I recently spoke at a local Leadership Forum on Opioid
Abuse. I was asked to speak to the role of hospital systems in addressing this
important issue. As I thought on what I would say, I realized there was very
little I could add. The crisis is epidemic and hospitals are ill-prepared to do
anything proactive. It is that overwhelming. Leading medical missions, I
learned an important lesson that has given me a different perspective on this.
The needs of the world are overwhelming as well. These needs, though, do not
become real to us until they become personal – you live it, breathe it, taste
it, smell it, touch it. In 2009, the opioid crisis became personal to me, it became real.
As a physician leader, I have sought to be transparent. Transparency is critical to establishing a culture that is safe and caring. Others can then feel safe to be the same themselves. In a culture characterized by openness and transparency, great things can happen! My “Bugle Notes” through the years hopefully have reflected this transparency to you.
I decided, after much thought and prayer, to be very transparent with you. Doing so leaves me feeling exposed and vulnerable but I choose to do it anyway. My hope is that through my story this crisis will become more personal to you and thus more real. This is my story of how close I came to going down that perilous path that is opioid addiction (or any addiction for that matter). I was fortunate that I stopped before I went too far down that path. Unfortunately, too many are unable to stop and continue the downward spiral toward that deep, dark pit called despair and its brother hopelessness. If this could happen to me, it could happen to anyone. If my story prevents even one of you from experiencing this, then the trepidation I feel sharing this will be worth it.
It began after my first back surgery in 2009 for an acutely herniated disc while leading a medical mission to Moldova in Eastern Europe. It was the worse pain I had ever experienced. My right leg was weak and numb. I had to be carried into my host home and put to bed – no running water, primitive outhouse, hit or miss electricity. It was not a good situation. I placed myself on prednisone hoping it would help but the following morning I was no better, in fact, worse. As the team leader, I realized I would have to be urgently evacuated to the U.S. However a “miracle” occurred that allowed me to regain neurologic function temporarily and I was able to finish the mission. That “miracle” may need to be the topic of another “Bugle Notes”!
Two days after returning home, I went to surgery. The surgery was a complete success. I was discharged on Oxycontin with a refill, which was common practice at that time. It did help the post-op pain and I was surprised how good it made me feel overall. It had a calming effect as well. Prior to the mission trip, there had been a lot of stress at home, my practice, and the hospital. I began looking forward to taking it. Since I was still on medical leave, there was no concern with it affecting my patient care. I would be at home enjoying the feeling. I rationalized that there was nothing wrong with that and, besides, I could stop anytime I wanted. Little did I realize the dangerous path I was choosing.
I found myself counting the remaining tablets each day. I started to dread when they would run out. I was embarrassed to call the neurosurgeon for another refill and have him think I was an addict or drug seeker! After all, that could never happen to me! Then reality set in. I used the last pill and within 24 hours I began having withdrawal symptoms- restlessness, abdominal cramping, diarrhea. Though relatively mild, it frightened me. I never imagined I could become physically and mentally dependent. I thought this only happened to people who were “weak” or lacked “self-discipline”. I was wrong.
It was a surreal experience in addition to being scary and humbling. Surreal because I never thought this could happen to me, humbling because it exposed my vulnerability. It gave me a new perspective on those who struggle with addiction of any type. If it could happen to me, it could happen to anyone! No one is immune.
The reality is that many of our colleagues are at risk if they are not already on a downward spiral. The pressures of medicine can cause anyone to seek an escape mechanism and substance abuse of any type is an easy way to go. I care for you and do not want any of you to fall into this seductive trap. The consequences are devastating. So, I share my story, not knowing how you will respond to it, whether it will change your view of me, or even question my fitness to be a leader. My fervent desire is that it will make this crisis more personal and thus more real to you. Only then can you better know the enemy you face and how best to defeat it.
Andy Lamb, MD