Medication fatigue is an unavoidable reality of life with chronic illness

Here’s a riddle: What has more compartments than a tackle box, more variety than a buffet, and takes longer to sort than a load of laundry you’ve ignored until you ran out of clean underwear?

If you said my weekly pill organizer, congratulations! You clearly know me or someone like me. Every week, I sit down with my medications and supplements spread across the table in front of me like a vendor at a pharmaceutical trade show. There’ll be bottles of every shape and size, blister packs, gel caps, and the occasional oddly enormous tablet that looks like it was engineered for a horse. With the calm efficiency of someone who has done this more times than he can count, I sort them methodically into their little plastic compartments.

The ritual itself no longer bothers me. It does, however, sometimes bother others who are watching me do it. The first time a friend or family member witnesses the full spread, the reaction is always the same. Their eyes show something between shock and surprise. They may let out a small whistle. I just smile and say, “CVS doesn’t have anything on me.”

Because they don’t. I’m basically a traveling pharmacy. And if you are living with myasthenia gravis (MG), or any number of other complex chronic conditions, you get what I’m saying.

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The humor is genuine. But underneath the joke is something known as medication fatigue. That’s not to be confused with the side effects of any particular drug. Rather, it’s the slow, cumulative weight of managing a complex medical regimen week after week, month after month, and year after year, with no end in sight.

Medication fatigue is real. It’s the moment you stand at the kitchen counter at 8 p.m., genuinely weary of swallowing pills. It’s the low-grade resentment you feel toward the pill organizer that makes everything manageable and also inescapable. It’s the mental overhead of tracking refills, calling pharmacies, navigating insurance, adjusting for food interactions, and remembering which pill can’t be taken within two hours of another one. The logistics are endless. The compliance required is relentless. And unlike many difficult things in life, there is no finish line.

For those of us managing MG, the regimen can be particularly involved. Mestinon (pyridostigmine bromide), immunosuppressants, supplements, and any number of additional medications add up to more than a morning and evening routine. We’re talking about a whole system.

So where does medication fatigue actually show up? Sometimes it’s a skipped dose. Even with periodic alarms from my phone, I do forget a dose here and there. Sometimes it’s bargaining. I’ll double up tomorrow. I’ve been good for months. One dose won’t matter. It might be resentment watching someone casually pop a single aspirin. Maybe it’s just staring at the pill organizer feeling something very close to grief for the version of yourself who never had to think about any of this.

None of this makes you weak. None of it makes you noncompliant. It makes you human.

In his unfinished novel “The Pale King,” David Foster Wallace wrote, “Routine, repetition, tedium, monotony, ephemeracy, inconsequence, abstraction, disorder, boredom, angst, ennui — these are the true hero’s enemies, and make no mistake, they are fearsome indeed. For they are real.” He was writing about government bureaucracy. He might as well have been writing about the 11 a.m. pill alarm.

An act of kindness

So what do you do with it? How do you keep showing up for the ritual when the ritual is exhausting?

For me, the answer is partly structural and partly spiritual. On the structural side, I’ve learned not to fight the system, but to make peace with it. The pill organizer is not my enemy. It is my ally. Sorting it once a week means I never have to make decisions at 6 a.m. when my brain is at its worst. That weekly Sunday ritual that alarms visitors is actually an act of kindness toward my future self. I treat it like a small, quiet discipline, like making the bed. It takes 10 minutes and buys me seven days of not having to think.

I hold on to a Bible verse that has gotten me through more than a few weary mornings: “And let us not be weary in well doing: for in due season we shall reap, if we faint not.” Taking my medication is, in its own quiet way, well-doing. It is faithfulness to my own body and the people who love me. It honors the life I am still very much trying to live.

That verse doesn’t make the pill organizer smaller or the schedule shorter. But it does reframe the act. I’m not just managing a condition; I’m planting something. And the harvest, as promised, is coming — if I faint not.

This week, I’ll sit down again with all of my bottles spread out in front of me. Someone may walk in and look at me the way people look at someone defusing a bomb. I’ll smile and say something about CVS. And then I’ll keep going, one compartment at a time, one week at a time, one quiet act of faithfulness at a time.

The pill organizer is full. That means I showed up. And for today, that is enough.

Note: Myasthenia Gravis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Myasthenia Gravis News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to myasthenia gravis.