The Blue Pill Mystery

Decades ago, one of my elderly male patients asked me what his “little blue pill” was for.

Naturally, my mind went straight to Viagra. Was his wife slipping it into his morning tray just to keep things interesting? Every morning, she lovingly brought him breakfast service worthy of a boutique hotel: his pills, a glass of water, and his lancet device for his fingerstick glucose check.

I do not make a habit of memorizing the exact size, shape, and color of every medication I prescribe. That would be impossible, and largely useless. Generics are manufactured by different companies and often bear no resemblance to the original branded medication. One man’s white oval tablet is another man’s pale yellow hexagon with an attitude problem.

But this gentleman did not have a long medication list, so I decided to play pharmaceutical detective.

Back then, we had the gigantic PDR—the Physicians’ Desk Reference—a medical encyclopedia large enough to press flowers, prop open a bank vault, or knock a burglar unconscious. Along with every known fact about a medication, it included pictures of the actual pills.

So I went through his medication list one by one, matching each drug to its image. Like a scavenger hunt for the overeducated, I found them all and wrote out descriptions for him.

“The small orange tablet shaped like a football.”

“The red-and-yellow capsule that looks like a rocket ship.”

“The white round one with the tiny numbers stamped on it.”

But the little blue pill remained a mystery.

Had another doctor prescribed something I had failed to record in his chart? Was he taking a vitamin? A supplement? A neighbor’s medication? A breath mint? Was his wife attempting to poison him with small doses of arsenic while disguising it as marital devotion?

The possibilities were endless.

He, his wife, and I all wanted to know.

I asked them to bring in his pill tray at the next visit, or at least bring me a picture of it. This was before digital photos, so they returned with an actual photograph printed on Kodak paper, which now seems as ancient as chiseling the medication list onto a cave wall.

I took out a magnifying glass and studied the tray like a forensic pathologist examining evidence from a crime scene. There was the orange one, the red-and-yellow one, the white one, and the others I had already identified.

Then I saw it.

The little round blue “pill” was not a pill at all.

It was the tiny plastic needle cover from his lancet device—the little cap his wife removed each morning before his fingerstick blood sugar check. Somehow it had landed in his pill tray and been promoted to medication status.

Mystery solved.

Apparently, he swallowed it every morning without question, which says something about either the trust he had in his wife or the number of things elderly patients will ingest if they are placed in a pill tray with authority.

Fortunately, it passed through without incident. I suppose he had not conducted the sort of thorough stool archaeology some patients proudly perform.

In the end, the little blue pill was neither Viagra, nor vitamin, nor poison.

It was a lancet cap.

A tiny plastic stowaway on the morning medication cruise.