Editor’s Comments
I Christina M. Ohnsman, MD, Editor
n my last year of residency, I was called to see a man who had been involved in a bar fight. The junior resident had called me in because one eye was so badly injured that he thought it would need immediate enucleation. The patient was an unpleasant drunk and hadn’t been an innocent bystander. I spoke with him and his wife at length about the need to remove the eye that night, and we proceeded to do the surgery. The smell of alcohol from his blood during surgery—heightened by my sixth month of pregnancy--was overwhelming. We admitted him to the hospital, and had a series of long conversations with him after he had sobered up. Upon discharge, I wrote a prescription for enough pain meds to last for 10 days, and emphasized that he needed to make them last until his first outpatient visit. He showed up in two days, saying that he had run out of pills and needed more. He became extremely belligerent and demanded to see my boss when I suggested that he might have a substance abuse problem. I called the oculoplastics attending, who took it from there. Months later, the patient returned and thanked me for helping him overcome his addiction. During med school and residency, I had been taught to be on the lookout for drug-seeking behavior. At times, most of my inner-city university hospital patients were IV drug abusers, unlike the community hospital patients I saw. Many years later, long after it seemed that my days of interacting with heroin addicts were over, heroin started making headlines again. This time, it had spread to the suburbs. It started with celebrities dying of heroin overdoses: Cory Monteith and Philip Seymour Hoffman. Then, articles about the epidemic of heroin-related deaths among teens started to appear on a regular basis. I had the attitude that this wasn’t something I needed to worry about. After all, my kids and their friends wouldn’t have any interest in hardcore drugs. I asked their opinions about how and why people start to use heroin, despite knowing that it was so often deadly. Did they believe that they would be the exception, that it would be safe for
them? The thought that anyone would inject a lethal drug into their vein for the first time was mind-boggling to me. But of course, I was looking at the problem from my own paradigm of waking up sober in the morning, able to think clearly and not powerless to addictive cravings. By the time someone uses heroin, they’ve been using other drugs for some time. Sometime later, I read Wild: From Lost to Found on the Pacific Crest Trail, a memoir by Cheryl Strayed. The author, who had been an intelligent, responsible, and trustworthy teenager, started using heroin as her life spiraled more and more out of control after her mother’s death. That made me think. Here was someone who seemed similar to my kids and their friends, yet she went down paths that I would never envision for them. Shortly after I finished reading the book, a patient’s mom—a farmer living the most wholesome life imaginable--mentioned that her teenage sister was addicted to heroin. Here were two completely unexpected addicts. Since then, I’ve read more and more about this scourge that reminds me it is a disease, and that many innocent people are suffering from it, directly or through their loved ones. A Facebook page called “The Addict’s Mom” describes in heartbreaking detail the fear, shame, secrecy, and loneliness experienced by the loved ones of addicts.
So what does this have to do with us? It’s essential that physicians understand the scope of the problem and our role in it, as outlined in this issue’s feature article by Lucy Cairns. We should take advantage of the educational resources offered by the PA Medical Society, listed in their companion piece. We must learn to balance adequate pain control with addiction prevention, as described by Gus Geraci. We need to stop and think before we use the term “addict,” as powerfully explained by Bill Santoro. Perhaps most importantly, we need to accept that this IS our problem, right here in Berks County, affecting our patients and their loved ones, as Kyle Robinson reminds us. Let’s help them know that they are not alone.
WINTER 2016
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