When I arrived at Beth Israel in the summer of 1999, eager to do something about the suffering all around me, I was already long familiar with the ways of crack addicts and street junkies. I’d marveled at their lies and their never-ending hustles. I’d seen their love for family, friends, and even God take a backseat to a new god, that white rock or powder, even if all the while they hated themselves for it. Little about that world surprised me anymore. But I was soon introduced to another world, a hidden drug culture right under my nose.
That summer, my first sickle-cell anemia patient showed up in the emergency department during one of my shifts at Beth. He was twenty-three, complaining of pain in his shoulders and upper back. I got excited—in the macabre kind of way that happens when a doctor is about to learn firsthand about an illness or injury he has seen only in textbooks.
Sickle-cell anemia is an inherited blood disorder that in the United States primarily affects African Americans. In a normal patient, red blood cells are oval-shaped, which is optimal for carrying oxygen and allowing blood to flow easily through arteries and veins to the organs and limbs. But a sickle-cell patient has abnormally shaped cells that look like a crescent or sickle. The deformed cells sometimes clump together, blocking the regular flow of blood and oxygen and causing excruciating pain in the deprived areas.
During medical school I studied the disease intensively, since I already knew I wanted to work in an urban hospital, and I figured the illness would show itself time and time again. So on that summer day, I knew all about the illness, but I’d never met anyone with it.
My patient looked like a skinnier version of the actor Wesley Snipes, with dark brown skin, a high-top fade cut close on the sides and back, baggy jeans, and a pair of tan boots. He was writhing on the stretcher.
“Doc, I’m in so much pain,” he cried. “I feel like I’m about to die!”
He asked for ten milligrams of Dilaudid, a semi-synthetic version of morphine that is far more potent. Ten milligrams of Dilaudid would have the same effect as about seventy-two milligrams of morphine. That much of such a powerful drug could kill the uninitiated, but to a person in chronic pain who has built up a tolerance for it, the high dosage just brings quick relief. I didn’t doubt for a moment that my patient needed it. At his age, he surely had experienced more than a few episodes of sickle-cell pain, which explained in my mind his certainty about the medication and dosage he needed. A quick glance at his chart showed that he’d been given ten milligrams of Dilaudid during his last E.R. visit.
I jumped into rescue mode, assuring the brother that I would take care of him and get him started on the Dilaudid, as well as an oxygen treatment, intravenous fluids, and the Benadryl he’d requested to soothe the itching often caused by histamines released with the medication. I rushed down the hall, found the attending physician, and immediately started describing my patient.
“I have a twenty-three-year-old sickle-cell anemia patient presenting with pain in his shoulder and upper back,” I said, full of urgency and earnestness. I mentioned the treatment I wanted to prescribe, in the hope that the attending would sign off quickly. The head doctor’s cavalier attitude caught me off guard.
“Oh, that’s Thomas Green,” he said, chuckling.
His face wore an inexplicable smirk.
“My young doctor,” he added, patting me on the back, “you have so much to learn.”
I was puzzled. Had I missed something in the diagnosis? The head doctor assured me that this was the right course of treatment for a patient whose pain hadn’t responded to lower dosages of the medication or weaker drugs. He approved my recommendation and walked away. Still, his initial response nagged at me. What had his smirk been about? I checked Thomas’s chart again, this time more carefully. Sure enough, he’d been given ten milligrams of Dilaudid during his last emergency room visit—as a matter of fact, during his last several visits. I slowed down, looking closely at their dates, and my jaw dropped. Thomas had shown up at the hospital in crisis at least fifteen times in the past month. Even for a sickle-cell anemia patient, that was excessive. No wonder the attending physician knew immediately who he was. And no wonder my supervisor found my sincerity laughable. This dude seemed to be running a game.
But how could I be sure?
Therein lies the doctor’s dilemma. We can diagnose illness, and we can identify the conditions that generally cause pain. But we cannot quantify pain. Medical professionals have long defined it in the same way registered nurse and pain management expert Margo McCaffery described it in 1968: Pain is “whatever the experiencing person says it is, existing whenever and wherever the person says it does.”
So now, despite my suspicions, I could not say with 100 percent certainty that Thomas was faking in order to get the drugs. I could have costly tests run to show there were no other ailments, but that wouldn’t prove there was no pain. Sometimes, even when we’ve done every test known to science, and they show no reason for pain to exist, it still does. Much of medicine remains mysterious; new discoveries are made every day. As a physician, I never want to see anyone suffer. My fulfillment comes in healing and easing pain and suffering. The last thing I want to do is make an unfounded accusation against someone who is genuinely suffering. There was another issue that concerned me, too: race and stereotyping. Thomas was African American, and I didn’t want to assume that he was lying to get a fix. As an African American man, I know what it’s like to walk into a room and feel the vibes of people who are making assumptions before they know the first thing about you.
I stood there reading his chart and reasoning. Thomas had a genuine disease, a painful disease, and I saw he had suffered mightily. Diminished blood flow to his hip tissues and bone had caused a degenerative condition called “avascular necrosis,” which had required him to undergo hip replacement surgery. His spleen had been removed after a buildup of sickled cells had caused a splenic sequestration—an enlarged spleen. And Thomas certainly appeared to be in pain now as he lay curled up on the stretcher. His chart indicated not only his tolerance for the drug but the decision many doctors before me had made to give it to him. So I followed suit and administered the Dilaudid.
About two hours later, making my way through the unit where Thomas had been assigned, I saw him sleeping soundly. Walking down the hallway, I accidentally bumped into his stretcher, which was pushed against a wall. He jolted straight up, looked at the clock, and said, “Hey, Doc, glad you’re here. I need more pain medicine.”
Beth Israel had a rule: Dilaudid and other narcotics of that type could be administered no more than once every two hours, and ten milligrams was the maximum dose that doctors were allowed to prescribe in the E.R. Thomas had awakened from a sound sleep already needing more pain medicine? He’d timed his request almost to the minute. With a string of emergencies vying for my time, I couldn’t stand there debating whether this guy was in real pain or playing me for a fool. “I’ll send a nurse to help you,” I said, dashing off to the next patient. Thomas would request a third dose, the maximum allowed without being admitted, before suddenly feeling well enough to go home. The attending physician’s words echoed in my head: My young doctor, you have so much to learn.
So began my education into the underworld of the E.R. Thomas showed up at the emergency department at least twice a week, same routine. What little faith I had in his sincerity began to fade, especially as I noticed the same suspicious behavior among about a half-dozen other patients, whom I came to know as the “sickle-cell posse.”
Ann and LaShawn were friends in their mid-twenties who probably had met in Beth Israel’s emergency department. When one would show up, claiming to be experiencing the worst pain of her life, the staff came to expect that within a half hour, the other would make her way there as well. Ann, short and slim, would stroll in, usually dressed in jeans, a T-shirt, and sneakers. She had a long, reddish-colored weave flowing down her back. And less than thirty minutes later, on cue, there was LaShawn, also short and thin, with gold streaks in dark hair that she kept mostly hidden under a baseball cap. They always asked to be assigned beds next to each other, and they’d bring nail polish and other beauty products to share. Since they were there for six hours or more at a time, they’d traipse up and down the hall to the vending machines, buying chips and sodas. As I passed them, I’d see the two sitting on one bed, their supplies spread out between them, giving each other manicures and pedicures, or braiding each other’s hair, like they were on summer vacation. Or they’d just sit there, chatting, dangling their legs, talking on their cell phones, and watching the clock.
Precisely two hours after getting their first meds, they’d raise their hands, like they were in school. “Doc, I’m due for my second round of pain medicine,” one of them would state, as if the next dose was supposed to be automatic. And after their third dose, they would say they were better and ready to go home. Hospital rules required me to admit a patient who showed no progress after the third dose. None of the so-called “frequent fliers” wanted to be admitted. Overnight stays in the hospital meant more regular monitoring and lower dosages of the narcotics over longer periods, and it completely cramped their itinerant style.
The gall of their assumptions angered me. I thought, You’re not automatically due for a second round of drugs; you’re allowed a second round if you’re in pain. And how much pain can you be in right now, painting toenails?
One day, a nurse who doubled at other hospitals was working her shift at Beth Israel when she recognized the pair of friends and exclaimed, “Oh my God, that’s Ann and LaShawn—I just saw them yesterday at University Hospital!”
It came as no surprise to anyone that the two women E.R.-shopped, visiting emergency rooms throughout the area to get drugs. An addict will go wherever and whenever to get her next fix. The drugs are also quite valuable on the street, and so a prescription could be a moneymaker.
The hospital tried mightily to help patients with chronic pain, and, of course, those who abused narcotics represented just a small portion of the ones treated for pain in the emergency department. And let me be clear: Not all sickle-cell patients are drug seekers. Likewise, not all drug seekers are sickle-cell patients. During practically every shift at least one patient came into the E.R. complaining of severe back pain, a toothache, a migraine, or some mysterious pain and offering a story that raised suspicions: His regular doctor was out of town, or her medicine was misplaced, or he was vacationing in the area and had left his medication at home. They usually asked for the narcotics by name: Dilaudid, morphine, OxyContin, Percocet were among the more popular ones.
Sometimes they even put on Oscar-worthy performances, like the guy who was brought by ambulance one day from the Newark train station. He was supposedly traveling back home to Massachusetts from Texas, and while on a layover in Newark he experienced what witnesses described as a seizure. He reported to our staff a past history of chronic back pain but no prior seizures. While being observed and awaiting the results of blood work, the patient again began convulsing. The resident on duty moved fast to administer medication, likely Ativan, to control the seizure. I rushed to the patient’s bedside. For several minutes, his body shook. But one thing stood out: He never let go of the bed’s handrail. Normally, a person having a grand mal seizure loses total body control and is incapable of holding or grasping anything. I opened his eyelids, and his eyes followed me. I knew exactly what was going on. I leaned over and whispered in his ear, “Stop it, I know you’re faking.” He didn’t respond.
It was rarely that easy to determine when a patient was just seeking drugs, though. Among the “frequent fliers,” having a documentable disease made the hustle easier. And it soon became clear to me that prescription drug abuse, once the nasty little secret of the rich and famous, was now a huge twenty-first-century problem in urban neighborhoods. These new addicts weren’t hiding out in abandoned houses, shooting up behind closed doors; their drugs of choice were administered by professionals in the cool, clean corridors of the E.R. And the unwitting dealers in this game weren’t working the streets with Glocks hidden in their pants, they had fancy degrees and wore white lab coats. That’s what bothered me the most: I started to feel like a high-class drug dealer.
When I mentioned to Ann and LaShawn that they’d been spotted in the emergency room at University Hospital the previous day, neither seemed fazed. Both said something like, “I was in pain, and University was close to where I was.”
So I treated them. I felt I had no choice. Number one, I didn’t want to take the risk of failing to treat a patient who was really in pain. State law requires that I provide medical care to everyone who comes to the hospital seeking it, and I couldn’t prove that these patients were not in pain. The hospital staff lived with the constant fear that a patient would complain to the state about being denied treatment, which could trigger an investigation and result in the hospital getting cited and potentially facing cuts to its Medicare/Medicaid funding. With dwindling resources forcing hospitals throughout the country to close their emergency rooms or shut down altogether, the threat felt very real. It was easier just to write the prescription.
Our pharmacy network lent a hand in helping to keep track of how many times a particular medication had been prescribed to an individual patient. Repeated narcotic prescriptions always raise a red flag, particularly if they come from different doctors. I received calls on numerous occasions from pharmacists alerting me that someone who had left the emergency department with a prescription written by me had recently been prescribed sixty tablets of the same medication by a doctor at another medical facility.
Then the pharmacist would ask: “Dr. Davis, do you still want me to fill the script?”
My response was always the same: “No, and I will notify my department so they’re on the lookout.”
There were times I tried to claim small moral victories, quietly reducing the dosage of the pain medication the staff administered to a patient I suspected of abuse, or refusing to send the patient home with a prescription for Percocet or OxyContin. Other times, I refused to give the third dose of Dilaudid, insisting instead that if the patient was still in pain, he needed to be admitted into the hospital. My refusal to follow the unwritten rules occasionally resulted in blowups. A patient would protest loudly, curse me out, and sometimes even trail me around the department, threatening to call the state to complain about poor treatment and a lack of respect.
That was sort of how I wound up one sunny spring day in 2002 sitting in the emergency medical director’s office. The discussion was to be my quarterly Patient Satisfaction Review, a survey that had become the latest trend in hospitals’ frantic quest to generate business in an era of budget cuts and reduced services. How satisfied a hospital’s patients were played a large part in its reputation. My scores, normally above average, had fallen a bit, I suspected because of my growing impatience with drug seekers. I arrived early for the meeting, and Dr. Fink’s secretary was kind enough to allow me to wait in his office. With coffee in hand, I stood mesmerized by the degrees, board certificates, and awards filling his wall. The office, located on the top floor of the hospital, offered a panoramic view of the Newark skyline, a sea of tall brick buildings interspersed with small patches of green. Far off in the distance, you could see New York City. Less than a year earlier, I’d watched the aftermath of the September 11 terrorist attacks from this window.
As I waited, I rehearsed in my head what I would say when Dr. Fink instructed me to be less confrontational. I would hear him out without agreeing to change my position. I would point to literature showing the rise in prescription drug abuse. I was not a drug dealer.
I glanced at the framed photos on the director’s mahogany desk. There were pictures of his family, his dog, and buddies dressed in army fatigues. I recalled Dr. Fink saying once that he was an army dude. I leaned in a bit to look more closely at a photo of him with his two sons, a black-and-white shot that had been taken outside, maybe while fishing or camping. The boys appeared to be close in age and tall and slim, like their father. Suddenly, without warning, Dr. Fink, a man in his fifties with just the right amount of salt-and-pepper hair to equal his experience, entered his office. Embarrassed, I straightened from my detective position over his desk.
Moving to his chair, he sat and motioned for me to take a seat across from him, which I did. He then said: “How are things, Sampson?”
“Things are well, Dr. Fink. No complaints,” I responded, keeping my cool.
“You know, Sampson, medicine is a great field,” he began, then continued for a few moments, talking about how doctors gain extraordinary wisdom from what we see in the field.
I nodded in agreement, waiting to hear where he was going with this conversation. We both were busy. And he hadn’t called the meeting to talk about the joys of medicine. Dr. Fink must’ve seen in my eyes that I was eager to get on with it, because he quickly got to the point. “Sampson, do you know why you’re here?”
Again, I nodded.
“Well, let’s just say, when you’re dealing with cases that are not actual emergencies, try to imagine one that truly moved you. I know you have plenty, so I won’t ask you.”
He paused. I was puzzled, and feeling a bit like I was in the principal’s office—I half expected my mother to come tearing through the door any minute, belt in hand.
I asked, “Is that it?”
“Yes, that’s it. Take care.”
Still slightly confused, I rose from my seat and left the office. Dr. Fink was a child of the seventies. Had I just experienced a hippie moment? Live peacefully and think of memorable cases. I laughed quietly all the way back down to the emergency department. It was an unexpectedly light moment in a frustrating scenario.
I often referred—or tried to refer—patients to the hospital’s social worker for pain-management counseling or to the psychiatry department for narcotics-abuse treatment, with the hope that they would get the help they truly needed. But there was not enough staff to handle the need, and there were rarely any available beds in the psych ward. And even when a room opened up, the patient held the upper hand: Nothing was mandatory. If he denied having a drug problem, he could refuse an intervention or check himself out of the hospital at any time, which is what usually happened. Beth Israel’s pain-management counseling tried to address the issue broadly, but many patients wouldn’t show up for scheduled sessions or refused to even make an appointment. Many patients didn’t see themselves as addicts. In their minds, an addict was the crackhead uncle begging for money on the corner or the strung-out sister pawning their parents’ possessions.
Because of the staff’s heightened suspicions, I’m sure there were times when patients who were hurting and needed relief were wrongly viewed as addicts, as well as times when addicts with real illnesses were indeed in pain. In those cases, they most likely received the appropriate medication and treatment, but perhaps with a little less compassion than they deserved. That is one of the heartbreaking fallouts of this dilemma.
No one was suspicious of Mr. Jacobs, though. He was an Afro-centric, Malcolm X–looking dude in his late fifties who usually wore an African dashiki and matching kufi cap. A couple of times I saw him receiving treatment in the emergency room late at night in his pajamas and robe. He carried himself in a dignified manner, and the staff treated him with deference and respect.
When I first met Mr. Jacobs in 2002, he mentioned the memoir I’d just written with George and Rameck. “Man, I heard about you young brothers,” he told me. “You’re doing great things in the community.”
At his age, Mr. Jacobs seemed like a modern miracle. He had lived more than a decade past the life expectancy of a man with sickle-cell anemia. (The average for a man with the disease is forty-two years; for a woman, forty-eight.) Mr. Jacobs kept up with the latest news, and whenever I saw him at the hospital, he talked about the racial politics of the disease, the need for more research, and how sickle-cell anemia always seemed to draw the short end of the stick when it came to government funding. The latest statistics and research rolled off his tongue. Mr. Jacobs told me that he had founded a small support group for sickle-cell anemia patients and their families and asked if I would speak at a future meeting. I agreed without hesitation. But we never nailed down a specific day. One thing seemed a little odd to me: For someone who had founded a group on behalf of those stricken with the disease, Mr. Jacobs never seemed to mingle with any of the other sickle-cell patients. Maybe he’s suspicious of some of them because they seek drug treatment so frequently, I thought. Maybe he’s worried that their actions might reflect badly on his group.
Sometime later, Mr. Jacobs was admitted to the hospital. The internist on duty that day ran a series of blood tests, including a routine screening for sickle-cell anemia. When the results came back, everyone was shocked: Mr. Jacobs did not have the disease; instead, he was simply a carrier of the trait, which in most cases causes no symptoms, or minor ones, such as anemia. Over the past decade, researchers have found that in rare cases, a person with the trait may experience severe exhaustion, greater rates of urinary tract and kidney infections, and, in isolated instances, even episodes of pain similar to the disease. Was Mr. Jacobs an anomaly? Or was he just a more dignified drug addict? I will never be certain, and as far as I know, nothing ever changed with his treatment. That’s the most maddening part of the dilemma.
There have been hopeful moments, though, like when I met fifteen-year-old Patrick. He was the color of cedar, with bright, happy eyes—and he was also the size of an average ten-year-old. The lack of adequate blood flow throughout the body sometimes stunts the growth of sickle-cell patients. Patrick’s mother, Janice, brought him to the emergency room one day with debilitating pain in his back and knees. He could barely walk.
Janice was in her mid-to-late thirties, with a bubbly, young personality. She seemed hip to the latest styles of clothes—looking put together in her jeans, heels, and leather jacket. More important, I could tell by the thorough way she answered my questions that she was hands-on with both her son and his medical care. She explained that she’d given him ibuprofen and his prescribed pills earlier, when he’d first complained of pain, but he hadn’t gotten any better. After examining Patrick, I told them I’d decided to start him on a small dose of morphine. His mother interrupted.
“Oh, no, Dr. Davis!” she said. “Don’t give him morphine.” She asked if he could start his treatment with Toradol, a non-narcotic anti-inflammatory prescription pain reliever similar to ibuprofen. But Toradol comes in a liquid that can be administered through an IV, which some patients believe brings relief faster than a pill. “He usually does fine with it,” she added.
While Patrick’s pain certainly seemed severe enough to merit the morphine, his mother had the insight to know that giving him narcotics too soon could be problematic later. I wanted to hug her. With her involvement, he had a better-than-average chance of staying on track.
Patrick reminded me of another teenager, Wayne, whom I’d met in 1999, my first year of residency, when I worked on the pediatric side of the department.
The basic facts matched. Wayne, too, was an African American teenager with sickle-cell anemia, and had come to the hospital with a woman, who I presumed was his mother. But that’s where the similarity ends. As I examined Wayne, the woman seemed to fade into the background. And when I asked about his pain or prior medications, he responded himself.
A short, round dude, he was unusually thick for a sickle-cell patient. His hair was braided in neat little cornrows; after that first visit, it was braided in a different style nearly every time I saw him. That day, Wayne was experiencing serious pain in his back and knees. I treated him with a dose of Toradol until the pain subsided. The teenager was upbeat and chatty, even in pain. The few times a year I saw him after that, I’d treat him with the maximum amount of Toradol and release him when the pain subsided. If his pain didn’t respond to the Toradol, I added a small bit of morphine. That approach seemed to work well; it kept the narcotics to a minimum and eased his pain. This is a common strategy in treating young patients with chronic pain.
When Wayne turned eighteen, I could no longer treat him on the pediatrics side. He was moved into the department’s general population, and he came to the hospital alone. It was not uncommon to have three or four sickle-cell anemia patients receiving treatment at the same time on any given day; whenever possible, the medical staff grouped them together to make the frequent monitoring more convenient for the nurses. Because of crowding and the reality that sickle-cell patients were usually there all day, their stretchers most often were lined up, head to foot, against the wall on the O side of the hallway, the observation area for stable patients. I began to notice Wayne mingling with the others.
It didn’t take long before he started showing up in the emergency room more frequently—changing from every few months to once a month to every other week. Then he began complaining that the Toradol wasn’t easing his pain at all. I wasn’t on duty each time he came to the emergency room, so I didn’t see it personally, but his chart told the story: one milligram of Dilaudid, then two, then four, and on and on. In just over a year, Wayne had gone from taking almost no narcotics to receiving ten milligrams of Dilaudid, the maximum dose. And the newest member of the posse learned well. He began instructing the duty doctor on how much medication he needed, and if the doctor ordered less, Wayne would follow him or a nurse around the department, demanding: “This is not my proper dose. I am in pain, and you need to give me my proper dose!”
By the time Wayne turned twenty, he had progressed to taking three rounds of the maximum dose of Dilaudid. One day, after his third dose, he said he was still in pain. He agreed to be admitted to the hospital and was transferred to an inpatient room. During one of her rounds, the nurse found Wayne lying motionless in bed. His chest wasn’t rising. She felt for his pulse. Nothing. His skin, normally a golden color, now appeared dull and dusky. She buzzed the nurse’s station, which called a Code Blue, and within seconds the medical response team was at his side, working to resuscitate him.
But it was too late. Wayne was dead.
It was spring 2002, and when I arrived at work the next day, the staff was still buzzing with the news and speculation on what had happened.
“Did you hear about Wayne?” someone asked, then filled me in.
I was startled. Even though I’d watched from a distance Wayne’s tragic transformation from sick kid to drug addict, I hadn’t seen this coming. There were rumors that he had either cocaine or heroin in his system as well as the Dilaudid that final day, or that he’d injected a street drug into his IV, trying for a faster, more intense high. As far-fetched as that may seem, there had been a similar incident in 2000, late in my first year on the job.
That patient also had sickle-cell; but, in addition, he bore a laparotomy scar from some type of surgery to his abdomen. The few times I’d encountered him in the emergency department, he was rubbing his belly, complaining of severe pain in his scar area. He was a grumpy dude, who barked orders at the staff: “Gimme my pain medicine, now!” His last day, he was in a room on the inpatient side when the nurse found him, unresponsive. A bottle of Robitussin was at his bedside. The staff suspected he had injected the cough syrup into his IV.
I never learned for sure what happened in either suspicious death. At the time, I was shocked. But recent studies show that prescription drug abuse is the fastest growing drug problem in the United States, and deaths from overdoses of prescription painkillers are on the rise. In a November 2011 report that examined such deaths from 1999 to 2008, the Centers for Disease Control and Prevention called the problem an epidemic, saying that prescription drugs are behind the overall increase in drug overdose deaths. Even more startling, a greater number of people are dying from overdoses of prescription drugs, such as OxyContin and Vicodin, than from cocaine and heroin overdoses combined. The rise in prescription drug overdose deaths has been so steep that by 2008, they were approaching the number of deaths from motor vehicle crashes, the leading cause of injury death in the United States.
A few weeks after Wayne died, I learned that another of our sickle-cell patients was his sister. Her name was Sarah, and she was in her mid-twenties, a few years older than Wayne. She had come to the emergency department for pain treatment that day and mentioned she had been struggling with depression since her brother’s death. Though Sarah and Wayne shared the same last name and had similar features—short and round with gold-colored skin—I’d never seen them together and hadn’t until that moment made the connection that they were siblings.
“I didn’t realize Wayne was your brother,” I told her. “I’m really sorry about what happened.”
Sarah, who always spoke in a soft, babyish voice, seemed distant and withdrawn. After that day, I noticed, she began careening downhill. I’d sometimes catch a glimpse of her, looking haggard and beaten down, a baseball cap or scarf pulled over her head, in a drug-induced sleep—or sitting in a daze on a hallway stretcher. This was doubly sad. Not only did both siblings have the same terrible, life-shortening disease, they both became addicted to painkillers … and perhaps more. I knew nothing about the siblings’ lives and struggles beyond the hospital, but I grappled with this question: Did we do more harm than good? We were supposed to help our patients, or at least do no harm. That’s what all doctors promise when we take the Hippocratic Oath.
As time went on, I grew more and more vocal among my colleagues with my complaints about the drug seekers and the anguish I felt prescribing narcotics when I had serious doubts about whether the patient needed it. One day, a fellow doctor blurted: “Just write the prescription. Why do you even care?”
I pondered that question the rest of the day: Why did I care?
The answer boiled down to this, I realized: When I was a naïve, impatient teenager, I’d walked away from drug dealing. I’d left behind the deceit and danger associated with that life and held on to hope that there was something better for me. I’d gripped every hand that reached down to pull me up and out. And no way had I come this far to end up in a fancy version of the hell I’d left behind.
At the moment, I wasn’t sure what, if anything, I could do. But I knew this: Remaining silent was no longer an option.