The State Steps In….

In July, 2002, the Texas State Board of Medical Examiners suspended my medical license temporarily. I was to have drug testing 8 times per month. They ordered me to attend Alcoholics Anonymous meetings because of my addiction. I did so but I never felt comfortable there. I hated hearing others talk about the helplessness of their addiction and how they had become victims of society. I was to attend “ninety meetings in ninety days.” Their stories of recovery reminded me of an Australian aborigines who had received a gift of a new boomerang but spent the rest of his life trying to throw the old one away.

In July, 2002, I had a seizure while at my office. I was taken to the hospital and was admitted to the psychiatric locked unit. While there, I was served with divorce papers. My wife and I were divorced. She got custody of our son and daughter. I got a defunct medical practice. The building was foreclosed on, and I moved into an apartment in Galveston.

The drug screens I was supposed to have to prove my sobriety were costing about $400 per month, I was to see the psychiatrist once a month. My child support was supposed to $1000 per month and I could not find a job. My truck was repossessed. I got an eviction notice from my apartment. I was in a black cloud and saw no way out. I decided that I was going to kill myself. When the police came to serve the eviction I held them at bay for 6 hours by holding a shotgun to my chest. I could not pull the trigger because somewhere in my despair I had the feeling that if I were to kill myself, I was going to miss something good. Again, I don’t know what, but I didn’t want to miss it. When I failed to be able to go through with it, I was put in jail for a week.

When I got out I had nowhere to go. I was homeless. A friend had an unused medical building in Crystal Beach that he let me use. I took a job at a grocery store for $6 an hour that was within walking distance. The state took half my check for child support and I could find no way to pay for the drug testing I needed. I kept telling myself that I would catch a break and be able to get back to practicing medicine so I could honor my obligations. Because I could not live on $500 per month, I was forced to move in with my sister in Katy. I had written letters to the Medical Board president, the Texas Medical Association president, the director of the drug rehabilitation section for the Texas Medical Association asking for help. None of them sent any reply.

Trying to force a change, I decided that I would “hit the street” to make something change. I packed as much as I could carry in a duffel bag and walked out of my sister’s house seeking any kind of change.

And then…

The practice that I had previously been with had closed down. I felt that the island of Galveston did need an urgent care clinic. In September of 2001, I decided to open an urgent care clinic on my own. As I was under-financed, I cashed in my retirement account to do so. I was the only employee – doctor, nurse, receptionist, marketing, billing, file clerk, and maintenance man. I was working 16 hours a day, mostly seven days a week.

The first lesson I learned was medical income takes three to six months to arrive after the patient is seen and that that payment was always less than was billed, while expenses do not wait to make themselves known. This created a strong tension between my wife and I. I was never home and yet had really nothing to show for it. I felt that I was working hard for my families future and yet I felt that my wife did not recognize this or that she thought I just did not care. This frustrated and depressed me. I was trying to provide the stability I had promised myself as a child. I was trying to make for myself the home I had always desired, and yet it seemed that my attempts were becoming more and more impotent.

I would work sixteen hours and then drive the hour home. My wife and children would already be asleep. I would get up and leave for work after only seeing them for twenty minutes or so as we were dressing. I would make the hour drive back to work to start it all over again.

This went on for a year. My stress level rose and my depression worsened even though I did not recognize it as such. My wife also became more stressed and depressed. I felt that I was letting my family down. When I tried to sleep, my mind would race with all the things left undone from the day before or yet to do in the day to come.

I needed rest. The clinic building I had bought had a shower and my fatigued mind thought that if I slept there a couple nights a week, that I might be able to be more productive. I had a patient that suffered from migraine headaches that would occasionally need a Demerol injection to get relief from pain. I had had it a couple of times after my surgery and it made me feel completely relaxed. I would lie sleeplessly on an air mattress in my office. It was only a few steps to the cabinet in which I kept the Demerol. In a moment of weakness, fatigue, and not thinking clearly, I tried it. I injected my thigh muscle with 50mg of Demerol. It was just like the first time I had taken Fioricet, incredibly sweet relief.

Just as the Fioricet held my headache at bay, the Demerol held my self-reflection at bay, but only temporarily so. In the past, as squeezing doses together had kept my headaches from returning, taking Demerol more often kept my self-reflective monster away. I took it all the time. Day, night, weekday, weekend, work or time off. I took it before seeing patients. And it is only by the grace of God that I did not hurt anyone. I took it when driving. I took so much of it that I started having seizures because the metabolites didn’t have enough time to wash out. I wrecked my truck because I had had a seizure while driving home traveling 70 mph on the freeway and I didn’t have a scratch. I don’t know why I didn’t die that day and I kept telling myself that God had something more he wanted to do with me. I don’t know what it is, but I hope I don’t miss it. That being said, there were times when I wish I had died that day, but that was just my cowardice.

It became less and less distant to the narcotic cabinet. My wife was concerned and wanted to get me help so I went to rehab, twice. I think that she thought that if she only could love me more, that she could help me to recover. But addiction does not seem to work that way. I kept going back to the narcotic cabinet, not because it make me feel good, but because it made me not feel. In my mind, when I took it, I didn’t have to see my impotence to give my family the life I had always wanted.

The adventure continues…

Things went along status quo. If the day got to be too much, just pop a couple more. and it would drift away. This was not how I had ever wanted to interact with someone I loved. And yet the shame of my using began to grow and a dichotomy split me down the middle; the me I knew as who I was and the me I knew when the drug helped me feel whole. This would be the crucible in which all relationships with me in the future would be formed.

Toward the end of my 4th year in medical school, whether out of shame or whatever, I decided that I would just be holding my girlfriend back were we to marry. We ranked residencies differently and she went to the University of Virginia while I stayed in Galveston.

Toward the end of my 4th year in medical school, whether out of shame or whatever, I decided that I would just be holding my girlfriend back were we to marry. We ranked residencies differently and she went to the University of Virginia while I stayed in Galveston.

Toward the end of my 4th year in medical school, whether out of shame or whatever, I decided that I would just be holding my girlfriend back were we to marry. We ranked residencies differently and she went to the University of Virginia while I stayed in Galveston.

I graduated from medical school and I started a residency in Internal Medicine. During my internship I met the love of my life, my future wife. We dated for four years. During those years I continued to take the medication. When she saw how often I was taking the medicine, she started to show disapproval. Because of this I did the only logical thing, at least the only logical thing for a drug addict, I began to lie about it so she would not think less of me. The mind of a drug addict is an interesting thing.

As I continued to take the medicine, it began to work less well. I increased the dosage to four tablets at a time and squeezed the doses more closely together. This continued over the next seven years. I joined a medical practice after finishing my residency. It was a good job working with good people.

My life seemed to be on track. As a child and young adult, my father was not a role model. He was an abusive and violent alcoholic. I hated the things his alcoholism did to both he and my family. There was no stability. I think he and my mother loved each other; they could just not live with each other. So we moved about every six months to get away again. I told myself that when I grew up I would make better for my future family. I told myself that I would get married once and raise any children I might have with love, compassion, and most of all, stability.

After my starting with the new medical practice, I asked my wife a question that I had never asked anyone – would she marry me. We were married after my first year of private practice. I had bought a small, rundown house and had remodeled it. We lived there for a couple of years. In July, 1996 we had a son, Jarrod. After the second year of private practice I accepted a job as an assistant professor at my medical school. I helped to run a newly opened urgent care clinic. My wife and I decided to move to a larger house. I worked at the medical school for four years as medical director of the urgent care clinic. After that the university made a decision to close the urgent care clinic and merge it into the Department of Family Medicine and my contract was not renewed. I felt hurt that the University did not want me to stay on in another capacity but I am sure the Fioricet had something to do with that.

 

How it started

I was sober until the age of 34. Yep, I said 34. My father was an alcoholic who made alcohol appear so unsophisticated that it never became even a curiosity. I disliked the taste completely whether that was a matter of taste or a coping mechanism. My first exposure to drugs was when I was a 2nd year medical student at The University of Texas Medical Branch, at Galveston. I was older than most of the other students and already wondered when they were going to realize I wasn’t really smart enough to be a doctor. Anyway, in my second year while battling subjects like biochem, pharmacology, and others I developed a headache. I came on insidiously but would never relent. It was as if a vice were squeezing my temples and forehead and then ramming a flaming stick down my neck. I could not concentrate. I could not study. I could not think. At UTMB we have what we call “Black Mondays”. Every five weeks we are tested on a Monday on all subjects. Now imagine trying to study with that skull-crushing pain. Tylenol or Motrin did nothing for it. My grades began to fall and my anxiety level raised. It did not help that my girlfriend was ranked #1 in our medical school class all four years.

I had to do something. I got a card for uninsured patients and made an appointment to see one of the faculty in the ENT Dept. Nothing moves quickly (or at least it didn’t then) in the uninsured patients clinics. Finally I got to see her and you can imagine my letdown when after taking a careful history and physical, shooting a sinus xray, and using the other ENT instruments left over from the surplus of the Inquisition she said that she didn’t think I had a sinus problem, she thought I should see a neurologist. Argggghhh! A consult was requested in the neurology clinic and I was again interviewed and examined and told, “I don’t think it is neurological, I think you have a sinus headache with secondary muscle contraction headache superimposed. He sent me back to ENT.

Three weeks later I was again in the ENT office with a headache I had had for four months. She told me that the only thing she could do was a cat scan to see if it showed anything. That was requested, scheduled, and done in 3 more weeks. Two weeks later I was back in her office and she told me I had two posterior sinuses that showed chronic sinusitis and that I needed to have an endoscopic surgical procedure. But since I actually did have a medical problem and maybe not just drug seeking, she wrote me a proscription for Fioricet #3 which is a barbiturate in combination with codeine, a narcotic. I went home took two tablets and within 30 minutes my headache that had been there for the last six months had nearly left. It was incredible. If there is a strong psychological reinforcer of addiction, I think this is the part that grabbed hold of my so tightly. I once again saw my ability to concentrate improve. I was less irritable for which I’m sure my girlfriend was appreciative. My grades began to improve and no longer did everything I had worked so hard for seem at risk. I also felt like doing things again…….Until the medicine wore off. Then the vice was reapplied. Two more tablets and sweet relief. I started squeezing the doses more closely together and then taking more that prescribed at one time.

I had an fiberoptic endoscopic sinus surgery. While in recovery the nurse brought me something for the pain of having bent left with a nasal splint the size of a Cadillac quarter-panel. She brought me Demerol and injected it into my hip. Nirvana. Bring on all of GM. The first surgery did not stop the headaches so she scheduled me to remove my middle turbinates. Still, my pain relented except by taking the Fiorinal with codeine or just regular fiorinal. It was easy to get. Ask a friend to write you a script or get it out of the sample closets. What I would not realize for a very long time is that my headaches were now caused by a rebound effect to the pain medicine and the treatment was to stop taking it.