Doctor, Doctor! Interacting with Health Care Providers

By Prentice S. 

I vaguely recall noticing, in my first foggy reading of the Alcoholics Anonymous “Big Book” while in rehab, that my profession seemed to be curiously over-represented. There are, in fact, three chapters in there written by medical doctors: “The Doctor’s Opinion,” “Doctor Bob’s Nightmare,” and “Physician Heal Thyself.” At age 26 and having graduated just nine months earlier from a prestigious school of medicine, I believe this fact encouraged me to keep an open mind to AA and its Twelve Steps.

It is quite clear to me now that I was and am still one of the very lucky ones. I like to say that I crashed and burned at age 26 during my medical internship. From the age of 14 or so, I was open to and did try any and every substance to escape the discomfort I felt in being me. That it began with alcohol and ended up with needles and diverted opiates wasn’t at all a surprise to me.

I’m grateful really for the way that my alcohol and drug career ended, as it came quickly and definitively. That I was illegally writing prescriptions for myself, stealing medications from unsuspecting patients (at times even jeopardizing their lives), and ultimately searching for a street source for my drug of choice was eventually enough to overcome the system of denial I’d built around my alcoholism/addiction.

What followed was a series of amazing coincidences, a considerable degree of dedication, and a moderate but earnest involvement with first Narcotics Anonymous and then Alcoholics Anonymous that has kept me clean and sober for over 29 years.

With Emergency Medicine as my chosen specialty and now with nearly 30 years of that work behind me, I’ve had literally thousands of interactions with patients who’ve been either in the grips of their disease or in various stages of recovery from it.

So what have I learned from all this that will be of interest and perhaps of use to the reader?

First, I can say with certainty that a career in Emergency Medical Services (doctor, nurse, physician’s assistant, paramedic, social worker, etc.) is a fantastic option for those of us in recovery. Never does a shift in the Emergency Department go by that I’m not given the opportunity to see one of us hitting their bottom. These interactions serve simultaneously as powerful reminders of the destructive power of our disease AND as opportunities to be of service. I believe these experiences have contributed greatly to my recovery.

Having been a patient myself on a handful of occasions, I can also share what I believe are the essential points of getting through medical situations successfully in recovery.

Good communication with your doctors is essential. Simply tell them you are an alcoholic and/or addict in recovery and that you need to be careful about which medications you take. Tell your dentist too. It’s as simple as that. Some will get it and some won’t, but I think more and more of us in the healthcare field are becoming sensitive to this issue. Alcoholism and addiction are like cancer in that almost everyone has been affected by them and that probably includes your doctor or dentist.

Early in recovery, I underwent arthroscopy of my knee for a partially torn ligament and insisted they do it under local anesthesia. I definitely cannot recommend that! Afterward it was obvious to me that I should have done what everyone else does and have the procedure under full anesthesia or a spinal block. We know from experience that pain medications (and other potentially mind-altering medications) can be used safely and responsibly by those of us in recovery. We are humans just like our non-recovery peers and don’t need to suffer unnecessarily. We just have to be FAR more careful about medication use than they do.

Just last week I took care of a nice older lady who was passing a kidney stone (reputed to be more painful than childbirth by women who’ve experienced both). She told me straight away and directly that she was 39 years sober and was hesitant to take pain medication.

As a doctor, I love it when patients share with me just how long they’ve been sober, so consider adding that detail; for me, it personalizes the degree of seriousness they bring to their recovery. We tried a non-narcotic medication without success and then confidently moved on to two small doses of morphine. That did the trick! A great example of honesty and good communication at work.

She gave me the nicest compliment the next day when I called to check on her (many Emergency Departments these days have “Call Back Programs” to see how patients are doing the next day … good public relations and good medicine). During that call, I tipped my hand that I was 29 years clean in the fellowship, to which she replied, “I should’ve known you were in the program … you were so sweet!”.

Her case raises another good point because she had an AA friend with her in Emergency. Be sure to include your sponsor and/or your close recovery friends in the conversation about prescribed medications. Bring someone along to the doctor visit if you think it will be helpful.

An example that points out a related principle was when I crashed my motorcycle and sustained some significant and quite painful injuries (concussion, multiple rib fractures, bruised lung, bruised kidney). Yes, some emergency doctors ride motorcycles! It was necessary and entirely reasonable for me to take an opiate pain medication (my personal drug of choice). For the 2-3 days that I was in real pain, I stayed in close contact with my recovery friend Henry who could be more objective about my situation and help me make good medication decisions.

I took my last dose on the third day when I was doing better. Interestingly, I had noticed that the medication had not up to that point had any real euphoric effect. With that final dose on the third day, however, there was a bit of a “high” which told me it was time to stop. It is known that for many patients, opiates have little or no euphoric effect when treating real pain. The bottom line is that the goal in pain management for those of us in recovery should be to use the mildest effective medication for the shortest necessary period of time.

And with that, I’ll thank my colleagues Dr. Silkworth, Dr. Bob, and the anonymous “doctor licensed to practice in a western state” for their contributions to “the Big Book” and to my recovery and I’ll hope that my experiences may contribute to yours.


About the Author

Prentice S. lives in Santa Cruz, CA where he practices Emergency Medicine and Sports Medicine. His home group is the Tuesday night Santa Cruz WAAFT AA meeting. His sobriety date is 2.11.87 so his 30-year anniversary is just around the New Year corner.
 

Audio Story

The audio version of this story was narrated and recorded by Len R. from Jasper, Georgia. Len is interested in starting a secular AA meeting in his area. If you would like to join him, please send an email to lenr.secularsobriety@gmail.com

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  1. John L. December 21, 2016 at 8:06 am - Reply

    Good, informative article.  I’m grateful that in early recovery I heard discussions like this.  I was in a bicycle accident  and needed open-reduction surgery for a shattered elbow.  The pain after the anesthesia wore off was unbearable, but only for a couple of minutes.  I pressed the emergency pain button by my bed and a plump little nurse came running towards me, with a hypodermic needle in her hand.  She jabbed it into me and in seconds there was no pain.  Later I needed physical therapy to regain the full extension of my arm.  I was prescribed codeine and aspirin before therapy, but even so it was difficult and painful.  After the course of therapy was over, and I could fully extend my arm again, I stopped the codeine with no problems.  If you need pain medication and it’s prescribed, use it, but be careful.

  2. Diane R. December 20, 2016 at 2:33 pm - Reply

    Terrific. I’ve always believed that ER MDs are by definition Adrenaline addicts. I’m thank you for being authentic about some of the possible consequences. Curls for your honesty and service to us all.

  3. Bill P. December 18, 2016 at 7:51 pm - Reply

    Thanks Prentice, for a superb, enlightening and useful article. My sobriety date is a little more recent than yours, i.e. Nov. 4, 1988. I was candid with  my primary care physician and followed his prescriptions which were in as low a dosage as possible and used only at times of real need. I have always believed that the etiology of alcoholism is substantially genetic and is also a result of cultural factors (e.g., college life!) but that it also involves a volitional factor and a patient will have a chance of recovery only by making a personal commitment.  Then, with the help of other recovering alcoholics, with or without the fellowship of AA, recovery becomes more possible, although all too many fail. The group is a powerful Higher Power and, for those in the latter stages of recovery, like I am, the 12th Step, helping others, becomes all important.

  4. Aric December 18, 2016 at 11:34 am - Reply

    Thank you so much for sharing your experience. One quick addendum – there is no scientific basis for the fact that someone in pain doesn’t feel the euphoric effect of opioids. This is a common misconception, one propagated in the late 90’s by pharmaceutical reps during the beginnings of the OxyContin scourge (along with the idea that less than 1% of patients on opioids for non-cancer pain developed an addiction). Just wanted to share that little tidbit!

     

    -2 years sober and loving it.

  5. life-j December 18, 2016 at 11:33 am - Reply

    Prentice, thanks. I can relate my own story on this topic. A bit over two years ago I had cancer, they took about 2/3 of my liver out (UCSF). Having already had a couple of other surgeries in recovery I did tell them I was in long term recovery, but otherwise let them give me whatever they wanted to. I did experience a couple of “better give me some now, cause I may be in pain later” moments. Drugs proper had never been a problem for me, and in the end didn’t turn out to be a bad problem for me now either, but it wasn’t without issues.

    First off, during my hospital stay, 9 days to begin with  (then back for another 4 with an infection) they pumped me pretty full, and I had horrible, evil hallucinations that I wouldn’t wish on anybody, but at least I had no pain.

    Then, of course I had a drain, which we didn’t expect to have to keep for very long, but it ended up being about 5 months, so I had to keep taking pain meds, oxycodine and morphine. Came back to invasive radiology to have the drain checked or replaced many times, also had a bile valve stent put in, and replaced, and subsequently removed.

    Once at the end of replacement of the drain, I had horrible pain, they checked it, and it was basically ok, so they gave me a shot of demerol, and the pain vanished instantly, how amazing!

    Ok, so now the fun part: getting off the drugs after I finally had the drain taken out.

    My family doctor, who administered it, didn’t push me about it, she was well aware of my situation, but let me do it on my own time. I cut back very slowly, cutting one pill in half at a time, took me several weeks. It is possible that I could have done it quicker, but even doing it as I did I had a lot of fear around it, whether there was pain that I had not felt, that I was now going to have, and without a doubt also simply an emotional/physical attachment, not wanting to let go of my newfound friend. There were moments of considerable fear. But I was far enough along in my recovery (26 years at the time) to where I was able to do it the way I had made up my mind to.

    I live in a small town, and we all know each other. The pharmacist went out of his way to congratulate me. Told me he had only seen a few other people actually get off after an ordeal like mine. Many apparently get stuck with it.

  6. Chris G. December 18, 2016 at 11:26 am - Reply

    Thank you for the excellent inside view of this issue. Few of us probably ever get to talk to a doctor about addiction, at a personal, hair-down level.

    For most of my drinking career, I did not share my true problems with my doctors, with sometimes pretty bad results. Once I got some recovery time, I changed that, and the improvement in my various medical treatments improved dramatically.

    At one point I had a new, young doctor; when I shared my past alcoholism and current recovery with him, he really did not know what to do at first. Over time, we had many good discussions. I became his “pet alcoholic”, and he was always looking for more insight about how it worked “on the street” to help him deal with others. That was a very good experience for both of us!

    I completely agree about the pain medication. After having a section of colon removed, I was very leery about taking anything narcotic, even though I never had abused narcotics, but it worked just as you say: treat the pain and then stop. No problems.

  7. Pat N. December 18, 2016 at 10:08 am - Reply

    Thanks, Prentice, and thanks for your service to others. I was a school counselor for years while a practicing alkie, and can’t imagine how many errors of omission and commission I commited. Fortunately, I had a few years left after I sobered up and could apply my experience to doing a better job for kids and families. My wife and I took one of my students, who  was 16,  to rehab (her family was drunk), and she eventually became a drug counselor herself. I hope I helped a few others as well. I was the first district employee ever to use our group insurance for treatment, and let the administrators know about it, hopefully paving the way for others a bit.

    A family practice residency program in Yakima, WA used to require its residents to go through the local inpatient program, whether they were addicts or not, just so they would learn what they would be dealing with. They got to go home at night, which patients did not. Some of them smoked a little weed on their own time, I know.

  8. Thomas B. December 18, 2016 at 8:48 am - Reply

    Indeed, Prentice, thanks for an excellent essay on the rational use of pain management medications as they are intended to be used, to relieve unnecessary severe pain, not to get high.

    I particularly appreciate you pointing out that if the medication is working as intended to remove the pain, one doesn’t get high. That was my experience twice, once using opiates after a hip replacement and again after major dental surgery. I have to say that I was a bit disappointed I didn’t get high — I just got cranky and irritable instead. Nevertheless, I talked about it at meetings and with close associates in the program.

  9. boyd p. December 18, 2016 at 7:50 am - Reply

    Thanks for another informative translation of the big book.  It is over the top quaint.  But rich with our experience if we can get past the barriers.  It’s pretty easy for me.  I just remember my dad’s world.  He got sober in July 1950, before the twelve and twelve was published.  If he can do it, I can, taking suggestions with a grain of salt.

  10. Larry K December 18, 2016 at 7:20 am - Reply

    Excellent read!

    Thank you for adding a sane voice to the discussion of pain medication.  I have found the mythologies of this issue complicated and diabolic at times.

    I personally feel that prolonged exposure to pain without a fall back management plan is akin to setting myself up for a relapse.   We don’t need to be martyrs.  We need to be as pain free as we can be.

    I remember soaking a molar with a half shot of alcohol and spitting it out after 20 minutes.  Awful pain, but the remedy allowed me to avoid dragging my three children in the middle of the night, down river in a boat in a thunderstorm to get to a hospital or pharmacy.

    It tasted awful.  numbed my tongue so i couldn’t speak properly…but it killed the excruciating pain.

    It was a trick i had learned from a dentist.

  11. John S December 18, 2016 at 5:56 am - Reply

    Thank you very much for writing this. I’m fortunate that I’ve not had any serious medical issues, but I do let my doctors know that I’m in recovery and I’ve always done that. It’s good to know that increasingly those in the medical profession are coming to understand the importance of knowing this key piece of information about their patients.

    Thanks again. This was very well done.

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