FAMILY/HEALTH

The Prescription Nobody Questioned

After surgery, the real ordeal began

Photo by pina messina on Unsplash

“The greatest burden lies in caring for those we cannot help.” ― Diana Gabaldon, Voyager

My mother is 83 years old. She is small, independent, and remarkably resilient. She has never been someone who complains or asks for help unless she truly needs it. When life presents a challenge, she faces it the way she always has — with determination and very little fuss.

When her orthopedic surgeon told her she needed a total knee replacement, she accepted it without hesitation. She arrived at the hospital early on a Friday morning, underwent surgery under spinal anesthesia, and was walking with a walker a few hours later. By late afternoon, she was discharged with a prescription for oxycodone to manage her pain.

That night, she fainted three times.

As frightening as it was, my family was not entirely surprised. I have a background in toxicology, and my sister is a physician. Between us, we understood what was likely happening.

Oxycodone is a powerful opioid. It can provide important pain relief after major surgery, but it also affects the central nervous system. It can lower blood pressure, cause dizziness, impair balance, and make it more difficult for the body to adjust when a person stands up. In older adults, these effects can be more pronounced.

A medication dose that may be appropriate for a healthy younger patient can affect an 83-year-old very differently, especially one who is small, thin, and recovering from surgery and anesthesia.

What troubled me was not that oxycodone was prescribed. Knee replacement surgery is painful, and effective pain management is essential for recovery. What troubled me was the feeling that no one had looked closely enough at the person receiving the prescription.

Not the average patient.

My mother.

An 83-year-old woman with very little body mass and limited physical reserve after major surgery.

The prescription seemed to follow a standard protocol. The surgery was routine, so the discharge medication appeared routine as well. Yet older patients are not simply younger patients with more birthdays behind them. Age changes the way the body handles medications. Lower body weight can increase a drug’s effects. Recovery from surgery can further reduce a person’s ability to tolerate side effects.

The next morning, after the third fainting episode, my brother and I took her to the emergency room.

The physician who evaluated her quickly recognized what had likely happened. She discontinued the oxycodone and replaced it with a carefully coordinated schedule of Tylenol, Motrin, and Celebrex. The new plan controlled my mother’s pain without causing further episodes of fainting.

During the visit, the physician made a comment that stayed with me. She said she never takes oxycodone herself because it “knocks her out.”

She said it casually, almost as an aside. Yet in that moment, it highlighted something important. The medication’s effects were not surprising. They were well known.

Opioids can be extraordinarily effective medications, but they are also powerful drugs. They can cause sedation, confusion, falls, breathing problems, and dependence. Older adults are often particularly vulnerable to these risks.

My mother recovered well after her medications were changed. She completed her rehabilitation and did not experience another episode like those first frightening hours after surgery.

Still, I find myself returning to the same question.

Why did it take an emergency room visit to arrive at a treatment plan that worked?

The issue is not whether opioids should ever be prescribed. In many situations they have an important role. The issue is whether prescribing decisions are sufficiently individualized.

Medicine works best when it treats patients, not protocols. Every patient brings a different set of circumstances — age, weight, medical history, physical reserve, and tolerance for risk. Those factors matter, especially when powerful medications are involved.

What surprised me most was not my mother’s reaction to oxycodone. Given her age and size, that reaction was entirely understandable.

What surprised me was how little her individuality seemed to factor into the decision before she left the hospital.

For a healthcare system increasingly focused on personalized care, that should give all of us pause.

Who is responsible when a prescription causes harm — the physician who wrote it, the system that made it standard, or both?

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