Written by a loving husband, a dedicated father, and an experienced anesthesiologist in Virginia
Just as things were beginning to look more optimistic after a few rough years, I was let go again from a job, despite having an unblemished track record while employed there. My past was back to haunt me.
I had been moonlighting at this hospital for a year and a half and was thrilled when leadership offered for me to come on board full time. My family was happy, healthy, and finally back on sound financial footing…and I had been sober going on 29 months. I was starting to hope that maybe I could finally put the train wreck of the last several years in the rear-view mirror once and for all.
Ironically, the offer of a promotion was what led indirectly to my being fired; it had prompted yet another background check, and even though I had previously disclosed every detail of my past and was initially offered the job after two previous and identical background checks, an H.R. bureaucrat, someone from out of state who had never set foot in our hospital, objected to my continued employment.
The nurses and physicians with whom I worked wrote letters attesting to my professional competence and good nature, and my immediate supervisors all lobbied on my behalf, but the decision stood. I was once again an unemployed physician, fired from another job that I was good at and loved, as a consequence of the fact that I am an addict.
It’s taken a while for me to acknowledge it, but yes, I am an addict. I became addicted to opioids after a painful surgery. I’m really not ashamed to admit it anymore; as a matter of fact, I am now completely up front and honest with my colleagues and employers about this.
Addiction is a disease, and until others acknowledge that it is a disease, our society will continue to stigmatize and shame those who suffer from it. I’m well aware of the statistics; that anesthesia professionals suffer from addiction at 3.5 times the rate of other physicians, and that often the presenting symptom of this disease is death. I’m not ready to be another statistic.
Here are a few more statistics:
- Addicted physicians tend to be young, highly talented, very personable, and well liked
- 33% of addicted anesthesia professionals have a family history of addiction (e.g. alcohol, drugs, gambling, etc.)
- Anesthesia residents are over-represented among the anesthesia professionals who suffer from addiction
- There are current studies which have already confirmed that fentanyl has been detected in an aerosolized form in the OR (thereby unknowingly exposing a potentially susceptible individual to a highly addictive drug)
Fortunately for me, I was caught before this disease killed me. I immediately enrolled in a three-month inpatient rehabilitation program, an experience, which was brutal for me. I missed my wife and kids more than I knew was possible. I went to bed every night bummed out and woke up every morning more bummed out.
I’ve never been profoundly depressed before. I now have a tremendous amount of empathy for folks that suffer from chronic depression. I’m not trying to elicit any undeserved sympathy here; I’m just telling it like it is. And more than just being depressing, rehab was hard. Especially for someone like me who wants instant gratification, who thinks he can do pretty much anything he sets his mind to without help from anyone, thinks the rules don’t apply to him, and is used to being able to talk his way out of pretty much any jam.
After spending the first few weeks in rehab in complete denial, I slowly began to realize that I needed to be there, that I really did have a serious problem that I couldn’t correct on my own.
I realized I had a lot in common with the other addicts enrolled; extreme narcissism, delusional self-confidence, mixed with unrecognized insecurities and melancholy, an uncanny ability to manipulate others while lying to ourselves, successful careers, and innocent families left behind in the wake of our destructive selfishness. I began to realize that rehab and recovery isn’t just about not drinking or using drugs; it’s about honestly acknowledging and facing the insidious demons of self-deception that cause us to destroy the things we cherish the most.
It’s also about acquiring an appreciation of the biochemical imbalances that make us crave dopamine ‘hits’ the way a starving dog craves a steak. The end result of actual sobriety from alcohol and drugs is just a fringe benefit of exploring and understanding all this.
When I left rehab, I knew I still had a lot of work to do. I continued with another three months of intensive outpatient therapy, enrolled in Virginia HPMP (with three to six random drug screens per month), and began attending several 12 step meetings every week.
I used to think of AA meetings as being a place where sad, cranky, desperate winos sit around smoking cigarettes and drinking coffee while complaining of their pathetic lives. In my experience this is far from the truth. Recovering addicts are some of the most hopeful, upbeat, supportive, honest, and authentic people I’ve ever met. Gratitude seems to be the glue that holds this all together. It’s something that is discussed at every meeting I’ve attended.
I now realize that I have so, so many things for which to be grateful. I’m surviving this disease without any major adverse health effects, my family is intact, my wife has been my biggest supporter and our marriage is stronger than it ever has been. I’m grateful for those friends who have stood by me. I’m grateful for my parents and siblings and cousins who have supported and encouraged me. I’m grateful for the nurse that reported my suspicious behavior which led to all this – it very likely saved my life.
Obviously, the journey hasn’t been all unicorns and butterflies. I’ve been fired from two jobs, created incredible hardships for my family, destroyed friendships and professional relationships, and I’m several hundred thousand dollars poorer due to lost salary, lawyer’s fees, insurance payments, and cost of rehab. But all that means nothing in light of the newfound focus I have on what’s really important to me: God, family, friends, and honest living.
After six months of sobriety, I was cleared by HPMP to return to work. I had planned all along to return to my old job, and it seemed as though my partners were supportive of this. They then fired me via email, without any discussion. This really felt like a kick in the teeth. I had been there 14 years and I truly loved the hospital and the people I worked with.
It wasn’t the firing as much as the indifference with which it was carried out that stung so much. I understand the decision to fire me; I did something inexcusable. I betrayed their trust and I put them in a position they didn’t ask to be put in. But I felt as though I had lost something more than just a job; I had lost the respect that I had earned from 14 years of being a solid partner with people I liked and enjoyed working with, and I lost the attendant goodwill that goes with that respect.
I felt like in their eyes, my former self had been erased and, in its place, stood only an addict. I know I have no right to complain, and I bear no resentments towards my former partners; this was 100% my fault. But what if I had been diagnosed with some other awful disease instead? Would the same indifference have been given to my firing? Would I have been judged only by my disease or seen as myself, but now with an illness? That knowledge is something that still plagues me more than the loss of the job itself.
By now, I have come to realize that my past actions will always follow me, and rightfully so-it’s legitimately fair to question whether any doctor who has abused opioids should be allowed to return to a job with access to narcotics, even with participation in a recovery program and monitoring. But the addicted are not immoral, evil, crazy, stupid, or weak-willed. We have a disease for which there is no cure, but one that can be successfully treated.
This treatment requires:
• Thorough understanding of the disease
• Long term care and follow-up, including monitoring
• Regular participation in recovery goals
If these principles are strictly adhered to, any addict who is committed to recovery should theoretically be in very little danger of relapse. But just like remembering to take a pill every day, compliance with therapy can be difficult. The statistics for maintaining sobriety for all addicts in recovery are pretty dismal; well over 50% relapse. And for opioids, the presenting symptom for 25% of those that do relapse is death.
The good news is that the statistics for anesthesiologists returning to practice, who are enrolled in a recovery program and who are in monitoring, are much better than those for all addicts. It’s hard to find exact numbers, but I’ve been told by several professional counselors that the success rate for these individuals is north of 90%, and anecdotally I know several addicted anesthesiologists in recovery who have successfully returned to work and continue to have fulfilling careers.
Reentry for anesthesiologists remains a controversial topic, and there is no current consensus on whether opioid abusers in recovery should return to the OR. In general, these decisions are made on a case-by-case basis.
The Talbot Recovery Program, used by several states as a guideline for determining if and when an anesthesia professional may return to practice, has developed a classification system for reentry into anesthesia, each category having numerous criteria:
- Category I: Return to anesthesia immediately upon successful completion of a treatment program
- Category II: Return to anesthesia after 2 years off
- Category III: Redirect to another specialty
I’m not pretending to have any answers. Strong arguments can be made both ways, but I will give you my opinion. As someone who has made several hiring decisions in the past, I would absolutely hire a physician with a history of addiction; if they have completed inpatient rehab, are actively involved in a recovery program, are monitored, and have maintained sobriety for more than six months.
I would treat them like any other applicant and would be willing to see beyond their tarnished past. I would see them as a physician, and a human, not an addict. As stated above, recovering addicts are some of the most authentic people I know. I would trust them as much, if not more, than many of the physicians I’ve worked with in the past, some of whom I know have abused alcohol or drugs themselves.
I’m sure some will disagree, and I respect that viewpoint. I base this opinion on my own experiences, my physician acquaintances who are also in recovery, and the overall success rate for physicians in recovery who continue to be monitored.
Addiction is absolutely a disease, and I think that maybe it’s time to consider treating addicts as people with a health problem. We didn’t ask to become addicts, it’s not something to which we aspire, and although we acknowledge that the responsibility for our actions lies solely upon our own shoulders, I think we are at least deserving of the consideration that many of us are pretty decent people.
Obviously, you can’t compare addicts to cancer patients. Pretty much all of us would agree that we aren’t deserving of the same degree of sympathy, and I’ve never heard anyone in recovery use the “disease” explanation as an excuse for their behavior. To the contrary, most of us really struggle with the guilt and shame of the hurt they have caused others, often to an extent that is unhealthy. But anyone can be a drunk or a drug addict. It takes something more to truly be in recovery; honesty, commitment, patience, gratitude.
I’ll say it again, the medical professionals I’ve met in recovery are the most honest, optimistic, grateful and supportive group of people I’ve ever known. They are genuinely good people. Regardless of one’s opinion on whether physician addicts in recovery should be reintegrated, I would hope that we could at least try to understand that addiction doesn’t make someone a bad person.
It’s not a character flaw, and being in recovery means that someone has been through an intense process of honest self-assessment that the vast majority of people will never undertake or endure.
- Arnold, WP. 1995 substance abuse survey in anesthesiology training programs: A brief summary. ASA Newsletter. 1995; 59(10):12-13,18.
- Headberg, Eric B. 2001 Anesthesiologists: Addicted to the Drugs They Administer. ASA Newsletter, volume 65]
- Gold, Mark S. 2006 Fentanyl Abuse and Dependence: Further Evidence for Second Hand Exposure Hypothesis. Journal of Addictive Disease, volume 25 (1): 15-21
- Talbott GD, Gallegos KV, Wilson PO, Porter TL. The Medical Association of Georgia’s impaired physicians program review of the first 1,000 physicians: Analysis of specialty. JAMA. 1987; 257:2927-2930.