’ for benzos…”
“What…?” Shock. Disbelief. Sheila is a responsible adult. A professional. Intelligent. Well-educated. Not your run-of-the-mill junkie type. How could she be going through withdrawals?
“Remember all those stomach problems I had last year?”
“I ended up on and off all kinds of different medications and finally got to a combination that helped. The doctor put me on Nexium for gastritis and Lerogin for IBS, twice a day to start and then said to drop down to once a day as I felt better. It worked, and I’ve been taking them both ever since until about a month ago when I couldn’t get Lerogin anymore. The pharmacist said I needed a new prescription, but I’d been feeling better and didn’t have time to go to the doctor, so it seemed like a good time to stop taking it.”
This was just before she went to see her sick father in Canada.
“I’d been so worried about my dad and work and getting ready for the trip and all, I couldn’t sleep. But then he was doing better and I got back, and I still couldn’t sleep. I’d nod off and then wake up 4 hours later and spend the rest of the night tossing and turning. Night after night—I hate that!”
“And then it hit me,” she said. “I sat bolt upright one day at dawn after yet another sleepless night—and I knew. With everything else on my mind, I hadn’t put it together earlier. All this anxiety started right when I stopped taking the medication! So I googled Lerogin and discovered that it contains chlordiazepoxide—a benzo (benzodiazepine). Everything I read kept going on and on about it being highly addictive, for short-term use only—no more than 2–4 weeks—and that it should never be stopped abruptly. Scared the heck outta me. Jeeze! No wonder I’ve felt so awful!”
Cold turkey benzo deprivation can cause all sorts of nastiness, including anxiety, sleeplessness, racing pulse, splitting headaches, nausea, confusion, difficulty concentrating, depression, achy joints, and the list runs on. She was justifiably miserable.
“It explained all my symptoms. And not only that—the side effects from taking them for over a year explain a lot of everything else that’s been wrong with me for all this time—fuzzy thinking, distractability, procrastination—no, wait—that’s probably just me…” At least she still had a sense of humor
She went to a gastroenterologist, who agreed with her conclusion, gave her sleeping pills to get her through the night, and suggested she go back on Lerogin until a neurologist could set her up with a plan for weaning off it gradually. She refused.
“No way! I was already 4 weeks in, and after I’d already done a month of misery; I wasn’t about to start all over from scratch!
She made the appointment with the first neurologist who would take her and was waiting for the 3 weeks to roll around to get in to see him the last I saw her.
In the meantime, she’s angry. “Why didn’t the doctor tell me that this was a double-barrel drug? Why did the pharmacy keep selling it to me even though I didn’t have a new script? And why the hell didn’t I know enough to check this all out way back when I first started taking it?”
And that’s the point:
In Chile, patients must be particularly proactive about health care.
Chile has excellent health care professionals, but the system works differently and has fewer safety nets. Large loopholes and a look-the-other-way attitude make it very easy for honest people to slip through the loose mesh of the “open-weave” health care safety net, so the bottom line is: you must be your own health advocate. This carries over into all areas of health care, but for the sake of focus, let’s just stick to medications for now. That in itself is plenty to get a grip on. Here are a few points to get us started:
1. The “Family Doctor / General Practitioner” concept is not very common.
Most doctors are specialists; there are very few GPs around, so when you have a problem, you have to diagnose it, find a doctor in that specialty, then cross your fingers that your diagnostic skills are on target. Otherwise you’ll be sucked into the hit-or-miss and time-consuming spiral of finding the right physician. Personally, I really miss having one doc who knows me and my family, who knows my life history better than I do, and who is able to put Point A from 2011 together with Point B from 1999 and Point C from my mother’s history and say, “Let’s have Dr. Soandso check this out.” About the closest I’ve been able to get is going to the same medical center so that while I may not see the same doctor twice in a row, at least they all have access to a single chart with all my info.
2. Ask questions… and do follow up research!
Old-school docs are used to being the boss and balk at questions, although thankfully, that is changing. Most younger doctors are much more open to proactive patients. In the end, you are the one who is going to suffer the effects of any errors, so be sure to remind the doctor of any allergies or special conditions you may have, ask how and how long to take the medication, and then look it up when you get home.
3. The pharmacist is following orders.
He or she will fill your prescription, but will not ask you about allergies and will certainly not have your records on file. No one at the pharmacy has any way of knowing that what Dr. González prescribed today is going to cause a major problem with what Dr. Martínez prescribed last week, because none of that information is available to them—unless you tell them. Be safe and ask! Let the pharmacist know what else you’re taking and ask if there is any conflict. Most are very willing to answer questions when asked, although my experience is that few will butt in on their own.
4. Many prescription-only drugs are available “OTC” (over the counter) in Chile.
Chilean pharmacies are rather relaxed, and up until fairly recently, generally pretty willing to hand over whatever you ask for. When I first arrived in Chile antibiotics were dispensed like aspirin—which can be pretty scary for anyone with allergies, although fortunately the names are similar enough (peninsulina vs penicillin, for example) that they’re easy to spot.
My friend Sheila learned the hard way. How about you? Do you have any suggestions for maneuvering through the Chilean medical prescription system? Similar (or very different) experiences in another country?