Physician Learns to Heal Himself

Mr. Gambini was an alcoholic I treated three times during my internship in internal medicine in the early 1970s.

Each time he was admitted with increasingly severe cirrhosis and life-threatening esophageal bleeding, and each time he was saved with all of the heroic measures available. His wife and two teen-age daughters would always be at his side or in the waiting room, praying.

During his third admission, two residents, a medical student and I worked over him all night and most of the next day before he stabilized. Sometime during the night, still stuporous, Mr. Gambini pulled his intravenous line out. As I attempted to put it back in, I said to the medical student: “I don’t know why this guy just doesn’t put a gun to his head. He’d be putting himself and his family out of a lot of misery. He just won’t stop drinking.”

Ten days later I discharged him with the same admonition: “You have to stop drinking. You’re dying.” I never told him how he was supposed to stop drinking. I probably didn’t know.

A week later Mr. Gambini was admitted again. This time to the morgue. He had put the barrel of a rifle in his mouth and pulled the trigger. I felt only a little remorse.

At the end of my internship year, I left internal medicine because I didn’t like working with the self-inflicted diseases of adults--the obese patients, the “chronic lungers” who wouldn’t stop smoking, the alcoholics and the drug addicts. I entered a residency in pediatrics, a specialty with “pure” disease to deal with.

But I was taking too many pills myself. Pills to get me to sleep. Pills to wake me up. Pills to calm me during those stressful days.

I learned in my preclinical years in medical school what everyone else learned--biochemistry, anatomy, physiology, histology, pathology and pharmacology. But I wasn’t taught any non-chemical coping skills for dealing with stress. None of my professors even said to me: “Learn how to take care of yourself. If you’re not healthy, you’re of no use to anyone.”

My addiction began during my first year in medical school when a psychiatrist put me on Valium to help me cope with the stress. Valium worked. It helped me to sleep. It helped me to concentrate when I was studying. It reduced the anxiety for me around examination time.

At the end of my first year, I tried to stop taking Valium, but then I would get anxious and restless and I couldn’t sleep.

I didn’t understand that I was addicted to it. I continued to take Valium and between 1966 and 1979 it was my constant companion, my best friend, my worst enemy.

During my second year of medical school I was taking increasing amounts of Valium. I began taking sleeping pills. A fellow medical student turned me on to marijuana. Soon I was on the street buying marijuana and smoking it daily. I liked the feeling of contentment and joy out of proportion to reality. Those feelings, I found, were more intense and lasted longer if I drank alcohol when I smoked pot.

I know now that when I graduated from medical school in 1970, I was certifiably a drug addict and in the early stages of alcoholism. I remember walking into a pharmacy soon after I received my medical degree and experiencing almost orgasmic excitement knowing that I could have any of the drugs that were on the shelves.

In the next few years I tried every mood-altering chemical that I could put in my mouth--Miltown, Tranxene, Ativan, Equagesic, Doriden, Noctec, Seconal, Librium, Pacidyl, Dalmane, Quaaludes, Valmid, alcohol and, my drug of choice, Valium.

I finished my residency in pediatrics and passed my written and oral boards within the next two years. I soon learned, however, that being a pediatrician was interfering with my life as a drug addict. I left pediatrics and went into the public health field, where there were no night calls or weekend work and I was less likely to make any life-threatening mistakes with patients.

The mind protects itself from unpleasant self-scrutiny. I could not, would not, think of myself as a drug addict. Drug addiction is something that happens to other people.

Those are the ones who show up in emergency rooms with needle tracks in their arms, jaundiced from hepatitis or fevered and weak with bacterial endocarditis. I wasn’t one of them.

I saw two psychiatrists at different times for depression. I told each of them during the course of therapy that I thought I was taking too many drugs. The first psychiatrist said, “You’re taking too many drugs because you’re depressed. I’ll have to treat your depression before we can get you off drugs.” He put me on Mellaril and Tofranil.

The second psychiatrist said, “You’re depressed because you have too many unresolved conflicts. We need to talk about these. Cut down on those other drugs you’re taking.” He put me on Elavil.

Surely, they would have told me if I were a drug addict.

In 1978, after 12 years of abusing drugs and alcohol, I began having periods of drug-induced amnesia--blackouts. I would have to see movies a second time. I went on a week’s vacation to Tampa, Fla., and remember nothing of the entire trip. I forgot appointments.

Although I wasn’t afraid of dying, the thought that I was damaging my brain terrified me.

In 1979 I entered a drug and alcohol treatment hospital. The medical director, after doing my history and physical, told me, “You’re a very sick man. It’s only by the grace of God that you’re not dead.”

But I still had some misplaced arrogance, and I was a reluctant patient.

I wanted special treatment because I was a physician. I didn’t see myself as being as sick as the other patients.

During my withdrawal from drugs and alcohol I had seizures, experienced agitated depression, and later, hallucinated. My arrogance and my denial began dissolving. I was in group therapy daily with other alcoholics and drug addicts. They told me that, although I was an impaired physician, I was primarily an impaired person. They showed me that I was just a run-of-the-mill, garden variety drug addict and alcoholic. They told me that if I wanted to get well I had to do the same things they did.

Finally, I believed them.

During my two-month hospitalization I was introduced to other physicians who were recovering alcoholics and drug addicts. These recovering physicians appeared emotionally well and seemed to have a serenity and joy I had never experienced. I wanted what they had.

Since my discharge from the hospital 15 years ago, I have maintained my sobriety. In a miraculous way, appreciated only by me and my family, I have been given my life back.

There was someone once who needed my help, and I treated him with disdain. Indeed, I may have indirectly caused his death because of my ignorance and judgmental attitude.

Mr. Gambini, wherever you are, I’m sorry.