This is what you find...
The patient has been a pack a day smoker for 65 years. He has a diagnosis of COPD, and he normally sleeps on 2 pillows and can't lie flat. He's also previously had an AMI.
His normal medications include seretide and spiriva, aspirin, ACE inhibitor, and diuretics. He has missed a few doses as his regular medications were not restarted post-operatively. He has been having sub-cut heparin and has been wearing TED stockings.