I went into an anesthesiology residency and began my love affair with Fentanyl, a narcotic-anesthetic that we use all the time. I saw how great it made patients feel. I tried it intravenously. With Fentanyl, if you use it once, you are hooked. It removed every trace of anxiety and tension I had felt. But I never became so high that I felt detached; I felt efficient and in control. My mistake was in thinking I would always feel this way.
Getting Fentanyl was ridiculously easy. All I had to do was open a cabinet and take as much as I wanted. I'd use a tourniquet and syringe to inject myself.
I got away with this for months and all the time I was using more and more. When my addiction reached its height, I needed to shoot up every two hours. So if an open-heart case took four or five hours, I'd have to leave in the middle of the operation, go to the men's room in the OR suite, get my fix, and then go back to the operating room and continue surgery. I was so quick, I could inject myself faster than most people actually go to the bathroom.
I had the "M. Deity syndrome." You know--I'm smart, I'm in control of this. And, being an anesthesiologist, I told myself I would know when to stop to prevent any disasters.
During one 20-hour neurosurgical operation, my relief came every two hours or so, and I went off for my Fentanyl fix. But later that night, my relief didn't show up for hours. I became edgy and distracted because I was experiencing withdrawal.
I was so distracted, I injected a blood product into the wrong port of a catheter. It caused a blood clot that went to the patient's lung, and the patient arrested. We gave him every drug imaginable--Adrenalin, calcium, bicarbonate--and we shocked him with the defibrillator pads a half-dozen times before his normal heart rhythm was restored. Luckily, he suffered no ill effects from the arrest.
People arrest during surgery for no apparent reason sometimes, so no one realized that my mistake had caused the arrest. At that time I was so deeply into my addiction that I even denied it to myself. Can you imagine? I had almost killed a patient, yet I convinced myself that I wasn't responsible.
Part of my recovery has been to admit my responsibility, which has been difficult, and to realize that I can no longer be an anesthesiologist. I have heard that about 85% of anesthesiologists and anesthesiology residents experiment with some of the drugs they give, especially Fentanyl, and I believe it. It's too tempting.
During my chief residency, I started to snort cocaine. I had a friend who sold it, so it was always easy to get. I had about 40 residents under me, and eight or 10 of us snorted cocaine together regularly, sometimes at the hospital. We'd go into the physicians' lounge late at night and have a little cocaine party while we were on call. I'm a hyper Type-A personality anyhow. Cocaine very quickly made me paranoid, but I still had a compulsion to use it.
After my residency, I was given a cardiology fellowship, an honor that can really help your medical career. But I resigned from it within a year because I had to be on call every third night for it and that meant I couldn't get high with alcohol or cocaine those nights.
I took a job in charge of an intensive care unit and a coronary care unit. I made $80,000 a year for a 50-hour week. I could make up the schedules, so I could have weekends off and work four days a week.
I started having severe blackouts during this period. They would scare me. I'd wake up in my apartment and couldn't remember how I got there or where my car was. It was only by the grace of God that I didn't kill anyone or myself when I drove home from bars. I never even got stopped by a cop.
I got into heroin next. I could get it pretty easily, but if I ran out, I would order a double dose of narcotics for a patient and give the patient half and myself half. I even had nurses I was dating get me prescriptions for Percocet, a narcotic. They would say it was for their grandmother and give it to me. No one ever confronted me about my drug or alcohol problem. You just don't go up to a doctor and accuse him of being a drug addict.
Each morning I'd carry about two dozen $20 bags into the hospital and take them into the bathroom or the on-call room. Here I was now making $100,000 a year, but I had to borrow money to get a flat tire fixed because I was spending $300 a day on heroin.
When I couldn't get high from heroin anymore, I took Quaaludes. I blacked out at the hospital once. At about the same time a nurse I knew told me she was worried about my behavior changes. My speech became slurred at times. I was really falling apart.
'People Are Concerned'
Also, at this time I got a beep to come to the hospital administrator's office. When I arrived, he was standing there with the director of medicine, and he said, "A lot of people are concerned about you." I asked why. He said I wasn't acting myself. I said, "Yeah, I've been working too hard. I'm going to take some time off." I think they were hinting at drug problems, but they didn't come out and say it.
The next day was a Friday. I bought $600 worth of drugs to get me through the weekend. Within about three hours, I had used them up. All the money I had in the bank was gone. I sat there looking at my TV set and tried to figure out how I could get it to the streets and sell it for my next fix. Then something came over me. I knew I couldn't live like this anymore. I knew I needed help. The next week, I went into treatment.
I'm recovering. I attend an Alcoholics or Narcotics Anonymous meeting daily and will continue to go every day of my life. If I miss even one, my attitude changes. It's not that I want to use drugs again, because I think that God has lifted that compulsion from me. It's that I revert to that self-centered, alcoholic way of thinking. The meetings keep me sane.
I had stress. I had pressure. I had anxiety. I had all those things that doctors have and that they take drugs to relieve. But in my case all those reasons for using drugs were irrelevant. I used drugs because I loved them. I loved them! They were wonderful! I loved to get high.
I totally disintegrated. Totally. I could shoot up 20 to 40 times a day, in my arms, my legs, my groin. I'd wear long-sleeved shirts to the hospital, and when I shot up in my hands, I'd put bandages around them and say I cut myself.
I realized that cocaine was ripping up my insides, so I took other drugs to counteract the damage. I took Inderal to slow my pulse and blood pressure and Valium so I wouldn't hallucinate or get too frightened or have a seizure. It's all part of the same cleverness that got you to be a doctor in the first place.
Would Use Anything
When I didn't have cocaine, I'd use just about anything I could get. I told my patients to bring all their medications whenever they came to see me. And then I'd say, let me go back into my office and check this, and if they had something I wanted, I'd take a handful and bring the rest back to them. It may sound funny now, but I'm not proud of that.
I'd also make up medical procedures for patients and order medications when they didn't need any. I'd just take it myself.
I went into a quick treatment program, but it didn't do squat. A 30-day wonder program. When I came back, I surrounded myself with recovering people. I moved them into my house. I held AA meetings in my home and went to them doped up. What a role model!
A group of the recovering doctors knew I'd gone back on drugs and came to my house one afternoon to get me. They found me on the roof shooting dope with my underwear on. They asked me if I had noticed that my life had become a bit unmanageable.
These doctors physically grabbed me, put me on a plane and sent me to a long-term treatment center. I shot the last of my dope somewhere in the friendly skies. That was more than five years ago. Those guys are good friends of mine now. They saved my life.
I'm sure some of the patients I saw during this period of my life were compromised medically by me. That would have been hard to avoid. But there's a lot of mythology about how complex medicine is. There are many things where you don't need to know much. You tell me your throat is sore--I look at it, take a culture, and give you an antibiotic. It doesn't take any great brain power to do that. It's like telling someone your street address. But there are other things where you do need to think, and I had stopped doing the more complex diagnostic maneuvers. I just got someone else to do them for me.
But I know I hurt one patient. He was a dying young man in pain. I stole drugs from him. I'll never forget that, and I don't want to.
From the book " MD: Doctors Talk About Themselves " by John Pekkanen. Copyright 1988 by John Pekkanen. Reprinted by permission of the publisher, Delacorte Press.