A Substance Abuse Story

Christina Miller Reiter, M.D

’m angry. I’m angry about the incredible waste of the whole situation; the waste of a career, the hurt to a wife, children and to our anesthesia family. I’m angry that he could have killed himself and left all of us here to pick up the pieces. I’m angry that it makes our specialty look bad and “ruins” it for the rest of us more trustworthy individuals who aren’t injecting the drugs we administer to our patients. I’m angry about the regulatory burden this places on our specialty.

I’m sad. I’m sad that someone could be in so much unbelievably excruciating pain as to resort to a behavior that is so self-destructive. I can’t even imagine how bad it could have been to have led to this. I’m sad that we could not have done something to ease the pain had we known. I’m sad for the pain of the family. I’m sad that it went on for so long. As it turns out, he wasn’t unusual — the average time someone injects fentanyl before being discovered is six to 12 months.

I’m hurt. I feel like someone pushed me down and kicked me in the gut. I didn’t even know him well. It has nothing to do with me. If this is happening all over, why can’t we do something about it until it is too late? That’s right, I want to do something. We’re always doing something. There is always that pressure. The pressure to take care of our patients, to get the cases started quickly, to wake up the patients quickly. The pressure to experience enough cases so that I know what to do when I’m the one they are calling “attending.” The pressure to read and learn all there is in this vast specialty of anesthesiology so I will know enough to take on the most awesome responsibility of being the patient’s guardian during surgery, and I do not do something stupid that could harm or even kill them. But our lives are also in our own hands. Do we take care of ourselves as well as we take care of our patients? Do we nurture ourselves so that these drugs we carry around to help our patients do not become poison to us?

I’m scared. I’m scared it could happen to me. I’m scared it could happen to someone I am close with. If he was injecting substances, and I carry them around all the time, what’s stopping me from doing it or the guy sitting next to me in lecture? I’m always tired and feeling stressed. There aren’t enough hours in the day to spend with loved ones and take care of the household. I know how to do it, so why don’t I? What is it that’s stopping me, or the guy sitting next to me? He’s exactly the kind of person who fits the profile for substance use; he’s caucasian, male, AOA, a top performer, the one you would want to take care of your family member.

I’m confused. I keep trying to understand how someone so bright would resort to such a self-destructive behavior. What could he have been thinking? Then I realize that there is no asking why. It’s an addiction, a chronic illness that cannot be explained rationally. It needs lifelong treatment from trained professionals, just like any other condition. It doesn’t mean he is a bad person, he’s just sick.

But what about curiosity? Are you curious about it? You could take the waste from a vial of fentanyl and inject it just once to see what it would be like. You wouldn’t even have to divert any away from the patient, which would be a federal offense. You think you could control it. You understand the pharmacokinetics and pharmacodynamics. You do it for your patients all the time. But you’re wrong — so wrong. You try it once, and if you’re lucky, you’re a recovering addict with a lost career and a damaged family. Not as lucky, and you’re dead.

Most days I don’t even think about those syringes I carry around in my pockets. They help me care for my patients by treating their anxiety and pain. They can be a nuisance when I forget to fill out my controlled substances sheet properly and get called back to the pharmacy. But today I can’t stop thinking about them. Today they feel like hot coals burning a hole in my pocket. I don’t want to carry them around lest they somehow leach out and poison me, ruining my career, my family and my life.

So how do I protect myself?

I have a personal physician. Why should I need a personal physician when I am healthy and can just have a colleague write a prescription for the occasional medication that I might need? I have a personal physician so that any medical conditions I have are properly taken care of, and I have someone to turn to if I were to have any problems. Earlier in my career, I laughed at the stories of anesthesiology residents going out, getting drunk and then putting I.V.s in themselves or each other for hydration or antiemetics. Now I see it as a gateway behavior, an abuse of our position that could possibly break down our own barriers about injecting ourselves, leading to other problem behaviors.

I do something for myself on a regular basis. I don’t always make the gym when I mean to or get to see the new movie when it comes out, but I do my best to not get carried away with all my responsibilities and forget to nurture myself.

I live for today and stop putting off the things that are important to me. How many times as a medical student did you think about how you couldn’t wait to be done with school? What about as an intern? Wishing away the rotations with Q3 call was how I made it through many times. Residency? If you’re not careful, before you realize it, you have put off doing things you wanted to do and have wished away nearly a decade of your life. I don’t think anyone should do that. I think about what is important to me and make career decisions based on that. I try not to get stressed about my enormous student loan debt that is greater than the mortgage on my home. I reassure myself that it will get paid off in a timely manner and that I will be able to live a comfortable life. I learn to say no. I realize it's OK to not always do everything perfectly. I don’t have to be Wonderwoman, because I already am.

I talk to my family, especially my husband, about these issues. I have given him ASA’s booklet on substance abuse that was sent to me with my membership materials.

Lastly, I’m thankful. I’m thankful that my colleague got help before he killed himself, intentionally or unintentionally. I’m thankful that I love my chosen career of medicine and specifically anesthesiology. I’m thankful to be at such a great residency training program, which has nurtured me professionally and personally. I’m thankful for my life, my friends and my family. I’m thankful that I haven’t had the urge to inject any drugs. I’m not naïve enough to think I’m not at risk of ever having a problem with substance abuse, because with an estimated annual incidence of up to 2 percent and a lifetime incidence of approximately 8 percent, we are all at risk. I’m at peace with my life and the choices I have made.

So now I ask, are you?

For more information on substance abuse, refer to the ASA Web site www.ASAhq.org/publicationsAndServices/chemical.pdf and read “Chemical Dependence in Anesthesiologists: What You Need to Know When You Need to Know It.” If you have questions or need someone to talk to, call the ASA’s Substance Abuse Hotline at (847) 825-5586.

Christina Miller Reiter, M.D., is a CA-3 Resident at Duke University Medical Center, Durham, North Carolina.