‘My program director wanted me to succeed more than I did’
Most people with alcoholism or substance misuse lead a double life. I was no different.

I lied to everyone. I was one person at work, and a different person at home.

I had a set of acquaintances that my family and my girlfriend didn’t know. These people used drugs with me or provided me with drugs. They were acquaintances from high school and college who didn’t judge me. We were not friends; we were simply people who enabled each other in a drug-using lifestyle.

I should have stayed closer to those who were actually close to me and worried about my well-being. I lied so much that I often didn’t answer my phone, because I had either run out of lies to tell or I couldn’t keep them straight. I was either evasive or confrontational, hoping people would not pry too deep.

I drove to another city a couple of times for the weekend, hoping to withdraw in a hotel and come back sober. Unfortunately, I never saw it through.

I also tried leaving the drugs in my car, but would give in and use them there. More than once, I woke up in my car, in the dead of winter, sometimes barely clothed, with the driver’s door open and the battery dead.

I was constantly fighting withdrawal because going through withdrawal feels like you’re dying without the bright light at the end of the tunnel. I would vomit and had diarrhea regularly. I had a few small seizures as I tried to withdraw from the Ambien.

I was always the first to leave the hospital every day, driving home with a bottle of pills in my hand. I always planned to take just a few to ease the withdrawal, but after the first pill, that thought was gone. I rationalized that I had nothing to do that night.

When I saw my parents, I would usually take just enough medication to feel comfortable. Sometimes I took too much and I never made it to their house. While visiting, I would often turn on the TV and pass out. I told them that I was exhausted from work.

Soon, however, I would get agitated because I could not sneak off and get a quick fix. I often left in a fit of rage, blaming them for everything and making them feel terrible.

I took whatever cash I could find. They would see me flipping through the cabinets every night in the hopes of finding a bottle of pills that I missed the night before. It’s difficult to believe my girlfriend stayed with me. I spent very little time with her and when I did, it was all about me.

I was angry and unreliable at work. Every workday morning, I’d tell myself “no drugs.” By noon I was confident that this would be the day I stopped. Around 4 p.m., I would get edgy and anxious. I fumed if someone was late to checkout. My coworkers were increasingly frustrated.

As my habit increased, I took as many pills of whatever type I could get. If I didn’t have pills, I would drink alcohol. My depression worsened. I didn’t care if I overdosed. I didn’t feel human anymore. My body was just for drugs. I had obtained my dream job and I was throwing it away. I couldn’t stop and I was too scared to ask for help.

I remember that once I was so desperate that I was licking an empty bottle of pills to get even a speck of the drug.

Another time, I was craving a pill and remembered that one had fallen between the seats of my car. I searched and searched and finally I took apart the inside of my car. I literally removed the seats, and took apart the center console and the inside of the doors. I spent about 6 hours looking before finally giving up without ever finding that pill.

Once my father (also a surgeon) got sick and had to have a diagnostic procedure. It happened suddenly and when I found out, my attending physician told me to go be with my father. Instead of going to the hospital, I went home, swallowed a bunch of pills, and passed out. To this day, this memory brings me to tears and I don’t think I can ever forgive myself for my behavior.

In another attempt get help, I went to psychiatrist 90 miles from home. With her help, I initially cut back on my drug usage. When I started using more again, I was too ashamed to tell her. So, I lied to her. I didn’t want her to think that I was a failure.

Roughly 3 years into this nightmare, when I was in the 9th month of my 3rd year of residency, at around 7 p.m. on a Monday evening, as I was driving home from the gym, my program director called to inform me that I was being placed on administrative leave for suspected drug misuse and poor performance.

I had been called into his office many times in the past about my issues. To this day, I am shocked that he tried as hard as he did. He wanted me to succeed more than I did.

Although I felt nothing but shame and weakness, I was relieved. I needed help and now that I had nothing to lose, I could go to rehab. I met with the physician’s health program of my state and told them the whole story.

I entered inpatient rehab and stayed for 90 days. My girlfriend was devastated and angry that I had lied to her. I was surprised that, in spite of their anger and resentment, my family supported me. When I was using, I didn’t think I mattered enough to hurt anyone. But I mattered to them. My dad told me he used to drive by my apartment just to make sure I wasn’t dead.

I hope my story helps other residents, who are quietly suffering, and their supervisors. In the face of uneven performance, tardiness, low scores on the Orthopaedic In-Training Exam, and other clues, it’s helpful to consider the possibility of depression or substance misuse. It is important that physicians understand that there is a way out of addiction without losing everything.

Next month in AAOS Now, Dr. Attum tells how he ultimately survived and recovered.

Basem Attum, MD, MS, is a research coordinator at the division of orthopaedic trauma, Vanderbilt University Medical Center. He can be reached at baattum@gmail.com.

From the Patient Safety Committee
As a medical student and resident, Basem Attum, MD, MS, struggled with an addiction to pain relievers and sleeping pills. This is part three of his four-part memoir, which provides an opportunity for each of us to examine our own potential for addictive behavior—whether to alcohol, drugs, gambling, sex, work, or something else. Our hope is that those who see similar maladaptive coping strategies in themselves will begin to address those issues before they become harmful.

You can find Part 1, “The Nightmare Begins,” online at www.aaos.org/aaosnow/17032 and Part 2, “Out of Control,” at www.aaos.org/aaosnow/17028. Part 3 shows how addicts delude themselves and others about their drug use.

Increasing evidence points to the importance of effective coping strategies such as adaptation and resiliency in creating optimal health, particularly when we reach the limits of current knowledge and technology. The AAOS Patient Safety Committee has an online Pain Relief Toolkit with tips on safe pain relief strategies. For more information, visit www.aaos.org/Quality/PainReliefToolkit.