Brandy, bridge, and other patient dilemmas

Introduction

My grandmother didn't want friends from the bridge club invited to her 90th birthday party last year. If her age became widely known, she worried that her standing—as a competitive player who takes her bridge very seriously—might be diminished. My grandmother is also mad about gardening, books, and film and has a wonderfully dry sense of humour. This becomes particularly evident about sundown, when she pours a hefty brandy or two while cooking dinner.

The family came up with all sorts of explanations when my grandmother began to complain of severe exhaustion last November. No wonder she was worn out; she was just back from a gruelling bridge competition several hundred kilometres away. Perhaps it was her heart; she'd been admitted to hospital with atrial fibrillation in July. Or maybe the years had finally overtaken her legendary stamina. She also had severe constipation. A medicines information line advised that one of the medications recently prescribed for bladder troubles—imipramine, oxybutynin, or estrone—was probably to blame.

By December, she could barely get out of bed. We knew it was serious; she wasn't worried about missing bridge and even had lost her appetite for brandy. Tests showed some problems with thyroid function, possibly due to the amiodarone she'd been taking since July, and low sodium concentrations. Despite phone calls to her specialists and visits to her general practitioner, it was difficult to get a satisfactory response to our fears that her medicines were making her …