How This Registered Nurse Went From a Rising Star, to a Hopeless Addict. (Part 3)

By the end of this entry, you will have an understanding of how I arrived at my present place of recovery. In How This Registered Nurse Went From a Rising Star, to a Hopeless Addict. (Part 2)  I described my battles with addiction that have helped me be able to identify a number of character flaws that have contributed to my propensity for addiction, including, poor coping skills, inability to communicate needs, bottling up emotions, and lack of physical and emotional self-care. We will cover these topics and many more in upcoming entries.  In Part 1 , I began my story with the events that led up to my addiction. Please follow the link above to read the beginning entry in this three part series.

As I rode home in the back of a cab, having just been terminated from my job, and confronted about diverting narcotics, I tried to think of what I would tell my wife. It was midnight, she would be in bed, and we were two thousand, five hundred miles from home. Her and the kids had joined me for the summer at my current travel assignment. It was to be an adventure of a lifetime for her and the kids, and a working vacation for me. Now, I was fixing to drop a bomb while she had no family nearby to comfort her. She had endured the same loss of our son that I had. Furthermore, she almost lost her own life, and had not had the crutch of opiates to numb her pain. I feared the burden of my sins would be to much for her, and wondered what the consequences would be. Once again, I underestimated her.

I sat on the stoop of our rental property and watched the sun rise over the mountains. I wondered if this would be the last sunrise I would see as an RN, and a married man. Finally, around six-thirty am, I found the courage to wake my wife and tell her the news.

Surprisingly, her first reaction was to reach out and hug me. I had blubbered like a baby through most of my confession, consumed by guilt and shame. She found the courage to assure me that she would be there to help, as long as I sought help for my addiction. I readily agreed, and began to search for resources for addicted nurses. What I found was a hodgepodge of opinions, advise, and mostly failure. After a week of scouring the internet, I was more confused and scared than ever. It seemed there was no way to find help and preserve my livelihood. As much as I felt like I deserved whatever bad things befell me, I could not condemn my wife and children for the sins of their father.

Ultimately, we decided to return home to the security of our hometown where  family was near, and support could be found. Upon arriving home, I found an addiction counselor and promptly made an appointment. I spent my first session relaying my torrid love affair with opiates. But there was one key detail I left out of my confession. I denied ever using any medication from work. My thought process was that if he knew my history of diversion, he would report me to the board. So, when I asked if it would be okay for me to return to work in a hospital setting, his answer was, “ If you feel comfortable with it”. I have a feeling if he had known my history, his answer would have been different.

I took a position with the local hospital, and continued to go to appointments with the addiction specialist. I still had the mind set of “I can do this myself”. But my resolve only lasted four shifts before I returned to my old ways. The shame and guilt over my failure was overwhelming. I felt complete despair. I now had created another secret to keep from my wife, my therapist, and my job. After only a couple of weeks, I began to daydream about overdosing. I felt like it would be a relief for my wife to not have to worry anymore. My children would be better off without me. I was in violation of my own moral and ethical standards. I could see no way out of the downward spiral I was in. I was defeated.

And then, I walked into work one evening and saw the nurse manager, and unit supervisor waiting at the nurses station. I felt a twinge of fear in the pit of my stomach. I knew it was to late for them to be here. And the guilt of my actions was never far from the surface. As I walked to the time clock to punch in, I heard my supervisor call my name. I turned and looked at her. She said, “I need to see you in my office”. I felt the twinge turn into a crashing wave of fear, but there was something else there as well. It was relief, mixed with resolve. I knew this was the time. I needed to end this now.

So as I sat down, I heard the words “Diversion of morphine”. I looked up as the next phrase “ Video evidence” left her mouth and found my ears. Finally,  I heard “We can offer help”. At this, I looked up and met her gaze. And in her eyes, I saw a genuine sorrow that touched me to my soul. I realized that I was not the first. That she had sat in that seat and looked across her desk and said these same words before. To another nurse. And I knew this was the time. And I confessed.

Once I started talking the words, and tears raced each other for the lead. I spoke of the origin of my addiction, of my attempts to control it, and my ultimate failures. Finally, I spoke of the ethical and moral standards I had trampled during these dark times. When I finished, I sat with a feeling of humiliation, but also, relief. I knew things would have to change now. I finally had no more secrets to tell. And as I sat silent, my supervisor began to speak.

She began by telling me that I was not the first, nor would I be the last to sit in this position. She then told me of the friends, of the colleagues, and of the peers, she had been through this with. She then offered words of hope rather than condemnation, which I was not expecting. She told me her hospital did not believe in punishment, but offered treatment. That I would have the opportunity to report myself to the state agency responsible for monitoring nurses, and after doing so, would be absolved of any punitive action by the hospital. I gladly accepted her offer, and walked out with no job, and no idea of what the future held, but I possessed something I hadn’t had in a long time. I had hope.

I entered drug treatment shortly after my conversation with the monitoring professional. After thirty days of intensive treatment, I was allowed home for a weekend visit. I encountered my neighbor within minutes of arriving. He proceeded to tell me that sheriff’s deputies had been at my house looking for me within the last couple of days. I felt my extremities going numb, and my throat tightened. There was only one reason I could think of for the authorities to be looking for me.

I immediately called the local jail and asked if I had warrants. I was stunned to hear the person on the other end of the line respond, “Yes, you have been charged with three counts of Larceny of a Controlled Substance, and you should turn yourself in now.” My blood ran cold. I called the treatment facility and asked if I could come back until I could sort out my legal trouble. I left my family, alone and scared, while I drove back to rehab. Monday morning, I drove from rehab to the jail and turned myself in. I was booked, fingerprinted, given a mugshot, and spent hours in holding. Fortunately, I was able to retain council and bond out. I could not believe,after forty years of living and being a person that believed in a high moral standard, that I was now facing felony charges.  If convicted, I will more than likely, never be a practicing nurse again. The outcome of these charges are still undetermined. Thankfully, I understand that I am responsible for my actions, and will face the consequences with courage and grace. I will be a role model for my children moving forward.

I spent a total of two months in inpatient treatment and I am continuing counciling. I practice physical and emotional self care, and I am working towards the future. As I continue on this path to recovery, I have added many tools to my kit. In the coming posts, I intend to cover the steps I, and others, have taken to break the throes of addiction. And with help, others will recover also.

How This Registered Nurse Went From a Rising Star, to a Hopeless Addict. (Part 2)

When I was in the depths of despair during my active addiction, I felt as though I was the only person in the world traveling this dark path, I have since found, there are more than I ever dreamed. Some of them working elbow to elbow with me.

In last weeks entry, How This Registered Nurse Went From a Rising Star, to a Hopeless Addict. (Part 1) , I ended with the revelation that I had begun to divert narcotics to supplement my prescribed dose of 100, 10mg Vicodin tablets every month. It started with a few tablets of Oxy, Vicodin, or various other, oral opiates, but soon became an every shift habit. I would come into work, scan through my patient charts, and look for patients that were on pain medication. I would check the last dose administered, when they were due again, and how often other nurses were administering them. Although I knew I was violating my Hippocratic oath, I was unable to stop. I justified my diversion as “what was necessary” to get the job done. I appeased my concience by telling myself that the medications I was taking were extra. Since I had never denied a patient his or her requested dose of pain medicine, I concluded that no one was being hurt by my actions.

This cycle continued unabated for the next two years. I began to feel paranoid that I was being watched. I had been witness to another nurse being escorted off the property for diversion, and it terrified me. I tried to casually ask around as to how they had been caught. My fear was that I could be making the same mistake. I was finally able to talk with the pharmacist one afternoon as I was leaving work. He was a young man around my age, and we often spoke of the latest football scores when we saw each other. I used our friendly acquaintance and after exchanging a few pleasantries, asked about the recently fired nurse. He informed me of a monthly report to compare administration rates among nurses in each unit. He said, if a nurse’s narcotic doses rose dramatically it would flag the system. Also, if administration rates were grossly out of line with other nurses, it would also alert them. Then, with paper in hand, a nurse could be approached, questioned, and ultimately drug tested if need be.

As I drove home, I was deep in thought.  I tried to remember my past administrations, and swore to myself to be more careful from now on. I had to be careful to document thoroughly, and not over administer narcotics in the future. I ultimately left this position out of fear of getting caught.

Soon after, I became a travel nurse so my family could benefit from the increased income. It meant many days away from home, and intense pressure to learn new hospital protocol quickly and seamlessly. I had to fly often, live out of a suitcase, and be away from my wife and children.

Travel nursing was an unhealthy environment for an opiate addict. By the time any discrepancies may have been noticed, I was on to the next assignment in another state and city. During this time, I was still sticking to my “code of ethics” I developed to justify my usage. I only took oral medication, I never injected, I never deprived a patient of pain medication, and I carefully  monitored my doses to prevent any chance of overdose, or nodding while at work.

All of this changed in early 2017. I was working on the west coast, my family was on the east coast. My wife and I were expecting our fourth child. A beautiful boy that would complete our family. I had flown home for eight days to make sure everything was in order for the delivery in two weeks. We were having a scheduled C-section and everything was going well. My wife was in good spirits and the doctors said everything with the baby was excellent. At the end of the eight days I flew back west to put in my last week before the baby came. I was taking a month off after delivery.

My first shift back after my visit was on a Monday. I was working nights, and everything was routine. At 3:15 am my phone rang. It was my mother-in law. My heart sank because I knew something wasn’t right for her to call at this hour. I answered the phone, and my life was changed forever with the next few words. My wife had suffered a massive uterine rupture, and the baby was dead. She was in surgery, had lost a lot of blood, and I needed to prepare myself that she might not survive. I boarded the next flight home not knowing if my children would have a mother, or I would have a wife, when I landed.

The next six weeks were a blur of grieving, crying, cursing, despair, and trying to find some sense of normalcy for our family. My wife and I decided I should return to work on the west coast to complete our financial plan. I felt a deep feeling of dread as I boarded the flight. I wasn’t sure how I would function so far from home, with the emotional wounds I was carrying. I had struggled with withdrawal from opiates during this time as well.

I walked into work the next night, pulled my patient charts, and proceeded to pull 3mg of dilaudid and inject it IV for the first time. All my pain disappeared, and for the next couple of hours, I was at peace. In the back of my mind I knew I had opened Pandora’s box, and trampled all over the last bits of my shaky “ethics”. Over the next few months my opiate usage ramped up dramatically. I soon found that with the increased potency of IV use, came the steady rise of my tolerance. Soon, my oral prescription was doing nothing more than warding off withdrawals for a few hours.

Withdrawals became increasingly severe. I would get off from work and, within a few hours, begin to experience intense sweating, cramps, nausea, insomnia, and restlessness. I tried to keep a stash to last me until my next shift, but found it increasingly difficult to space out my doses. Soon my “code” was out the window. I was pulling every available dose, from every patient assigned to me. I had a feeling of impending doom that was only quieted by another strong dose of Morphine or Dilaudid.

I was called into my unit manager’s office one day near the beginning of my shift. I knew this day was coming, and had hoped I would be on to the next assignment before they caught on. I walked into the office and took inventory of the room. Along with my unit manager, was another woman in business attire, and a gentleman who had a buzz cut and looked suspiciously like an authority figure. I began to wonder what my wife was going to say when I came home. She was going to be devastated.

I walked out of the office not sure what had happened. I was not fired, drug tested, or disciplined in any way. I halfway expected officers to swarm down on me as I walked out of the hospital. The meeting had felt an awful lot like an intervention. I was questioned about my medication administration rate for narcotics. I denied everything, and pled the case that I was attentive to patient needs and that resulted in a higher number of narcotic administrations than other, less attentive nurses. My nurse manager attested to my great work ethic, strong relationship with my patients, and likeability amongst my co-workers. I was ultimately told to lower my narcotic administrations and everything would go away. Unfortunately, by this time, I was an addict. And I was powerless over my addiction.

A few weeks later, I was beginning my shift and sorting through my patient charts to plan my night. I had reduced my narcotic administration some, but I had fears that it wasn’t enough. I once again, hoped I would be on to the next assignment before I was confronted. As I charted, I became aware of two security guards walking down the hallway in my direction.  They were accompanied by the hospital Chief Nursing Officer. My heart leapt into my throat. I had already taken 3mg of dilaudid an hour earlier, and I knew this time there would be no pass. I was right. I was escorted to an empty room, searched, and then taken to the ER for testing. I was then called a cab and escorted from the hospital grounds. Thankfully, no police were called. But, I had a wife at home that was fixing to have a bomb dropped on her.

To be continued next week………..

 

How This Registered Nurse Went From a Rising Star, to a Hopeless Addict. (Part 1)

As I stood with my back to the height chart, waiting for the bulb to flash for my mug shot, I considered how I had managed to fall so far. Only a few weeks prior, I was working as a travel nurse, making really good money, and providing quality patient care. Now, I was being booked on three felony counts of larceny of a controlled substance, and four weeks into a drug rehab program for professionals. But let’s start at the beginning.

I first remember using prescription pain medication as a young man in my early twenties. I was playing basketball with some friends, attempted a jump shot, and grotesquely twisted my ankle on the landing. My physician gave me thirty Vicodin and sent me home. I took one, and within minutes, was extremely nauseous, and drowsy. I took them sparingly over the next few days, only when the pain was to great to bear. Then, the pills sat in my medicine cabinet for the next few years until I threw them out for being expired.

Fast forward a few years and I was working for a large package delivery company. There was bending, lifting, and twisting for hours on end.  One day, as I bent to place an especially heavy item on the ground, I felt a twinge in my lower back. Blinding pain then shot down my left leg and I was unable to straighten up from my hunched position. A few X-rays, and one MRI later, I was diagnosed with multiple herniated discs, and stenosis in my lumbar and sacral region. I was started on 5mg hydrocodone with 325mg acetaminophen. Initially, the medication provided much welcome relief. Curiously, I had no symptoms of nausea this time. The tablets provided pain relief, and also, a feeling of well being. Euphoric practically. I continued to take them until I was well enough to return to work.

Over the next five years, I would repeat the process over and over. My back would flare up and a prescription would be given. I would receive just enough relief to get by. I once asked my doctor about the risk of addiction. He assured me that addiction was not as common as people thought, and I was at low risk. I told him that I was now having to take double the prescribed dose to get the same amount of relief. His solution was to double my dose to 10mg hydrocodone, and increase the number of tablets a month from 50 to 100.

I noticed within a few months, that when I would stop taking my pain medication, that I would become irritable, get muscle cramps, insomnia, and clammy sweats. I once again questioned my doctor, and he once again, reassured me that I was not becoming an addict. He described the difference between “dependence” and “addiction”, telling me that my body was dependent on the medication, which was a normal experience for someone on pain management. I had my doubts, but at this point, I liked how the drugs made me feel, and he was giving me the green light to continue.

I decided to embark on a new career path at the age of thirty-two. My wife and I had two children, and I wanted to move into an area that would afford me the opportunity for advancement, but also time home with my family. My wife’s mother was a nurse with over thirty years experience, and she loved her job. I admired her dedication and longed for the sense of fulfillment she seemed to enjoy. After talking with my wife, I enrolled in classes and left my job.

While attending school, I managed to land a position at the local hospital working in the operating room, as an OR technician. I was able to observe the surgeons in action, and learn from the nurses. Although less strenuous, I still struggled with back pain. And I continued to take more and more prescription pain medication.

My first position as a Registered Nurse was on a stroke and orthopedic rehabilitation unit. I was so proud of those two letters after my name; RN. I had worked endless hours of clinicals, labs, and classroom work to get those two letters. For the first two years, I was on top of the world. I was good at what I did, and I was happy in my career. And then, one morning as I was getting ready for work, I bent to raise the toilet seat. I felt that horrible, familiar feeling as another disc in my backed slipped.

I spent the next week on the couch with my feet propped up on pillows, taking heavy doses of pain killers. I was not a candidate for surgery, although the pain and damage was significant. I was desperate to get back to the job I loved, and to provide for my family. We had sacrificed so much during the time I was in nursing school. We had no savings, and my wife was a stay at home mother with our, now three, children. I returned to work with a great fear that I would be unable to do the job.

It was within the first week back from my latest injury that I first took pain medication while at work. I justified it by telling myself, “I am doing what I have to in order to provide for my children”. I soon found that my 100 Vicodin tablets were not enough. I was running out within two weeks of filling the prescription. Despite my knowledge as a nurse, I was unable to control the amount I was taking. To me, this was a clear sign. I knew that I was an addict, despite what my doctor said. It was becoming secondary to take the medication for my pain. I was primarily taking it to feel normal, and function at work. I felt energized, clear headed, and motivated while taking pills, and quite the opposite when I ran out.  I asked my doctor for an increase in my prescription. The doctor who was once all to eager to encourage increased doses, now refused. He cited increased pressure from the federal government as a reason for not wanting to go over the current amount. According to him, if he prescribed me more than 120 pills a month, he would land on a list of prescribers that must report to the FDA.

Within a month of using my first Vicodin at work, I diverted my first tablet. Looking back, I am convinced I didn’t intend to do so at that point in time. I remember it very clearly. I pulled two Percocet from the medication dispense machine and proceeded to take them to my patient. I scanned both tablets, poured him a glass of water, and proceeded to complete my pain assessment. The patient then stated he would like to change his mind and only take one tablet. While trying to hide my annoyance, I complied and removed one of the Percocet from the cup and placed it in my pocket, all the while thinking of the trouble it was going to be to rechart all this information. Suddenly, I had a jolt of excitement run through me. Maybe this was a blessing in disguise. I was currently dealing with a nasty case of withdrawals from running out of pain pills a couple days prior. I could take this Percocet and reduce my suffering. The extra pill would only be discarded anyway. I wouldn’t be depriving my patient of pain relief, and I could be a better provider for all of my patients. This was my twisted logic at the time. So I took the tablet, and within minutes my symptoms of withdrawal were gone.

This started a regular cycle of, usage at work, diversion, lies, and deceit that would carry over the next year. I continued to receive my prescription of Vicodin every month, and supplement it with extra doses of patient medication every shift. I came to hate myself. I knew what I was doing was wrong. I knew I was an addict, but I couldn’t stop. And I tried often. I would schedule my shifts to enable me to take eight days off in a row, thinking I could detox while I was off, and be back to normal by the time I had to report to work. But I was never able to last more than a couple of hours. I began to realize that I had done something to my body that now caused it to crave opiates. I knew that, at some point, I would get caught. I knew that my family would be devastated, and I knew I could possibly lose my wife and children. And yet, I still couldn’t stop. I felt a deep feeling of despair. I thought I was at rock bottom. How wrong I was.

To Be Continued in next weeks Entry………………..