By the time Richard Ready became chief resident of neurosurgery at a prominent Chicago-area hospital, prescription drugs kept him going.
Stimulants to stay alert through his daily rounds. Heavy pain relievers to numb his emotions after his mother's death. A powerful sedative to calm his nerves.
In the second year of his residency, Ready became a regular user of a type of Tylenol mixed with codeine. He'd steal them by the dozens and carry them inside a little plastic bag in the pocket of his lab coat. His tolerance was so high that he'd take up to 70 pills a day to stave off withdrawal.
"Sometimes I'd be standing in the operating room and it'd look like I had the flu," Ready said. "So I'd excuse myself and I'd run into the bathroom, eat 10 [Tylenols with codeine], and in maybe five or 10 minutes I'd be normal again."
Ready's battle with drug addiction may seem extreme, but it's a common fight inside hospitals, clinics and pharmacies. Some studies suggest as many as 10% of those in the healthcare field are using drugs or battling some level of addiction, a rate similar to that in other white-collar jobs.
What makes doctors and other medical professionals unique, experts say, is their knowledge of the hardships of heavy drug use, their easy access to medication and the risk their addictions pose to patients.
"To go to a doctor who is impaired can really have deadly consequences. It's no different than an airline pilot who is using drugs or alcohol in that you're often dealing with life-and-death circumstances," said Steve Levin, a medical malpractice attorney in Chicago.
Ready knows his clouded judgment put patients at grave risk. But as far as he knows, he said, he never harmed a patient in the operating room.
"You become two people. You become what you want other people to see and you become what you are," said Ready, 66, who has been sober for 25 years and is now an addiction specialist treating other medical professionals in the Adventist hospital system in Chicago's suburbs.
Ready recently began counseling a respected nurse on leave from a hospital who used bathroom breaks to inject herself with the strong narcotic pain reliever Dilaudid. She said she needed the drug to keep herself together at work because her home life was in shambles, Ready said.
"The biggest problems doctors and nurses have is they think they can handle it," said Ready, medical director of the New Day Center, a treatment facility in Westmont, a Chicago suburb. "You become delusional about what you think you can control."
Looking back, Ready said, it was easy for him to become addicted to drugs because he came from a family of alcoholics and had been a high-functioning alcoholic himself. His desire to drink was fueled by a rambunctious youth and a stint in the Marine Corps, he said.
By the time he entered medical school in Nebraska, Ready said, alcohol had consumed his life — but it didn't prevent him from studying and advancing his career.
In his fourth year in medical school, Ready was assigned to give an important presentation to a noted visiting surgeon. The event would have been stressful under any circumstances, but Ready said his drinking made him even more nervous and paranoid. He read a magazine ad for a low-level sedative called Tranxene, promoted as a way to reduce anxiety.
Ready said he wrote himself a prescription and took a few the morning of the presentation. Afterward, he was lauded for his calm, steady performance.
That was the beginning of his relationship with prescription drugs, which not only gave him confidence to cope with the stress of being a doctor, he said, but an inflated sense of his abilities.
Addiction specialists say the denial that comes with heavy drug use is more acute among medical professionals because of their understanding of narcotics.
"You analyze things to death. You say, 'I understand medicine, so therefore [I] can't fall victim to it,' " said Sue Sitton, a nurse supervisor at New Day.
That "intellectualization" of drug use, as Sitton calls it, makes it less likely that doctors and nurses will seek help. That's why hospitals and healthcare clinics have tightened rules over the years to force employees to get help, limit access to certain medications and conduct random drug testing after treatment.
One nurse who kicked a heavy addiction to Percocet and Vicodin at the New Day Center said co-workers often knew who was using drugs and made it easier to get them.
"I had doctors offer me prescriptions for certain things," said the nurse, who is back at work at another Chicago-area health center and did not want to be identified. "Medicine is still a good ol' boys' club in some ways, and they try to take care of each other."
Ready said he was certain many of those around him during his final year as chief resident suspected he was using drugs. When word got back to his supervisor, Ready was fired on the spot.
He sank deeper into drug and alcohol addiction and eventually became homeless, but finally got help through a yearlong treatment program in Wisconsin.
When he emerged from rehab, he had trouble finding a job in medicine. A small clinic gave him a chance as a family-care specialist, and his Alcoholics Anonymous sponsor drove him to his first day on the job.
"My sponsor picked me up at the end of the day and we both sat in his car and just cried because it was such an emotional experience," Ready said.
Ready is trying to help as many others as he can to bring an end to their addiction before it costs them everything.
"Addiction is a disease, and it's not pretty," he said. "I guess I'm proof of that."