Friday, January 22, 2021

Getting Personal

I once spoke at a 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


  1. I came to read this post via your "A surgeon left his own son’s funeral to take care of your child" post on KevinMD. That post made me want to seek you out and say, thank you. Thank you and all the other med profs who have sacrificed for their patients. As a 7 year Stagve IV prostate cancer patient, I have had so many professional and effective instances of care. Care that has typically been given with supportiveness, compassion, empathy and genuine concern. Your article here is good food for thought. Due to ongoing pain from chemo, I take opiods as managed by my palliative care physician. Dancing with this potential devil requires open, honest conversation between patient and physician. 30 years ago I had a dear friend who was a marvelous guy and a damn good pulmonary specialist. He made the mistake of "taking care" of himself and a back problem. To my knowledge, he still has his license but he got in some serious legal issues not to mention the mental/emotional devastation. SO 1) Don't be your own physician and 2) thank you folks for all you do for the Average Joe like me. I'm sometimes not sure I express my heartfelt gratitude often enough nor with adequate words.

    1. Scott,
      Thank you for your heartfelt words! As a physician, it is always most encouraging to receive words of thanks! Thank you as well for reading my "Bugle Notes". I hope you find them a source of encouragement! My plan is to continue writing them though possibly to a broader audience.

      Thanks again!

  2. It was a learning experience, reading your blog. That, we, as physicians are also human and exposed to similar temptations is an eye opener. You have become a greater leader in my eyes. My deepest regards.

  3. Ray, I am sorry for not responding sooner. Thank you for sharing this! Most of all, thank you for taking the time to read my "Bugle Notes"! It means a lot to me that you would do so. They are written to encourage our peers who continue to do the hard work of medicine! Thank you for all you do!

  4. Please, explain to me: what is the difference between Narco (Hydrocodone/Tylenol 325mg) and Oxycontin? Please, no one explained it to me, but I need to know?

    1. Glenn, thank you for taking the time to read and then respond to my story. Oxycontin is the next higher level of an opioid for pain control. It is a derivative of hydrocodone/acetaminophen that is more potent. These two meds are all in the same family of opioids that are classified as you know as a controlled substance. Hope this helps!

  5. Dr. Lamb,
    Thank you for sharing your courageous journey through post surgical opioid dependency. We need more physician leaders like you to shed light on the risk and ease of becoming opioid addicted. Stories like yours helps us look out for our colleagues, friends and family. I intend to share with many.
    Richard Reidy D.O.
    Emergency Medicine
    Clinical Assistant Professor
    Michigan State University

  6. Dr Lamb,
    I read this article you wrote on KevinMD today. I applaud and honor your courage and dedication to be transparent for the benefit of others. I am on the faculty at a medical school where there is an annual presentation by a panel of physicians and pharmacists who have had real issues with addiction. Their accounts of the events of their lives leave the students spellbound, silent, and deeply touched. The students feel the honesty, the authenticity, and are grateful for the strength they witness. I trust that your efforts will touch many lives, and be of benefit in ways you may never specifically hear about. May you continue to find nourishment each and every day! J Webster, MD

  7. Dr. Webster,
    I am greatly touched by your kind words. Thank you for taking the time to write me! Your medical school is doing an amazing thing with the annual presentation you mentioned. How powerful that must be! Teaching and modeling transparency to those coming behind us is critical if we are to change the culture of healthcare to one of transparency and trust. Our patients deserve that and the future of medicine is dependent upon it as well. We need leaders who are willing to be so and the best way to raise up those future leaders is for them to see it in action.
    Thank you again! I am truly humbled.