Real Medicine

A Letter To An Addicted Colleague

Dear Colleague

When you walked up to me with a three-day old IV-port and told me that you were on daily pethidine for severe peptic ulcer disease, I suspected something fishy.

I told you to get triaged by the nurses because I wasn’t offering any favours; and your wife – an impeccable woman – came to me. “I’m his wife,” she said. “And we have a problem. He is dependent on pethidine.”


You arrived at the beginning of my shift, and you remained a presence throughout.

I’m sorry I avoided you.

You were several years my senior. I knew that you knew it, because you were trying so hard to butter me up. You knew I would feel pressured, and I did. How could I deny a senior doctor’s request?

So I handed you over to my senior colleagues.

Maybe that was a learning opportunity missed; but it was so busy in Accident & Emergency that day, and your situation was distracting. I was afraid I would cave.

I’m sorry I avoided saying it to your face. ADDICTED. DEPENDENT.

I worried for your pride. I was afraid for your feelings. How silly – you had a problem, even if you denied it, and my biggest concern was insulting you. Instead I beat around the bush. Technicalities. Kept taking you back to the medical officers.

You must understand that you were intimidating. In my personal space, your arm around my shoulder, “Do it for your colleague, please.”


No, I could not. Will not.

I’m sorry we did not have the facilities to admit you. In this town, private rehab facilities are filled to capacity for months in advance, and they only take voluntary patients. And in the public sector, we simply do not have the beds for a rehab program.

I’m sorry I did not spend more time with your wife. She must be so frustrated. Perhaps even afraid. Among the rush of acute cardiac syndromes and stabbed chests and CVAs, she silently disappeared into the maelstrom. She was not a patient, but perhaps talking to her could have helped your relationships – and you, in the long run.

I am sorry the system failed you. Somewhere a mistake was made, and it became easier for you to get your hands on drugs that should have been strictly controlled.

I am afraid to write about this, and I don’t even know which of the myriad reasons it is: am I ashamed, and if I am, ashamed of what? Of you? Of the profession? Or of myself?

I wish I had told you: you are not alone. This happens to so many of our colleagues. We are silent about it. We are ashamed. And in that shame, we fail you.

I will do better next time.

You haunt me. I so hope you got the help you needed.


4 thoughts on “A Letter To An Addicted Colleague”

  1. I am sorry, that sounds incredibly difficult. I know you know you cannot do it all and should not do some things ever. Even for a colleague. I hope the pain of the haunting goes away, but not the lesson. You did the right thing, you are awesome Mariechen.


  2. Oh dear. Where I live and work both the College of Physicians and Surgeons and the Law Society have enacted mandatory reporting of colleagues with addictions and or other conditions that could seriously impair judgment of the professionals those bodies govern (present company included). On one hand I understand (risk to public, risk of losing the privilege of remaining a self governing profession being high on the list of “reasons”, leaving aside any alleged well-being of the addicts and others suffering that disease or other condition(s)). On the other hand I cringe at these rules and from my involvement both in the regional lawyers assistance program and on adjudicative law society committees I know too well the lifelong toll that addictions in particular can have on the addict. And I know most of us don’t rat out our colleagues even though we could be disciplined for our failure to do so. I don’t envy you. Or your “colleague” and echo your hope that whether through his impeccable wife’s candour or otherwise he gets the help he needs. Before something truly tragic (serotonin toxicity or one of the other unhappy ill effects of opioid use among them and God forbid harm to a patient) happens. Is there any professional assistance society for docs in your neck of the woods?

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