I walked up to the room and peered in the open door. Within the room, between two flimsy partitions, there was an array of chairs in a horseshoe shape. The room was bathed in fluorescent lighting raining upon the generic hotel conference room chairs and tan carpet. Two men who clearly knew each other well were loudly discussing something, the closest was a loud, obese man with a booming voice and a southern accent. They were at least twenty years my elder and were quite comfortable there. I felt like an alien presence.
I dreaded my inevitably awkward entrance and contemplated skipping this meeting. Instead I walked into the room, poured myself a cup of coffee, and sat down opposite the two men. They introduced themselves and we shook hands. We exchanged small talk about flying for a while and I started to feel like I belonged.
The discussion veered into the realm of flight physicals as this physician shared his story of difficulty obtaining his medical certificate as a pilot after his addiction treatment. Assuming that I was also in recovery he stated, "as you probably know" in reference to flight physical difficulties. I immediately felt like an outsider as if I were attempting to blend in. Not wanting to offend him, I clarified that I didn't have addiction issues of my own. At this time, the seats were filling up with others for the meeting.
After further small talk, the meeting was called to order. The facilitator lead us in the serenity prayer,
God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
The speaker was an older physician who had spoken in some of our meetings the previous day. A very kind and caring man, he clearly had compassion for others who were struggling with addiction. He shared his story of dealing with addiction in his life. The addiction was not his own but those of his family and he found Al-anon to help him cope at a time where his life felt out of control. He spoke about his gratitude with their sobriety and for the support that he has received.
Another physician discussed his addiction. With the help of providers who subsequently became his colleagues, he was sober and helping others in addiction medicine. His son fell into the same trap as him and he has managed to find sobriety despite his genetic disadvantage for which this man carried some guilt.
After each share, the group would thank the speaker. After some silence, another speaker would introduce themselves followed by the ritual, “Hi, ____!” It struck me how the ritual gave many comfort at a time where their lives had no order. There were others like myself who were observers at that meeting. Nevertheless, most of us spoke at some point about how addiction had touched our lives. Some lost family members and attempted to share through tears and sobs. Many explained how their loss or their family member’s struggle motivated them to help others.
This was the second day of the conference that I attended, the California Society for Addiction Medicine Review Course. Attending were over 850 physicians, physicians’ assistants, nurse practitioners, and therapists who practiced addiction medicine to some extent. The first thing that caught my attention were the name badges when I picked my registration packet. “Greg” it stated in large, bold letters, with “Greg Greenberg, MD” much smaller underneath. It might surprise you to know that physicians are pretty narcissistic and I found this act of humility to be refreshing.
I attended the meeting through a scholarship from the Medical Education and Research Fund (MERF) which sounded a lot like smurf to me. I knew I would have a merfy time. Our badges should have been blue. As part of this scholarship, we had early morning meetings, lunch meetings, and dinner meetings throughout the conference. This was designed so that we could share our experiences, learn from each other, and have a support network for difficult problems that arise in the treatment of addiction. What I did not expect was the amazing group of people from whom I am learning to be a better physician.
Most conferences that I attend are in emergency medicine. That field carries the highest burnout of any specialty and as one would imagine, many of those who attend are adrenaline junkies, cowboys, and crusty. Juxtaposed against those in addiction medicine is a sharp contrast. Many of those who were teaching us at this conference have been in addiction medicine for decades. Everybody was positive, enthusiastic, supportive and incredibly excited about what they could do for their patients. I was expecting everyone to hold hands and sing Kumbaya at any moment. I wasn’t sure if we were going to leave in Priuses or old Volkswagen Beetles. When one of us spoke, they thanked us for sharing. What kind of doctor thanks another doctor for sharing? Surely I must have entered the Twilight Zone with a sprinkling of Ecstacy.
Treating addiction is very difficult. The patients are going through horrible times in their lives, often early in recovery they will take it out on their treating providers, and people who are struggling with addiction are often not very nice to those around them. Nevertheless, everybody at this conference was so positive, so excited, and everything we learned was an opportunity to bring that knowledge back to their practice and help people. We had residents, psychiatrists, allied health providers who were all part of the team contributing what they could to help our patients.
At the meetings and the lectures, there were no discussions about how to protect yourself from law suits. Not once did anyone complain about salaries or not being paid enough. There many discussions about advocacy. Advocacy for our patients, not for us. There was a lot of discussion about the growing opioid epidemic and concerns about our politicians doing what is right for those who need treatment. In a room of so many health care providers, the focus was clearly on helping as many people treat addiction as possible.
One of my workshops was on motivational interviewing. Apparently, my usual approach of “stop using meth or you’ll die,” may not be the most effective approach. We learned how to partner with our patients, show them that we care, and let them tell us what they want to change. Each table had a facilitator and every one of them had an amazing amount of energy and excitement about what we were doing. They clearly wanted to help us learn so we could find a way to help patients steer clear of bad habits. My facilitator, Ladonna, could best be described as having the enthusiasm of Mary Poppins, the skill of Marcus Welby, and the patience of a kindergarten teacher. Our instructor, Ken, was one of the most kind, gentle, and supportive physicians I’ve had the pleasure of learning from. The emergency department would eat him alive! In our discussions, many of us lamented patients who we lost, hoping we could learn from that experience to try not to repeat it. We all have some element of guilt. Although it was the patients' actions that resulted in their death, we still grieve for the loss of a human being who we could not save from addiction.
I’m writing this column after returning from a reception for us to meet and talk. We talked with other people treating addiction in the hopes of learning something to improve our own practice. I received advice from some of the founders of addiction medicine and gave advice to others who wanted to know my experience with implementing an addiction medicine program. You could feel the excitement in the room. I even forgot that we were talking about the “junkies” and “addicts” that “choose” their disease in Redding. Because in fact, that’s not what they are. They are human beings who are fighting the most difficult fight of their lives, and I was in a room full of people who will do what they can to help those who the rest of society shuns.
At my table sat six clinicians from Redding. One was a physician from Shasta Community Health Center who advocates for the homeless, whose dedication is amazing. Another who has dedicated her career to helping those battling addiction, especially pregnant women. We even had a resident in Family Medicine with a big heart who wants to help our community. We had a physician and physician assistant from Hill Country; both very dedicated and compassionate. Last and probably least was me, making the metamorphosis from burnt out emergency physician to compassionate addiction medicine specialist. All six of us are fully committed to helping Redding with its problem with addiction without asking, “What’s in it for me?” There are many others in Redding who are dedicated to helping as many people as possible. I am committed to continue my practice in addiction medicine even though it pays much less than my work in emergency medicine.
I now have a different view of addiction medicine. The science and the medicine has not changed. The people who are practicing addiction medicine are truly remarkable. Many are motivated by their own struggle with addiction or that of a loved one. Many others are motivated because that is where they feel that they can do the most good. I feel privileged to be a part of a truly amazing group of people who are so dedicated to helping others. I am motivated by their amazingly positive approach to a condition that society views as very negative. I am inspired by what amazing clinicians and human beings have chosen the calling of addiction medicine and I hope that I can proudly follow in their footsteps.