You are Not Alone – Nurses and Addiction
Amy Taylor, RN
Before everything happened to me, people would ask, “Who are you?” My first and strongest response was, “I’m a nurse.” Those three words put me into a category of trust, compassion, intelligence and admiration. A true stereotypic belief system, but I loved that feeling. I was the nurse who always wanted to be one. From the moment I started as a nurse’s aide until I was a manager in Intensive Care, I was a dedicated nurse. I loved my patients as if they were my own family.
In 1986, I eagerly entered into a prestigious nursing school. As I worked away, I reveled in every moment of learning about people. I was elected president of my nursing class and held that position until graduation day. After graduation, I took a full-time night position in the Intensive Care Unit of a local hospital. I loved the challenge and knew that the high tech, high stress environment would strengthen my love for learning.
The pace and challenge of Intensive Care felt natural to me. I liked knowing that my peers considered me knowledgeable, just for being a part of that department. I cared a lot about what others thought of me. I think I still do. The desire to please everyone was one of the reasons that I overextended myself many times.
As a new nurse, I absorbed the reaction to addicted people in Intensive Care. Nurses viewed these patients as a “problem” and would mention the word “addict” frequently when reporting on an admitted addict from shift to shift. Their other diagnoses, such as high blood pressure or a heart condition would rate a one-time mention at best. I think that the “addict” label enabled nurses to put a screen between “them” and “us.”
Once, a nurse who had just been released from drug rehabilitation, started back to work in the adjoining unit called Neuro Intensive Care. The gossip among the staff was terrible. Everyone pointed fingers and whispered about her. I joined in. No one reached out to support her, as we all saw the differences and not the similarities between us. She was alone, ostracized by her peers. Everyone kept a safe distance as if addiction were contagious or could be transferred by simple association. After she left our unit, she left nursing altogether.
And then I became an addict, and I accepted the stereotype of an addict. I felt I personified the media’s image of a person wasting away on drugs in the gutter alone and without goals or a job. I was the outcast in my mind, dirty, unkempt, a person who was a societal problem. It was the polar opposite of what I was. I felt alone, humiliated and lost.
During the time that my addiction began to grow, I had undergone a hysterectomy and was taking Vicodin for pain. Due to monetary constraints, I returned to work earlier than I should have and started to divert medications when I didn’t have anything of my own available. I would rationalize that I had the prescription anyway, so it didn’t matter that I was using our stock medications.
I imagined that I would see “problem drug use” as though it were a big white line in the center of the road. After all, I was a nurse; I knew what I was doing. I assured myself that if I ever got close to that line, I would turn back. Even as the addiction grew, I believed I would stop. Alas, after six months, I had to face that there was no line, and even if there were, it is so blurred that crossing it is easy and unstoppable.
When Vicodin wasn’t working anymore, I started using Demerol by intramuscular injection. I was making mistakes and my duties took longer than usual. Thank God, I never harmed a patient. By this time, I was telling myself that because I wasn’t using intravenously, I still wasn’t an addict. I no longer used medications to relieve physical pain, but to release of the pressures I was under. I can’t explain how the euphoria the drugs provided had changed to a feeling of being “normal.” I felt as if everyone were handling life better than I was, and the world started to become overwhelming.
I imagine I had a sensation similar to that of pre-panic attacks. If I took the drugs, the knots in my stomach went away, and the overwhelming feeling would give way to a sense of calm and reassurance. If anyone knew how lost I was getting as my addiction grew, they never let on. My drug use veiled my problems so that no one else would be aware unless I told them personally.
But I was becoming forgetful. I felt the need to sleep all the time. As soon as I would get my hands on the stock medication, I knew I could no longer resist the urge to start using. I would stand in the bathroom with a syringe in my hand and wonder if I could wait a bit longer. The intervals had become minutes between doses. My tolerance to drugs was climbing.
Once I was in the bathroom, something inside would remind me that I could no longer function without drugs in my system-so I would use in order to be able to move on. Demerol gave way to Morphine because I was afraid of getting caught by diverting too much Demerol. Suspicions on the part of the staff were growing, and I heard rumors that a nurse down the hall who was taking drugs got caught that week. I ached to know what had happened to her, but other than bitter gossip, I only heard that she was gone. Would I be next? It didn’t matter. I couldn’t stop.
The end came in two stages. The first wave of disbelief came after my manager sat me down to ask if I had anything I wanted to say about possible drug use. I stuck to my denial and was sent home that day “to think about it.” The department manager made references to my surgeries, illnesses and attendance. Quiet statements were made for me alone to hear. Under her breath she said she knew I had been diverting but didn’t have enough evidence to prove it yet. She informed me that she would send me to the EAP (Employee Assistance Person).
She tried desperately to save me, but I was not ready to let anyone in. There was no time to wait, and no more false answers were needed. This approach was going to get done THEIR way.
MY identity was taken that day and it hurt as if someone had physically torn my heart out. I left work to tell my husband, Jim. I had first planned to lie, to try to take the blame off myself. But the evidence was too damning. I knew once I mentioned a suspicion of drugs he would finally have a reasonable explanation for my recent erratic behavior. Humiliated and ashamed, I entered my house that night. My husband was sympathetic, and confirmed that he had considered drug use long before this confession. I cried and avoided direct eye contact. “My boss thinks I’m taking drugs from work. They want me to go to treatment and through their program. I’m sorry. I am so sorry.” My voice trailed off into sobs. I still couldn’t say the word aloud of what I had done.
“As long as you get paid then we’ll be okay. You should take the time off. Take time to get yourself together,” Jim’s denial was strong. He couldn’t admit now that his wife, who he was so proud of, could be a drug addict. He focused on the concrete facts that he could rationalize in this moment of crisis.
“There will be no money Jim. I can’t return to work until I do what they say. If I admit to this, I can go to treatment then come back to work. My license won’t be reported to the state.” I went on, “This is the only way to protect my career.”
Jim sat in silence for a long time. He began to cry. There were so many financial problems looming over us already. In the previous year, I had undergone multiple surgeries, a high-risk pregnancy and many other medical complications that had caused me to use up all my paid time off. Many of our bills were still unpaid. We were already facing foreclosure on our house and repossession of a car. We brainstormed late into the night to try to find a way to make everything work out.
Neither of us understood much about addiction and its associated risks. It seemed like a short-term problem that would pass if we went along with the hospital’s proposal.
We concluded that my taking time off wasn’t a viable option at this time.
I did something I thought would help. I signed up for a nursing agency without telling anyone at the hospital. I planned that I could schedule myself around rehabilitation and counseling appointments. I swore to myself that no one would know that I was still working. I stayed on rotating shifts in the intensive care units. I didn’t know that these were two of the most dangerous environments for an addicted nurse.
Back at rehab, the counselors were telling me over and over not to work, but to concentrate on recovery. They insisted that putting an acutely addicted nurse back into the “narcotic box” has the same logic as putting an alcoholic behind the bar. But I believed I could play the game and “get through” treatment while working.
I lasted a few months on the job, but the rate I was using drugs was skyrocketing because of the increased stress surrounding me. I believed my addiction safely put protective walls around me. I had learned to avoid all the overwhelming feelings by using drugs. Within six months, I was caught by the police for diversion of narcotics from the hospital the agency had sent me to. Now there would be no more denial; I was in more trouble than I had ever believed. I was ashamed, humiliated and desperately looking for something to fix what I had done to my life. I wanted it to be a big mistake that would go away.
Stepping away from reality into my own world with the drugs had become my strongest coping mechanism. I had no idea how to undo the mess I was in. This time, because I was caught diverting narcotics again, both hospitals reported my license to the Illinois Department of Professional Regulation. I had to start dealing with the State Board of Nursing and the criminal justice system.
I searched the Internet for something I could use as a guide to what lie ahead. I needed to know about discipline on my license, hearings at the court and the Illinois Department of Professional Regulation, reentering my nursing practice and beginning a new life. To my disbelief I found I had nowhere to turn. I vowed I would find a way someday to fill this void by writing something to allay the fears that were running through my head.
I reentered the profession after eight months of focusing on recovery. After almost three years of nursing duty, I had managed to regain a strong reputation and a clean record at the hospital. I was back in Intensive Care and working rotation shifts.
Then, a new injury and an unexpected disclosure of my past to my coworkers pulled me back to my reality. Many of my colleagues were virtuous and judgmental toward me. I felt alone again. I had been placed back on Vicodin for the injury and the cycle of addiction and avoidance returned with a vengeance.
I never thought I would be the one to relapse. Using the medication for pain turned to self-medication to avoid feeling the anguish of the rejection of my peers. I didn’t realize that a part of me would always be an addict. Someone explained to me that addiction was like a sleeping tiger; it continues to grow and grow during the time that the addict isn’t using, getting stronger and more dangerous every day.
Its strength during my relapse was stronger than it was when I had used drugs before. I was caught diverting Demerol again. I sat before a row of administration from my department and the pharmacy, preparing to defend myself against a pile of evidence that documented my return to drugs.
I chose to walk away from the confrontation. I knew what I had done, and now I would be responsible and face it. I resigned the position I was working in SICU. I felt like a failure, and continued to blame myself for falling into the same situation.
Writing and
healing
I was ready to put nursing away forever until I received an e-mail from a nurse in reference to a book I had written. Almost five years after I had posted a statement on a nursing forum that I was going to write a book about the process addicted nurses go through, I received a message from a nurse who was looking for the book. The pain of relapse still stung with sharpness. I wondered if I was ready to attempt this project. I was afraid that I would inevitably fail again. In the past I tried to prove I could overcome addiction and succeed. At this moment, I wondered if I ever could. Reluctantly I started writing. This time, I was better prepared, with renewed energy and a much wider knowledge base.
After recovery, I didn’t have an answer when people asked, “Who are you?” Everything that I would choose as an answer seemed long gone. I used to be a nurse, used to be a mentor, used to feel smart and used to feel I could make a difference. I had to re-enter rehabilitation as a shell of who I once was. No longer could I make excuses for my bad behavior or for why I was there in the first place.
Now, I had to see the similarities and not the differences between myself and the others in the room. This showed me that I was ready to work the program. At first I did not like having to share so much personal information with strangers, but as I shared, I began to reconstruct myself.
I had to return to the hospital (the one I had worked in prior to going to treatment). Everyone stared and people who knew me refused to talk to me. As anticipated, I felt alone and humiliated. Then, a girl I had only met moments before in group therapy was at my side. Seein my distraught expression, she placed her arm on mine. “Stare at me like we’re talking.” She said as she shuffled me through the building making continuous small talk to distract me. Once outside, in the hot sun, I cried in her arms.
My faltering esteem crumbled. Eleven years of nursing turned to ashes at my feet. The girl comforted me, saying “if everything you thought you had in nursing turned to ash so fast, then it wasn’t part of the enduring substance you thought it was.” She continued to stand with me until I regained my composure.
As her comment sunk in, I began to realize that she was right. I was more than an addict or a nurse. I was a person. I had to let other nurses know that this wasn’t the end. What I would learn from that day forward proved to be the most powerful of the lessons. My book will hopefully provide answers to those who are seeking them, along with the strength to prevail. I found out that hurdles can lead you to a bigger, unexpected destiny if you let them.
As Sigmund Freud said, “What we do not resolve we repeat.” This knowledge is essential to those who are choosing to change their addictive situation into a learning opportunity. Although I want to say that there are several aspects of my journey I would loathe to repeat, I cherish what I have learned through their resolution.
So when people ask me, “Who are you?” I don’t refer to titles or stereotypes anymore. I say, “I am Amy.”
Amy Taylor, RN is the author of Before During
and After: A Nursing Handbook for Substance Abuse, a book about drug
addiction and recovery. Copies of the book may be obtained from International
Medical Publishing, Inc. PO Box 479, McLean, VA 22101 Phone (703) 356-2037 Amy
may be reached through the publisher at www.internationalmedicalpublishing.com