by Dr. Michael Miller

Patients, fellow nurses, even many may docs knew that he was a very good nurse who cared. Of course, not perfect as his supervisors fretted after every visit because his documentation was haphazard at best and nonexistent at worse. But patients loved him, each one waiting expectantly in their homes for this caring ray of nursing sunshine. I am confident the status update phone calls made to other physicians were as informative and clinical as were mine, but he exuded a warm boyishness that was appealing. Yes, there was evidence that something was not quite right. Yes, the documentation may have been a clue, the fact he needed to change jobs every few months, but his reputation as a caring, hard working nurse was never tarnished.

When an opportunity arose to move to health care programming in the home setting, he dove in headfirst with all the exuberance and passion he could muster. But the program oversight mentor manager was unable to demonstrate the skills and honesty my friend craved. Another other life lesson punishing his spirit, he returned home. He briefly worked as a nurse for the only remaining opportunity based on his documentation legacy, a care agency whose practices left him more disillusioned and depressed. Unexplained (or poorly explained) encounters with law enforcement resulted in lawyer fees but nothing rose to the level of permanent damage to that most important to him, his license to care.

We connected off and on for the next few years until I received a text asking me to meet with him, that he had a “need to talk." The 30-minute face-to-face meeting unrolled a long history of substance abuse, heroin, narcotics, other substances he had used for years to assuage his pain of depression and failure when hoped-for panacea antidepressants failed to change his fates.

He asked me to help him with his addictions, noting that he had tried many types of treatments before with some success, albeit limited. Eventually, another blast of reality forced him to swallow or snort his way to relief. He acknowledged he had to have help as he recognized he was ruining his life and that of his family. Like most who live this kind of double life, he had successfully hidden this from them for years until a chance finding of information from an addiction treatment scenario led to his admission of problems. 

Of course, the insurance was poorly chosen, insufficient and hard to navigate, but ultimately, he entered our program. The initial drug screen showed the facts of his two days prior and the pain of his withdrawal was palpable. The recommended treatment program was actually excitedly accepted, mental health appointments were made and he left feeling that he might make it. His accompanying family expressed gratitude that he had found someone to trust and, moreover, had taken advantage of the opportunity.

A text from him a few days later improved my day by telling me he was doing well. The treatments – both medication and counseling – were helping. Meeting attendance was underway and I succumbed to the notion that he might finally have crossed back over to sobriety with some longevity. He was going forward in recreating his life and I had been allowed to participate, a sobering honor.

A few nights later, my physician associate texted me regarding a message from a care agency in another county. They wanted him to know that one of their former nurses that had worked with us had died. He could not remember the name but just some extrinsic minutia, like that the nurse made guitars, was a musician and had worked in Indy. The text ended with the addition that the nurse had a drug problem and my associate was told he had sought care in our program but no one was sure if he got to us for help.

At 11 pm at night, I read that text, but sleep was first on my mind and so I headed to bed. The next morning, another text provided the misspelled name of my nurse-patient-friend as the victim of fate's cruel joke. A late message from the family left the evening before at the office confirmed the truth. Having told the owner of his crash pad that he had a dinner date, he headed to the bathroom on the floor below to enter eternity, and was found a day later.

With each encounter I have with those hoping to reclaim their lives and dignity from this spoiled fruit of the poppy or a bottle of courage, I struggle to understand how each individual differs in how they deal with life, stress, relationships, the good, the bad, and the unknown. I have no answer nor do I ever expect to as even if I think I am getting close, another crack appears in my protective wall. This pervasive addiction crisis will touch someone near and/or dear to us and probably already has, even if you aren’t aware now. Heath care workers like my friend have no immunity to any of the obstacles thrust upon us abruptly or insidiously that overthrow our consciences.

I ponder how to recognize when someone is in real trouble, more when the slightest of clues appears. These fine defects in a veneer of competence and veracity that are a telltale sign something is amiss. But I, like my friend, am human, and so the desire to trust fellow health care workers, my friends, my colleagues seems to be a desperately needed life preserver that gets harder and harder to cling to. The best anyone can do is to trust yourself and hope that is enough to start the rest of the process of helping others.

This epidemic and all the proposed cures depend on one thing: the individual's ability to help themselves. You cannot legislate stupidity nor mandate people accept the help they seek and then swerve away from at the last second. At its most basic, the determination of how we live and die seems to be impacted mostly by fate, the wrong person at the wrong place at the right time for what becomes the inevitable. Articles and news stores in which uneducated lay experts and legislators purport to have to key through mandates, and program creation are well-intentioned but misguided.

Flinging money and resources at this problem through haphazard program creation like our ongoing efforts at drug interdiction are futile. No program, counseling, medications or other can have an effect on an addict who has not yet rediscovered their soul and that happens suddenly. The moment in which they realize they need help is fleeting, and occurs like a thunderclap. Like a child earning to crawl, it happens in a haphazard, uncoordinated fashion and then can disappear just as quickly. Wrong place, wrong time is how they start their journey and how it almost always seems to end. Our job is to hope we are there just as the lighting strikes.

A friend of mine was a good nurse. He died, and nothing anyone could do could prevent it. Nor could he.

Dr. Michael Miller is Board Certified in General Surgery by the American Osteopathic Association and initially received his 10-year certification in wound care by the American Academy of Wound Management in 2000 and the American Professional Wound Care Association in 2005.

His practice has been devoted exclusively to wound care and related issues since 1998. He is one of very few full-time physician wound care specialists in the State of Indiana, as well as the U.S. He has published numerous articles in peer-reviewed journals, written chapters in wound care texts, and presented poster exhibits and podium presentations at numerous domestic and international conferences.

Dr. Miller is also a consultant to numerous companies in the wound care industry and provides expert consultations to professionals in the investment and legal industries. In addition to his clinical practice, he owns several patents on wound care devices. Dr. Miller was named the American Osteopathic Foundation's 2010 Physician of the Year.