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 quickly...to 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.