Sunday, November 9, 2008


The Boston Globe article paints the picture all-too-clearly: "He was dead when they found him in the storage closet at the hospital...There was a half-filled vial of propofol...a syringe filled with midazolam...empty vials of morphine, hydromorphone, and Demerol...And then there was one nearly empty vial of vecuronium - an intravenous muscle relaxant that...would shut down the body's respiratory system in roughly three minutes, leading to certain death."

It's that last sentence that I found so chilling. He gave himself 100 milligrams of Propofol (half of the usual anesthetic induction dose, the effects of which would wear off in a few minutes), maybe, 10 or 20 milligrams of morphine, two to four milligrams of Dilaudid, and, say, 50 to 100 milligrams of Demerol, all of which would have depressed his respirations and affected his level of consciousness if he hadn't been accustomed to narcotics - but who knows what state of tolerance he was in when he took this final dose? - and then, perhaps, ten to twenty milligrams of vecuronium, guaranteed to paralyze him for at least half an hour, and to kill him in much less time. How horrifying and sad and awful.

Anesthesiologists are four times more likely than other physicians to be treated for drug addiction. Some theorize that second-hand exposure sentitizes our brains. Others blame easy access.

I'm with Christina Miller Reiter, M.D. (who wrote about a colleague who did not kill himself or perish accidentally): "I’m angry that it makes our specialty look bad and 'ruins' it for the rest of us more trustworthy individuals who aren’t injecting the drugs we administer to our patients...I’m sad that someone could be in so much unbelievably excruciating pain as to resort to a behavior that is so self-destructive. ..There is always that pressure. The pressure to take care of our patients, to get the cases started quickly, to wake up the patients take on the most awesome responsibility of being the patient’s guardian during surgery...But our lives are also in our own hands. Do we take care of ourselves as well as we take care of our patients? Do we nurture ourselves so that these drugs we carry around to help our patients do not become poison to us?"

Doctors are notoriously bad at taking care of themselves. At first, because they're barely allowed to, during training - no time to eat, no time to sleep, no time to rest, expectations of total self-immolation for the sake of medicine. Later, though, why is it sometimes still so hard? Well, frankly, because sometimes there's no time to eat, no time to sleep, no time to rest, and no mercy for anything less than total perfection (excellence just isn't enough). And getting support from each other? It's nice when it happens, but in many circles it's considered weak to wish for it.

Here's a sobering tidbit from Newsweek: "No other profession has a higher suicide rate."

There's something very wrong with that, I think, if it's accurate. There's something very broken about this system. Something that's going to take complete overhauls of subsystems to improve.

I am thankful that I've never even had an INKLING of a desire to try any of the drugs I use every day as I practice anesthesia. Not once. Zero interest. But maybe I'm just lucky. There but for the grace of my genetics and brain chemistry go I. I hope I stay lucky; that's all I can say. And for our the loved ones of fallen colleagues who were not so fortunate, who have suffered or are suffering unimaginably right now, I pray that peace and hope come back within reach in the not too distant future.


Dragonfly said...

Good post, very topical as well. I had a friend try it after having extensively researched how to make it look like an accident. Luckily she wasn't able to get hold of any particularly lethal drugs, and didn't do any lasting damage.

T. said...

Dragonfly, that's terrible. I hope she is doing okay.

Ann of the Incredible Gift said...

Genetics and brain chemistry, it's a lottery, isn't it? You know something about your parents, and so an idea about your own genetics, but it doesn't tell you everything.

I am reminded of reading that when heroin was first produced in the lab, each member of the lab team tried it out. Their conclusion: not habit forming. As soon as the 'miracle drug' reached the general population, addiction showed up.

Who will figure out what it is that makes one susceptible to addiction? And will it become practical to say which of those among us have the genetics to bypass addiction?

I can understand his refusal to go home to be the subject of a home town scandal. It's pride, and maybe concern for what his family would be dragged through..

But still... What a loss! What a shame!

Anonymous said...

Dear t,

once again I sit here after a 24h shift, with my eyes burning and my body weak and shaky and that terrible, terrible feeling of sleep deprivation that makes everything feel and seem different than usual.
I have come to learn not to trust my thoughts and feelings too much when I'm in this state - because I know that if I were my 'real self' everything would look and feel only 1% as dramatic as right now. I thank God that He has helped me to come to this understanding and knowlege of myself, which, in the least, is self-preserving!
I'm sure that we anesthesiologists are under a kind of pressure, which you perfectly stated in your post, that I don't see other specialities under. and I really feel that other people don't understand what we go through. we work alone - completely alone - and are always alone under stress, which in my opinion is much worse than being under pressure as a team.

a long time before I even dreamt of becoming an anesthesiologist, my sister took the road that some of our colleagues choose to take. I keep thanking God for every day helping me to choose the path of Life, to choose Love, to choose the meaning I know He dreams for my life... instead of taking the road of desperation, loneliness and deep, deep sorrow.
I know that unfortunately the line is very thin... between sanity and insantiy, between serenity and complete desperation where one feels completely lost.
I can only hope that these crucial moments in my life will be rare and that when I'm in one of them, I can reach out to the ones that love me, believing truly and deeply that Life and Love always have the last word - always.

T. said...

Catarinolas, that is such a good point. I know I've written about that before somewhere: that terribly ALONE feeling at the head of the bed. We do work alone, and our work can be very isolating, EVEN with a great team to help. I'm sure that contributes to that tremendous pressure.

I've often fantasized about being in a job that allows me to contribute to society without requiring me to face such high stakes, and face such daily stress...but I knew the stakes going into it and chose it anyway, because on some level I really do love the work, so what can we do?

I'm sorry about your sister's painful road and I truly wish you well on yours, which I hope will always be filled with that Life and Love.

rlbates said...

T, I agree with you. Terribly sad and such a waste.

Anonymous said...

I am not a doctor and I wonder sometimes if doctors are at risk of going down the rabbit hole because they have to look at people in extreme close up. I wonder if that is a psychological challenge for doctors. Or is it just the isolation and job pressure? I don't know. It is terrible that people in a high paying profession who get to really help people at the same time cannot find happiness and peace.

Anonymous said...

"Some theorize that second-hand exposure sensitizes our brains."

We always speculated about the gases in the room since we did mask inductions on almost everyone. One of our anesthesiologists would put the mask on their face, then move it away, then put it back...well, when it wasn't on the patient's face it was usually in the nurse's face! I definitely got light-headed more than once. Part of the job, I guess...but also maybe why I can't remember what I had for breakfast!

Anonymous said...

Hi T,
I understand how you can feel alone in your job. I have only had general anesthesia as a patient for one surgery, but I remember thinking that I was alone too. After reading your blog, I know that my anesthesiologist was actually with me the whole time.

If I ever need an anesthesiologist again, I will be sure to let her know that I appreciate her being my partner and that I will try my best to stay "with" her, even if I can't talk.

I know you feel a lot of pressure to be perfect. But I think most patients can understand that you are a human being trying to do your very best for them. Maybe I am unusual, but I would be happy with that, no matter what the outcome.

gelci72 said...

Anonymous - I've had similar thoughts. For some doctors, the pay is unfairly low considering their responsibilities, and the responsibilities are stressful. For others, the pay is higher but the stress is enormous. For many, it may be easy to forget the happiness and peace that come from helping others when having to deal with abuse and nastiness from coworkers, administrators, patients, insurance companies, colleagues, etc. I am sure that for all who give in to despair, the contributing factors are many and varied.

Katy - is it the ambient gas, or the loss of neurons that they say we all suffer from the lack of sleep of motherhood? Hmm... :)

Megan - thank you for your thoughtfulness. It's deeply appreciated!