Ballad of a sober man: an ER doctor’s journey of recovery [PODCAST]

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“Now, in her afterlife, she occasionally accompanied Maggie on excursions into my head, usually at night. Make that a double vodka.

I thought I had finally learned in sobriety how to put them in the past, encased in a box, and keep them there. Still, sometimes they found a way out to visit me. The program taught me how to at least limit their appearances.

I worked hard over the months, showing up for shifts with an energy I had not seen in myself for decades, a newfound enthusiasm I had not felt since my residency days back in Baltimore.”

“J. D. Remy” is an emergency physician and author of Ballad of a Sober Man: An ER Doctor’s Journey of Recovery.

He shares his story and discusses his KevinMD article, “A sober emergency physician returns to work, just in time to face the COVID-19 pandemic.”

This episode is sponsored by Elsevier Health. Looking to update your personal or professional medical library? Shop Elsevier Health’s Holiday Sale and save up to 35% on your purchase of medical books! Plus, you can take an extra 5% off your order with code KEVINMD at checkout. Take advantage of the biggest sale of the year from Elsevier, the world-leading provider of medical books and reference materials. Shop us.elsevierhealth.com now through December 31.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have J. D. Remy. He’s an emergency physician, and he wrote a book, Ballad of a Sober Man: An ER Doctor’s Journey of Recovery. And there was an excerpt from this book on KevinMD titled “A sober emergency physician returns to work, just in time to face the COVID-19 pandemic.” JD, welcome to the show.

J. D. Remy: Thank you, Dr. Pho. Thanks for having me. I appreciate it.

Kevin Pho: So we’ll get into your article and book in a bit, but first off, can you share your story and your journey to where you are today?

J. D. Remy: Sure, absolutely. Well, I was born in a very comfortable suburban environment in New Jersey, raised by my mother and stepdad. My track to medicine was unique in the family, the first doctor in the family. Everybody else was school teachers, blue-collar workers, business owners. I found my calling with medicine, and with emergency medicine in particular. I enjoy the field of medicine, in which I get to practice different kinds of specialties at a rapid pace. I enjoy the shift work of emergency medicine. I have been doing it 25 years now.

I got into it in the ’90s. I went through medical school and residency, and I found my job in the Shenandoah Valley, and I have by and large been here ever since, with one detour that I believe you and I will be talking about.

Kevin Pho: Let’s talk about that now, and I’m sure it’s the basis for your memoir, Ballad of a Sober Man: An ER Doctor’s Journey of Recovery. So why don’t you share your story with my audience and tell me the impetus for you to write your memoir?

J. D. Remy: Absolutely. So not only was I the first physician in the family, but, dubiously, I was also the first alcoholic in the family. I think the alcohol followed me in my younger college days, fraternity days, where it was more of a party thing. Then I got into my professional years, when I got my first job. I was very happy. I felt like I had arrived in emergency medicine. I took up positions in the hospital, on committees. But the alcohol seemed to follow me, and I found myself using alcohol to soothe troubled nerves and anxieties, and before I knew it, it was my go-to. It became liquid therapy for me, if you will, to the point where I was starting to use it every day. Eventually, I collapsed under the weight of all the alcohol and ended up, in one single day, four years ago today, by the way, in rehab.

Kevin Pho: So tell me how it was starting to affect your work in the hospital.

J. D. Remy: It had been a way of soothing my nerves after work. What it soon became was my default, where I was starting to drink any time I was not at the hospital. So I would go to the hospital and work a very busy, stressful shift, and instead of doing the things for stress relief that are healthy, such as exercise, meditation, mindfulness, or just speaking with my spouse, I took the alternate route, and I would go down to a special section of our house where I kept my stash, so to speak, and would consume alcohol. I generally did it alone, and of course, that’s unhealthy as well. That bred more alcoholism as time went by, and before I knew it, it was kind of surrounding me, and I was having a hard time functioning at all.

Even though I was not drinking at work and I was not drinking at the hospital, the panic attacks and the sweating and the palpitations were always with me in those last years of my drinking career. Eventually, what ended up happening was I was hospitalized for acute alcohol overdose in my own hospital, having rolled into my own emergency department acutely intoxicated, and apparently put on quite a show for the very staff that I worked alongside, taking care of those very kinds of patients in my own career. That all happened in early November of 2016.

Kevin Pho: Now, did any of your colleagues and support staff that you were working with have any suspicion of your alcohol abuse?

J. D. Remy: There was suspicion toward the end, in my final year of drinking. It was picked up on by our leadership. They couldn’t put their finger on exactly what was wrong. Same thing with my spouse, because I was a closet alcoholic, and I wasn’t telling anybody. And so they asked me to undergo a neurologic evaluation, thinking maybe there was something wrong with me from a neurologic standpoint.

Alcoholics are by their very nature very deceitful, and we are quite intelligent in our ways of deceiving. I managed to deceive my own neurologist and my own family physician into thinking that this was just situational anxiety that I could get control over through therapy and through meditation and some other relaxation techniques. And so they permitted me back after a hiatus of about a month. Now, my alcoholism took its death spiral at that point, to the point where I could not stop drinking, and then I was ultimately hospitalized. So yes, it was picked up on by the staff.

Kevin Pho: Now, immediately before rehab, did you have any treatment for your alcoholism at all?

J. D. Remy: No, because I was still in denial. I thought, “I can control it,” even up until the very end. And I had some life events occur which were negatively impacting me, the death of my father and a few other things, and I used those as an excuse to continue to drink, to say to myself, “I can put off tapering my alcohol use,” until I got to a point where it was no use. I was ultimately taken out of my house by ambulance on that fateful day.

Kevin Pho: Tell me what rehab was like, and tell me about that, of course.

J. D. Remy: Sure. I entered rehab with all the arrogance and narcissism that I had accumulated over years of being a professional and being put in positions of power and authority, and I felt like I could outsmart the system. Little did I realize that the best way to go into remission from alcoholism is to listen to people, to ask for help, all the things that I believe that I, as a physician, was not very good at. I like to be independent. I like to show. And the resolution of acute alcohol intoxication and acute alcoholism is just the opposite. It’s relying on the professionals. It’s talking things out. It’s asking for help.

So I had a very hard time early on. When I finally let go and accepted my situation for what it was, that I was an alcoholic, and I could not control it, and my life had become unmanageable, I threw myself into the mosh pit of the recovery network. Only then did I start to recover, and I worked a 12-step program, and it worked out very well for me, after 10 weeks of rehab and then a period where I was in the health professional monitoring program in my state. All of these things together, plus therapy, plus working a program on a daily basis, and lo and behold, I’m at a point where I’m now grateful that I’m four years in remission.

Kevin Pho: Fantastic, and congratulations on your sobriety.

J. D. Remy: Thank you.

Kevin Pho: Now, for those clinicians who may not be familiar with the steps, can you actually outline the steps from rehab back into the physician workforce?

J. D. Remy: Absolutely. Well, if a physician in my state is hospitalized for alcohol or substance abuse, it is the duty of the vice president of medical affairs and administration to report to the state medical board. And so an automatic investigation is launched, and my license is put on suspension. Then I am referred into the health care professional monitoring program, and it’s a series of contractual obligations that I have to follow to help stay sober and to rehabilitate me back to my profession.

This includes a certain number of meetings every month, a certain number of therapy sessions every month, recording my meetings, reporting in to a case manager, having my bosses report in that I’m doing well. This is a monthly and ongoing thing, submitting to drug screens and alcohol breathalyzers several times a month. It’s a five-year contract, and it’s very rigorous, and appropriately so. Because it boasts, in some of the research, you will see up to a 90 percent success rate for these sorts of programs in states. And so they’re meant to bring physicians and medical professionals back into the fold from an otherwise very, very difficult disease to overcome.

From that point, the monitoring program let me back into medicine, but I waded in gradually. I went to an urgent care for a while. I did a little bit of teaching at a university in my field. And then when they saw that I was making progress, that I had so many negative drug screens, that my reports were favorable, my drug screens were clear, then they said, “OK, you can go back to emergency medicine.” And I not only returned to emergency medicine, but I returned to it with an enthusiasm and a vigor that I didn’t have ever in my professional career, probably not even since residency. I’m thrilled to be practicing emergency medicine at this level once again. I feel like I’m at the top of my game.

Kevin Pho: Now, when you went back to the hospital that you previously worked at, what was the reaction of the medical staff and your colleagues?

J. D. Remy: One can separate that into separate categories. The people who I believe have been touched by the disease, who understand the disease, welcomed me with open arms. I even got hugs. I got, “Welcome back, keep working it. We’re so proud of you.” Then we got the avoiders, the people who didn’t quite know what to make of me and were not sure if they were going to be trusting me in a professional context. And then you had the people who maybe were touched by alcoholism in a negative way, or profoundly impacted by the disease, who were my detractors, who felt like I did not belong. And they separated themselves out fairly quickly.

The majority of people were very welcoming. It was a little uncomfortable at first, because these are the very people who I worked with, who then saw me at my worst. But now I’ve built things back. And particularly since COVID, I’ve demonstrated that I am back professionally; I am back emotionally and intellectually. It takes time to rebuild these bonds and to demonstrate to people that I am the professional I always have been, and more.

Kevin Pho: And what about medical administration at your institution? What was their response upon your return?

J. D. Remy: Well, they need to follow a rigorous credentialing program. So when I first applied, I went through their wellness panels, and then I went through their credentialing committees, and I sat before panels, and I answered questions, and there was a mountain of paperwork and bureaucracy. They handled it much like the bureaucrats would. There was not a lot of emotion there. They just wanted to make sure that I was safe to practice medicine and that I was not posing any kind of hazard to the patient population, because in actuality, that’s their job. And once I was able to show them this, both through my credentialing and then eventually when I got back into things, they were much more comfortable with it, and I’m receiving notes of congratulations even from administration now.

Kevin Pho: Now, one of the excerpts in the book that you contributed to KevinMD was “A sober emergency physician returns to work, just in time to face the COVID-19 pandemic.” Tell me what was going through your mind. Now you’re back at work, and now we’re facing COVID as an emergency physician. What was going through your mind?

J. D. Remy: Absolutely. You know, I clawed my way back. I’m feeling good. I’m feeling healthy. I’m just getting my stride. People are starting to trust me in the emergency department again, and then COVID hits. Well, COVID creates a certain endemic fear, I believe, in our culture. Everybody is afraid of it, professionals and patients alike, administrators.

I believe that as an emergency physician in recovery, as any medical professional in recovery, we are, in a sense, even better equipped to handle the COVID pandemic, because we are prepared to accept everything that comes our way, and to think through it methodically and logically, and handle things. We are seeing not only patients but our coworkers and colleagues decompensate over it at times, and we feel like those of us in long-term recovery, who have been through the anguish of acute-phase recovery and are now in a long-term recovery phase, are very well emotionally equipped and are actually serving as an emotional resource to our colleagues on the fly, who are getting very nervous about being around all this COVID. People don’t want to come to work, or they are getting very uncomfortable in high-pressure situations, particularly with the very sick COVID patients, and we have paradoxically, in a lot of ways, turned out to be a bit of a rock of stability in our departments. So I think we are a good addition to the team, particularly at this time of crisis.

Kevin Pho: We’re talking to J. D. Remy. He’s an emergency physician, and he’s the author of the book Ballad of a Sober Man: An ER Doctor’s Journey of Recovery. JD, what are some of the lessons that you could share with clinicians who may be going through a similar situation?

J. D. Remy: Sure. There is life after recovery professionally. I thought my professional life was finished, kaput, when I went to rehab. “No one will ever hire me again.” That couldn’t be further from the truth. The best thing a professional can do, someone who’s terrified of losing their license, of losing their reputation because of a hidden disease, the best thing they can do is summon the courage to come out with it, to go through the paces, to go through the steps for their own health, for the health of their families, and they will find a very bright future in long-term recovery. They’ll go through some difficult trials, but that’s appropriate. In the end, everybody comes out ahead.

Kevin Pho: Now, what are some resources that you can recommend for these health care professionals who may be trying to re-enter the workforce after a situation with substance abuse?

J. D. Remy: Well, I would encourage any health care professional, doctor, nurse, pharmacist, to reach out to their health professional monitoring program and their specialty boards, which can be an enormous resource. In addition, there are meetings of Alcoholics Anonymous and Narcotics Anonymous specifically for medical professionals. It’s called Caduceus, and you can find those online. They are basically AA meetings and NA meetings for medical professionals, and we sit in a circle, just like in AA for the general public, and talk out our issues, but it has a bit of a professional bent. So we talk about return to work, and you hear other people’s stories, and we realize that we are not alone in this.

Kevin Pho: And for those health care professionals who do want to return to work, what are some of the biggest challenges that they anticipate facing?

J. D. Remy: Well, first and foremost is staying sober and remaining in remission, and that requires working whatever program works for that person. I happen to choose a 12-step because it has been enormously successful for me. But the other challenges are dotting your i’s and crossing your t’s when it comes to your state medical boards. Do what they need you to do. Don’t get reactive, don’t get authoritative, or let your ego seep into things. Work with your credentialing agencies and your credentialing committees and your hospitals, and do what they ask. They are not there as the enemy. They are there to help guide us along while keeping in mind public safety.

And so I submitted myself. I sat prostrate, and I did what I had to do. My advice would be to listen to these people, because they do care, in the end, because we do want to strengthen our medical community. Substance abuse is endemic in it. And the problem is that we are more fearful of that, I believe, than the general population, for the reasons that I had outlined earlier.

Kevin Pho: Hey, my final question: What’s your take-home message that you want to leave with the KevinMD audience?

J. D. Remy: My take-home message is, we will always be better off allowing ourselves to be a little more vulnerable and not hiding our secrets. We are only as sick as our secrets. The most liberating feeling I had in the world was writing that book and telling the world about my journey out of the darkness of alcoholism and into the light of recovery, without the fear of judgment. Because the exposure is what helped me in my long-term recovery.

Kevin Pho: JD, thank you so much for sharing your story and sharing your time, and thanks again for being on the show.

J. D. Remy: My pleasure.

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