Tracing the Flow: How Medications Shape Life at Northwood

To grasp the sheer scope and complexity of medication work at Northwood, I started with a strikingly simple question: how much medication flows through one building in just one day? I turned to Lawton’s Pharmacy, which revealed a snapshot of life at Northwood: 2,836 prescriptions for 303 residents, amounting to 4,927 doses. Yes, almost 5000 doses for 303 residents in a single day. That’s an average of 9.3 prescriptions and 16.26 doses per resident—every single day (well, that one day).

But the numbers only tell part of the story. These pills, creams, and injections don’t just flow through bodies—they weave their way through the institution, passing through rooms, hands, systems, and objects, leaving traces on everything and everyone they touch. To make sense of this intricate choreography, I took the numbers as my starting point and followed the flow of medications as they coursed through the corridors and bodies at Northwood.

Real-world research or empirical sociology or ethnography became my lens, a way to capture the daily rhythms of polypharmacy as it unfolded in real time. Over nearly a year, I immersed myself in the life of Northwood, physically shadowing the routines, rituals, and relationships that kept the system running. I sat in nurses’ rooms, observed ‘doctor day,’ followed the anti-psychotic project, lingered in dining rooms, and attended pharmaceutical and therapeutics committee meetings. I shadowed the staff—LPNs, nurses, physicians, and administrators—and asked them questions that cut to the heart of the practice: who and what keeps this medication flow alive? What habits, objects, and decisions sustain it? What are the ripples, both intended and unintended, that follow?

From training sessions to the smallest moments of care, I watched as medications shaped not just the daily work but the identities, power dynamics, and relationships at Northwood. I tracked how objects—charts, binders, pill bottles, even the physical layout of rooms—dictated the flow of work and shaped the people moving through those spaces. Each scene became a microcosm of the larger system, a place where people and objects collaborated, collided, and kept the machinery of polypharmacy humming along.

I brought a practice-based framework to this tangled world (Nicolini 2012; Gherardi 2019), asking not just what happens, but how and why. Northwood revealed itself as a place where the ordinary—like filling out a form or handing a resident their pills—is anything but simple. Every action and interaction is part of a larger pattern, a living, breathing system where medications are both a lifeline and a constant presence shaping life within the institution.