You never know what people will do.

This older man came in with blood pressure problems. We resolved it quickly and easily with a new medicine ( at the time) that employed a sophisticated technology to slowly release the medicine over an entire day. It consists of a metal shell with the medicine inside. There is a tiny laser drilled hole on one side of the pill with a dry sponge on the inside of the hole. as the pill travels down the gut it absorbs some of the fluid and the sponge enlarges pushing the medicine out in a controlled manner.

The metal shell passes with the stool. It is called a Ghost pill.

This gentleman had been a CPO ( chief Petty Officer) in the navy and was someone much more used to getting things done than asking for permission.

it turned out that he noticed these pills passing through and worried that they were not dissolving. He said later that he almost called me several times to ask about it. But instead he decided to cut them.

He was surprised that a knife had no effect at all on them. So he tried a chisel but that had no effect. so he used a dremel with a metal cutting blade. That did the trick.

Unfortunately all the medicine for the day was released immediately. We actually saw him in the office a few times after this. He never mentioned his actions and because he took the pills in the morning his pressure was fine at the office. However during the night it was bouncing up and he had a severe stroke. 

I could not initially understand how he could have had such a severe stroke. His pressure had been so good every time he came in. it took a while to get all the above information and make sense of it.

I did ask if the difficulty in cutting it gave him pause. He admited that he was surprised how resistant it was but that he just pushed through.  Luckily he recovered better than most and got nearly 85% of his function. I dont think he has cut a pill since then.