Clean Enough: An Educational Process

Clean Enough continues:
An Educational Process
I was able to stop using codeine after returning home and to my job in the operating room.  I dodged a bullet– or so it seemed.  I continued to drink wine, beer, and the occasional margarita, but I had convinced myself that drinking was an isolated vice that was necessary given the stress of my job.  Yes, the AA and NA people said that alcohol would take me back to my ‘drug of choice’, but they didn’t understand my special situation, and didn’t know how smart I was.  The scary incident in the Bahamas faded from my memory.  Looking back, it wasn’t that big of a deal.
About ten months later I was having a tough week.  I had a bad cold, I was feeling depressed (my mood always takes a hit when I am sick), and my wife and I were in one of those low stretches that visit most marriages.  Seemingly out of the blue, I thought about how I had stopped the codeine after my vacation months earlier.  Hey– I must have learned to control my use of codeine!  And since I have control, I can take a small amount of codeine for my cold… and perhaps get a tiny bit of euphoria… but then I will stop just like I did before!   That thought—that I now had ‘control’—would be the end of my career as an anesthesiologist.  Similar to the experiences of many other addicts, my relapse was horrible; much worse than my original addiction.  I was like a rat pushing a lever to get food in a lab experiment, using medications from work, shooting up intravenously, and taking doses that I knew could be fatal.  I even injected contents from unlabeled syringes, hoping they contained something to make the sickness go away, and not the paralyzing agents that would have killed me.  Every Friday I brought home enough fentanyl to cover the weekend, but no matter the amount, it was gone by Friday night, leaving me sick from withdrawal every Saturday and Sunday.  At some point I didn’t even care about getting busted. There is a great line in the movie ’28 Days’:  “this is no way to live…. this is a way to die!” 
I was met by a security officer one Saturday morning as I entered the hospital to scrounge the operating rooms for drugs, and he apologized for having to escort me out of the hospital.  The next morning I met with the my wife, a member of my anesthesia group, and the hospital CEO, telling them that I only needed a minor, outpatient ‘tune-up’, since I knew all this recovery stuff already.  But the CEO pointed out the needle marks on my hands and arms, and said that any possibility of working again required residential treatment.  I left the meeting wondering whether to just put all of us out of our misery or to instead go into treatment.  As an aside, I remember that feeling now when I am trying to get a person to enter residential treatment– my aversion to treatment was so strong that suicide seemed a reasonable alternative!  I did choose treatment over death, but not by a long-shot. 
The night before going to treatment I watched my 12-year old daughter play a piano duet, her teacher playing the part that I was supposed to play.  Laura and I had practiced the piece together for weeks, but with my hands shaking and dripping sweat I was in no condition to play.  I have many shameful memories from my ‘using days’, but memories of that night will always be among the worst of them.
I was in severe withdrawal the next morning, too sick to enter the treatment facility, so I spent some time in acute detox in a locked psych ward.  My shoelaces were taken from me so that I couldn’t hang myself.  I was given a room at the end of the hall where I waited for the pain to stop, minutes becoming hours.  Clonidine was ordered, but was to be held for blood pressure below 90. Every time I heard the nurse I tensed my muscles, trying to push my pressure higher, but I was so dehydrated that I couldn’t get my blood pressure high enough for even one dose!  I will point out that people write on the web that ‘Suboxone withdrawal is the worst;’ in detox I could barely walk for the first few days, and for a month or two I was so weak that I became short of breath after walking 100 feet.  Sleep and appetite took a couple months to return.  After experiencing withdrawal many times, and watching many people go through withdrawal from substances including buprenorphine, I can say with complete confidence that buprenorphine withdrawal can be significant, but is NOT as severe as withdrawing from opioid agonists.  Those who say otherwise are being influenced by the fact that current misery always feels worse than ‘remembered misery.’   People withdrawing from buprenorphine go to work every day and complain about how bad they feel; those withdrawing from oxycodone, methadone, heroin, or fentanyl lie in bed and DON’T complain, as they are too sick to write on the internet!
I eventually transferred to the treatment center where I would spend the next three-plus months of my life.  The program consisted of work from sun-up to bedtime, and included individual therapy, group therapy, art therapy, music therapy, experiential therapy, relaxation training and guided imagery, ropes and challenge course, physical training, and twelve step groups.  One irony of treatment is that a person is ready to leave at about the time when he no longer wants to go.  I now see the experience as a wonderful gift to myself.
I had a number of ‘consequences’; I lost my job and my hospital privileges, and I was disciplined by the licensing board.  I was ordered to attend treatment and twelve step meetings for the next five years, and I was subject to random urine testing at a frequency of at least twice per week.  I did as I was told and time went by.  At one point I decided to repaint the interior of our house, and beige walls were replaced by forest green, golden tan, and light burgundy.  I took up running and got in better shape.  I became active in community theater, something I had always wanted to do but now had time for.  I became more involved in the day-to-day lives of my children.
I had been released from residential treatment the day after September 11, 2001, and I found out a few days after the horrible attacks that my best friend from college, Commander Dan Shanower, had been killed at the Pentagon on that day.  My attention to his tragic death led to finding a job with the Transportation Security Administration providing medical clearance for new airport screeners.   That brought in some money, and we sold our vacation cottage to help pay the bills, but I knew that I needed a new career.  I loved being an anesthesiologist, but I knew that most relapses in anesthesiologists came to light when the addict was found dead in a call room.  After significant sober reflection I decided to return to residency—this time in psychiatry, to get back to my early interests in the mind and brain.
Starting over
It was difficult being a lowly resident again, but things could have been worse.  I know doctors with addictions who never made it back to practicing at all.  I have known addicts who died from their addictions.  Those AA bumper sticker slogans often contain true wisdom; my most appropriate bumper sticker reads ‘Gratitude is the Attitude.’  A common recovery phrase is ‘the Chinese symbol for crisis means opportunity.’  I don’t know whether the statement is true, but the sentiment is accurate.  I have seen recovering people do some amazing things, and I hope to be one of them.
My relapse, horrible as it was, resulted in a wealth of opportunity.  I mentioned my participation in Community Theater; circumstances also led to a position as a columnist for the trade journal Psychiatric Times.  I for years had dreamed of teaching but only now do I participate in that dream, teaching addiction and other topics to medical students and residents.  I appear in a weekly radio show about psychiatry and addiction, and I am, of course, writing this book!  None of these things would have happened if not for that fateful day in Eleuthera seven years ago.  I am not saying that my relapse was a good thing—don’t get me wrong about that!  But addiction– and relapse– do not have to be the end of one’s life.  For me, in many ways they were only the beginning.