Interview by Frances Mei Hardin, MD

Courtney Barrows McKeown, MD, is a dynamo. She’s everything you would want and expect in a surgeon: confident, articulate, acutely self-aware. Her movements are deft and self-assured. She’s an open book; she’ll tell you what she thinks, where she’s been, and what she’s learned. There’s something else about her, too, that immediately sets her apart from the typical surgeon. It’s humility. 

The first time that I met her, I suppose the very first thing I noticed was that she had gravitas. She could command a room. Didn’t make herself small even though often our society tells women, even female surgeons, to do so. The next thing I noticed, once she started talking about her experiences, was that she had an overwhelming grace in her reflections on training and early career experiences. For most of us it takes years to heal and learn to take stock of the ways in which we played a part in the training experiences or workplace relationships that didn’t go in our favor. Dr. McKeown, in contrast, led with that universal truth. She had an immense gratitude for the things that had broken in her favor, and the people who had been in her corner, yes. But she had reached the level of self-actualization where that gratitude extended even for the things that had not broken in her favor. 

Dr. McKeown was raised in Danvers, MA, as the oldest of four children. She excelled as a student-athlete and held herself to an extremely high standard from a young age. After obtaining a B.S. in Biology from Boston College she went on to spend two years as a research assistant at the Children’s Hospital in Boston, then attended New York Medical College, where she was inducted into Alpha Omega Alpha (Honor Medical Society). When she was a third-year medical student on clinical rotations, she says, “surgery chose [her].” She couldn’t imagine doing anything else. 

She completed her general surgery residency at Beth Israel Deaconess Medical Center in Boston, graduating in 2020, followed by a fellowship in the Midwest.  

When we sat down for this interview, Dr. McKeown made her two objectives clear. First, that this would be a story shared to help anyone who can relate to what she went through, or benefit from her wisdom gained through experience. And second, to publicly acknowledge those who helped her along the way, because she couldn’t have done it alone. 

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PART I. RESIDENCY

I: What was your residency experience like?

C.B.M.: Overall it was great, actually. It was an academic program, graduating nine chiefs annually, which is a relatively larger program size, but very tight knit. Usually residents in our program did at least two years of research during training, and I chose to do three years of research after my PGY3 year. Surgery residency is not easy (nor should it be), but my program struck a good balance between providing excellent training while also being a supportive environment. I loved my co-residents, and many are among my close friends to this day. They have been my closest confidantes and biggest supporters even after training and over the past few years. There was very little one-upping or malignant behavior – that stuff wasn’t really tolerated, and it was rare, regardless of PGY level.  

I: What was your relationship to substance use in residency?

C.B.M.: Looking back, there were warning signs even before medical school; my relationship with substances, especially alcohol, was never really normal. Alcohol was something I used to feel like I fit in, or to numb the feelings of anger, pain. I learned later that addiction does run on both sides of my family, so there is a genetic predisposition in my case.

My mental health issues first became apparent during the research years, which I had initially been looking forward to. I was initially really excited about all of the interesting and flashy research projects that my principal investigator (PI) had assigned to me, but it didn’t take long to realize that it wasn’t a good fit for me. The PI, a surgeon who no longer works at that hospital, was difficult for me to work with. I was assigned to many different projects that weren’t related to one another – some were outcomes and other clinical research, and I was also working in a lab that was relatively new and didn’t have the infrastructure in place yet to be a worthwhile time investment as a surgical resident. Hindsight is 20/20. And in that person’s defense, I didn’t ever say no to anything. 

Instead of realizing what my limitations were, I just kept trying to power through and isolated myself. I started using Adderall to improve my focus, and eventually started increasing to unhealthy doses. The disease process of addiction takes over – all you care about is doing well and you need more of it as you develop a tolerance. It was 2016 when I started using it to theoretically help my performance, but in reality it quickly became counterproductive. 

I: I think many surgeons, me included, can identify with the pressure to excel in residency and the difficulty that we have in saying no to projects or extra opportunities. The fear of letting people down or not living up to our fullest potential can lead down some dark paths. 

Where did that lead next?

C.B.M.: At one point I couldn’t get anything done, though in the moment I thought I was. My sleep cycle was a mess. My PI didn’t know what to do with me. They thought I’d be a rockstar but I was unable to even put a PowerPoint presentation together on time, I was late to meetings … I remember going to a national meeting for a podium presentation, and I had panic attacks in the hotel room beforehand.

I had never had panic disorder or diagnosis of anxiety prior to taking this medication but had several other panic attacks in the following months. I couldn’t sleep when taking it either, so then I was using wine to help fall asleep. The main thing that initially got me into treatment was that I took so much Adderall that I had a psychotic episode in August 2017. I can remember everything that I did and said, and I even remember paranoid delusions that my brain had created at the time – but I had zero control over them, and while they were happening, I was convinced they were real. I was still on research then, fortunately not on clinical rotations. I did call my program director (PD), some other residents, and even a couple of attendings at that time, because a lot of the delusions centered around an imagined plot to get away from the PI. I can only imagine how those phone calls sounded. 

I: How did you end up getting treatment?

C.B.M.: I initially got into a different emergency room in the city after my husband and a friend took me there. I was diagnosed with conversion disorder and sent home. I didn’t tell them I was taking anything – I had burnt my hand a few days earlier when things started going off the rails, so I told them I was there for that. In my delusional thinking I thought that it wouldn’t be safe to let them know about the substance use. 

I: Fair enough, so the ED sent you home with a misdiagnosis. Did things improve? 

C.B.M.: Basically, I hadn’t slept for four days, even though I had stopped the medication by then. But once the episode starts it’s challenging to get out of it without proper treatment and time. The next day my husband took me to another hospital, and I ended up in an inpatient psych hospital for 8 days. 

I: What did people in your residency do to support you, and what was the most helpful? 

C.B.M.: My program director was an incredibly busy surgeon and vice chair as well. I found out later that she did a lot behind the scenes to ensure that no one from the PI’s lab or research group would contact me, and maintained my confidentiality throughout. During that hospitalization she was communicating with my husband to ensure that I was getting help, and to confirm that he had all the paperwork to file FLMA for me so that I’d still get paid while out on leave. The other attendings who I tried to involve in that bizarre delusional plot never questioned me about anything after, other than to check in and make sure I was ok. My co-residents showed up for me in numerous ways, more than I could ever list in a single interview. 

I: That makes a huge difference, having a PD who cared about you as an individual and took the time to make sure you would be covered. What ended up happening with your research PI? 

C.B.M.: I knew that working with the same PI again was not an option – it was not a good fit, and I’m sure that feeling was mutual. About a month or so after getting home from the hospital, I met with my PD. I wasn’t sure what to expect, but it didn’t take long for me to realize that she was in my corner. The moment when I started to feel safe again, was when my PD said, “I’ve already talked to the PI, and you don’t have to work with them again. I’m going to have you work with me for the rest of the year. I am more than happy to have you on some projects so you can publish, but I want you to take care of yourself and get better.” Getting publications was still one of my big concerns at that time, so it was a great reassurance. That’s also when I stopped feeling as much shame about the whole thing. She said, “You can tell me as little or as much as you want, if you don’t want to talk to me about it, then that’s fine.” 

I: It’s incredible that she was able to handle this in a way that re-established psychological safety for you at work. What did you guys end up deciding regarding return to clinical care? 

C.B.M.: I asked her if I could go back to moonlighting during those last ten research months. She was like, “Well, about that, I do need to be sure that you’re ok to go back.” That’s obviously valid! The way she responded was gentle and nonjudgmental. She told me that I’d have to see the Physician Health Program (PHP) for our state and that they’d evaluate me to see if I was safe to return to clinical work. 

I: What happened with the PHP, and did you receive any additional treatment? 

C.B.M.: I never had another panic attack or episode of psychosis. Once I had clarity, I realized that I wanted to focus on my recovery and did some outpatient treatment in a day program. I was not required to do any inpatient treatment at that time, although it was offered to me. Of note, if it’s inpatient, they typically offer places out of state, and I’d heard horror stories about the cost. Especially for early career physicians, resident physicians, medical students… cost poses a huge barrier to treatment. One resident colleague at a different hospital had mandated inpatient treatment (dictated by the board), and they said it was $50,000 for three months out of pocket in 2017. Fortunately, the programs and responses are getting more flexible with time. 

I: When you’re on research your resident salary typically comes from the PI and their grants, etc. When you separated from your PI, how was your salary covered? 

C.B.M.: This is another huge thing that the department did for me that I really appreciated. My PD spoke with our chair, who was also supportive and kind, and he approved for the department to just cover my salary for the remainder of the ten months that I’d be on research. That was something that made it easier for me to not worry about moonlighting or financial security. 

I: I’m so impressed by the compassion and support from your PD and chair. I think it’s also wonderful how you shout them out as major influences who made your journey as smooth as possible when things got choppy. Were there any specific words that stood out to you from those conversations, that you’d recommend to those who are hoping to support others in similar situations?

C.B.M.: My PD told me that as long as I was working with the PHP that I didn’t have to tell her anything I didn’t want to. Eventually, I felt comfortable telling her everything. I thought she would judge me, because you know… drugs are bad, and people who do drugs are bad … and, well, I judged me. 

But she just said something along the lines of, “I can see that you punished yourself for this, but I think it’s time to stop now, forgive yourself, and move forward.” It didn’t even occur to her to judge me about it. Ever since then we’ve been incredibly close and remain in touch to this day.

I: Did you share your story with coresidents at the time? 

C.B.M.: I did choose to disclose what was going on with me to select individuals. I was always pleasantly surprised: no one looked at me funny, and in fact, often they would reply with something they themselves were struggling with at the time. Eventually I stopped being surprised. The culture at my program didn’t make me feel shame about it.

I: I love that. I think a lot of resident physicians are struggling in private and by being honest about your own journey, it emboldens others to do so as well. 

C.B.M.: I wouldn’t find out about urine tests until the day that I would have to go. So, it could be an easy clinic day or a day where I’m in the trauma OR all day. I found that it was easier to tell a few people I was on service with, “by the way, this is the deal, so if I tell you I have to go, then that’s the reason.” This way people knew that I wasn’t flaking out of responsibility if I disappeared for a little bit. I could have probably also just said that I needed to go. 

I: What was the treatment plan during residency? 

C.B.M.: PHP (Physician Health Program) determined that it was substance use that led to psychological sequelae. I entered into a monitoring agreement for the next three years, with two years of residency left. That third and final year would be the year I was in fellowship training.

I: What really is the PHP (Physician Health Program)? We received a few short presentations on this in residency, but not much. 

C.B.M.: The PHP exists in 47 states and DC. These are confidential programs designed for physicians struggling with health issues that have the potential to be impaired if not treated. Commonly it’s for a mental health condition (of which substance use disorder is one), but it could be for a physical health issue too if that has the potential for impairment. Most programs are separate from the medical board, and when possible advocate for therapeutic options rather than disciplinary. Some of the states are more punitive but in general, progress is being made. The programs evaluate physicians to ensure that they’re safe to practice, provide treatment recommendations, and in many cases monitor physicians with substance use disorders. 

This allows the physician to remain in practice if he or she is compliant with the terms. Examples of these terms include remaining abstinent from all mind-altering substances, attending meetings, seeing a therapist with addiction expertise, etc. Part of these contracts include an obligation to report to the medical board if one doesn’t comply – like a positive test, or refusal to participate in recommendations. If you googled me then, you wouldn’t have found anything about what happened during my residency in Boston. There were never any allegations of patient harm, I did not have any run-ins with the law, and I was getting treated and compliant with my program, so nothing needed to be reported to the board.

*Additional information and resources on PHPs can be found at www.fsphp.org.

I: What are you most proud of from your eight years of residency? 

C.B.M.: That’s a hard one. Even though some things, especially on the research side, didn’t go as planned, there’s still so many great memories and moments of pride. I won a teaching award my chief year, which was voted on by coresidents. I love to teach and have a lot more compassion for others because of my experience. I know that sometimes in the past I was guilty of being too hard on people too, and not being open-minded. I had really high expectations of others – if someone was underperforming, there are times I could have been more understanding. Rather than just saying, “oh that person dropped the ball,” WHY were they dropping the ball? If they had gotten to this point in their career (e.g. surgery resident) they’re generally very competent and high achieving. 

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PART II: FELLOWSHIP

I: So, after residency, you went on to a highly competitive fellowship in a new state. What was that transition like?

C.B.M.: I moved to a new city where my husband and I didn’t know anybody. In residency I had a support system, I was there for 8 years, developing relationships, and my parents lived 30 minutes away. I had people who cared about me in residency. For fellowship, I moved to this new place where no one knew me, and I’d only be there for one year …

If you don’t have a great recovery foundation, it can be really hard to go into a new setting. 

I: I can only imagine how jarring that would be. How was fellowship going on a day-to-day basis?

C.B.M.: I did not cope well with the perceived lack of external validation. I started dreading going into work, which was totally new. People have described me as someone who would go skipping into the OR because I loved it so much. Eventually I started using wine to cope with the feelings of being anxious, depressed, and hiding that from my husband. 

After some time one of the tests came back positive (I was not drinking at work, but the tests will pick up alcohol consumption from the past three days or so on a urine test). I remember thinking that this was game over. I knew I wanted help, but I was also terrified, because I knew what all this meant:

When you have a positive test, the PHP is obligated to report that to the medical board. They have to do that, because if they don’t then they wouldn’t have trust from the medical board. 

I: What does it mean, practically speaking, to have the PHP report it to the medical board?

C.B.M.: The state I was in at the time (of note, this has changed recently) defined any physician who had a relapse – workplace related or not – as an impaired physician. And impaired physicians in that state’s medical board regulations, must be disciplined. I talked to an attorney and there wasn’t any way to get out of a suspension or disciplinary restriction on my license. So, I was better off signing a consent agreement. I was placed on immediate medical leave from my fellowship. 

I: I’m so sorry, the process sounds harrowing. It is particularly notable that the regulations have since changed in that state to where the same incident would not be handled in the same manner today. 

C.B.M.: Yes – and that change just happened in the past 6 months. It won’t have any bearing on my case, but I’m glad it will be better for the next generation.

I: I admire your acceptance and lack of bitterness about this. What were the next several days like after that positive test?

C.B.M.: I was terrified and didn’t want to talk to anyone but my attorney, and I called my psychiatrist a few days later. It felt like my world was crashing down, and my reflex was to retreat into a corner (or better yet, disappear) – no fight, just flight response. I was so scared to tell my husband what had happened that I would just leave the house every day (even though I was on medical leave, not working at the hospital) and just come back when I should have been done with work. 

I: What happened to the fellowship?

C.B.M.: Ten days after the positive test, with no communication from my program in between, the GME sent a two-line email that said my fellowship had been terminated because I had violated the substance use policy. I was told that my former attendings were told not to communicate with me, and it’s disappointing that things happened that way. 

At the time when I got that email, that felt like the thing that sealed the deal, that my career was over, and I’d let everyone down. 

I: I am so sorry you felt that way. I understand. What was going through your mind in those days?

C.B.M.: I had never previously thought about hurting myself until that day. In the ten days prior to getting the email that I had been terminated from fellowship, I was googling about physician suicide, daily. There was not helpful stuff online. I could not see a way past this entire thing, and my whole identity was wrapped up in being a high-achieving surgeon. I started looking up what happens to my husband if I’m gone – does he have to pay off all my medical school loans? I thought he’d be better off without me. I thought that if I got a bottle of wine, I’d work up the courage for 60 seconds to really do it. 

I: I am so glad you didn’t. How did you get help?

C.B.M.: I called my psychiatrist, with whom I’d developed a close relationship. He was the only person I told about what had happened. I told him what I’d been thinking, that I didn’t find most suicidal options very appealing, and didn’t want to leave behind a violent mess. I thought I could work up the courage to jump off the top of the parking garage, or there was this bridge I used to pass from one hospital to another that was over a construction site. I thought if I drove my car off that, then I wouldn’t hurt anybody, no one would see me, and I definitely wouldn’t survive the fall. My psychiatrist, clearly concerned about this level of detail and planning, asked to call my husband. 

I was drinking wine in my car which was parked just a quarter mile from my house at the time of our conversation. Ian came and picked me up, and what I remember is me telling him I ruined our lives, my career is over, etc – and he just looked me in the eyes and kept responding with I love you, I love you, I love you. I couldn’t believe that he still did. He brought me home.

I went to treatment three days later. I’m grateful I did. I wouldn’t be where I am now and able to handle things and practice as a surgeon if I hadn’t had that treatment and recovery. The gift of desperation, rock bottom, there’s different names for it. Everybody can get off the elevator at any floor they want.

I: What was treatment like this time?

C.B.M.: In the state I was in, there were board-approved treatment provider options both in and out of state. My in-state option was completely covered by my insurance provider (I had to apply for costly COBRA coverage however once my fellowship was terminated). I spent 30 days there as an inpatient. Treatment duration varies by state, and on a case-by-case basis. The physician-only treatment programs are often 90 days. I was three weeks into inpatient treatment when my license was officially suspended for 90 days, the minimum discipline sentence.

Afterwards, I completed 6 weeks of outpatient therapy in a day program. I then began participation in an aftercare program, which is essentially a moderated support group meeting, weekly for two years. This was in addition to the 12-step recovery meetings I attended, which were a minimum of three per week. Having a sponsor as part of one’s 12-step program is encouraged, but not required – I highly recommend having one to maximize your chances of success. All of these things laid the groundwork for me to get better. While some of it was mandated, my active willingness to take suggestions and put in the internal work was crucial. 

I: I’m so glad you got treatment and time to heal. How important was your support system in getting through that time?

C.B.M.: My heart breaks for anyone in my position who doesn’t think they have someone to call when it all hits the fan, or doesn’t have a loved one to come get them like I did. Ian set aside his own feelings of hurt and disappointment to not only stick by me, but drag me out of that very dark place when I didn’t see a way out. He deserves all the credit for that, and I’m still in awe of the grace he displayed through all of it. 

When the dust settled, there was a lot of trust that needed to be rebuilt, and that doesn’t happen overnight, but he continues to be my biggest supporter. I am also fortunate to come from a close-knit family and have maintained close long-term friendships over the years – they all helped support me in their own ways throughout this process. One of the many perks of working a real recovery program this time around was the extra support system received there as well. It was a privilege to connect with people who struggled with similar disease and found their way to the other side – I don’t think I’ve laughed as much in my whole life as I have in these past two years, so we’re far from a glum lot!

I: Beautifully said. What things did you do or handle differently in recovery this second go-around?

C.B.M.: There were several things I did differently than I had before.

1. Acceptance/perspective. You need to arrive at the conclusion yourself that this is a problem. In the past I had gone through the motions to keep working. I didn’t think I was an addict, I still had it stigmatized in my mind. It finally came to a point where I was open to looking at things differently and regarding myself as an open canvas. The rest came a lot easier afterwards because I was willing.
2. Inpatient treatment was necessary for me. 12 steps worked for me. Many of them are ways of knowing yourself better. In the middle of the steps, you have to list all these resentments (my list was pretty long) and I was at the top of it. There were also all these individuals and entities, including the medical board. You go through the list with your sponsor and ask, well what was my part and contribution to these? As evil as the supposed villains in my story sounded at first, I had a part in every one of those things that happened. It felt like a huge weight lifted off once we went through that process, and that was a turning point where I started to feel like the hero of my story rather than the victim. But it is a process, so it didn’t happen overnight. 
3. Got a sponsor. I still have the same one today. 

When you start doing the right things, things start working out. 

I: That’s very true. What advice do you have for anyone who’s in a similar situation and faced restrictions on a medical license?

C.B.M.: When you have something like this happen, you need to break down how you get back into very small, manageable steps. It’s not just ‘how am I going to be a surgeon again.’ Instead, it’s ‘how do you get the medical license back.’ I needed to complete all the treatment outlined, then get evaluated by three different psychiatrists, and the appropriate time needed to pass (90 days). Break it down into manageable steps.

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PART III: ATTENDING

I: Once you had your license reinstated, what happened next? 

C.B.M.: By the time my license was reinstated, I had done enough self-reflection to know that I did not want to pursue the subspecialty that I went to fellowship for. The new plan was to get a job as a general surgeon, and my husband and I both wanted to move back to New England. New Hampshire checked a lot of boxes for both of us. I met a physician friend from New Hampshire in a recovery meeting who was in a position to mentor me through the licensing process and make sure I had the necessary resources in place to succeed, both from a sobriety and professional standpoint. That process went very smoothly.

I applied for jobs, got a few interviews, and eventually accepted an offer at a community hospital in southern New Hampshire. I had been very transparent about everything during my interview process, and that place greeted me with open arms. It was a huge relief to work somewhere and not feel like I had to hide things or feel ashamed of them. 

I: That’s wonderful! 

C.B.M.: It was a good first job, particularly for someone fresh out of training. My partner was really supportive and never made me feel less-than for calling for help, and in fact encouraged it. Things had been going well for me clinically and otherwise, but unfortunately there was a lot of financial restructuring and budget cuts at the hospital, along with service lines being cut that hurt our referral base. The hospital and its staff were wonderful, but it was owned by one of the large for-profit healthcare corporations. So, a little under one year into my practice, I was laid off, along with several other physicians at the institution. 

I: I can’t imagine what that was like, when you were in a good groove and felt like it was finally a happy ending!

C.B.M.: The first thing I did when I got home was tell my husband, and we spent the night together. The next day I called both my sponsor and the director of the PHP in the state as someone who had shown me a lot of support, because she truly cares about its participants and is a major reason why that state’s program is so strong. This was definitely the first time that the state PHP director was on my “phone a friend” list when something like this happened. I don’t even remember what she said anymore, but whatever she said made me feel better by the time the call ended. 

This speaks to why it’s so important to have a good foundation for sobriety and mental health in general. At that point I’d been sober for nearly two years, and of course it was a devastating event at first. But I had done the work, so I was able to take a very devastating situation where it felt like the rug was pulled out from under me, and handle it in a healthy manner. I didn’t resort to maladaptive behaviors. To do so, you need to have support, and people who trust and love you. 

Hopefully everyone has someone they can call. And if they don’t, they can call me.

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PART 4. FINAL THOUGHTS

I: Do you have any favorite quotes at the moment?

C.B.M.: “When the student is ready, the teacher will appear.” – Lao Tzu

“Do the best you can until you know better. Then when you know better, do better.” – Maya Angelou

“I know today that if I cannot change the wind, I can adjust my sail.” – Anonymous 

I: What are you most excited about in your career moving forward?

C.B.M.: This! I’ve always been transparent about my journey when I had to be, but now, the cat’s out of the bag – anyone can google me and find out about these events. I’m the best qualified person to tell my story. This is my first time discussing my journey in a public forum and I’m doing it for other physicians. I’ve felt pulled for a while now to turn all the pain and shame into a gift for other people – specifically, any physicians or surgeons who are feeling the same way that I did. I want to get people off their islands. You can eventually start making changes when you connect with other people who can relate to you, and change happens when people feel safe. You have to get your own house in order first. I’m excited about how that will look in the future and am still spitballing ideas at this point. I’m passionate about my practice as a surgeon and being able to care for my patients while advocating for physicians.  

I’ll delve more into the job search and transition period in my upcoming podcast. Thankfully, there has been a very positive plot development, which I couldn’t have seen coming, and am so excited for.

https://npsaday.org/toolkit/

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Dr. McKeown is thriving and just shy of 3 years sober.

She is moving with her husband and dog to start her new job as a general surgeon in TN.

Dr. McKeown will be sharing more of her story on the Boss Business of Surgery podcast in early 2024.