In the earlier article entitled “Overcoming Addiction in Residency & Fellowship,” I shared my past struggles with substance use disorder during training, including a relapse during my fellowship, which led to some severe consequences: a career earthquake, if you will. This was my rock bottom. As I write this piece, I am coming up on three years of sobriety, and am so grateful for how much better life is today as a result. My career as a surgeon was not over as it turns out – instead, we’re just getting started. I am a board-certified general surgeon, and am about to start a job that seemed like a faraway fantasy a couple of years ago. I realize now that these opportunities are not possible unless I put my recovery first.

I still see a therapist and psychiatrist regularly, routinely attend 12-step and Caduceus meetings (12-step meetings for physicians) like I did before. I wouldn’t want to discredit any of those things – because they are all important pieces. But there were several things I did differently after my relapse and career earthquake compared to what I had done before, when I was initially introduced to them during my residency training. It can really just be summed up by saying that since March 24, 2021, I have been “all-in.” I wanted to detail the differences that came with being all in as a roadmap for anyone who is struggling with a similar situation.

ONE: ACCEPTANCE / PERSPECTIVE

There are many ways to describe this but to keep it simple: you need to arrive at the conclusion yourself that you have this disease, your life has become unmanageable because of it, despite your best efforts to make it appear otherwise, and that it will not go away until you get help. It’s critical to truly believe it at your core. You could go to the most elite 3-month, physician-only treatment center, have the best therapist/psychiatrist team, and the most supportive family and workplace in the world, but if you have this disease and you don’t go all-in on this acceptance concept (also referred to as “step 1” in the 12-step programs), those things will not be enough. In the past, I had gone through the motions, sometimes spitefully, and did what I was contractually obligated to do in order to accomplish my endgame, which was to keep my career on track (and yes, I can now lightheartedly appreciate the ironic humor of that…). That external motivation might work for a little while, but it is not sustainable – particularly when you find yourself dealing with external stressors beyond your control, which are inevitable in life. 

Despite the genetic predisposition and the now-obvious behavior to suggest otherwise, I still refused to believe I was someone with a substance use disorder. I simply believed that I had made a mistake, lapse in judgment, moment of weakness (or several moments over several months). I still had it stigmatized in my mind; I was in denial and felt a great deal of shame. In my case, it took certain devastating consequences and the demoralization that followed for me to accept this reality. This is not an uncommon phenomenon for individuals with substance use disorder, but it doesn’t have to be this way for everyone. “You can get off the elevator at any floor you want.” In my case, those events allowed me to get to a point where I was open to looking at things differently and regarding myself as an open canvas who was willing to take suggestions. I was able to forgive myself. Everything afterwards seemed attainable because I was willing. 

I had arrived at this part of the process by the time I completed 30 days of inpatient treatment. At that point my external circumstances had not really changed, yet I felt a massive sense of relief and overall faith that I would be ok, regardless of what happened career-wise. And I think that really speaks to the power of this whole acceptance business.

TWO: WORKING A 12-STEP PROGRAM

I know other flavors of programs exist and have been effective for others, but I can only speak to what worked for me. Twelve-step programs are AA, NA, OA, etc (basically “insert your addiction of choice” and add an anonymous, there’s probably a 12-step program for it). I started working with a sponsor shortly after coming home from inpatient – I still have the same one today – and she is such a breath of fresh air. I jokingly call her my “recovery sensei.” I’ve probably given her a few gray hairs since we met, especially at the beginning, but she is one of the most authentic, kind, and patient people I know.

You can’t really go through this step-process without a sponsor or at least a fellow recovery friend you can be honest with. The best ones will be kind and gentle when you need it, but also tell you what you need to hear, even when it’s not what you want to hear. It’s very similar to having a coach, with the 12 step program as their go-to game plan. Many of the steps are just ways of knowing yourself better, connecting with your values, and frankly being a better human. A big part of this is also accepting the help of some entity/power greater than yourself (for me, that’s God, but if you’re not religious there are a whole list of other non faith-based alternatives that have been used successfully). 

One turning point that stands out is that about a third of the way through, you have to list all of your resentments (aka my “shit list”). This was a few months into sobriety, and I was still really angry at that time, so the list was pretty long. While I was definitely at the top, it also included many of the individuals and entities that I was convinced were the villains of my story, or at the very least treated me unfairly- like the medical board, past employers, toxic bosses, etc. You then review everything in detail with your sponsor and then ask, “What was my part in all of this? What fears and character defects played into this?” As evil as some of these “villains” seemed initially, I can tell you that I played a significant part in every one of those things that happened. 

The righteous indignation I felt about the harsh consequences further melted away after my sponsor challenged me: “Well if those bad things had not happened, do you think you would be sober today?” The answer was an easy “No,” I personally needed to have those consequences happen for me to really embrace this whole thing, and it is a firm foundation now. It felt like a huge weight was lifted off once we went through that process, and that was when my narrative changed and I truly believed it. I had become the hero of my own story, rather than the victim. Having lived on both sides, I can say where I am now is a much better and peaceful place. It’s made me better in every aspect of my life. But it is a process, so all of that didn’t happen overnight. It’s also not a linear process, so I sometimes have to go back and repeat a few things, particularly if a new resentment pops up, or I act in a way that I am not proud of (particularly if it hurts someone else). But overall I am much better than I used to be, and I do the best I can. Never underestimate the power of a heartfelt apology or amend when needed.

When I started doing the right things for the right reasons, things started working out, and I am in awe of the amazing turns my life has taken. It hasn’t been all rainbows and unicorns. I’ve also suffered through some difficult life events including being laid off from my first job several months ago, difficulty with the subsequent job search, death and illness of loved ones, and a few others, but I didn’t have to drink or use substances to cope with these events. Instead I now have tools to deal with life on life’s terms. 

I also am so grateful and excited for my latest career opportunity, where I’ll be moving down to Columbia, TN to join Columbia Surgical Partners. I will be working with several bad-ass female surgeons who are also amazing humans – it is a fantastic fit, and such an empowering work culture, what’s not to like? I could not have written a better plot twist myself. You’ll have to tune in to the Boss Business of Surgery podcast next month to hear the full story, but it’s a good one. 

THREE: INPATIENT TREATMENT

In the past, I had only done an intensive outpatient program (aka partial hospitalization program) in terms of addiction-focused treatment while I was living in MA. The PHP had offered a couple of inpatient options as well, but they were all out-of-state and prohibitively expensive. This highlights one cost barrier (among many) that disproportionately burdens students/trainees or early career physicians when engaging with PHPs or medical boards. I would love to see more progress in this space to reduce the financial burden it places on our next generation. 

After I relapsed during fellowship in the Midwest and the medical board became involved, inpatient was required – but fortunately an in-state option existed that was covered by health insurance, which was a relief. Inpatient treatment was definitely helpful! I think the most important thing it gave me was a safe place free of judgment, distractions, and substances where I could just pause and breathe for a second, process everything that happened, and go through all of the necessary emotions that one experiences when undergoing an identity death. Several “anger letters” were written, then burned. I learned a lot more about my disease and the recovery process. 

As I crept out of my shell, I developed very close friendships with several brave women there – some health professionals, some not – all with the same disease, and we each came into that place with our own deep-rooted pain and combination of complex emotions. Despite that, my most cherished memories were the stories we shared with each other, how much we laughed, and just took joy in things that would normally seem mundane. 

Advice for anyone in a similar situation, or that has restrictions on their license:

First things first, get on firm footing with your recovery. This includes your physical, mental, and spiritual health. Once you have taken the courageous steps to get help and address the acute crisis, just breathe…this may affect your career, but the only person who has the power to let it end your career is you. If I can do it, so can you. Pause and take advantage of this “sabbatical” to ensure you know what you want. So many of us get on this high-speed train that is med school, training, etc, and we never stop to question or ensure that the choices we made back when we were younger are still what we want. Perhaps even worse, we never really knew ourselves on a deep level in the first place (raising my hand…). 

Shortly after I returned home from inpatient treatment with some clarity, I had a mini existential crisis. I questioned everything – I had a sense that I lost myself somewhere along the way, where the choices I made were mainly fueled by ego, a false sense of achievement, and external validation. I couldn’t recall exactly when I veered off-track though, and then I got really overwhelmed. Was it just the subspecialty, surgery in general (+/- academia), or earlier – maybe even the decision to go into medicine? That’s when it’s really helpful to have an outside perspective to keep you from going down a rabbit hole. 

I think it was actually my sponsor (not a physician) and my old PD (a surgeon) who each said something to the effect of, “Well if you go back, no one said you couldn’t leave if you decide you’re not happy.” That perhaps the decision might be easier to make once I began practicing again to see if it was true to me. It sounds so simple now – but sometimes we make things more complicated for ourselves than they need to be, and it takes someone else to point that out. Unless you are certain you’re unhappy and this isn’t your calling, I think it’s worth it to get back in there as your healthy self and settle that debate once and for all. 

I decided that being a general surgeon was the best decision for me (rather than pursuing another fellowship), and I am happy with that decision today. Once I was back in practice, I remembered all the genuine reasons I loved being a surgeon, which were slightly different from my original motivations, but more true to me and consequently more sustainable. I am fulfilled, engaged, and consider it a privilege to be able to do this everyday. I consider surgery my vocation, but it is not my entire identity – I am a wife, aspiring sponsor, dog mom, auntie, big sister, daughter, granddaughter, and avid sports fan, to name a few. I also know I have a calling beyond the OR now – which is to help other physicians with similar struggles as myself – whether it’s through writing, sharing of resources, speaking, advocacy work, etc. 

As far as the practical stuff goes, I have a whole list of things I wished I knew that are beyond the scope of this article, though I am more than happy to share with anyone who wants to know more. A general piece of advice is that when you have something like this happen, you need to break down how you get back into very small, manageable steps. If you’re coming off a license suspension, and you happen to be unemployed like I was, focus on getting the license back first. To do that, 

• Notify the necessary entities of the suspension (which is probably a whole article on its own, so we may have to cover this separately) – but it includes DEA, ABS (if you’re certified), etc. Frankly, I was a little disappointed with the advice I received from my attorney about this, as he was counseling me about which agencies I needed to notify – there were a couple of entities I wasn’t even aware of (but he should have been), and those later came back to bite me. Fortunately that was nothing that I couldn’t bounce back from, but it was a source of frustration and stress.
• Complete all the treatment outlined, then get evaluated by three different board-approved psychiatrists to assess my “fitness for duty”, and the appropriate time needed to pass (90 days). 
• File the necessary paperwork to get the license reinstated – which will come with its own list of terms/conditions (such as having a “workplace monitor”, recovery meeting attendance, regular drug tests, etc). 
• Once the license was reinstated, I started applying to jobs, and I was transparent about what happened – better they hear from you than on their own, which they will. Obviously you don’t want to sound rehearsed, but definitely practice telling your narrative to a trusted mentor/advisor etc who has relevant experience. Stick to the facts of what happened, focus on where you are now and how it has made you better. 
• In parallel to job applications, I knew I wanted to move to NH, so I started the whole licensing application process, which comes with its own set of steps to break down.
  • Answer the questions honestly, and have your explanations reviewed by either a health care attorney ($), or see if the PHP in that state would be willing to do that.
    • I can’t speak to every state, but Dr. Molly Rossignol (director of the NH PHP) and her staff are the best! She provided me with very helpful feedback, and also helped me tell my narrative in a more factual manner where I focused on my recovery – and I was able to do the application with her guidance, without a lawyer. She gave me a run-down of the hospitals in NH, particularly which ones are “recovery-friendly” or not. That helped target my job search a bit. When I got laid off from my first job, she was one of the first people I called when I was upset, and she made several calls to try and help me with another position. I haven’t had that type of experience in other states, but the NH PHP is definitely a special group.
  • Regardless of the state, if you already are in a monitoring agreement, be it a board-mandated one or even a confidential/voluntary PHP agreement, in my experience the license process is a lot smoother if you first initiate an agreement with the PHP in the state you are moving to. This also likely helped with my license success in NH, despite being less than a year out from the disciplinary action in the Midwest. The PHPs are well versed in transferring contracts between states, so they will be able to guide you on how to go about this.

That’s just one example. Break it down into manageable steps, make a list, check it twice, don’t do it solo. And don’t forget to breathe…

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