You Are Our Front Lines...

My soapbox time…  I remember in nursing school learning about addiction just enough to know the word.  I thought I knew what a rehab was, but I really didn’t have a clue.  I became a nurse and my career started in ICU.  I, like every doctor and nurse, had many patients that had addictions.  I would roll my eyes and become annoyed having to treat them, astonished at the amount of meds they could take.  I eventually became an addict, and still had no clue about addiction.  I remember my family dragging me to a rehab and that was my first view inside the doors.  Within the first few days, they mentioned the word 12-step program.  Wasn’t sure what they were talking about, but I was forced to listen.  They forced me through the first 4 steps in a matter of 3 weeks and sent me on my way.

I am writing this because I believe our medical professionals are not educated about addiction or how to treat addicts.  You are faced with the dilemmas of whether or not to give pain meds, how much to give, and whether your patient is really in pain or just seeking drugs.  I’m going to give you a few things to consider and hopefully give you the opportunity to see things in a different way.

As I mentioned before, my family had to drag me to rehab the first time kicking and screaming, and I mean that literally.  I even lost a toenail on the way because of my childish behaviors.  I was pregnant and trying to get off high doses of pain meds and was having a hard time, so they took me there to help me sober up.  I went through the 30-day program.  I always have very high-risk pregnancies and this one was no different.  After returning home, I went into labor and was only 21-weeks pregnant, not a viable pregnancy.  I was living in the same city as a relative who was a RN at a local hospital.  So, still having a sick mind, I knew NOT to go to her hospital for that meant she could have some sort of control of my care.  I traveled to the only other hospital in town and waddled into the Emergency Dept.  I had been in labor at home taking care of my other son for 3 days by this point, all alone.  My relative knew I was headed there but she was working so I didn’t expect to see her.  This relative, trying to help with my sobriety, bless her heart, had called the Emergency Department and notified the physician that I was an addict and he should not give me pain meds, my reason for NOT going to her hospital was now failing.  The physician sent me to the basement for a sonogram.  They wheeled me in and put me in this dark room and the sono-tech did the sonogram and had this terrible look on her face and said she had to go talk to the doctor.  She left me in this dark room, in the basement of the hospital, without a call light or any way to get help.  I was left in this state for about 30 minutes while the doctor reviewed the problems.  Let me remind you, I am now in full blown end stages of labor, no pain meds, and terrified because I know something is bad and I am probably in the midst of losing my child, still completely alone.  By the time she returns, I am moaning in pain and my body is naturally pushing. (I’m going to stop here because I want you to see that this is the way we treat addicts/alcoholics.  Not on purpose, not because we want them in pain, but because we have a stigma in our head of what an addict looks like and what an addict acts like.  We don’t stop to think about the fact that an addict is a human like every other human and could, in fact, truly be in pain.  We are scared to treat addicts.  We are scared to make them feel better because God forbid they end up feeling good… Our minds tell us they don’t deserve to feel good.) 

The end of this story is, when the tech finally arrived back in the room and realized how bad I was, she rushed me upstairs.  The doctor realized what was going on and rushed me up to labor and delivery where shortly after arriving I delivered my baby boy and he died.  His name is Cole and he was beautiful.  This experience was one of the most traumatic things I have ever been through.  I was then given a medicine help with bleeding that instantly gave me a spinal headache.  I still was not treated for the pain.  I begged the doctor to send me home because I was in so much pain and he finally got tired of my complaining and did just that.  He sent me home with nothing but sadness, loss, and now a horrific amount of pain.

Now, I want you to stop and think about that patient.  I want you to consider that when somebody struggles with addiction, they know where and how to get drugs.  They don’t have to come to a hospital.  When we don’t treat their pain, they know where to go to treat their pain.  They don’t need a doctor or a nurse to treat pain.  If you don’t treat them, they will find it elsewhere.  So, now we are putting the patient on the streets to self-medicate, and they aren’t going to come back next time they are in pain because we broke their trust, so they continue to self-medicate and not take care of medical issues.  They come in for help, we treat them like an “addict” and make them feel shameful and less of a person, and then we turn them out where they can find meds and dose them inaccurately.  Not safe… And I know no medical professional intends for this to happen.

I also want you to consider that, as a medical professional, it is not our responsibility to treat their addiction.  We are NOT qualified to treat addiction.  Addicts have to want help to be helped.  They have to hit their rock bottom and that is nobody’s but theirs.  What we can do is help keep them safe while they are in our care.  If an addict needs pain medicine, it is best to give them meds in the facility and not prescribe meds to have at home.  If they need meds at home, you treat them as any other patient and prescribe them like you normally would; only you try to help them make a plan.  As a recovering addict I have had a baby and surgery in recovery.  I worked with my sponsor and made a plan before it ever came up.  I sat down with my parents and asked them to control the meds and give them to me as prescribed when needed.  I explained to them what they would see in my behaviors.  My mind gets sick all over again when I have to take these meds and I start trying to manipulate and abuse them.  I know that now.  I can make a plan and explain this ahead of time and have a plan set up for when it happens so my recovery is safe.  If you have to send a script home with them, try to help them make a plan with a relative that can help them control the meds.  Offer them names and resources to help them if and when they are ready.  Call somebody that is in the program to come in to the hospital and talk to them about solutions.  Touch them on the arm while you are talking to them and make them feel like you care.  When a nurse or doctor treats this person like they deserve to be treated, with respect and care, you cannot imagine the affect it has on that patient.  That simple act of kindness could be the difference that may change their life.  That is a small moment that you can give them to make them feel normal, cared for, human.  An addict/alcoholic in their addiction does not feel these feelings often.  Be the one person they see this week that looks at them like you care about them.  You never know how long it’s been since they had that and it may be life-changing.

For the recovering addict, please do not call them in a narcotic to the pharmacy for them to pick up.  I have the most wonderful doctor in the world, I believe.  A couple weeks ago my nerve disease flared up and I called his office and said, “I need something for my nerve disease because the pain is bad, but I don’t want narcotics.”  The nurse said I will talk to him and call you back.  She later called back and says, “He called you in a script for Hydrocodone and it should be ready soon at your pharmacy.”  My mind started spinning.  I could almost see it spinning.  It was like I had two heads, one was telling me nobody knows you are getting this, get it and run!  Nobody will find out!  The other head was telling me I don’t want to relapse, call somebody, call somebody, call somebody.  Thank God, my sobriety was strong enough to overrule my addict brain.  I called my mom immediately and my parents helped me control the medication.  I am sure in this doctor’s mind, he was giving me a very small dose and would not refill it so I was safe.  What he didn’t think about is, again, I’m an addict, I know where to go to get pain meds.  I don’t need him to refill it.  Once I get started on that road, there is no stopping me.  I can’t stop myself.  Work with the recovering addict to also make a plan.  Narcotics should not be given without seeing them in person and making sure they have a safe way to administer the meds as ordered. 

There are so many ways the medical community can be a part of their patient’s health, and I understand there is not time to do everything we want for every single patient we have, but please do what you can.  You are our front lines.  The way you treat them when they want help is how they are going to remember what help looks like forever.  If you are rude and demeaning, they aren’t going to be as likely or willing to go seek help elsewhere.  If you are kind and helpful and get them to the right people in the program to help them, we can make a difference together.

Addiction affects every single one of us in one way or another.  You are in the position to help these people.  If you can, take the time to attend a meeting that you suggest to these patients.  Learn about addiction and how to treat it, not just what our books say, but talk to people that are affected by this disease.  Not every meeting is the same.  Not every meeting is as strong in sobriety as the next.  Don’t be a by-standard, be involved.  I write this based on my experience.  I tell my story because I AM YOU.  I am your family member.  I am your neighbor.  I am someone you know…  Addiction does not discriminate.  I AM YOU.