Nancy Kruger Cohen -- the harried mother of a 5-year-old and an 8-year-old -- begins each day with her gray thyroid tablet, taken on an empty stomach.
But one day, while multi-tasking under pressure -- preparing waffles for breakfast, packing lunchboxes with sandwiches and zipping up winter jackets for the walk to school -- she grabs the wrong prescription bottle.
"As the pill goes in, my tongue pauses -- Is it usually pink? -- but I swallow anyway. And then the mistake is clear," said the New York City writer and art director. "I have taken a sleeping pill at 8:15 a.m."
"The scene freezes: me, staring at the word Ambien, yelling to the girls about boots, running in slow motion to the bathroom," she said. "I used to be able to make myself throw up, but now not even a toothbrush will work, so I give up and unlock the door to find the girls, boots on. We leave."
So begins her day -- one in which she texts her girlfriends, throws up over tea, crashes in bed and eventually spends the evening playing with her children, uncharacteristically oblivious to the mess and confusion. Her memory of the day is, of course, spotty.
"Chaos at home is a common denominator in a lot of accidental poisonings," said Marcel J. Casavant, a toxicologist and medical director of the Central Ohio Poison Center at Nationwide Children's Hospital in Columbus.
"Kids may be playing, mom is fixing dinner, dad is getting in from work and grabbing mail or whatever dads do," he said. "But there's a lot going on, and someone decides it's time to administer medication."
At least half of all Americans take at least one prescription drug, with one in six taking three or more medications. The biggest increases in prescriptions were for antidepressants, nonsteriodal anti-inflammatory drugs, and blood sugar and cholesterol lowering drugs, according to a 2004 Department of Health and Human Services report.
Cohen credits a grandmother who is a doctor for the array of sleeping aids in her medicine cabinet: two kinds of Ambien, as well as melatonin, progesterone cream, 5-Hydroxytryptophan and Valium, "for emergencies."
"Everyone's cabinet is unhinging with confusing chemical choices," she writes in a recent essay, "Mothers Little Helper," in the New York Times magazine.
"What happens if you take his Lipitor and he takes her Prozac and she takes their Skelaxin and they take our codeine? Or Desitin becomes toothpaste and mouthwash gets in the neti pot? We're all one misdose away from something."
Casavant said his poison control center, one of three in Ohio, fields at least 100 calls a day, "a couple of dozen" of which are unintentional medication mix-ups. "We have a lot more chemicals and a lot more medicine these days."
A school nurse recently called the poison control center because a teenager thought he might have taken his grandmother's medicine.
"It's not just a mom trying to medicate herself," Casavant said. "Sometimes we have three or four generations of people in the house, with one or more people per generation on various meds. Maybe it's not Mom taking her nighttime med in the morning, but Mom giving one of Grandpa's meds to the girl who's running late on her way to school."