” She was not confused. She was tired. There is a difference, and I have seen both from my side of the counter.
All those years in the basement pharmacy of a county hospital, and the thing that still surprises people is how ordinary this is. A heart pill from one doctor. A stomach pill from another. Something for sleep that started as a sample. Something for the joints that a neighbour swore by. Each one made sense on the day it was prescribed. Nobody looked at the whole shelf at once. It is like a kitchen cupboard where everyone in the family keeps adding a spice jar and nobody ever takes one out. One day you cannot find the salt.
I am not saying the medicines are wrong. Most of them are right, or were right once. I am saying that when someone over sixty tells me their memory is slipping, the first place I look is not their brain. It is the brown bag. The bottles and boxes, the ones from the drugstore shelf too, the ones in the bathroom drawer never mentioned to anyone. That is the whole idea behind running a brown-bag review the slow way, on a kitchen table, with time to look at each thing.
The hardest part is not the sorting. The hardest part is that nobody wants to be the person who asks. People are polite about their pills in a way they are not polite about anything else. They will argue with a doctor about cholesterol and never once mention the capsule that makes them groggy until noon.
A man named Gerald came to one of my reviews with a paper grocery bag that clinked. He set it down and said, “My daughter made me come.” I said, “Good for her. Sit down.” We spread everything out on the table. He watched me line the bottles up in a row, and after a minute he said, “It looks different when you see it all together.” I said, “It always does.” He pointed at two bottles and said, “Those are the same thing, aren’t they.” I said, “That is a question for your doctor, but it is a very good question to bring her.” He wrote it down. That is the part I care about. He wrote it down, because what is written down is remembered, and what is not written down is a coin rolling under the stove.
A friend asking for advice would hear this from me. Put every single thing you take into one bag, prescriptions and the rest. Bring it to the pharmacy counter at the grocery store, the one where they still know you, and ask them to look at the whole list. Not one bottle. The whole list. The pharmacist has more time than the doctor does, and looking at the whole list is exactly what we trained for. Then take the same list to your doctor and ask one question: is everything on here still doing a job I need done? That is all. One question. You are not firing your medicines. You are checking the payroll.
I will give you a real example, though I will keep the medicine names out of it, because that is not my place. We sat for forty minutes. By June she told me she was finishing the crossword again on Sundays. I would not label that as extraordinary. I call it a smaller bag.
Now, people ask me whether it is better to bring the bag to the pharmacist or straight to the doctor, and I have done it both ways for years, so I will tell you honestly. The pharmacist first. Here is why. The pharmacist sees the overlaps on paper in five minutes, the duplicates, the two things that fight each other, and can hand you a clean list with the questions marked. Then the doctor visit goes twice as far in half the time, because you walk in with the list instead of a memory of the list. Going straight to the doctor with the bag works too, and I have sent plenty of people that way when the pharmacist was swamped, but the visit runs long and half of it gets spent just sorting. The pharmacist sorts for a living. Let them sort. Then let the doctor decide. Two hands, one job each.
There is one more thing I look for, and it has nothing to do with pills. I do not guess at it. I just ask whether anyone has looked. Sometimes the answer is yes and everything is fine, and that is a good afternoon too.
Ordinary forgetting has a shape. It is the name that comes back at eleven o’clock while you are doing the dishes. It is walking into the pantry and forgetting why, then remembering the moment you sit back down. I put my own keys in the fridge last winter and found them next to the butter, and I laughed, because they came back to me. The other kind of forgetting does not come back, and it does not laugh with you. But you do not start by dreading the second kind. You start by checking the first kind’s usual suspects, and the bag on the table is suspect number one. If you want the wider map of all of this, medicines and memory at sixty is where I keep the whole picture, and it is not a frightening picture.
Alter a single variable before moving on. Give each change a month or two before you judge it. Write everything down in one place — I use a paper calendar by the phone and a little notebook, and I fill my pill organiser on Sunday mornings at the kitchen table, the same way I have for years. None of this is fancy. Fancy is not what works. What works is boring and repeatable, like measuring instead of guessing.
And before you do any of it, before you even find the bag, pull up watch the underlying memory slip video after this note and see what is usually behind these slips and what one woman did about hers. It is the next thing to do, before the sorting, before the questions, because it will tell you which questions are worth the trip.
Gerald came back that spring with a smaller bag and a better mood. He said his daughter was pleased. I said, “Tell her she can come next time too.” He said she had already asked.
Why memory slips after sixtyWatch the video: why memory slips after sixty and how to get it back.
The coat rack at the centre lost a peg that winter and nobody has fixed it. I think about that peg more than I should.